HomeMy WebLinkAboutContracts & Agreements_187-2007_CCv0001.pdf AGREEMENT
THIS AGREEMENT,made and entered into this 16'day of October,2007,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 ASR Constructors,Inc.of the City of Riverside,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 to perform
construction of the Sports Park Restroom Building project,complete, all as shown, specified,and made a part
of Contract No. 240300-7270/47105.
2. For the Contract Sum of S 533,000-00,in accordance with the terms and conditions of the Contract Documents.
Pursuant to Section 22300 of the California Public Contract Code,Contractor has the option to deposit securities
with an Escrow Agent as a substitute for retention of earnings requirement to be withheld by the City pursuant
to and Escrow Agreement.
3. Time for Completion. The work shall be completed within ninety (90)work days from and after the date of
the Notice to Proceed.
4. Liquidated Damages. Failure of the Contractor to complete the work within the time allowed will result in
damages being sustained by the City. Such damages are, and will continue to be, impracticable and extremely
difficult to determine. The Contractor shall pay to the City,or have withheld from monies due it,the sum as set
forth in the General Provisions for each consecutive calendar day in excess of the specified time for completion
of the work.
Execution of the contract shall constitute agreement by the City and Contractor that the liquidated damages
amount per day is the minimum and actual damage caused by the failure of the Contractor to complete the work
within the allowed time. Such sum is liquidated damages and shall not be construed as a penalty, and may be
deducted from payments due the Contractor if such delay occurs.
5. 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 and
Payment Bonds; Standard Specifications and Standard Plans for Public Works Construction; Contract
Documents and Supplemental Specifications; all referenced specifications; and any Addenda thereto.
6. 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.
7. 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 omission of the Contractor,its employees
or agents in connection with the performance of the Contractor's obligation under this contract.
8. Insurance. All policies of general liability and business automobile insurance required by this contract shall
name the City,its elected officials,employees,and agents as additional insureds. Any insurance required under
this contract shall be primary with respect to the City and non-contributing to any insurance or self-insurance
maintained by the City.
9. Resolution of Construction Claims. Claims made by the Contractor in the amount of$375,000.00 or less shall
be processed by the City pursuant to the provisions of Part 3,Chapter 1,Article 1.5 of the Public Contracts code
(commencing with Section 20104). All claims shall be in writing and include the documents necessary to
substantiate the claim. Nothing in subdivision (a)of the Public Contracts Code Section 20104.2 shall extend
the time limit or supersede the notice requirements provided in this case from filing claims by the Contractor.
Pursuant to Public Contract Code section 9201, if the City receives a third party claim in relation to this
Contract, the City shall timely notify the Contractor. The City shall be entitled to recover reasonable costs
incurred in providing the notification required by Public Contract Code section 9201(b).
10. Eligibility of Contractor/Subcontractor. Contractor and any subcontractor agree to abide by California Public
Contract Code Section 6109 and California Labor Code Sections 1777.1 and/or 1777.7 and certify that they are
not debarred and are eligible to work on this project.
11. Assignment of Agreement. No assignment by a party hereto of any rights or interests under this agreement will
be binding on another party without the written consent of the party sought to be bound.
12. Successors and Assigns. The City and Contractor each binds itself, its partners, successors, assigns and legal
representatives in respect to all covenants, agreements and obligations contained in the contract documents.
13. Severability. Any provision or part of the contract documents held to be void or unenforceable under any law
or regulation shall be deemed stricken,and all remaining provisions shall continue to be valid and binding upon
the City and Contractor.
IN WITNESS WHEREOF,the parties hereto have executed this Agreement in duplicate on the day and year first
written above.
CITY SEAL
Bf.
y:
M Mayor,City 0�
or,City of Redlands
,,County of San Bernardino,California
ATTEST:
Ci lerk City of ern
County of
San Bern California
ASR Constructors n
Name of Contractor
CONTRACTOR SEAL By: -6, 1
Signature of Authorized Ag t
Signatory's Title
�A-
Signature of Authorized Agent (if necessary)
----S az),innit-k
Signatory's Title (if necessary)
615395. A, B,C51.C8. C27.C29,
Contractor's License No.
WORKERS' COMPENSATION INSURANCE CERTIFICATION
SPORTS PARK RESTROOM BUILDING
CONTRACT No. 240300-7270147105
Every employer except the State, shall secure the payment of compensation in one or more of the following ways:
(a) By being insured against liability to pay compensation in one or more insurer duly authorized to write
compensation insurance in this State.
(b) By securing from the Director of Industrial Relations, a certificate of consent to self-insure, either as an
individual employer or as one employer in a group of employers, which may be given upon furnishing
proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any
compensation that may become due to his or her employees.
I 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 of this
contract. (Labor Code Section 1861
Date
ASR Constructors A/m.
Name of Contra X/br
I"
7j
By:
ut
Signature of A X rued Agent
s.
Signatory's Title
615395
Contractor's License No.
PERFORMANCE BOND BOND NO. 8212-89-47
PREMIUM: $7,847.00
WHEREAS, the City Council of the City of Redlands, State of California(hereinafter designated as"City"), and
ASR Construe tors Inc.(hereinafter designated as"Principal") have entered into an agreement whereby Principal
agrees to install and complete certain designated public improvements, which by said agreement dated October 16,
2007, and identified as Contract No. 240300-7270/47105, is hereby referred to and made a part hereof;and
WHEREAS, under the terms of said agreement,Principal is required before entering upon the performance of the
work,to furnish a good and sufficient faithful performance bond with the City.
