The URL can be used to link to this page

Home My WebLink AboutPAVEMENT COATINGS CO. iRecording Requested By, And When Recorded Mail To: Recorded in Official Records, Orange County Clerk of the Council,City of Santa Ana Hugh Nguyen, Clerk-Recorder 20 Civic Center Plaza,P.O.Box 1988 I IIII11111111 IE� IIl1 II I III 1111111111111 11111111 NO FEE Santa Ana,CA 92702 I * $ R 0 0 a 9 7 4 0 2 9 8 $ 2017000521098 11:24 am 12/04117 217 416 N12 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 F I 4 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 LOCAL STREET SLURRY SEAL 2016-2017 under contract entered into on JUNE 20, 2017, with PAVEMENT COATINGS CO., on which contract THE OHIO � M w CASUALTY INSURANCE COMPANY is surety. The property on which such work mo improvement was placed is in the City of Santa Ana, County of Orange, State of California, and o z described as Project No. 17-6882 located at: VARIOUS LOCATIONS. The work improvement aon said property was accepted as completed on SEPTEMBER 29, 2017 . ow vCITY OF SANTA ANA,A MUNICIPAL CORPORATION wa � F zF d II b © Dated: l Z� Princi al ivil En ' eer-T31one Chesanek a TITLE a 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 , f, and I declare under penalty of perjury that the facts therein stated are true. Executed on I 7i7 2i0 1 — , at Santa Ana, Califo 'a J (Signature of ndividual swearing that the contents of Notice of Completion are true.) THIS NOTICE OF COMPLETION MUST BE RECORDED WITHIN TEN(10)DAYS AFTER COMPLETION THE REGISTER Thu spa as for fill ng at amp only 625 N GRAND AVE, SANTA ANA, CA 92701 Telephone (714) 796.7000 / Fax (714) 796.6050 (2015.5 C,C.P,) State of California County of ORANGE as Notice Type: SID - NOTICE INVITING BIDS Ad Descrlptlfl Local Street Slurry Seal FY 16-17 I am a citizen of the United States and a resident of the State of California; I am over the age of eighteen years, and not a party to or interested In the above entitled mailer. I am the principal olork of the printer and publisher of the THE REGISTER, a newspaper published In the English language In the city of SANTA ANA, county of ORANGE, and adjudged a newspaper of general olrculatlon as defined by the laws of the State of Callfofnla by the Superior Court of the County of ORANGE, State of California, under date 11/19/1905, Casa No, A21046. 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: 05/02/2017,05110/2017 Executed on, 05110/2017 At SANTA ANA,CA I certify (or declare) under penalty of perjury that the foregoing Is true and correct, !l Signature * A 0 0 0 0 0 4 4 3 1 3 8 1 CNS#F 3006006 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 *20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: Local Street Slurry Seal 2016-17 Date of Approval: 06/20/2017 Project Numberls): PWA -2017 -797 -CITY Project Location: 1 CityWlde (Partlal) City: Santa Ana County: Orange ER Number: ER -2017-43 Project Description: The Construction includes applying slurry seal material to surface of roadway. Applicant Name: Kenny Nguyen, City of Santa Ana Public Works Agency Applicant Address: Ross Annex, 20 Civic Center Plaza, 3rd Floor M-36 POSTED ] I'"1 i"`1 SANTA ANA, CA 92702 1— � J {,,,/ Name of Public Agency Approving Project: City Council �°(2 5 2011 Name of Person or Agency Carrying Out Project! Nguyen, Kenny Exempt Status: ORANGE COUNTY CLE •RECORDERDEPARTNEW ❑ Ministerial (Sec. 15268) DEQ ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269(b through e)) ❑ General Rule (Sec. 15061(b)(3)/(5)) FILED ❑ Statutory Exemption: RI Categorical Exemption: 15301(b) MAY 2 5 2017 Reason(s) Why Project is Exempt From CEQA: 15301(b) Consists of repair/maintenance of existing public facilities. ORANGE COUNTY CLER - ECORDER DEPARTMENT BY: DEPUTY City Contact: ,,qn Nguyen Telephone: (714)647-563' Signature: _ Title: AS31 j L i' �,' J r•10,1' Date: �y✓�S %7 SANTA ANA CITYCOUNCIL V Miguel A Pulido Michele Martinez Vlncento Sarmlento Jose Solodo P. David Benevides Juan Villegas Sal Thaler Mayor Mayor Pro Tam, Ward 2 Wards Ward Ward Wards wards muli0fteMaaaa,Sxa doenauidesaunLsane am INI, I�Yae�ffinants ena.atq HIh IN Illlsll II IIIrIIIIIrIIrIIIII NO FE7; II * R 0 0 0 9 2 9 2 9$ 201785000562 4:29 jim 05/25/17 41 OR02 Z01 0.00 60.00 0.00 0.00 0100 0.00 0.00 0.00 MAYOR ACTING CITY MANAGER Miguel A Fulda " Gerardo Mouel MAYOR PRO TEM CITY ATTORNEY Michele Martinez - Soria R. Carvalho COUNCIL MEMBERS CLERK OF THE COUNCIL P. David Benevides.;;-• Marla D, Hulzar Vicente Sarmlentc Joao Solodo Sal Tinajaro Juan Vlllegas n CITY OF SANTA ANA PLANNING E BUILDING AGENCY 20 Civic Center Plaza (M•20) P.O. BOX 1986 .Santa Ana, Callfomla 92702 (714) 867.2700 • Fax (714) 973,1461 vow,sana NOTICE OF EXEMPTION 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 *20 Santa Ana, CA 92702 Santa Ana, CA 92702 Project Title: Local Street Slurry Seal 2016-17 Date of Approval: 06/20/2017 Project Numberls): PWA -2017 -797 -CITY Project Location: 1 CityWlde (Partlal) City: Santa Ana County: Orange ER Number: ER -2017-43 Project Description: The Construction includes applying slurry seal material to surface of roadway. Applicant Name: Kenny Nguyen, City of Santa Ana Public Works Agency Applicant Address: Ross Annex, 20 Civic Center Plaza, 3rd Floor M-36 POSTED ] I'"1 i"`1 SANTA ANA, CA 92702 1— � J {,,,/ Name of Public Agency Approving Project: City Council �°(2 5 2011 Name of Person or Agency Carrying Out Project! Nguyen, Kenny Exempt Status: ORANGE COUNTY CLE •RECORDERDEPARTNEW ❑ Ministerial (Sec. 15268) DEQ ❑ Declared Emergency (Sec. 15269 (a)) ❑ Emergency Project (Sec. 15269(b through e)) ❑ General Rule (Sec. 15061(b)(3)/(5)) FILED ❑ Statutory Exemption: RI Categorical Exemption: 15301(b) MAY 2 5 2017 Reason(s) Why Project is Exempt From CEQA: 15301(b) Consists of repair/maintenance of existing public facilities. ORANGE COUNTY CLER - ECORDER DEPARTMENT BY: DEPUTY City Contact: ,,qn Nguyen Telephone: (714)647-563' Signature: _ Title: AS31 j L i' �,' J r•10,1' Date: �y✓�S %7 SANTA ANA CITYCOUNCIL V Miguel A Pulido Michele Martinez Vlncento Sarmlento Jose Solodo P. David Benevides Juan Villegas Sal Thaler Mayor Mayor Pro Tam, Ward 2 Wards Ward Ward Wards wards muli0fteMaaaa,Sxa doenauidesaunLsane am INI, I�Yae�ffinants ena.atq " State of California - Department of Fish and Wildlife 2017 ENVIRONMENTAL FILING FEE CASH RECEIPT t DFW 753.5a (Rev. 01/01117) Previously DFG 753,5a r. 30.2017 0525 LEADAGENCY EMAIL (If CITY OF SANTA ANA 05/25/2017 COUNTY/STATE AGENCY OF FILING DOCUMENT NUMBER Orange 201785000562 PROJECT TITLE LOCAL STREET SLURRY SEAL 2016-17 PROJECT APPLICANT NAME PROJECT APPLICANT EMAIL PHONE NUMBER CITY OF SANTA ANA PUBLIC WORKS AGENCY (714) 647-5632 PROJECT APPLICANT ADDRESS CITY STATE ZIP CODE ROSS ANNEX, 20 CIVIC CENTER PLAZA, 3RD FL M-36 SANTA ANA CA 92702 PROJECT APPLICANT (Check appropriate box) E]d Local Publlc Agency E] School District E] Other Spatial District [] State Agency []✓ Private Entity CHECK APPLICABLE FEES: ❑ Environmental Impact Report (EIR) $3,075.26 It 0.00 © MltlgatedlNegative Daclaratfon (MND)(ND) $2,216,25 $ 0.00 [] Certified Regulatory Program document (GRP) $1,045.50 $ 0.00 El Exempt from fee Q Notice of Exemption (attach) CDFW No Effect Determination (attach) ❑ Fee previously paid (attach previously Issued cash receipt copy) ❑ Water Right Application or Petition Fee (State Water Resources Control Board only) $850.00 $ 0.00 County documentary handling fee $ ❑ Other $ PAYMENT METHOD: ❑ Cash ❑ Credit ❑ Check ❑ Other TOTAL RECEIVED $ 0,00 HAZEL L. BENNETT, DEPUTY CLERK ORIGINAL- PROJECT APPLICANT COPY •COFWIA8a COPY• LEAD AGENCY COPY -COUNTY CLERK DFW 753.5.