HomeMy WebLinkAboutContracts & Agreements_104-96_CCv0001.pdf mucoraect in official Records, County of
San Bernardino, Errol J. Mackzurri, Recorder
RECORDING RMUESTED By if-
AND AHN RECORDED MAIL TO No Fee
rt Doc No . 19970116266
CITY CLERK 1 : 47pm 04/03/97
CITY OF REDLANDS
36 CAJON STREET 205 20067877 02 11
P 0 BOX 3005 11 41 - 1 1
REDLANDS CA 92373 PG FEE APF I GINIS PH CPY CRT CPY ADD NAI PEN PR POOR
L
5 6
NON ST LN SVY CIT-CO TUNS TAX DA CHRG
NOTICE OF COMPLETION FEES NOT REQUIRED
Notice Pursuant to Clvd Code Section ,this notice must be Ned within 10 days after completion of work. PER GOVERNMENT CODE
Notice is hereby given thatSECTION 6103
t. The undersigned is owner or corporate officer of the Owner Of the interest Or estate stated below in the Property hereinafter described:
2. The full name of the owner is: CITY OF REDLANDS
3. The full address of Use owner is: 35 CAJON STREET, P 0 BOX 3005
REDLANDS CA 92373
4. The nature of to Interest or estate of the owner is; In fee.
5. The full names and full addresses of all persons, if any,who hold tide with the undersigned as joint tenants or as tenants in common are:
NOT APPLICABLE
6. A work of Improvement on the property hereinafter described was completed on March 21, 1997. The work done was:
Eureka Street and Third Street Improvements, Contract No. 22-9527-4230.
7. The name of the contractor for such work of improvement was: S J Burkhardt Inc
6157 Madatt Street,Wra Lamar CA 91752 October 15, 1996
Oft of C-Ilrao
The property an which said work of improvement was completed Is In the city of Redlands,County of San Bernardino,state of California,
and is described as follows: Eureka Street, from Redlands Blvd north to Stuart Avenue.
9. The street address of said property is: Not Applicable
Dated: March 27, 1997
Oadmd Ad nih1*00n Eniik*wDepwbr&K Cly of Raftnft
VERIFICATION
1, the undersigned, say I am the Public Works Director of the decd of the foregoing Notice of Completion. and have read swd Notice of
Completion and know 1he COMM thereof the same is true of my own knowledge
I are under penalty of perjury that the foregoing is true and correct.
Executed on March 27, 1997,at Redlands,catilornia-
%b*,,Woft okwor Pubfic works WMW-K C�Syftd�.�
AGREEMENT
THIS AGREEMENT, made and entered into this fifteenth day of October, 1996, by and between the
City of Redlands, a Municipal Corporation, organized and existing under the laws of the State of
California, hereinafter referred to as the "City", and
S. J. Burkhardt, Inc. A California Corporation
a partnership consisting of
or an individual trading as
of the City of Mira Loma, Ca. County of- Riverside
State of California, hereinafter referred to as the "Contractor".
WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, agree as follows:
1 SCOPE OF WORK: The Contractor will furnish all materials and will perform all of the work for the
following:
To perform construction of Eureka Street Improvement project, complete,all as shown, specified,
and made a part of Contract No. 22-9527-4230.
2. THE CONTRACT SUM OF:
3. TIME FOR COMPLETION: The work shall be completed within forty(40)work days from and after
the date of the Notice to Proceed.
4. CONTRACT DOCUMENTS: The complete Contract includes all of the contract documents set forth
herein, to wit; Notice Inviting Bids, Instructions to Bidders, Proposal and Bid Forms, Bid Bond,
Agreement,Performance Bond, Payment Bond, Plans and Specifications,all referenced specifications,and
anv Addenda thereto.
5. ATTORNEY FEES: In the event any legal action is commenced to enforce or interpret the terms or
conditions of this Contract the prevailing party shall, in addition to any costs and other relief, be entitled
to recovery of its reasonable attorney's fees.
6. DEFENSE OBLIGATION: The Contractor shall defend the City,its elected officials,officers,agents,
and employees from and against any and all claims, losses, damages, and causes of action, including death,
brought by any person or persons for or on account of any wrongful or negligent act or ormitission of the
Contractor,its employees or agents in connection with the performance of the Contractor's obligation under
this Contract.
7. INSURANCE: All policies of insurance required by this Contract shall name the City, its elected
officials, employees, and agents as additional insureds, and such insurance shall be primary with respect
to such additional insureds and non-contributing to any insurance or self-insurance maintained by the
additional insureds.