NOW,THEREFORE, said Principal and the undersigned as corporate surety,are held and firmly bound unto the
City in the sum of FIVE HUNDRED THIRTY THREE THOUSAND & NO/1004Z511ars ($5L3,000.00-- )
for
00.00--
for the payment of which sum well and truly to be made, we bind ourselves, our heirs, successors, executors and
administrators,jointly and severally, firmly by these presents.
The condition ofthis obligation is such that ifthe above bounded Principal,his orher heirs,executors,administrators,
successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants,
conditions,and provisions in the said agreement and any alteration thereof made as therein provided,or his or her
part,to be kept and performed at the time and in the manner therein specified,and in all respects according to their
true intent and meaning,and shall defend,indemnify and save harmless the City,its elected officials,officers,agents,
and employees,as therein stipulated,then this obligation shall become null and void;otherwise it shall be and remain
in full force and effect.
As a part of the obligation secured hereby and in addition the face amount specified therefor,there shall be included
costs and reasonable expenses and fees,including attorney's fees incurred by the City in successfully enforcing such
obligation, all to be taxed as cost,;and included in any judgement rendered.
The surety hereby stipulates and agrees that no change,extension of time, alteration or addition to the terms of the
agreement or to the work to be performed thereunder or the specifications accompanying the same shall in anywise
affect its obligations on this bond,and it does hereby waive notice of any such change,extension of time,alteration
or addition to the terms of the agreement or to the work or to the specifications,
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named,
on 18 OCTOBER 2007. Bond No. 8212-89-47
ASR CONSTRUCT C. (SEAL) FEDERAL INSURANCE COMPANY (SEA
Principal Surety
ply: By:
Signature SignaANETTE SEIDL, ATTORNEY—IN—FACT
Address: MOUNTAIN VIEW RD
WARREN NJ 07059
(Notarial Acknowledgineats of Principal and Surety) Telephone.- (2-0-8 ) 903-4607
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of
SAN DIEGO ss.
On 18 OCTOBER 2007 before me, GLADYS D. ROGERS, NOTARY PUBLIC
Date Name and TMe of Officer(e.g.,'Jane Doe.Notary Pubk")
personalty appeared JEANETTE SEIDL
Names)of Signers)
personally known to me
❑ proved to me on the basis of satisfactory evidence
to be the person(j)whose name(k) ishm subscribed
_ to the within instrument and acknowledged to me that
4ie/shel executed the same in �k►is/her/
GLADYS D. ROGERS �
Commission# 1537880 authorized capacity(ies}, and that by 4WherAheir
Notary Punic - California signature( ) on the instrument the person(), or the
San Diego County entity upon behalf of which the person(t) acted,
My Comm.E es Dec 24,2CX�t3 executed the instrument.
WITNESS my hand a eal.
Place Notary Seal Above
e of Notary Public
OPTIONAL
Though the information below is not required bylaw,it may prove vatuab to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s):
❑ Partner—❑Limited ❑General ❑ Partner—❑ Limited ❑General
• Attorney in Fact Top of ttnenb here 0 Attorney in Fact V
❑ Trustee ❑ Trustee thumb Top of here
❑ Guardian or Conservator ❑ Guardan or Conservator
❑ Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
SURETY
�;
POWER Federal Insurance Company Attn: Surety Department
SW Chubb
OF
Sure Vigilant Insurance Company 15 Mountain View Road
'Surety ATTORNEY pacific Indemnity Company Warren,NJ 07059
ct-fySB
Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY,a New York corporation,and PACIFIC
INDEMNITY COMPANY,a Wisconsin cotporation,do each hereby constitute and appoint Larry D.Cogdill,Ingrid Erika Crosby,Brooke Lafrenz,Michael W.
Thomas and Jeanette Seidl of San Diego,California-- — ----- - ------- ---
each as their Ism and lawfut Attorney-in-Fad to execute under such designation in their names and to affix their corporate seats to and deliver for and on their behaft as surety
thereon or otherwise,bonds and undertakings and otter writings obligatory in the nature thereof(other than bail bonds)given or executed in the course of business,and any
insbunents arrhendug a altering the same,and consents to the modification or afteration of any instrument referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 15th day of November,2004.
41
,meth C.Wendel, nt Secretary Oohn .Smith,VKe President
STATE OF NEW JERSEY
county of Somerset ss.
On tris 15th day of November,2004 before me,a Notary Public of New Jersey,personally came Kenneth C.Wendel,to roe
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY.and PACIFIC INDEMNITY COMPANY,the companies Whicth
executed the foregoing Power of Attorney, and the said Kenneth C.Wendel,being by me duty sworn,did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof,that the seals affixed to the
foregoing Power of Attorney'ace such corporate seals and were thereto affixed by authority of the By-Laws of said Companies:and that he signed said Power of Attorney as
Assistant Secretary of said Companies by Eke authority;and that he is aoquairted with John P.Smith,and knows him to be Vice President of said Companies,and What the
signature of John P.Smith,subscribed to said Power of Attorney is in the genuine handwriting of John P.Smirch,and was thereto subscribed by authority of said By-Laws and in
deponents presence.