(R4v. 2015121.9) '�91R1 3 1 20fi, CPW��, CITY OF SANTA ANA EXHIBIT 3 GMAW n CONSTRUCTION CONTRACT G//Gl.S32dt.V O PROJECT NO. 17-6882 LOCAL STREET SLURRY SEAL 2016-17 This CONSTRUCTION CONTRACT is made and entered into this 20th day of June, 2017 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 "CITY"), and Pavement Coatings Co. (hereinafter "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 Local Street Slurry Seal 2016-17 Project (hereinafter referred to as the "WORK OF IMPROVEMENT") 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 • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and 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 the WORK OF IMPROVEMENT the sum total amount not to exceed Eight Hundred Sixty -Two Thousand Eight Hundred Sixty -Two Dollars ($862,862.00), as set forth and identified in the BID PROPOSAL, which is attached hereto and incorporated herein as Exhibit "A." The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not 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. rev. 12/20/2016 Page 1 of 3 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT 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 WORK OF IMPROVEMENT 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 (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of Ten Thousand Dollars ($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000), the Warranty Bond amount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent (10%) of the final contract price. 8. 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. H Page 2 of 3 IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: MARIA D, HUT.ZAIi ld Clerk of the Couneil APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: J FUNK Assistant City Attorney RECOMMENDED FOR APPROVAL: FRED MOUSAVIPOUR Executive Director Public Works Agency CITY OF SANTA ANA Interim City CONTRACTOR: Pavement Coatings Co. DOUGFORD President Page 3 of 3 CITY OF SANTA ANA PROPOSAL Exhibit A PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 SID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM: 'Pavement Coatings Co. 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 Qty Unit Unit Price Amount 1 Unclassified Excavation 60 CY $ $ 385.00 23,100.00 2 Cold Mill (2") 53,000 SF $ $ .26 13,780.00 3 AC Pavement 780 TN $ $ 83.60 65,208 4 Rubberized Emulsion Aggregate Slurry 1,050 TN $ $ (REAS), Type 11 644.50 676,725.00 5 Adjust Manhole Frame & Cover to 4 EA $ $ Finished Grade 1,650.00 6,600.00 6 Furnish and install New Water Valve 4 EA $ $ Frame & Cover to Finished Grade 1,100.00 4,400.00 7 Temporary Construction Sign 6 EA $ $ 366.00 12,196.00 8 Crack Sealing _ I L6 $ $ 42,900.00 42,900.00 Protection of Surface Utility Frames & I LS $ $ Eto Covers 4,200.00 4,200.00 Signing and Striping I LS $ $ 23,753.00 23,753.00 P-1 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 Exhibit A LOCAL STREET SLURRY SEAL 2016-17 TOTAL BASEBID $ �Q2 , The lowest responsible bidder shall be selected based on the total base 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 hid item shall not be subject to the "25W 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. t This bid item is considered a Specialty Item per Section 2-3.2 of the Standard Specifications. TIME FOR CQNt I,TION OF IIyIPIt(7VEMBNTSAHD LIf UD3ATED DAMAGES The undersigned bidder hereby proposes to complete the Work for the total base bid amount shown above, by October 31, 2017, or within thirty (30) working days after the commencement date stated in the Notice to Proceed, whichever occurs earlier. The liquidated damages .amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $3,800 per calendar day. Name of Firm Pavement Coatings Co. Signature of BIDDER. Title President (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.) P-2 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 BID PROPOSAL TO: CITY COUNCIL OF THE CITY OF SANTA ANA FROM; Pavement Coatings Co, 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 speciflmdons for the unit price(s) or lump sum(s) set forth in the following schedule: Item Description Qty Unit Unit Price Amount 1 Unclassified Excavation 60 CY $ $ 385.00 23,100,00 2 Cold Mill (2") 53,000 SF' $ $ .26 13,780.00 3 AC Pavement 780 TN $ $ 83.60 65,208 4 Rubberized Emulsion Aggregate Slurry 1,050 TN $ $ (REAs),Type 11 644.50 676,725.00 5 Adjust Manhole Frame & Cover to 4 EA $ $ Finished Grade 1,650.00 6,600.00 6 Furnish and Install New Water Valve 4 EA $ $ Frame & Cover to Finished Grade 1,100.00 4,400.00 7 Temporary Construction Sign 6 EA $ $ 366.00 2,196.00 6 Crack Sealing I LS $ $ 42,900.00 42,900.00 9 Protection of Surface Utility Frames & 1 IS $ $ Covers 4,200.00 4,200.00 10 Signing and Striping 1 LS $ $ 23,753.00 23,753.00 P-1 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 TOTAL BASE BED , 0 The lowest responsible bidder shall be selected based on the total base 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. f This bid item is considered a Specialty Item per Section 2-3,2 of the Standard Specifications. 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, by October 31, 2017, or within thirty (30) working days after the commencement date stated in the Notice to Proceed, whichever occurs earlier. The liquidated damages amount, in lieu of the amount specified in Subsection 6-9 of the Standard Specifications, shall be $3,800 per calendar day. Name ofFirm Pavement Coatings Co. Signature of BIDDER Title President (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.) I P-2 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 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/her 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 tan (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, 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 ofFinu Paverne l Datings Co. Signature of BIDDER Title President (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.) Torn Mucenski, Secretary Nathan Beylerr, Treasurer P-3 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 CONTRACTOR'S LICENSING AND REGISTRATION STATEMENT The undersigned contractor, or corporate officer, declares under penalty of pequry 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: Pavement Coatings Co. Business Address: 10240 San Sevalne Way, Jurupa Valley, Ca 91762 Business E -Mail Address: dford@pavementcoatings.com Telephone; 714®326-3011 State Contractor's License No. and class: 303609, A & C32 License Expiration Date: State Dept. of Industrial Relations (DIR) 1000003332 Registration No.: State Dept. of Industrial Relations (DIR) 6/30/1$ Registration Expira " at Signed: Title: President P-4 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 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 pail 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 Pavement C atings Co. Signature of BIDDER Title President (if an individual, so state) P-5 of P-16 CITY OF SANTA ANA PROPOSAL PROJECTNO:: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 OWNERSHIP AFFIDAVIT STATE OF CALIFORNIA ) COUNTY OF ORANGE CITY OF SANTA ANA Doug Foss , 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 isduly vested with the authority to make and execute instruments for the co -partnership by: who constitute the other members of the co -partnership. CORPORATION That he is of: Pavement Coegngs Co. a corporation which is making the foregoing proposal: ❑ JOINT VENTURE That he is of-, one of the parties making the foregoing proposal as a jointventure, 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 propos outx ct, far himself or any other person, Signature of Bidder Subscribed and sworn to before me this day of 20 Signature of officer Administering Oath (Notary Public) P-6 of P • 16 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 oFN%,C-'`( dk,) On beforeme,i1�3�_. ((i 1J1 r L3Y til t, Dae ` Here Insert Name and Titleha Officer personally appeared of who proved to me on the basis of satisfactory evidence to be the person whose name(t is/ate subscribed to the within instrument and acknowledged to me that he/ste/trey executed the same in his/hdr/thgtr authorized capacltyCA, and that by his/her/trr signaturev on the instrument the persona, or the entity upon behalf of which the person(slacted, executed the instrument. ARYf$TRJNG All ).14)1 - Notary Public-Califarnla z a 'm '� ` Riverside Cod 4 �4 z ' Commission # 2169350 My Comm. Expires Oct 24, 2020 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS myhand and official seal, Signature Public Place Notary Seal Above 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: � ill l L�+ Document Number of Pages: __L_ Signer(s) Other Th n Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: _1 Corporate Officer _. Title(s): Partner — D Limited 1 General i-11 Individual i 1 Attorney in Fact [J Trustee 0 Guardian or Conservator Other: Signer Is Representing: Date: Signer's Name: Corporate Officer — Title(s): L1 Partner -. 