CD-19
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in duplicate on the day
and year first written above.
CITY'S,SEAL,
410040*0 A��
v ayor, City of Redlands
County of San Bernardino, California
ATTEST:
.. last
City Clerk, City of Redlands
County of San Bernardino, California
S.J. BURKHARDT, INC.
Name of Con actor
CONTRACTOR'S SEAL By:
4gnat4Autholed Agent
Steven J. Schmitz-Sec./Treas.
Signatory's Title
Signature of Authorized Agent afnecessary)
Signatory's Title (if necessan-)
510982 "A"
Contractor's License No.
CD-20
WORKERS' COMPENSATION INSURANCE STATEMENT
1, the undersigned and authorized agent for the Contractor, am aware of the provisions of Section 3700
of the Labor Code which requires every employer to be insured against liability for workers'
compensation or to undertake self-insurance in accordance with the provisions of that code, and I will
comply with such provisions before commencing the performance of the work under the City's Contract
No. 22-9527-4230.
S.J. BURKHARDT, INC.
Name of Contractor
By:
Signat',61V Authoriz gent
4�K
Steven J. Schmitz-Sec./Treas.
Signatory's Title
510982 "A"
Contractor's License No.
CD-21
BOND �F 5-500 6965
PRE Ti is $4,182.00
EXECUTED IN TRIPLICATE
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS
That S. J. BURKH—ARDT, INC.
as Contractor,
and WASHINGTON INTERNATIONAL INSURANCE COMPANY as Surety.
are held and firmly bound unto the City of Redlands, hereinafter called City,in the sum of
TWO HUNDRED NINETY EIGHT THOUSAND SEVEN HUNDRED FIFTEEN—{$29$,715.00)
for the payment of which sum well and truly be made, we bind ourselves, our heirs, executors, administrators,
successors, and assigns,jointly and severally, firmly by these presents.
WHEREAS, said Contractor has been awarded and is about to enter into the annexed contract with said City to
perform all work required under the City's Contract No, 22-9527-4230.
NOW, THEREFORE, if said Contractor shall perform all of the requirements of said contract required to be
performed on their part. at the times and in the manner specified therein, then this Obligation shall be null and void,
otherwise it shall remain in full force and in effect until 90 days after completion.
PROVIDED, that any alterations in the work to be done or the materials to be furnished, which may be made
pursuant to the terms of said contract, shall not in any way release either said Contractor or said Surety thereunder,
nor shall any extensions of time granted under the provisions of said contract release either said Contractor or said
Surety. and notice of such alterations or extensions of the contract is hereby waived by said Surety.
SIGNED AND SEALED, this 14TH day of OCTOBER 1996.
WASHING i INTERNATIONAL
S. J. BURKHARDT, INC. (SEAL) INSU CE COMP (SEAL)
Principal Surety
BY.
igna
Signature MICI AEL A. QUIkLEX
7- _
Steve J. Sc z-Sec./Treas. ATT61KEXMLIjNj—FACT 7 ,
Address: 1930 THOREAU DRIVE, #101
SCHAUMBURG, IL 60173
Telephone: (800 1 338-0753
(Sleal and Notarial Acknowledgment or Surtty)
L
i CD-22
L
STATE OF CALIFOWNIA
SS.
COUNTY OF ORANGE
{Jn OCTOBER 14, 1996 before me, M. TREDINNICK, NOTARY PUBLIC
PE1 SONALLY APPEARED MICHAEL A. QUICLEY
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/her/ l
their signature(s) on the instrument the person(s), or the
VR e
entity upon behalf of which the person(s) acted, executed $ T
the instrument.
WITNESS my hand and official seal.