Notarial Seat KATHERINE KAMCHER
�� 7 t NOTARY PUBLIC OF NEW JERSEY
NOTARY��'. No.2316685
PUB y Coaumrasron Exprros July 8,2009 Notary
Public
� JERg� CERTIFICATION
E*ad from fie By-taws of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY.and PACIFIC INDEMNITY COMPANY:
'Ad powers of attorney for and on behalf of Che Company may and shan be executed in We name and on behaff of Cie Company,either by the Chairman or Che
President or a Vice President or an Assistant Vice President,pk*y with the Secretary or an Assistant Secretary.under Wheir respective designations-The
sgnaiture of such officers may be,ngraved,printed or kMographed.The signature of each of the following officers:Ctukman.President,any Vice President,any
Assistant Vice Presiders,any Secretary,any Assistant Secretary and the seal of die Company may be affixed by facs"e to any power of attorney or to any
certificate relafuig I iereto appointing Assistant Secretaries or Attorneys-fn-Fad for purposes only a executing and attesting bonds and undertakings and other
writings obligatory in die nature thereof,and arty such power of attomey or certificate bearing such facsuiile signature or facsimile seal shall be valid and binding
upon the Company and any such power so executed and certified by such facsartae signature and facsimile seat shad be valid and bindug upon the Company
with respect to any bond or undertaking to which it Is attached
I.Kenneth C.Wendel,Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGiLANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY
(tie do hereby cettify that
n the foregoing extract of the By-Laws of Cie Companies is true and cared,
n the Companies are duty licensed and authorized to transact surety Ws'uness in all So of the United States of Amedca and Cie Distrid of Cdumbia and are
authorized by the U.S.Treasury Department;further,Federal and Vigilant are licensed in Puerto Rico ant the U.S.Vugin islands,and Federal is kensed in
American Samoa,Guam,and each a tie Provinces of Canada except Prince Edward Island;and
ut- -the foregoing Power of Atomey is tnie;correct and in full face and effect
Given under my hand and seats of said Companies at Warren,NJ this 18TH day of OCTOBER 2007
3s��C,F,o �,�irb u �`�SurhtihrrFcot
AdCHApF �+i r,S��' 4Fk
Kenneth C.W ndet,Assistant Secretary
IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICITY OF THS BOND OR NOTIFY US OF ANY OTHER
MATTER,PLEASE CONTACT US AT ADDRESS LISTED ABOVE,OR BY Telephone(908)903-3493 Fax(908)903-3656
e-mail: suretypchubb.com
Form 15-10-0225B-U (Ed.5-03) CONSENT
' ALL-PURPOSE ACKNOWLEDGMENT
STATE OF
17 �
�����y �� �
On /v before me. ak
personally appeared
personally known to me (or proved on the basis of satisfactory evidence)to be the person(s)whose name(s) /wu/e
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon
behalf ofwhich the person(S)acted,executed the instrument.
WITNESS my hand andoffi |seal,
R ,KJBLIC AND FOR THE SAID STATE
CAPACITY CLAIMED BY SIGNER SIGNER IS REPRESENTING
NAME oppsoaom(s) o* ENTITY(IES) NAME oppsnsow(s) ou ewT/n?/ss>
F—\ INDIVIDUAL(S)
[—1
CORPORATE
OFFICER(S)
F—1 PARTNER(S) '^^^`~'
F-1 ATTORNEY-IN-FACT
[] TRUSTEE(S)
[-7 SUBSCRIBING WITNESS
F] GUARDIAN/CON SERVAT0R
F—1 OTHER
ATTENTION NOTARY: Although the information requested below is optional it could prevent fraudulent attachment
ofthis certificate tounauthorized document.
Title orType ofDocument
THIS CERTIFICATE Number ofPages
MUST BEATTACHED
TOTHE oOCummT Date ufDocument
DESCRIBED 4JTHE RIGHT
S|gner('s) Other Than Named Above
EXECUTED IN DUPLICATE
PAYMENT BOND BOND NO. 8212-89-47
PREMIUM INCLUDED IN THE
PERgORNA1,CE designate as
2,C,ty,,),
WHEREAS, the City Council of the City of Redlands, State of California(hereina er esigna e as and
ASR Constructors Inc, (hereinafter designated as"Principal")have entered into an agreement whereby Principal
agrees to install and complete certain designated public improvements, which by said agreement dated October 16,
-7270/41105, is hereby referred to and made a part hereof-,and
2007, and identified as Contract No. 2403 00
WHEREAS, under the terms of said agreement,Principal is required before entering upon the performance of the
work,to furnish a good and sufficient labor and materials payment bond with the City to secure the claims to which
reference is made in Title 15 (commencing with Section 3082)of Part 4 of Division 3 of the Civil Code of the State
of California.
NOW,THEREFORE, said Principal and the undersigned as corporate surety,are held and firmly bound unto the
City and all contractors,subcontractors,laborers, materialmen,and any other persons employed in the performance
of the aforesaid agreement and referred to in the aforesaid Civil Code of the State of California in the sum of
FIVE HUNDRED THIRTY THREE THOUSAND AND NO1100-- dollars($ 533.000.00-- )for materials
furnished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to
such work or labor,that said surety will pay the same in an amount not exceeding the amount herein above set forth,
and also in case suit is brought upon this bond,will pay,in addition to the face amount thereof,costs and reasonable
expenses and fees, including reasonable attorney's fees, incurred by the City in successfully enforcing such
obligation,to be awarded and fixed by the court,and to be taxed as costs and to be included in the judgement therein
rendered.