0 Limited 0 General Individual Ll Attorney in Fact i_- Trustee ❑ Guardian or Conservator L' Other: Signer Is Representing: 02014 National Notary Association ° www,NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 BID BOND KNOW ALL PRESENT that, Pavement Coatings Company as BIDDER; and ThP Chin Casualty.tnauranca C`Dngwyas SURETY, are held and firmly bound unto the CITY OF SANTA ANA, as AGENCY, in the penal sun of _ Ten Percent of Amount aid —Dollars ($10% of Amount aid ),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, KIDDER 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 19 day of_ May 12017, BIDDER* Pavement Coatings�any 10240 San Sevaine Way, Jurupa Valley, CA 91752 951-682-1091 SURETY'" The Ohio laity Insur'nce Company 625 Maple Avenue, Keene NH 03431 800-763-9268 BB; i 1800 East Lambert Rd., Suite 225, Brea, CA 92821 714-257-9644 Richard L. Wells (Att2 ey-In- act) Subscriber{ and sworn to before me this day of 20._,. Signature: Notary Public in and for the County of , State of * Provide BIDDER/ SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. P-7 of P-16 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no amhorltyto bind the Company except In the manner and lathe extent herein stated. Cerlif cafe No. 7666886 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company KNOWN ALL PERSONS BY THESE PRESENTS`. That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company Is a corporation duly organized under the laws of the Slate of Massachusetts, and West American Insurance Company Is a corporation duly - organized under the laws of the State of Indiana (herein collectively called the "Companies'), pursuant to and, by authority herein set forth, does hereby name, constitute and appoint, Frank Moron LyamA:Slone Piebardi Wells all of are city Or onen , state of VA n soon Individually it there be more than one named, its true and lawful aftomey-muddet to make, execute, seal, acknowledge and delivah for and on its behalf as surety and as Its act and deed, any and all undertakings bonds mcognizances`and other suretyobligations in pursuance of these presentsand shall be as binding uponthe Companies as if they have been duly signed by the, president and attested by the secretary of the Companies in their own proper persons. - IN WITNESS WHEREOF, this Power of Attorney boa bean subscribed by an authorized officer or officlaf of the Companies and [lie corporate seals of the Companies have. been affixed thereto lhls 13th day of March ,_2017 nor', - The Ohio Casualty Insurance Comp a ny GibertyMutual Insurance Company West meiican Insurance Company l STATE OF PENNSYLVANIA as David M. Esrey,, Assistant Secretary COUNTY OF MONTGOMERY Orf 73th day of March 10-11, before me personally appeared David M Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and Wast American insurance Company, and that he, as such doing aulborized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a. duly authorized officer. - IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania of) the day and year first above written. �p PASfi COMMONWEALTH OF PENNSYLVANIA F�Q-Vaaw c,"ir to I Noted.]Scot f T r sa Protons, NM7ry P.rbnc By. .. hC.b't.LV.._---- .,. .... ._.. Qe ` Upp'+ M nae Twp Montryn nary Ci nip -Teresa Pastela, Notary Public �n pew 11 aw Comn iss nn Exph ea M1lamh TF 2eL1 9��'Eet. gyp Mbmbu44¢t rmrtva( pA , to, o, Nantes " - dqy R11 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty: Mutual Insurance. Company, and West American insurance Company which resolutions are now in full force and effect reading as follows: ARTICLE IV— OFHCER6 Section 12. Power ofAtforney. Anyofficer or therofAcial office Corporation authorized forthal purpose in writing by the Chairman or the President, and subject: to such limitation as the Chairman or the President may prescrlba, shall appoint such attenre/s-Ili-feat as maybe necessary to apt in behalf of the Corporation to mase execute, seal, acknowledge and deliver as surety, any and all=andertakings, bonds recognizances and other surety obligations. Such adorneysln-fact subject toothe limitationssetforih in their respeotivo powers of attorney, shall have full power to bind the Corporation by their. signature and execution of any such instruments and to Slash thereto the seal of the Corporation, When so the provisions of this article maybe revoked at any gone by tile Board, the Chairman, the President or by the officer oroff ieets granting such poweror authority ARTICLE XIII —Execution of Contracts -SECTIONS: Surety bonds and Undertakings Anyofhcer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairmanorthe president may prescribe, shall appoint such attorneys�irrfact,as may be necessary to actin behalf of the Company to make, execute, -seal acknowledge add delver as surety any and all undertakings bonds, reeognizances and other surety obligations Such atemays-in-fact subject to the limitations set forth in their 'respective powers of attorney, shall have full power to bind the Consent by their signature and execution of any such instruments and to attach thereto the sent of the Company. When so executed such instruments shall he as binding as if signed by the president and attested by the secretary. - Certificate of Designation—The President of the Company, aetlng pursuant to the Bylaws Ph the Aompany, authorizes Dave M Carey Assis(aht Secretary to appoint such aborneystl fact as may be necessary to ac( on behalf of the Company to make, execute, seal, acknowledge: and deliver as,surety any and all undenakiPgs, bonds recpgnizances and other surety obligations; - - - AuthorizatioL--By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanfoallyreproduced signature of anyovershoot secretary ofthe Company, wherever appearing upon a crifted copy of anypowerof attorney issued by Ute Company In connection with surety bonds, shall be valid and binding upon the Company with the same force and affect as though manually affixed. _ - I Renee C. Llewellyn theundersigned,Assistant Secretary, The Ohio Casually Jnsuianee Company. Liberty Mutual Insurance Company, and West American Insurance Company do hereby dedify that the original power of attorney of which the foregoing is a full true and correctcopyof the Power of Attorney executed by: said Companies, Is in full force and effect and has not been revoked.- IN TESTIMONY WHEREOF, have hereunto set my hand and affixed the seals of said Companies this: 19 day of MAY 20 17 ua,` p i3 9 191? 5 1r)nT - eytti ienee �CL_f.�_c1Stant.S2CretaYy 266 of 300 I-MS_12673_e22017 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § I 18S 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 May 19, 2017 before me, os personally appeared n A. Slone, Notary Public 1 --fere Insert Name and Title of the Officer Richard L. Wells Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the perscn(Q whose name(o is/are subscribed to the within instrument and acknowledged to me that h".W41" executed the same in h"erlth& authorized capaclty(las), and that by his/hetYthoir signature(* on the instrument the person(4), or the entity upon behalf of which the person(N acted, executed the instrument, LYNNA, $LONE - - - - - - - Notary- Public- -Calif o-rn-la- - Orange County Commission # 244740 M; Comm, Ex ires Dec 16,2019 t I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS myyhandd an official seal, 4Z Signature- / Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this Information can deter alteration of the document or fraudulent reattachment of this form to can unintended document. Title or Type of Document: Number of Pages: _ Document Date: Signeri Other Then Named Above: Capacli Maimed by Signer(s) Signer's Name: I I Corporate Officer Title(s): 11 Partner — E-) Limited E] General I I Individual [) Attorney in Fact Ej Trustee (D Guardian or Conservator 1.1 Other: Signer Is Representing: Signer's Name! Corporate Officer Title(s): Partner — (I Limited El General E] Individual 1-1 Attorney in Fact 0 Trustee D Guardian or Conservator I.] Other: Signer Is Representing; 02014 National Notary Association - www.NatiorialNotary.org - 1 -800 -US NOTARY (1-800.876-6827) Item 9{5907 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE g 1189 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 Caflfornia County of 1-L ) J On 1 Jl before mj7 i Date Here Insert Name and Tie the Officer personally appeared of Signal who proved to me on the basis of satisfactory evidence to be the person(s/whose name) is/aA subscribed to the within instrument and acknowledged to me that he/stye/tty6y executed the sameI his/hqr/thgr authorized capacity(ie and that by his/her/tAir signature( on the instrument the person(, or the entity upon behalf of which the person(12racted, executed the instrument. SUNSHINEARMSTRONG Notary Public • California a Riverside county Commisslou # 216935; r z'- M Comm. 6xPires Oct 2A, 2020 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Notary Public 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 Ac w„e�nt Title or Type of Document: j(k Document Date: Ajq Number of Pages: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: =f Corporate Officer -- Title(s): -'Pat -tner — ? I Limited ❑General D Individual 0 Attorney in Fact J Trustee C] Guardian or Conservator I Other: Signer Is Representing: Signer's Name: C Corporate Officer — Title(s): ❑ Partner — i Limited 1-1 General [j Individual [_ Attorney in Pact C; Trustee C] Guardian or Conservator Cl Other: Signer Is Representing: ©2014 National Notary Association ° www,NationalNotary,org • 1 -800 -US NOTARY (1-800-676-6827) Item #5907 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-1.7 LIST OF SUB -CONTRACTORS Section 4100 or. 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: ''/x% of the bid or $10,000, whichever is greater o Buildings, parks, or other projects: %z% of the bid Section 1725.5 of the Public Contract Code requires all Subcontractors be registered with the State Department of Industrial Relations (DIR). BIDDER proposes to subcontract certain portions of the work to the funis listed below: Name_License DIR Reg, #/Exp. Location Phone-11Q.LL Name DIR Reg #/Exp. Location i Phone -1 M Type Of Work i _ i � t r� � Type Of Work Amount$ 11142-1QOp,gC., Amount$ 4Li C(z. 00 Name License#/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Signature of Bidder Name License #/Exp. DIR Reg. #/Exp. License # Location Phone Type Of Work Amount $ Name License #/Exp. DIR Reg. #/Exp. N License# Location Phone Type Of Work Amount $ P-8 of P-16 Q CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 The following are the names, addresses, and telephone numbers for THItEE public agencies for which the BIDDER has performed similar work within the past three years. 1. City of Buena Park 6650 Beach Blvd. Buena Park, CA 90622 (2014-15 Slurry Seal Project #558 Bid No. 2014-11) Name and Address of Owner. Wood Nousome, wnousome@buenaparlc:com, (714) 562-3678 Name and Telephone Number of person familiar with project. $541,920.00 Install Type I REAS 412!2015 Contract Amount Type of Work Date Completed 2, City of Santa Monica/ Sully -Miller Contracting Co. 1685 Main St., Santa Monlca 90404 ( Annual Paving & Sldewwalk Repair Project) Name and Address of owner. Hany Yanni Demitrim, P.E. Hanny.Demitri@SMGOV.NET (310)458-2201 ext 5385 $493,220.00 Contract Amount Aperson familiar with project. Install Type II REAS Type of Work 4/21/2015 Date Completed 3, San Diego Gas & Electric/ A.&M. Ortega Construction, Inc. 8326 Century Park Ct., San Diego, CA 92123 Name and Address of owner. Junior, (619) 820-8017 Name and Telephone Number of person familiar with project. $158,494.00 Contract Amount Install Type II REAS Type of Work 4/2/2014 Date Completed The following are the names, addresses, and telephone numbers of all brokers and sureties from wham BIDDER intends to procure insurance and bonds. The Ohio Casualty Insurance Co. Adamson & McGoldrick The City Drive South, Suite 200 CA.92868 1800 E. Lambert Rd. Suite 225 CA 92821 714-634-3311 714-257-9644 P-9 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 ADDITIONAL REFERENCES The following are the names, addresses, and telephone numbers for THREE public agencies for which the BIDDER or Subcontractor has performed similar work in the past five years. 1. City of Cathedral City, 68700 Avenida Lalo Guerrero, Cathedral City, CA 92234 ( East Palm Dr. Slurry Seal) Name and Address of Owner, 770-0349 Name and Telephone Number of person familiar with project. $165,400.00 Type II REAS 11/17/2015 Contract Amount Type of Work Date Completed 2, City of Culver City, 9700 Culver Blvd. Culver City CA 90232 Name and Address of owner. J. Christopher Evans, (310) 253-5621 Name and Telephone Number of person familiar with project. $376,668.00 REAS Appllcatlon 8/3/2012 Contract Amount Type of Work Date Completed 3. Clty of Palm Desert 73510 Fred Waring Drive, Palm Desert, CA. 92260 (2014 Slurry Seal Prolect No. 751.14, Contreot C33230 Name and Address of owner. Ryan Gayler, 760-776-6450, rgayler@citypalmdesert.orq or person $1,608,780.00 PRMSSlurrySeal -Type II Contract Amount Type of Work 8/26/2014 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. The Ohio Casualty Insurance Co. 790 The City Drive South, Suite 200 Adamson & McGoldrick 1800 E. Lambert Rd. Suite 225 Orange, CA. 92868 Brea, CA 92821 714-634-3311 P-10 of P-16 714-257-9644 CITY OF SANTA ANA PROPOSAL PROJECT NC.: '17-6882 LOCAL STREET SLURRY SEAL 2016-17 NON -COLLUSION AFFIDAVIT (Title 23 United States Code Section 112 and Public Contract Code Section 7106) In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the 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 other 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. BIDDERS are cautioned that making a false certification may subject the certifier to criminal Signed State of California County of Riverside Subscribed and sworn to (or affirmed) before me oil this day of , 20_, by , proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me Notary Public Signature Notary Public Seal P-11 ofP-16 CALIFORNIA ACKNOWLEDGMENT CIVIL C1 a 7notary public or other officer completing this ce tificate verifies anly the Iden: ty of the individual who signed the to which this certificate Is attached, and not the truthfulness, acouracy, or validity of that document. State of C lifornia County of st7�� On t r'v ''r d,a1)_1 before me, 4. personally appeared Here Insert Name and Title of t* Officer Name) of Signero who proved to me on the basis of satisfactory evidence to be the personA) whose namep) is/aA subscribed to the within instrument and acknowledged to me that he/slbitthey executed the same in his/*/thtir authorized capacity(ie�j; and that by his/hir/coir signature(�on the instrument the persorg, or the entity upon behalf of which the person(9acted, executed the instrument. SUNSHINE A8MI;TgGNG Notary PublIC - California Riverside County Commission # 2169350 M Comm. Ex fres oct 24, 2020 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. of Notary Public Place Notary Seal Above 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: R aLo_o) tJS ) 0j Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(les) Maimed by Signer(s) Signer's Name: ❑ Corporate Off leer — Title(s): F1 Partner — ❑ Limited General Cl Individual [_,'Attorney In Fact C' Trustee Guardian or Conservator C_i Other: Signer Is Representing: Signer's Name: * Corporate Officer — Title(s): -.I Partner — Ll Limited Ej General Individual C? Attorney in Fact Trustee C: Guardian or Conservator Ds Other: Signer Is Representing: 02014 National Notary Association ° www.NationalNotary.org ° 1 -800 -US NOTARY (1-860-876-6827) Item #5907 CITY OF SANTA ANA PROPOSAL PROJECT NO,: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 NON-DISCRIMINATION CERTIFICATE The undersigned contractor or corporate officer, during the performance of this contract, certifies as follows: The Contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The Contractor shall take affirmative action to ensure that applicants are employed, and that employees are treated during employment without, regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause. 2. The Contractor shall, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. 