GJ f (-` This area for Official Nota
Signature
Seal
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
❑ INDIVIDUAL_
C❑ CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
nTLE(S)
PARTNER(S) ❑ LIMITED
❑ GENERAL
ATTORNEY-IN-FACT NUMBER OF PAGES
TRUSTEE(S)
El GUARDIAN/CONSERVATOR
El OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESE"NG:
NAME CSE PERSONS)OR EAi MITES)
SIGNER(S) OTHER THAN NAMED ABCVE
Al-L-PURPOSE ACKNOWLEDGEMENT
vKA,'>H1/VU/U/V 1/yII:HN-41/U/UAL INSUPANCE COAMPANY
�
POWER DFATTORNEY
KNOW ALL BY THESE PRESENTS: The*,'he Washington International Insurance Comupny' aco,poradon organized and existing under ,he
|uw'sufthe State ofArizona, and having its Principal office inthe Village ofSchaumburg, Illinois does hereby constitute and appoint
JHA WN BLLME� JfN8V8R JO/IVS7DIV, A41CHAfIA. QUICLEY AND DWIGHT REI1lY
E4CH0VTHEIR SEPA R4DFCA P4LJTY
its true and law/u! aosrnuy(a)'in'fact to execute, seal and deliver for and onits beha|( as surety, any and all bonds and undertakings,
/scognizanoee' contracts of indemnity and other writings obligatory in the nature thereof, which are nrmay be aUowed, required, or
permitted by law, statute, 'u|o' regulation, contract o, othervvise, and the execution of such instrument(s) in-pursuance of these presents,
shallbe as binding upon the said Washington International Insurance Company as fully and amply, tuall intents and purposes. as if the
sameas been duly executed and acknowledged by its President and its principal office.
This Power of Attorney shall bolimited in amount to $2.000.Q0O.00for any einQ|a obligation.
This Power of Attorney is issued pursuant to authority granted by the resolutions of the Board of Directors adopted March 22' 1B78'July
3' 1980 and October 21. 1986 which read, in par,. as follows:
lThe Chairman of the Board, President, Vice P'ea|dent, Assistant Secretary, Treasurer and Secretary may designate Attorneys-in-
Fact, and ouoho'ba them to execute on behalf of the Company' and attach the Seat of the Company thereto, bonds, and
undertakings, reougnizanoeu' contracts of indemnity and other vv/idngu obligatory inthe nature thereof, and tmappoint Special
Attorneys'in-Fact, who are hereby authorized to certify copies of any power-of-attorney issued inpursuant to this section and/or
any of the By-Laws of the Company, and to remove, at any time, any such Attorney-in-Fact or Special Attorney-in-Fact and revoke
the authority given him.
2. The signatures of the Chairman of,he Board, the President, Vice President, Assistant Secretary, Treasurer and Secretary, and the
corporate seal of the Company' may be affixed to any Power of Attorney, certificate, bond or undertaking relating the,eto, by
facsimile. Any such Power of Attorney, certificate bond or undertaking bearing such facsimile signature or facsimile seal affixed
in the ordinary course of business shall be valid and binding upon the Company.
|NTESTIMONY WHEREOF
I t;64m hington International Insurance Company has caused this instrument to be signed and its corporate
seal to be affixed by i4V' gft$q Vier, this 2nd day of November, 1994.
�ASHINGTONCOMPANY
PA
c� SEAL
STATE OF |LL|Nq|S�� '
COUNTYOFCOOK> "��*�:�y��
On this 2nd day of November, 1994, before me came the individual who executed the preceding instrument, to me personally know, and,
being by me duly sworn, said that heisthe therein described and authorized officer of the Washington International Insurance Company;
that the seal affixed to said instrument is the Corporate Seal of said Company;
|NTESTIMONY YHEREOF �| have h�y�ynto oat my and affixed
my �ua|' the day and year written.
~_ � —~ /
"OFFiCIAL SEAL"
9 ub-
CERT|0�A�����~ �--�- - �� �
STATE OF ILLINOIS)
COUNTY OF COOK)
1,the undersigned, Secretary of WASHINGTON INTERNATIONAL INSURANCE COMPANY, an ARIZONA Corporation, DO HEREBY CERTIFY
that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked, and furthermore that Article III,
Section 5 of the By-Laws ofthe Corporation, and the Resolution of ,he Board of Dirwctoru, set forth inthe Power of Attorney, are now
in force.
Signed and sealed in the County of Cook. Dated hl��8d f OCI08G8 19 96
BOND #S-500 6965
PREMIUM INCLUDED ON PERFORMANCE BOND
EXECUTED IN TRIPLICATE
PAYMENT BOND
KNONV ALL PERSONS BY THESE PRESENTS
That S. J. BURKHARDT, INC. as Contractor,
and WASHINGTON INTERNATIONAL INSURANCE COMPANY as Surety,
are held and firmly bound unto the City of Redlands. hereinafter called City, in the sum of
TWO HUNDRED NINETY EIGHT THOUSAND SEVEN HUNDRED FIFTEEN—{$298,715.00) dollars,
for the payment of which sum well and truly be trade, we bind ourselves, out heirs, executors, administrators,
successors, and assigns,jointly and severally, firmly by these presents.