It is hereby expressly stipulated and agreed that this bond shall inure to the benefit of any and all persons,companies
and corporations entitled to file claims under Title 15(commencing with Section 3082)of Part 4 of Division 3 of the
Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this bond.
Should the condition of this bond be fully performed,then this obligation shall become null and void;otherwise it
shall be and remain in full force and effect.
The surety hereby stipulates and agrees that no change,extension of time,alteration or addition to the terms of the
agreement or to the wort:to be performed thereunder or the specifications accompanying the same shall in agnosia
affect its obligations on this bond,and it does hereby waive notice of any such change,extension of time,alteration
or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named,
on 18 OCTOBER 2007. Bond No. 8212-89-47
ASR CONSJ (SEAL) FEDERAL INSURANCE COMPANY (SEAL)
Principal P I Surety
- K—F>
By: By:
Signature SigrcJE ETTE SEI L, ATTORNEY—IN—FACT
__ 1 ,; m��TATW VT
Address. 15 MOUNTAIN VIEW RD
WARREN, NJ 07059
(Notarial Acknowicdgments of principal and Surety) Telephone: (228®)903-4607
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of SAN DIEGO
On 18 OCTOBER 2007 before me, GLADYS D. ROGERS, NOTARY PUBLIC
Date Name and Title of Office,(e.g..'Jane Doe,Notary Pubkc)
personally appeared JEANETTE SEIDL
Name(s)of Signe(s)
M personally known to me
❑ proved to me on the basis of satisfactory evidence
to be the person()whose name(A) Wamsubscribed
to the within instrument and acknowledged to me that
#+e/she/they executed the same in 4is/her4vek
GLADYS D. ROGERS authorized capacity(io4, and that by 4*dherAheir
Commission# 1537880
signature($) on the instrument the person(ft or the
[ Notary Public - Californlo entity upon behalf of which the person(.L) acted,
Son Diego County fexecuted the instrument.
MY Comm.E)ires Dec 24,x008
WITNESS my hand o )ci s al.
Place Notary Seal Above
lure of Nary Pubic
OPTIONAL
Though the information below is not required by law,it may prove valu le to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer—Title(s): O Corporate Officer—Title(s):
❑ Partner—❑ Limited ❑General ❑ Partner—❑Limited ❑General
* Attorney in Fact Top of thumb here ❑ Attorney in Fact
❑ Trustee Top or thumb Here
❑ Trustee
❑ Guardian or Conservator ❑ Guardian or Conservator
❑ Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
SURETY
Chubb POWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
'Surety ATTORNEY Pacific Indemnity Company Warren,NJ 07059
Know All by These Presents,That FEDERAL INSURANCE COMPANY,an Indiana corporation,VIGILANT INSURANCE COMPANY.a New York corporation,and PACIFIC
INDEMNITY COMPANY,a Wisconsin corporation,do each hereby constitute and appoint Larry D.Cogdill,Ingrid Erika Crosby,Brooke Lafrenz,Michael W.
Thomas and Jeanette Seidl of San Diego,California
each as their true and lawfut Attorney-in-Fact to execute under such designation in their names and to affix tl-ietr corporate seats to and deliver for and on their behalf as surety
thereon or otherwise,bonds and undertakings and other writings obligatory in the nature thereof(other than bait bonds)given or executed in the course of business,and any
instruments amending or attering the same,and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof,said FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed theircorporate seats on this 15th day of November,2004.
Xf Lted P.Smith,
4<en.neth Wendel,Ass ts(56t Secretary P Vice President
STATE OF NEW JERSEY
County of Somerset
on this 15th day of November,2004 before me,a Notary Public of New Jersey,personally can-,--Kenneth C.Wendel,to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY,the wnpanies which
executed the foregoing Power of Aftomey, and Cie said Kenneth C.Wendel,being by me duty swam,did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY and knows tt-ie corporate seats thereof,that the seats affixed to the
foregoing Power of Attorney are such corporate seats and were thereto affixed by audiority of the By-Laws of said Companies;and tiat he signed said Power of Attorney as
Assistant Secretary of said Companies by like authority,and that he is acquainted with John P.Smith,and knows him to be Vice President-of said Companies;and that the
signature of John P.Smith,subscribed to said Power o(Attomey is in the genuine handwriting of John P.Smith,and was thereto subscribed by authority of said 13Y-Laws and in
deponents Presence.
Notarial Seat
KATHERINE KALBACHER
NOTARY PUBLIC OF NEW JERSEY
y No.2316685
--a Commission Expires JuIY 8,2009
PUB Notary Public
CERTIFICATION
Extractfrom the By-Laws of FEDERAL INSURANCE COMPANY,VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY:
`All powers of attorney for and on behalf of Itie-Company may and"be executed in tie name and on behalf of the Company,either by the alainnaft or the
President or a Vice President or an AssisUnt Vice PresidervL jointly with the Secretary or an Assistant Secretary.under their respective designations_The
signature of such officers may be engraved,printed o(litthographed.The signature of each of tie following officers:Chairman,President;any Vice President any
Assistant V"President,any Secretary,any Assistant Secretary and the"of the Company may be affixed by facsirritte-to any Power Of attorney or 10 any
certificate relating Viereto appointing Assistant Secretaries or Atlfciffieys-Ki-Fact for purposes only of executing WA attesting bonds and undertakings and other
writings obligatory in the nature thereof,and any such power of attorney or certificate bearing such facsimile signature or facsimile seat shaft be Valid and binding
upon the Company and any such power so executed and certified by such facsimile signature and facsimile seat shaft be valid and binding upon the Company
with respect to any bond or undertaking to which it is attached!