3, The Contractor shall send to each labor union or representative of workers with which he/she has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the Contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 4. The Contractor shall comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 5. The Contractor shall furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and oilers 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 fiuther 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. P-12 of P-16 CITY OF SANTA ANA PROPOSAL PROTECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 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 Cha Signed: Title: President Firm: Pavement Coatings Co. Date: 5/22117 P-13 of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 STATEMENT REGARDING APPRENTICESHIP REOUIREMENTS 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 amour California Apprenticeship Council, Signed: Title: PI"esIdE'ilt Pavement r r * r. Date: 5/22/17 P-14 of P-16 CITY OF SANTA ANA. PROPOSAL PROTECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 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 other io'e ei rt1ed, Signed: ...__._ Title: President Firm: Pavement Coatings Co, Date: 5522/17 P -IS of P-16 CITY OF SANTA ANA PROPOSAL PROJECT NO.. 17-6882 LOCAL STREET SLURRY SEAL 2016-17 PUBLIC CONTRACT CODE SECTION 10162 QUESTIONNAIRE 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 X If the answer is yes, explain the circumstances in the following space. P-16 of P-16 PAVEMENT COATINGS CO. 10240 San Sevaine Way Mira Loma, CA 91752 Contractor's License #303609 City of Santa. Ana Public Works Agency_ Receptionist Third Floor, located in City :call 7'G Ross Annex, 20 Civic Center P1aza,P%-22, Santa Ana,CA 92701 Le'l`ti60Y231g' pio:44 Bid Proposal: Project No. 17-6882, Local Street Slurry Seal 2016-2017 Bids: Tuesday the 23rd day of May,2017 2:00 PM CITY OF SANTA ANA Bond No. 024067782 BONDS PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS that Pavement Cnatings Cn as CONTRACTOR, and The Ohio Casualty Insurance Company a corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Eight hundred sixty-two thousand eight hundred sixty-two Dollars ($ 862,862 ), which is 100 percent of the total contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated June 20, 2017 for Project No. 17-6882; Local Street Slurry Seal 2016-17 if CONTRACTOR or any subcontractor fails to pay for any labor or material of any kind used in the performance of the Work of Improvement to be done under said Contract Agreement, or fails to submit amounts due under the State Unemployment Insurance Act with respect to said labor, SURETY will pay for the same in an amount not exceeding the sum set forth above, which amount shall insure to the benefit of all persons entitled to file claims under the State Code of Civil Procedures; provided that any alterations in the work to be done, materials to be furnished, or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of said alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 5 day of July 2017 . CONTRACTOR* Subscribed and sworn to before me, this day of 20_ Signature: Notary Public in and for the County of , State of Rate of premium on this bond is $ nia per thousand. Total amount of premium charge is $ incl. In Performance Bond . To be filled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 2of3 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT iS PRINTED ON RED BACKGROUND. 'This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. _7898848 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WeslAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Stale of Massachusetts, and West American Insurance Company is a corporation duly organized under the Taws of the State of Indiana (herein collectively called the "Companies'), pursuant to and by authority herein act forth, does hereby name, constitute and appoint, Frank Moronea; Lynn A, Slone- Richard L. Wells ail of the oftyof BREA state of CR each Individually if there be more than one named, Its true and lawful attomey-To act to make, execute, sea], acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings bonds recognlzances and other: surety obligations IR pursuance of these presents and shall be as binding upon the Companies as of they have been duty signed bythp'.:prosidentand attested by the secretary of the Companies In their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer of official of the Companies and the corporate seals of the Companies have been affixed thereto this 13th day of March -2017 . Ohio Casually Insurance Company al W RThe Liberty Mutual insurance Company as CM"11-1 West9mericannsuranceCampany ' gY ....- a-'-.-70 ate+. .. ......................... ............... STATE OF PENNSYLVANIA ss David M. Carey) Assistant Secretary g "- COUNTY OF MONTGOMERY on c d On thisf3_ t day of March 2017.before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance U F- N Company, the Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing Instrument for the purposes >,U) 6 therein contained by signing on behalf of the corporations by himself as a duty authorized officer- N W M ? IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year firstabove written. E O 4) SQ "6 0 h PAST COMMONWEALTH OF PENNSYLVANIA 6`' pnkv L` 'Ys� <Y Nmrix; S��/L{'__rl.�/ Q rh V—'�" (rr W� c^v. h 4 5 F Tuns' 16fP 'a rlaiaryrllbliC SY' ... ... ........ tl O qe Upper Menon"IWn, Monfeom rY County Teresa PasC811a Notary Public q g v My Commissron Exsires March 28 Soot 1,, t5vtiy� G Bart O *?�v� Marcher rcu,aylvmo(zA acaror of Nomnue BO up I= 'to ThisPower of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 00 4) -Insurance Company, and WestAmerican Insurance Company which resolutions are now in full force and effect reading as follows: .0 m ARTICLE IV- OFFICERS - Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose In writing by the Chairman or the President, and subject D c to such limitation as the Chairman or the President may prescribe, shall. appoint Such attorneys -in -fact, as maybe necessary to act in behalf of the Corporation to make, exe0afe, seal, 4 O C acknowledge and deliver as surety any and all undertakings,bonds, mcognizances and other surety obligations. Such aborneys-Infact, subject to the limitations set forth in their respective -'� to E N powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto. the seal at the Corporation. When so ,'. a) wexecuted, such instruments shalt be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -In -fast under > c' ,� the provisions of this al dere may be revoked at any time by the Board, the Chairman the President or by the officer or officers granting such power or authority. ).n. CCoJw ARTICLE XIII- Execution of Contracts -SECTIONS. Surely Bonds and Undertakings. Any officer of the Company authorized for that purpose in wrung by the chairman or the president, ID and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to actin behatfof the Company to make, execute, ro seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizanees and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their �+" �0 respective powers of attorney, shall have full cowers, bind the Company by their signature and execution of any such Instruments and to attach therea the seal of the Company. When so 06 executed such instruments shall be as binding as if signed bythe president and Snacked by the secretary, ci � Certificate of Designation- The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey Assistant Secretary to appoint such social f- e - fact as may be necessary to act on behalf of the Company to make execute, sea} acknowledgeand daliverasfeurety any and all undertakings, bonds, recognlzances and other surety obligations. Authorization -By unanimous consent of the Companys Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company In connection with surety bonds shall be valid and binding upon the Company will) Vie same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned AssistantSecretary, The Ohio Casualty Insurance Company Liberty Mutual Insurance _Company, and West American Insurance Company do hereby eedify that the original power of attorney ofwhichthe foregoing Is a full true and correct copy of the Power of Attorney executed by said Companies, is In full force and effect and has not been revoked. - IN TESTIMONY WHEREOF, i have hereunto set my hand and affixed the soils ofsaid Companies this 5.