WHEREAS, said Cootrutor has been awarded and is about to enter into the annexed contract with said City to
perform all work required under the City's Contract No. 22-95274230.
NOW, THEREFORE, if said Contractor. or Subcontractor, fails to pay for any materials,equipment, or other
supplies. or for rental of same, used in connection with the performance of work contracted to be done, or for
amounts due under applicable State law for any work or labor thereon, said Surety will pay for the same in an
amount not exceeding the sum specified above, and, in the event suit is brought upon this bond. a reasonable
attorney's fee to be fixed by the court. This bond sl:W1 inure to the benefit of any persons, companies, or
corporations entitled to file claims under applicable State law and will remain in force until 90 days after
completion.
PROVIDED, that any alterations in the work to be done or the materials to be fimnislied, which may be made
pursuant to the terms of said contract, shall not in any way release either said Contractor or said Surety thereunder,
nor shall any extensions of time granted under the provisions of said contract release either said Contractor or said
Surety, and notice of such alterations or extensions of the contract is hereby waived by said Surety.
SIGNED AND SEALED, this 14TH day of OCTOBER 1996.
WASHING N INTERNATIONAL
S. J. BURKHARDT, INC. (SEAL) INSURfI&C CMP
............
Principal Surety
Principal
Y_
B
Ignatu MIC EL A. QL GLEY
-
�even J. Schmic./Treas. ATTORN — N—FACT
Address- 1930 THOREAU DRIVE, #101
SCHAUMBURG. IL 60173
Telephone: (_8 00 338-0753
(Stai and Notamt Ackwwtedginent of Surety)
CD-2-3
STAIT OF CALIFORNIA SS.
COUNTY OF ORANGE
On OCTOBER 14, 1996 before iric. M. TRINNICK, NOTARY PUBLIC
PERSONALLY APPEARED MICHAEL A. QUIGLEY
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/her/
their signature(s) on the instrument the person(s), or the tof T !E C
entity upon behalf of which the person(s) acted, executed CC A
the instrument.
my comr.rnaer kat�
WITNESS my hand and official seal.
This area for QfficialVlotarial Seal
Signature
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
INDIVIDUAL
❑ CORPORATE OFFICER
T TITLE OR TYPE OF DOCUMENT
.ITLE,"
PARTNER(S) 11 LIMITED
El
El GENERAL
ATTORNEY-IN-FACT NUMBER OF PAGES
TRUSTEE(S)
GUARDIAN/CONSERVATOR
OTHER:
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(SI OR ENT MIES',
SIGNER(S)OTHER THAN NAMED ABOVE
00hi K(.v t>'q ALL-PURPOSE ACKNOWLEDGEMENT
vv/1,')H1/VUyU/V I/VI&HNAJ7U/VAL INSURANCE- COAPANY --
~
POWER OF ATTORNEY
KNOW ALL BYTHESE PRESENTS: That the Washington International insurance Comapny. acorporation organized and existing under the
laws of the Slate of Arizona, and having its principal office inthe Village of Schaumburg, Illinois does hereby constitute and appoint
_
SHA WNBlUME, JENNIFER JOHNSTON, MICHAEL A. QUIG/EyAND DWIGHT REILL Y
EACHxV 77fflR SfPAR4TE CAPACJTy
its true and lawful attorney Is)'in'fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakinga
recognizances, contracts of indemnity and other writings obligatory in the nature /he,aof, which are or may be allowed, required, or
'
pa/minodby |avv' statute, rule, 'egu|adon. contract orotherwise, and the execudonofsuch inat,ummnt(s) in-pursuance ofthese preme''ts
shall be as binding upon the said Washington International Insurance Company as fully and ampiy^ tnaUintents and pu,poses, as if the
`
same has been du|yexecuted and acknowledged by its President and its principal office.
This Power of Attorney shall be limited in amount to $2,000,000.00 for any single obligation.