1,Kenneth C.Weridet.Assistant Secretary of FEDER&INSURANCE COMPANY.VIGILANT INSURANCE COMPANY,and PACIFIC INDEMNITY COMPANY
(the*Companies')do hereby oerfify that
the foregoing ewact of the By-Laws of the Companies is true and correct,
(i) the Companies are duty koensed and aufixxi to transact surety business in aft So of the United States of America and the District Of Columbia and are
authorized by the U.S.Treasury DeparVnert further,Federal and Vigilant are licensed in Puerto Rico and the U.S.Virgin Islands,and Federal is licensed in
American Samoa.Guam,and each of the Provinces of Canada except Prince Edward island;and
@)i -Ove foregoing Power of Attorney is true;correct and in full force and effect
Given under my hand and seats of said Companies at Warren,NJ this 18TH day of OCTOBER 2007
wxqr
4
ew
Kenneth AW nLAMsstzint Assistant
�IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM,VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
VEN
f t RATTER,PLEASE CONTACT US AT ADDRESS LISTED ABOVE,OR BY Telephone(908)903-3493 Fax(908)903-3356
e-mail-. surer chubb.carn
Form 15-10-022513-U (Ed,5-03) CONSENT
��.
'~ ALL-PURPOSE ACKNOWLEDGMENT
STATE OF--?,ICOUNTY OF � I
On /o before mg.
*
pe�mna|ly appeared
personally known tomne (or proved onthe basis ofsatisfactory evidence)tobe the peraon(y)whose namg(e) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon
behalf ofwhich the person(S)acted,executed the instrument.
WITNESS rnyhand and n#no|seal,
41
NOTARY PUBLIC �JD FOR THE SAID STATE
CAPACITY CLAIMED BY SIGNER SIGNER IS REPRESENTING
NAME orpsnnow(s) on swT/T,(/ss) wxms or psnnow(s) on smn/Tr(/cs)
�l
INDIVIDUAL(S)
F�
�� C0RPORATE
OFFICER(S)
rn�cw
| | PARTNER(S)
F-] ATTORNEY-IN-FACT
F�
�� TRUSTEE<S>
F�
�� SUBSCRIBING WITNESS
F�
�� GUARDIAN/CONSERVATOR
F�
�� OTHER
ATTENTION NOTARY: Although the information requested below is optional it could prevent fraudulent attachment
of this certificate to unauthorized document.
Title orType ofDocument
THIS CERTIFICATE Number ofPages
MUST BEATTACHED
TOTHE oUCOMmT Date ufDocument
DESCRIBED ATTHE RIGHT
Signer(s) Other Than Named Above
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Company Profile rage i oi
Company Profile
FEDERAL INSURANCE COMPANY
P.O. BOX 1615 15 MOUNTAIN VIEW ROAD
WARREN, NJ 07061-1615
800-252-4670
Agent for Service of Process
JERE KEPRIOS, C/O CT CORPORATION SYSTEM 818 WEST SEVENTH STREET, 2ND FLOOR
LOS ANGELES, CA 90017
Unable to Locate the Agent for Service of Process`?
Reference Information
NAIC 4: 20281
NAIL Group 4: 003-8
California Company ID #: 0059-6
Date authorized in California: December 18, 1902
License Status: UNLIMITED-NORMAL
Company Type: Property & Casualty
State of Domicile: INDIANA
Lines of Insurance Authorized to Transact
The company is authorized to transact business within these lines of insurance. For an explanation of
any of these terms,please refer to the glossa °.
AIRCRAFT
AUTOMOBILE
BOILER AND MACHINERY
BURGLARY
COMMON CARRIER LIABILITY
CREDIT
DISABILITY
FIRE
LIABILITY
MARINE
MISCELLANEOUS
PLATE GLASS
http://interactive.web.insurance.ca.gov/webuser/idb_co_arof utl.get_co_prof?p_EID=2652 10/24/2007
Company Profile Page 2 of
SPRINKLER
SURETY
TEAM AND VEHICLE
WORKERS' COMPENSATION
Company Complaint Information
CD=Qsjt(_Z__CQqipjaint Studies
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Last Revised-September 11,2007 12:43 PM
Copyright(0 California Department of Insurance
http://interactive.web.insurance.ca.gov/webuser/idb_co_prof utl.get co_proPp EID=2652 10/24/2007
IDATE(MWDDNYYY)
-ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/01/2007
MATTER F INFORMATION
THIS CERTIFICATES ISSUED -1
PRODUCER ( 09) 822-2221 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
DOES NT AMEND, EXTEND
Kennedy & Sharp Insurance, Inc. HOLDER. THIS CERTIFICATEFFORDED BY POLICIES BELOW.OR
17577 Arrow Blvd. , #107 ALTER THE COVERAGE AFFORDED
P.O. Box 948
CA 92334- INSURERS;AFFORDING COVERAGE... NAIC#
0 Ca ac_lt
Fontana �k. e c
INSURERA:North American Capaci
INSURED Underwriters INSURER B: Ins. Underwriters
ASR Constructors, Inc. St t. I a
INSURER c:American States Ins.