� day of July 17 �fNSur pq � rp 92 ,�J �Iv ml3adi� - �N q�. � O 131 a � 1912 c 1991 '� 9y: f a' Renee C. Jew existent Secretary ayes, i:. J _, lon,.�' _2 rrvolu kk' a 43 of 300 LMS 12673 022017 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Anotary public orother officer this certificate verifies only the identity ofthe 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 before me, Lynn A. Slone, Notary Public Date Here Insert Name and Title of the Officer po,onnW|y appeared Richard LWells xamo(s)m/ who proved 1umeunthe basis ofsatisfactory evidence tnbothe K%whose namo0ois/are ouUannood tVthe within instrument and acknowledged to nnathat he8GHef4-hexecuted the same in hia/henA"irauthorized oopaoity(i+$),andthu1byhim/he*ftnsiroi a1na(�&nnihmin:trumontLhmpenoun8h' or the entity upon behalf of which the person(N acted, executed the instrument. I i� Orange County Z Commission # 2134740 My Comm, Expires Dec 16,20 19 Place Notary Seal Above | certify underPENALTY OFPERJURY under the laws ofthe State ofCalifornia that the foregoing paragraph iotrue and correct, VV[7NESG my h dd fficlol seal. Signature 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 mmvunintended document. Description efAttached Document Title nrType ofDocument: Document Date: Number oYPages: __,_____8igner(a)Other Than Named Above: _________ Capacity(les) Claimed bySigner(s) Signer's Name: []CurpormteOfficer ---UUols): Partner —[1Limited []General [j Individual [] Attorney in Fact F' Trustee |] Guardian orConservator E.; Other: Signer |oRepresenting: Signer's Name: L]Corporate Officer --Tlt|okd: [jPartner --[]Limited []6wnena} [||ndividuo| {]Attorney inFact F_ Trustee OGuardian orConservator [] Other: Signer |nRepresenting: 08U14National Notary Association ^www,NationaiNo\ury»/8`1^0DV~USNOTARY (1'U0O~876^8A27) |tom#5907 CALIFORNIAALL-PURPOSEa r o A notary publle or other officer completing this certificate verifies only the identity of the Individual who signed the document to which this cerfiftate is attached, and not the truthfulness, accuracy, of validity of that document State of California ) County of Riverside On July 6, 2017 before me, Sunshine Armstrong, Notary i Date Here Insert Name and Title of the Officer personally appeared Tom Mucenksi NameO of Signer who proved to me on the basis of subscribed to the within instrument or the entity upon SUNSHINE ARMSTRONG Notary Public • California < ire s Riverside County z s Commission # 2169350 My Comm Expires Oct 24, 2020+ to be the person) whose name Isl e me that heisoeAley executed the`same in I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature. _ Slgnetre fNotaryPublic Place Notary Seat Above OPTIONAL Though this section Is optional, completing this Information can deter alteration of the document or fraudulent reattachment of this form to an unintended docurnerrt. Description of Attached 'Document Title or Type of Dooument} rDocument para, Number of Pages: Stg e) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Corporate Officer — Tute(e)s i Partner — I:.I Li nrced General Individual r` Attorney in Fact Trustee 0, Guardian or Conservator C-1 Other;' Signer Is Representing: Signer's Name: _ J Corporate Officer — Title(s): Partner -- Limited'U General E! Individual ill Attorney in Fact 1.1 Trustee 2 Guardian or Conservator I.1 Other: _ Signer is Representing: 02014 National Notary Association , wvrw,Naf ona(Nomty.org - 9 -800 -US NOTARY (1-806-876-6827) Item #369 f7 CITY OF SANTA ANA Bond No. 024067782 BONDS PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 WARRANTY PERFORMANCE AND PAYMENT BOND (To be submitted upon project completion as a condition of project acceptance) KNOW ALL MEN BY THESE PRESENTS that Pavement Coatings Co. as CONTRACTOR, and The Ohio Casualty Insurance Cmmpany a corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Eight hundred sixty-two thousand, eight hundred sixty-two Dollars ($ 862.862 ), which is 25 percent of the final contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated June 20. 2017 for Project No. 17-6882: Local Street Slurry Seal 2016-17 if CONTRACTOR faithfully warrants the work done under said Contract Agreement against material or quality defects for a period of one year after acceptance by the AGENCY, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY; provided that any alterations in the obligations or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of such alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this day of July , 20 17. Subscribed and sworn to before me, , this day of 20 Signature: Notary Public in and for the County of , State of Rate of premium on this bond is $ nia per thousand. Total amount of premium charge is $ incl. in Performance Bond . To be filled in by Surety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 3 of 3 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts ofthose named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 7.6.66718 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS, That The Onto Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company Is a corporation duty organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Frank Memories; Lynn A. Slone; (Richard L. Wells all of the city of BREA , state of CA each Individually If there be more than one mined, its true and lawful attorney -In -facto make, execute, seal, aoknnwtedge and deliver, for and on its behalf as surety and as Its act and deed, anyand all undertakings bonds, recogmzahGes and other surety obligations, in pursuance ofthesa presents and shall be as binding upon the Companies as If they have been duly signed by the president and attested by the secretary of the Companies In their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 13th day of March 2017 The Ohio Casualty Insurance Company Liberty Mutual Insurance Company ro do 0) p u eta 491 7 = West American Insurance Company David M Carey Assistant Secretary C STATE OF PENNSYLVANIA as (a ro COUNTY OF MONTGOMERY C tim On this 13th dap of March 2017, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance V f- 0 an Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes T� 0 M therein contained by signing on behalf of the corporations by himself as a duly authorized officer a) Did Itt 2"> IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial sea at King of Prussia,Pennsylvania, on the day arid year first above written. O N COMMONWE.ALTHOFRENNSYLVANIAsn'lp/ Tore Psskr,ire Not., Puhhr t3y: u'„>yF 0 d i l l�"'U ..,.... = Unix, Me hunTwp.. Montgomery t"ounty loreso Pastella Notary Public Cauthority M,Co In..9bn E,nIcs Mrom J 20210 EoaThis Power of Attorney is made and executed y authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual W C, Insurance Company, and West American Insurance Company which resolutions are now In full force and effect reading as follows: Z v• TpN y X61 ro0). ARTICLE IV- OFFICERS- Scotian l2.Power ofAttorney. Any officer or olharoffloial of the Corporation authorized for that purpose hwriting by the Chairman or the President, and subject pC tto such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, z, A c acknowledgeand deliver as suretyany and all undertakings,bonds, coognlzarlces and other surety obligations. Such attorneys -in -fact