This Power o/Attorney is issued pursuant to authority granted by the resolutions of the Board of Directors adopted March 22, 1978 July
3. 188Oand October 2l' 198Wwhich read, inpan. asfoUovvs: '
l. The Chairman of the Board, PesNen,, Vice Preshdent, Assistant Secretary, Treasurer and Secretary may designate Attorneys-in-
Fact, and authorize them to execute on behalf of the Company, and attach the Seat of the Company tharmto, bunds` and
undertakings, ,ecognizannmo' contracts of indemnity and other writings obligatory inthe nature thereof, and to appoint Special
Attorneys-in-Fact,. who are hereby authorized to certify copies ofany pow ar'of- —
at�ornoy is�uwdinpu, uant xor��s oaotion ` d/o,
any ofthe By-Laws ofthe Company, and toremove, utany time, any such Auo,nay'inrFact cnSpecial Auoroey-i* revoke
-oke
the authority given him.
2. The signatures ofthe Chairman of,he 8uand' the President, Vice President, Assistant Secretary, Treasurer and 800retary, and the
corporate seal of the Company, may be affixed to any Power o/ Attomney, certi5cata, bond or undertaking relating thereto, by
facsimile. Any such Power nf Attorney, certificate bond or undertaking bearing such facsimile signature or facsimile aua| affixed
in the ordinaordinarycourse ufbusiness shashallbevalid and binding upon the Company.
|NTESTIMONY VVHERE
this instrument tubusigned and its corporate
jer, this 2nd day of November, 1994.
jP
COMPANY
RPO EAL
ZMA illiam D. Sterrett, Chairman of the Board
COUNTY OF COOK)
On this 2nd day of November, 1994, before me came the individual who executed the preceding instrument, xomepersonally koow �nd
being by ma duly sworn, said that he is the therein described and authorized officer of the Washington (mmmmnabona| Insurance Com' '
Company;
that the seal aMixedtusaid �mrumontimthe Corporate Seat nfsaid Company;
- ��� ��----- --�� '
IN TESTIMONY WHEREOF, | have hmreun,o set my hand and affixed my Official 3sa|, the day and year written.� abnvm written.
~_==-___ _
"OFFiCIAL SEAL"
pu�,;ilt, State of ilIA101's
My Crafzis*on Exp4es 10-796
*ires jctober 7 1996
CERT|O�AT�=_=— �--�-- ' �
STATE OF ILLINOIS)
COUNTY OF COOK)
1,the undersigned, Secretary of WASHINGTON INTERNATIONAL INSURANCE COMPANY, an ARIZONA Corporation, DO HEREBY CERTIFY
that the foregoing and attached POWER OFATTORNEY remains in full force and has not been ,evoked. and furthermore that Article |{|'
Section 5 of the By-Laws of the Corporation, and the Resolution of the Board o/ Directors, set forth inthe Power of Attorney, are now
in force.
Signed and sealed in the County nfCook. Dated hf. 14T14 day f OCI08ER
19 96
/�'/{r►0RLI. r �■ I CAT l�1 I �T DATE fMM/t}DtYYt
_ __ BURKSJ1 10/18 96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MERIDIAN INSURANCE SERV. INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JOHN BACCARELLA HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
4501 E. LA PALMA AVE #150 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
ANAHEIM CA 92807 COMPANIES AFFORDING COVERAGE
JOHN BACCARELLA COMPANY
Phone No. 714-693-9 00 f=asNo. A AIG-AMER INT'L SPEC LINES INS
INSURED
COMPANY
B VALLEY FORGE INS CO (CNA)
COMPANY
S. J. BURKIiARDT, INC. C GENERAL SECURITY INSURANCE CO.
6157 Marlatt COMPANY
Mira Loma CA 91752 D CONTINENTAL CASUALTY (CNA)
COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
ITR DATE MWIDDIYY) DATE(MMtDDIYY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE $ 1,000L000
A X COMMERCIAL GENERAL LIABILITY 91644—CA96050150 05/31/96 05/31/97 PRODUCTS-COMPIOPAGG $ 1,000,000_
CLAIMS MADE ®OCCUR PERSONAL&ADV INJURY $ 1,000,000
X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE _$j'000,000
X XC:U INCL. FIRE DAMAGE(Any one fire) $ 50,000
MED EXP(Any one person) $ 5,000
AUTOMOBILE LIABILITY
B X ANY AUTO BUA 1034892493 05/19/96 05/19/97 COMBINED SINGLE LIMIT $ 1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) S
X HIRED AUTOS
BODILY INJURY S
$ NON-OWNED AUTOS tPer accident)