5230 Wilson Street
INSURER D:
,Riverside CA 92509INSURER E:
-
COVERAGES HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
THE POLICIES OF INSURANCE LISTED BELOW CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED
REQUIREMENT,TERM OR CONDITION OF ANY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
BY
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION
TIVE U:� 001 LIMITS
M' �n ITS
M
NSR OD`L POLICY NUMBER DATE �DA (MMIDDIYY)
LTR NSR TYPE OF INSURANCE $ 1,000,000
/ / EACH OCCURRENCE
GENERAL LIABILITY GE T RENTED $ 50,000
PREMISES Ea occurrence
X COMMERCIAL GENERAL LIABILITY 11 0 5,000
A CLAIMS MADE M OCCUR PNG0001300-03 11/23/2006 11/23/2007 MED EXP An one person 111 1,000,000
PERSONAL&ADV INJURY $
OCPGENERAL AGGREGATE $ 2,000,..000
PRODUCTS-COMP/Op AGG $ 1,000,000
EN'L AGGREGATE LIMIT APPLIES PER:
POLICYCOMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO1 BODILY INJURY $
ALL OWNED AUTOS (Par person)
SCHEDULED AUTOS BODILY INJURY $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS1 PROPERTY DAMAGE $
(Per accident)
AUTO ONLY-EA ACCIDENT $
GARAGE LIABILITY OTHER THAN EA ACC $
ANY AUTO AUTO ONLY: AGG $
83641-034 11/23/2006 11/23/2007 EACH OCCURRENCE $ 4,000,000
B EXCESSIUMBRELLA LIABILITY LQ1 B71 AGGREGATE $ 4,000,000
OCCUR �CLAIMS MADE $
DEDUCTIBLE $
RETENTION $ TORY LI ETSTA 0 R WORKERS COMPENSATION AND
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
ANY PROPRIETORtPARTNERIEXECUTIVEEMPLOYEE$
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-POLI $
If yes,describe under
SPECIAL PROVISIONS below 12/09/2006 12/09/2007 $300,000 Limit
OTHER Leased or Rented 01-CE-716026-8 $500 Deductible
C, Equipment
DESCRIPTION OF OpERATMS/LOCATIONSNEMICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Job: Sports Park Restroom. Building
Except in the case Of non payment 10 days notice will be given
Certificate Holder is Named as Additional insured on General Liability Per
,form ,CG2010 11-65 CANCELLATION
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
-- &---WTO Do So SMALL IMPOSE ANY KIND UPON THE
City of Redlands jjU POSE No OB
------------ OR LIABILITY OF
ill West Lugonia Avenue ITS AGENTS OR PRIESENMAitNfES-i
THORIZ
Redlands CA 92374- ACORD CORPORATION 1988
ACORD 26(2001108) Page I of 2
INS025(0108).05
ELECTRONIC LASER FORMS,INC, (800)S27-0545
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the
of suchen) must
t be endorsed. A statement on this
certificate does not confer rights to the certificate holder
if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side and theacertdoes
cafe holder,sniorte a does�t tract between affrmatively arhnegatvey
insurer(s), authorized representative or producer,
amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2801108) gage 2 of 2
,, INS025(0108).05
^
POL/CYNUMBER: P%DX1300 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERSn LESSEES OR
CONTRACTORS — (FORM
B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name ofPerson orOrganization:
Any person or organization to which you are obligated by virtue of written contract to provide insurance
such as is afforded by this pn|icy, but only with respect to (1 ) occurrences taking place after such written
contract has been executed and (2) occurrences resulting from work performed by you during the policy
period, or occurrences resulting from the conduct of your business during the policy period,
(If noentry appears above, information required k/complete this endorsement will beshown /nthe Declarations as
applicable to this endorsement.)
VVHD /SAN INSURED (Section /|) isamended to include as an insured the person ororganization shown kn ,he
Schedule, but only with respect to liability arising out of"your work" for that insured by or for you.
Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be
primary insurance and any other insurance maintained by the Additional Insured(s) shall be
excess and non'ronhibutory. but only asrespects any claim orliability determined tobethe
result of the sole negligence or responsibility of the Named Insured and only if required of the
Named Insured bywritten contract.
|
2010 11 95 Copyri�h� |nsuranceSemices Office inc 1984 Page 1 of O
,
`
POL/CYNUKJBER: PNI0000Isoo oz COMMERCIAL GENERAL LIABILITY
CG24O41UQ3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Any person or organization to which you are obligated by virtue of written contract to provide insurance
such as is afforded by this policy, but only with respect to (1) occurrences taking place after such written
contract has been executed and (2) occurrences resulting from work performed by you during the policy
period, or occurrences resulting from the conduct of your business during the policy period.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable tothis endoraemenL)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV -
COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended bythe addition ofthe following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your ongoing operations or ~your work" done
under contract with that person or organization and included in the "products-completed operations hazard". This
waiver applies only tothe person ororganization shown in the Schedule above.
,G 24 04 10 93 Copyright. Insurance Services Office, Inc- 1992 Page 1 of 1 O
DATE(MMMDNY"
ACD E OF LIABILITY INSURANCE 10/0112007
Mr. CERTIFICAT —THIS—CERTIFICATE IS ISSUED AS A MATTER OF INFOR ION
PRODUCER -(909) 822-2221 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kennedy & Sharp Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO_W.