subject to the undtationsset'forth in theirrespective "a E powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such Instruments and to attach thereto the seal of the Corporation. When so ca N p ro executed, such Instruments shall be as binding as if signed bythe Presldentand attested to by the Secretary Any power or authority granted to any representative or attorney-in-fact under > -0 the provisions df Chis article may be revoked atony [!me by the Board, the Chairman, the President or by the officeror cfacers granting such power or authority. ) 0 ,ro ARTICLE XIII - Execution of Contracts- SECTION 5 Surety Bonds and Undertakings, Any officer of the Company authorized for that purpose in writing by the chairman or the president, >. and subject to such limitations as the chairman orthe president may prescribe, shall appoint such attorneysdn-fact, as may be necessary to act in behafl of the Company to make, execute, *- m A seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their o? Z o respective powers otatforney, shall have full power to bind the Company by their agnature and execution of any such instruments and to attach thereto the seal of the Company. When so 0 o executed such instruments shall be as binding as if signed by the president and attested by the secretary, 'j Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M, Carey Aii Secretary to appoint such attorneysIn- h r fact as may be necessary to act on behalf of the Company to make execute, seal acknowledge and deliver as -surety any and all undertakings, bonds, reeegnizences and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company In connection with surety bonds shall be va11d'and binding upon the Company with the same force and effect as though manually affixed I, Renee C. Llewellyn, the undersigned Assistant; Secretary, The Ohio Casualty Insurance Company Hhehy Mutual Insurance Company, and Wast American Insurance Company do hereby verify that the original power of attorney of_wIhQh the foregoing is a full true and correct copy of the Power of Attorney executed by said Companies, Is In full force and effect arid has not been revoked, - 1N TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 5 day of Jtlj y r 20 17 m V"'r""tee By: -r- ? Renes G. Llaw ssisiank Secretor y 118 of 300 LM9 12973 022017 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Anotary public orother officer completing this certificate verifies only the identity ofthe 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 before me, Date personally appeared A,Slone, Notary Public Here Insert Name and Title of the Office Richard LWells of who proved tonneunthe basis (dsatisfactory evidence k)bethe ($ whose numoWis/are subscribed tothe within instrument d acknowledgedto me thatexecuted the same in IrWherfteir authorized capacity(les), and that by his/fpo«8�eir signature% on the instrument the person(N, or the entity upon behalf of which the person% acted, executed the instrument. I certify under PENALTY {}FPERJURY under the laws nfthe State c1California that the foregoing paragraph imtrue and correct, LYNN A. SLONE WITNESS myhand and official seal. Notary Pu lie -California Orange County Z Commission # 2134740 Signature— MY Place Notary Seat Above OPTIONAL Though this section /ooptional, completing this information can deter alteration ofthe document or fraudulent reattachment nfthis form k/mnunintended document. Description of Attached Document Title nrType VfDocument: Document Date: Number of Pages: — Signnrhs) Other Than Named Above: _________ Capm##ylies)Claimed by Signer(s) Signer's Name: [] Corporate Officer -^Tit|o(s): []Parnor--[]LinoiLaU []General []Individual [] Attorney inFact L|Trustee i]Guardian nrConservator Signer |nRepresenting: Signer's Name: [] Corporate Officer --llde(s): [] Partner --[]Limited []8*nora| E! Individual [] Attorney inFact ITruuieo [] Guardian orConservator 1-1 Other: Signer |pRepresenting: 02D14National Notary Association ^www.Natinna|N,8myurg^1^8O0~U8NOTARY (1~0OO`870'0827) kem#5807 CALIFORNIA • POSE ACKNOWLEDOMENT CIVIL CODE A notary public or other officer completing this oertif oohs verifies only the idersity of the individual who signed the document to which this certificate is attached, and riot the truthfulness, accuracy, or validity of that document. State of California } County of Riverside On July 6, 2017before me, Sunshine Armstrong, Notary Date Here Insert Name and Title of the Officer personally appeared Tom Mucenksi Namely) of Signer(af who proved to me on the basis of satisfactory evidence to be the person(pfwhose namor(Vis/ape subscribed to the within instrument ;and acienowiedged to me that he/site/thrr executed the same in histhOr/thy�iit authorized capacity(ieo, and that by his/l erftpeir signature(o on the Instrument the persons), or the entity upon behalf of which the personas) acted, executed the Instrument. ,� +,HIN. ARMSTRONG Notary Public • Calitornla Riverside County Commission # 2169350 MY Comm.Expires Oct 2a, 2020+ Place Notary Seal Above Though this section is optionel, compieifng I certify under PENALTY OF PERJURY under the taws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal, Slpnature _„ Signature Notary Public the document or Description ofAttached 'fOooument �'S Title or Type of Document. i _ Document Date: Number of mages: Signers) C>th, Than Named Above; Capacity(Ns) Claimed by Signertsl' Signer's Name: Corporate Officer -- Title(s): Partner Limited EJ General i Individual . Attorney in Fact 11 Trustee a Guardian or Conservator Ll Esher; Signer Is Representing: Signer's Name; L_ Corporate Officer -M'Rha s)s E Partner — E] Limited 'I.1 General L, Individual Attorney in Faint L_I Trustee L Guardian or Conservator t-] Other, Signer Is Representing, 02014 Netionai NofaryAssucietion > www.NationaiNotary.org - 1'•at10-US NO'TAFiY (1.806-876.6827) item lf5e07 CITY OF SANTA ANA Bond No. 024067782 BONDS PROJECT NO.: 17-6882 LOCAL STREET SLURRY SEAL 2016-17 FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS that Pavement Coatings Co. as CONTRACTOR, and The Ohio Casualty Insurance Company a corporation, organized and existing under the laws of the State, and duly authorized to transact business under the laws of the State of California, as SURETY, are held and firmly bound unto the City of Santa Ana, as AGENCY, in the penal sum of Eight hundred sixty-two thousand, eight hundred sixty-two Dollars ($ 862.862 ), which is 100 percent of the total contract amount for the above stated project, for the payment of which sum, CONTRACTOR and SURETY agree to be bound, jointly and severally, firmly by these presents. THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas CONTRACTOR has been awarded and is about to enter into the annexed Contract Agreement with AGENCY dated June 20, 2017 for Project No. 17-6882; Local Street Slurry Seal 2016-17 if CONTRACTOR faithfully performs and falfills all obligations in the performance of the Work of Improvement to be done under said Contract Agreement in the manner and time specified therein, then this obligation shall be null and void, otherwise it shall remain in full force and effect in favor of AGENCY; provided that any alterations in the obligations or time for completion made pursuant to the terms of the contract documents shall not in any way release either CONTRACTOR or SURETY, and notice of such alterations is hereby waived by SURETY. IN WITNESS WHEREOF the parties hereto have set their names, titles, hands, and seal this 5 day of July .1 20 17. Subscribed and sworn to before me, this day of 20 Signature: Notary Public in and for the County of , State of Rate of premium on this bond is $ varies per thousand. Total amount of premium charge is $ 4,442 To befilled in by Scerety *Provide CONTRACTOR /ADMITTED SURETY name, address, and telephone number and the name, title, address, and telephone number of authorized representative. 1 of 3 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except In the manner and to the extent herein stated. CertificateNo. 