% PHYSICAL DAMAGE $1,000 DED ON BOTH COMP
AND LOLL PROPERTY DAMAGE S
GARAGE UABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE s2,000,000
C X UMBRELLA FORM GP 5038533 05/31/961 05/31/97 AGGREGATE 52,000,000
OTHER THAN UMBRELLA FORM S
WORKERS COMPENSATION AND X I
TORAT 7 OEn-
EMPLOYERS'LIABILITY
EL EACH ACCIDENT $ 1,000,000
D THE PROPRIETOR/ INCL WCC 14 4500571 11/20/95 11/20/96 96 EL DISEASE-POLICY LIMIT $ 1,000,004
PARTNERS/EXECUTIVE
D OFFICERS ARE: 11EXCL WCC 14 4500571 11/20/95 11/20/96 EL DISEASE-EA EMPLOYEE $ 1,000,000
OTHER
E € SCHEDULED EQUIP 96AS10901 05/19/96 05/19/97 TOTAL LMT $1,676,231
E ' LEASED/RENTED EQUI 96&810901 05/19/96 05/19/97 ANY 1 ITM $ 100,000
DESCRIPTION OF OPERATIONSILOCATIONS;VE LESfSPECIAL ITEMS
***COMPANY E -- NAVIGATORS INSURANCE COMPANY.
>*10 DAY NOTICE FOR NON PAYMENT OR NON REPORTING OF PAYROLL.
CERTIFICATE HOLDER IS HEREBY NAMED AS ADDITIONAL INSURED PER LAC-AD1992
RE: EUREKA STREET IMPROVEMENTS, CONTRACT #22-9527-4230; $298,715, 90 DAYS
x
CERTIFICATE HOLDER CANCELLATION
CITYRED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE fSSUING COMPANY WALL WA0 MAIL
CITY OF REDLANDS 30 DAYS WRITTEN NOTICE TO THE CERTfFICATE HOWER NAMED TO THE LEFT.
P.O. BOY 3005
REDLANDS CA 92373
AUTHORIZED REPRESENTATI t
JOHN BACCARELLA�'� ' I jP
A ORD 25-S'(1/95)
L A ;":;RD C3FtRAT1fllU 19I38
POLICY NUMBER: 91644-CA96050150
INSURED: S.J. BURKHARDT, INC.
THIS ENDORSEMENT CHANGES THE POLICY - PLEASE READ IT CAREFULLY
ADDITIONAL INSURED ENDORSEMENT
IF YOU ARE REQUIRED TO ADD ANOTHER PERSON OR ORGANIZATION AS AN
ADDITIONAL INSURED ON THIS POLICY UNDER A WRITTEN CONTRACT OR
AGREEMENT CURRENTLY IN EFFECT OR BECOMING EFFECTIVE DURING THE
TERM OF THE POLICY AND A CERTIFICATE OF INSURANCE LISTING THAT
PERSON OR ORGANIZATION AS AN ADDITIONAL INSURED HAS BEEN ISSUED,
THEN WHO IS AN INSURED (SECTION ii) IS AMENDED TO INCLUDE AS AN
INSURED THAT PERSON OR ORGANIZATION (CALLED "ADDITIONAL
INSURED") .
THE INSURANCE FOR THAT ADDITIONAL INSURED IS LIMITED AS FOLLOWS:
1. THAT PERSON OR ORGANIZATION IS ONLY AN ADDITIONAL INSURED
FOR ITS LIABILITY ARISING OUT OF "YOUR WORK" OR ON BEHALF
OF THIS ADDITIONAL INSURED; AND
2. THE LIMITS OF LIABILITY FOR THE ADDITIONAL INSURED ARE
THOSE SPECIFIED IN THE WRITTEN CONTRACT OR AGREEMENT, OR IN
THIS POLICY, WHICHEVER IS LESS. THESE LIMITS ARE INCLUSIVE
OF AND ARE NOT IN ADDITION TO THE LIMITS OF INSURANCE SHOWN
IN THE DECLARATIONS; AND
3 . ALL OTHER POLICY TERMS, CONDITIONS AND RESTRICTIONS ALSO
APPLY INCLUDING, BUT NOT LIMITED TO THE "OTHER INSURANCE"
PROVISIONS.
THIS ENDORSEMENT AND ANY COVERAGES PROVIDED HEREIN APPLY ONLY TO
THE POLICY TO WHICH IT IS ATTACHED AND IS NOT EXTENDED TO ANY
OTHER POLICY ISSUED TO THE INSURED.
PREMIUM: INCLUDED.
ADDITIONAL INSURED(S) :
CITY OF REDLANDS
LAC-ADI992