=ATE
101
011200
17577 Arrow Blvd. , #107
p.O. Box 948 INSURERS AFFORDING COVERAGE NAIC#
Fontana CA 92334- eric Stat,
INSURER A:American. States Ins. Co.
INSURED B
ASR Constructors, Inc. iNSURERB�
5230 Wilson Street INSURER C:
lRiversIde CA 92509- IN' NOTWITHSTANDING ANY
COVERAGES THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P EFFEC VE PO CY EXPIRATION LIMITS
NSR DWL TYPE OF INSURANCE POLICY NUMBER D M OD D (MMIDD
LTR NSRO EACH OCCURRENCE $
GENERAL LIABILITY DAMAG TO RENTED ce $
PREMISES Ea occuffen
COMMERCIAL GENERAL LIABILITY MED EXP one n $
CLAIMS MADE F—�OCCUR PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRe
POLICY JE T LOC
COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY $
ALL OWNED AUTOS (Per person)
SCHEDULED AUTOS BODILY INJURY $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS PROPERTY DAMAGE $
(per accident)
AUTO ONLY-EA ACCIDENT $
GARAGE LIABILITY OTHER THAN EAACC $
ANY AUTO AUTO ONLY: AGG $
EACH OCCU $
EXCEsSJUMBRELLA LIABILITY AGGREGATE $
OCCUR CLAIMS MADE $
DEDUCTIBLE $
RETENTION $ WC TATH7 OTH-
TOATLIM S
_T I ER
WORKERS COMPENSATION AND E.L.EACH ACCIDENT $
EMPLOYERS*LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE EE$
OFFICERIMEMBER EXCLUDED? r L-DISEASE�POLICY ILAIT 1-t
if yes,desenbe under 1$533,000 Special
SPECIAL PROVISIONS below
OTHER 10/15/2007110//15//2008 Form $5000 Ded.
A Builders Risk 01-CH-661199-1
DESCRIPTION OF OPERATIONSILOCA'nONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIIAL PROVISIONS
Job: Sports Park RestrOOM Bldg.
Certificate Holder is Named as Mortgages,
CANCELLATION
CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED To T14E LEFT,BUT
FAILURE TO 00 So$HALL IMPOSE NO GATION OR LIABILITY OF ANY KIND UPON THE
City of Redlands IN AGENTS OR REPRESENTATIVES
111 West Lugonia Avenue AUTHO R
CA 92374- ACORD CORPORA
Redlands TION 1988
Page 1 of 2
�CORD 25(2001108) ELECTRONIC LASER FORMS,INC�-(80Q)32f�545
INS026(oiw-05
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this
certificate does not confer fights to the certificate holder in lieu of such endorsement(s).
if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001/08) Page 2 of 2
INS026 pw-05
DATE(MMIDD/YYYY)
LIABILITY INSURANCE 10/01/2007
CERTIFICATE OF L ' T
-ACORD. CER OF INFORMATION
THIS CERTIFICATE IS ISSUED AS A MA �q
RIGHTS UPON THE CERTIFICATE
PRODUCER (909) 822-2221 ONLY AN CONFERS NO go
H LDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND,OR
Kennedy & Sharp Insurance, Inc. LTER THE DIED BY THE POLICIES BELOW_.
17577 Arrow Blvd. , #107
P.O. Box 948 CA 92334- INSURERS AFFORDING COVERAGE NAC#
Fontana INSURER A:Redwood Fire & Cas. Ins.
INSURED INSURER B:
ASR Constructors, Inc. INSURER C:
5230 Wilson Street INSURER D:
RiversideCA 92509- INSURER E.
COVERAGES BEEN ISSUED-TO THE INSURED N ED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
THE POLICIES 0 INSURANCE LISTED BELOW HAVE ICATE MAY BE ISSUED OR MAY PERTAIN,
DITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF
REQUIREMENT,TERM OR CON T To ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
CE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT THE INSURANCE CLAIMS. Po CY EFFEC VE POLICY EXPIRATION
DATE
LIMITS
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C TE(MMID I DATE MMIDD
I SR ADD% TYPE OF INSURANCE POLICY NUMBER
LTR NSR EACH OCCURRENCE $
GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea occurrence $
COMMERCIAL GENERAL LIABILITY MED EXP An one son $
CLAIMS MADE 17 OCCUR PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS-COMPIOP AGG $
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO-
POLOC COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY (Ea accident)
ANY AUTO BODILY INJURY $
ALL OWNED AUTOS (Per person)
SCHEDULED AUTOS BODILY INJURY $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS PROPERTY DAMAGE $
(Per accident)
AUTO ONLY-EA ACCIDENT $
GARAGE LIABILITY OTHER THAN EA ACC $
ANY AUTO AUTO ONLY: AGG $
EACH OCCURRENCE $
EXCESSfUMBRELLA LIABILITY AGGREGATE $
OCCUR El CLAIMS MADE $
DEDUCTIBLE S U- X TH
/2007 10/01/2008 To $
RETENTION $ w7A34741 10/01 Y LI S ER
1,000 r 000
A WORKERS COMPENSATION AND E,L,EACH ACCIDENT $
EMPLOYERS'LIABILITY 1 000,0001
ANY PROPRIETORIPARTNER/EXECUTIVE E L DISEASE-EA EMPLOYEE$ -I--'
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-POLICY LIMIT $ 1,000,000
If yes,describe under
SPECIAL PROVISIONS below
DESCRIPTION OF OPERATIONS(LOCATIONWVENICLEStPXCLUSIONS ADDED BY ENDORSEMENTI9PECULL PROVISIONS
Job: Sports Park Restroom Bldg. 10 day notice to insured of cancellation for non-payment
of premium/non-reporting Of Payroll "Employers Liability Limit $1,000,000(per Accident/AggrOgatO
policy Limit)" Blanket Waiver Of Subrogation applies per endorsement
CANCELLATION
CERTIFICATE HOLD-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT,BUT
__FAIL�O Do So SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE
City of Redlands SENT 13j;i§
NSURE
G OR RE
111 West Luaonia Avenue A
CA 92374—
Redlands ACORD CORPORATION 1988
Page I of 2
ACORD 26(2001/08) �4545
ELECTRONIC LASER FORMS,INC. (800)3
INS025 p108),05
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the poliicy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
he
cy, certain
icies
If SUBROGATION at WAImet on subject rtificate terms to the does not conferns of right t to the' certificate hollder in mayrequire
of rsuch
endorsement. A statement
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer,dodhe polices certificate
s ed therholder nor does it affirmatively or negatively
amend,extend or alter the coverageY
ACORD 25(2001108) page 2 of 2
`INS025(6108).05
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY FORM NUMBER
INSURER REDWOOD FIRE& CASUALTY INSURANCE COMPANY WC-99-0306
(ME-ID: 01)
WAIVER OF SUBROGATION
--------------------
WE AGREE THAT IN CONSIDERATION OF TEE ADDITIONAL PREMIUM CHARGED,
THE RIGHT OF SUBROGATION CLAUSE CONTAINED, IN THIS POLICY IS
HEREBY WAIVED AS RESPECTS THE FOLLOWING PERSONS OR ENTITIES:
"ANY PERSON OR ORGANIZATION TO WHOM -YOU ARE OBLIGATED BY VALID
WRITTEN CONTRACT WHEREIN YOU HAVE AGREED TO. FURNISH THIS WAIVER' "
THIS ENDORSEMENT APPLIES ONLY To THOSE PERSONS OR ENTITIES LISTED
IN THE FOREGOING PARAGRAPH.
THEINSURED AGREES TO MAINTAIN PAYROLL AND CONTRACT RECORDS
ACCURATELY IN ORDER TO SEGREGATE THE REMUNERATION FOR EMPLOYEES
WHILE ENGAGED IN THE WORK FOR WHICH THIS WAIVER WILL APPLY. THAT
INFORMATION WILL BE VERIFIED By THE INSURER AT FINAL AUDIT.
A SURCHARGE OF 3% SHALL BE APPLIED TO THE RISK'S STANDARD
p3LMaum, SUBJECT TO A MINIMUM CHARGE OF $500, AND WILL BE.
COLLECTED UPON COMPLETION OF THE FINAL AUDIT.
This endorsement changes the policy to which is attached and is effective on the date Issued unless otherwise stated.
(The Information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 10107 policy No. W7A34741 Endorsement No. 16
'nsured
ASR CONSTRUCTORS, INC (A CGRP}
Countersigned by
Authorized Representative
FNI 10-04
DATE(MM1DDIYYYY)
ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/01/2007
PRODUCER (909} 822-2221 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kennedy & Sharp Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
17577 Arrow Blvd. , #107
P.O. Box 948
Fontana
CA 92334- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A:General Insurance Com an
ASR Constructors, Inc. INSURER B:
INSURER C:
5230 Wilson Street INSURER D:
Riverside CA 9255.09-. ENSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING AN
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.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS
INSR DWLPOLI
TYPE OF INSURANCE CY NUMBER DATE MM/DDNY) DATE(MM/DDfYY)
LTR NSR EACH OCCURRENCE $
GENERAL LIABILITY DAMAGE TO RENTED $
PREMISES Ea occurrence
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE D OCCUR MED EXP An one n} $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
GENT AGGREGATE LIMIT APPLIES PER:
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
{Ea accident)
X ANY AUTO
24-CC-19829A-1 10/19/2007 10119/2008 BODILYINJURY $
A ALL OWNED AUTOS (Per person)
SCHEDULED AUTOS BODILY INJURY
X HIRED AUTOS (Per accident) $
X NON-OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
AUTO ONLY-EA ACCIDENT $ _
GARAGE LIABILITY
OTHER THAN EA ACC $__._._.._.
ANY AUTO AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
AGGREGATE $
OCCUR CLAIMS MADE $
DEDUCTIBLE $
RETENTION $ WC STATU- OTH-
WORKERS COMPENSATION AN6 TORY UM17S X ER
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE / I E.L.DISEASE-EA EMPLOYEE$
OFFICERJMEMBER EXCLUDED?
if yes describe under E.L.DISEASE-POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Job: Sports Park Restroom Bldg.
Except in the case of non payment 10 days notice will be given
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
City of Redlands FAILURE T SO SHALL IMPOSE N0 OBLIGATION OR LIABILITY OF ANY KIND UPON SNE
111 West Lugonia Avenue !INSURE TS OR SENTA
f
Redlands CA 92374- (D ACORD CORPORATION 1988
ACORD 25(2001108) Page 1 of 2
M-INS025{4148).05 ELECTRONIC LASER FORMS.INC.-(840)327-0545
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such
endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001/08)
q- iNS025{o�oa}.a Page 2 of 2
6-M