7666688 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WestAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company Is a corporation duly organized (most the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of this State of Indiana therein collectively called the "Companies"), pursuant to and by authority heroin set forth, does hereby name, constitute and appoint, Frank MoronesLunn A. Slone RloFiard L. Wells all of the city of -BREA,stela of CA each h individually if there be more than one named, Its true acid law ul attorney -iii -fart to make, execute, seal, acknowledge and deliver, for and on Its behalf as surety and as its act and deed, any and all undertakings bonds reeognizances and other surety obligations in pursuance ofthess presents and shall be as binding upon the Companies as if they have: been duly signed by the president and attested by the secretary of the Companies In their own proper persons, IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official ofthe Companies and the corporate seals of the Companieshave been affixed thereto this 13th day of March 2017 eA The Ohio Casualty Insurance Company Liberty Mutual Insurance Company a aa) t�1z5 0 4 0 0 A West RehashInsuranceCompany NseP oyr n '�`a�l ry U) do €a STATE OF PENNSYLVANIA as David M. Carey; Assistant Secretary a »% R COUNTY OF MONTGOMERY c Npr On this 13th day of. March 2247 before me personally appeared David M, Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance M t- 0 a Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing Instrument for the purposes 6 T therein contained by signing on behalf of the corporations by himself as a duly authorized officer. U to IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal hitting of Prussia Pennsylvania, on the day and year hrst above written, b COMMONWEALTH; OF PENNSYLVANIA ///Do� "�0 rot w ..'L3 ol .� ( Nn[n. ai SMI BYt qt Tcrema na tcla Notary Pu6il< _ p�% Upper MaarnTwre Mantpomary County T9reea Pastella, Notary Public Qauffority My coormL oo Exp res Mac 2FF 2021fl�Ftonto Peflc,0,ir a Aw rile,cf Mtarlms �0 o a to This Power of Attorney is made and executed by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual In q aj a`, Insurance Company, and WestAmerican Insurance Company which resolutions are now in full force and effect reading as follows: « �? U). Ln ARTICLE IV—OFFICERS—Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman orthe President, and subject O c to such limitation as the Chairman cribs President may prescribe shall appoint such attorneys -In -fact, as may be necossaryto act in behalf of Cho Corporation to make, execute, seal, ,r 0 c acknowledge and doliver as surety any and all undertakings, hourly, recognlzances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth In their respective =$ E 6 powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such Instruments and to attach thereto the seal spire Corporation, When so 0 es executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power orauthority granted to any representative or attorney-in-faot under %*-� '" the provisions of this article may be revoked at any time by the Board, the CIthado m the President or by the officer or officers granting such power or authority. on .six ARTICLE Xlti— Execution of Contracts —SECTION 5. Surety Bonds and Undertakings. Arty offteer of the Company authar¢ed for that purpose in writing by the chairman or the president, w > and subject to such limitations as the chairman orlhe president may prescribe, shall appolntsuch attorneys -fn -fact, he may be necesgaryto actin behalf of the Company to make, execute, E e�9 O :3seal, acknowledge and deliver as surely any and all undertakings bonds, recognlzances and other surety obligations Such attorneys -in -tact sabJect to the limltatlons sat forth In their tx respective powers ofatlorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so 00 executed such Instruments shall be as binding as Feigned bythe president and attested bythe secretary, ` 0 . Certificate of Oesignatloa - The Prasiden4of the Company, rating pursuant to the Bylaws of th$6ompany, authorizes David M. Carey Assistadi.5ecretary to appoint attorneys -In- r fact as may be necessary to act on behalf of the Company to make execute, seal, acknowledge and deliver ad`.surety any and all undertakings: bonds, recognlzances and other surety obligations, Authorization— By unanimous consent ofthe Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney Issued by the Company in connection with surety bonds shall be valid and binding upon the Company with the same Farce and effect as though manually affiked I, Renee C. Llewellyn, the undersigned Assistant Secretary, The Ohio Casualty Insurance Company Liberty Mutual Insurance. Company, and West American Insurance Company do hereby eortify that the original power of attorney of which i the foregoing is a full hue and Correct Copy of the Rower of Attorney executed by said Companies, Is In full force and effect and has not been revoked - 5 July 17 IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this day of -,20 t(V INSp 1 Ik! CCCj x W.c `+C: i, wLlew By:R.Ks{{ffff/si}}syy�ta p`r4n J,2yPfQ nyfeye nYA}t"Secretary Re a�°�9 ny3` A'y1i�g� 88 of 300 LMS 12873 022017 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 Co__�2range On `,/v before me, Lynn A. Slone, Notary Public Duio Here Insert Name and Title ofthe Officer personally appeared Richard LWells of who proved iunnoonthe basis ofsatisfactory evidence tnbe the (% whose nmnoewiu/e* subscribed tnthe within instrument and acknowledged in nnathat ha/wW444executed the same in hin/hmnMteh`authorized oopaoity(iam),andthu1byhs/hw,fMh/8rui ok,*(%mniheinotrunoontthnpenovnAW' or the entity upon behalf of which the person(@) acted, executed the instrument. Orange County ZZ Commission * 2134740 Place Notary Seal Above | certify underPENALTY OFPERJURY under the laws u[the State vfCalifornia that the foregoing paragraph istrue and correct. \mITVEG8 my hand , anPfficial seal. Signature gna vure of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment oythis form tomnunintended document. Description c6Attached Document This orType nfDocument: Document Date: Number of Pages: —5igner(o) Other 'Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: [] Corporate Officer --Th|ekV: []Partner --[]Limited []General [lIndividual [] Attorney inFatt. i!Trustee [] Guardian n,Conservator [lOthoc Signer Is Representing: Signer's Name: [] Corporate Officer ~`Th|ek8: LPortner— OUmitod C. General 1_1 Individual [] Attorney inFact []T,uutwe [| Guardian nrConservator [] {8hyc Signer ioRepresenting: @2O}4National Notary Association ^wwe.NatiomdNodory»rg^1~0AO~USNOTARY p~800'87V^882D |tom#5807 CALIFORNIA ID 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 Riverside On July 6, 2017 before me ___. Sunshine Armstrong, Notary Grate Here Insert }Name and Tide of the Oft ar personally appeared Tom Mucenksi Nam# of Signer(6 who proved to me on the basis of satisfactory evidence to be the porson(y whose name(V isl�re subscribed to the within rostrum t and acknowledged to me that be&�Sattorey executed the same in Nefh{lfrltheKauthorized capacity(t , and that by hlsth f rfthiir signature} In the Instrument the persorio),- or the entity upon behalf, of which he person( acted, executed the instrument, oUNSNINE ARMSTRONG Notary Puhllc • California z a w Riverside Coun.y Commission # 2169350 My Comm. Expires Oct 24, 2020 ~ Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of Catifornip that the foregoing paragraph is true and correct. WITNESS m hand and offickai seal, Signature Signa re df Notary J�ubfic� Though this section Is optional, completing this information can deter alteration of the document or Capaaity(ies) Claimed bySigner(s) Signees Name: Corporate Officer — Title(s) , E Partner t_;( Limited: .. General Individual D Attorney in Fact _3 Trustee C Guardian or Conservator 0 Other; Signer Is Representing: Signer's Name: __ L,; Corporate Officer — Title(s):: Partner J Limited i..l General C.; Individual D Attorney In Fact t i Trustee lit Guardian or Conservator * Other; Signer is Representing: