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Contracts & Agreements_177-2012_CCv0001.pdf
V L.LJ OCT - 9 2012 Christiansen Pipeline, Inc. PUBLIC WORKS CONSTRUCTION CONTRACT This Public Works Construction Contract ("Contract") made and entered into this 16th day of October , 2012, by and between the City of Redlands, a municipal corporation organized and existing under the laws of the State of California, (hereinafter "City"), and Christiansen Pipeline, Inc. (hereinafter "Contractor"). City and Contractor are sometimes individually referred to herein as a "Party" and, together, as the "Parties." In consideration of the mutual promises contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK: Contractor shall furnish all materials and perform all of the work for the following: Brookside Avenue Water Pipeline Replacement Project, complete all items as required by the Contract Documents (as herein defined) and Specifications for City's BROOKSIDE AVENUE WATER PIPELINE REPLACEMENT PROJECT, PROJECT NO. 71234. 2. THE CONTRACT SUM: City shall pay Contractor the sum of $289,660.00 as consideration for its performance of the Work in accordance with the terms and conditions set forth in the Contract Documents. Pursuant to Public Contract Code Section 22300, Contractor has the option to deposit securities with an escrow agent as a substitute for retention of earnings requirement to be withheld by City pursuant to an escrow agreement as set forth in the Public Contract Code Section 22300. 3. TIME FOR COMPLETION: The Work shall be completed within Thirty (30) calendar days from and after the date of the delivery to Contractor of a written Notice to Proceed by City. 4. LIQUIDATED DAMAGES: Contractor's failure to complete the work within the time allowed will result in damages being sustained by City. Such damages are, and will continue to be, impracticable and extremely difficult to determine. Accordingly, Contractor shall pay to City, or have withheld from monies due to Contractor, the sum of Five Hundred Dollars ($500) for each consecutive calendar day in excess of the specified time for completion of Work. Execution of the Contract shall constitute agreement by City and Contractor that Five Hundred Dollars ($500) per day is the estimated damage to City caused by the failure of the Contractor to complete the Work within the allowed time. Such sum is for liquidated damages and shall not be construed as a penalty, and may be deducted from payments due Contractor if such delay occurs. 5. CONTRACT DOCUMENTS: This Contract includes all of the Contract documents set forth herein, to wit; Notice Inviting Bids. Instructions to Bidders, Contractor's Proposal, Bid Bond, Agreement. Performance Bond, Labor and Material Bond, Plans, General Conditions, Special Conditions, Special Provisions and Specifications, and any addenda thereto. D 6. ATTORNBYS, FEES: In the event any legal action is commenced to enforce or interpret the terms or conditions of the Contract documents, the prevailing Party in such action, in addition to any costs and other relief, shall be entitled to recover its reasonable attorneys' fees, including fees for use of in-house counsel by a Party. 7. RESOLUTION OF CONSTRUCTION CLAIMS: Claims by Contractor in the amount of$375,000 or less shall be made by Contractor and processed by the City pursuant to the provisions of Part 3, Chapter 1, Article 1.5 of the Public Contract 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 Public Contract Code Section 20104.2 shall extend the time limit or supersede the notice requirements provided in this case from filing claims by Contractor. 8. ELIGIBILITY OF CONTRACTOR/SUBCONTRACTOR: Contractor and all of its subcontractors shall 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. 9. ASSIGNMENT O0` AGREEMENT: No assignment by a Party of any rights or interests under this Contract shall be binding on another Party without the written consent of the Party sought to be bound. 10. SUCCESSORS AND ASSIGNS: City and Contractor each binds itself and their respective successors and assigns in respect to all covenants, agreements, and obligations contained in the Contract Documents. | |. 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 he valid and binding upon City and Contractor. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first written above. City of Redlands (SEAL) (Owner) CM,/ ii ' By: t ,lik,7466 Mayor, City of Redlands, County of San Bernardino, California ATTEST: j... I City Clerk, City oWkedlands County of San Bernardino, California (SEAL) Christiansen Pipeline, Inc. Name of Contractor ; .. , , 1 r , ,r ' 0/ ' 1 I/ ) l'76/ By:,Ik_.,./.1) AC i ) i, Lx 11-4-j I-1 Signature of Authorized Agent Secretary/CFO Title n/a Signature of Authorized Agent (if necessary) Title 763546 Contractor's License No. CD WORKER'S COMPENSATION INSURANCE CERTIFICATION Description of Contract: City of Redlands Municipal Utilities & Engineering Department BROOKSIDE AVENUE WATER PIPELINE REPLACEMENT PROJECT PROJECT NO. 71234. Labor Code Section 3700, provides, in part that: "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 worker's 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) Dated this 1 6th day of October , 20l2. Christiansen Pipeline, Inc. (Contractor) r/ LYAfti � ,A�J s |L'8' Lii4 / (sinature) Secretary/CFO (Official Title) (SEAL) (Labor Code Section 1861 provides that the above certificate must he signed and filed by the Contractor with the Owner prior to performing the work of the contract ) [D4 ^ , EXECUTED IN DUPLICATE BOND NUMBER 024045047 PREMIUM: $8,690.00 PERFORMANCE BOND Whereas, the City Council of the City of 8edlundo. State of California, and Christiansen Pipeline, Inc. (hereinafter designated as "Principal") have entered into an agreement whereby Principal agrees to install and complete certain designated public improvements, which said agreement, dated OCTOBER 16, 2012, and identified and identified as BROOKSIDE AVENUE WATER PIPELINE REPLACEMENT PROJECT, PROJECT NO. 71234 is hereby referred to and made a part hereof; and Whereas, said Principal is required under the terms of said agreement to furnish a bond for the performance of said project. COMPANY Now, therefore, said Principal and THE OHIO CASUALTY INSURANCE , as sucoty, are held firmly bound unto the City of Redlands (hereinafter call "City"), in the penal sum of Two hundred eighty nine thousand six hundred sixty dollars and zero cents ($289.660.00) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our hoico, aucccasors, executors and administrators,jointly and severally, firmly by these presents. The condition of this obligation is such that if the above bounded phncipu|, his or hers heirs, euecotnrs, administrator, 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 their part, to be kept and performed at the time and in the manner therein upccidcd, and in all respects according to their true intent and nncaning, and shall de6:od, indemnify and save harmless the City, its elected nfUciaiu, ofhccra, agents and cmp|oyrou, 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 annnun, specified therefore, there shall be included costs and reasonable expenses and fees, including reasonable attorney's fees incurred by the City in successfully enforcing such obligation, all to be taxed as costs and included in any judgment 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 c6unge, 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 above named, on OCTOBER 16, , 2012. (SEAL) (SEAL) CHRISTIANSEN PIPELINE, INC. THE OHIO CASUALTY INSURANCE COMPANY / ^ , = =" . '_- J/Ji/� L~^ �\ �8�\ _ B`/ ^~ (Si ~ ( / ---' JEREMY ���D ATTORNEY-IN-FACT Address: 7THE 'CITY DRIVE SUITE 200 ORANGE CA 92868 (Seal and Notarial /\cknow\eJgmcx( of Telephone (714 ) 634-3311 Surety) CD 5 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On /�/i 4'/(, before me, R. NAPPI "NOTARY PUBLIC" 111 (Here insert name and title of the officer) personally appeared JEREMY PENDERGAST who proved to me on the basis of satisfactory evidence to be the personjsrwhose name(aryis/aFe-subscribed to the within instrument and acknowledged to me that he/sheithey executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(.$)-on the instrument the person(sj'or the entity upon behalf of which the personjs) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. •••• R. NAPPI COMM.#1977782 WITNESS my hand and official seal. NOTARY PlID•CAIIfoRNIA t47selDE cotitiTY MN Comm Jim 1,2018 j( Signature of Notary Public (Notary Seal) • ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in Colifornia must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document, The oniv exception is !f a document is to be recorded outside of California_In such instances,any alternative acknmriedgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in • California (i.e. cert 5'fng the authorized capacity of the signer). Please check the (Title or description of attached document continued) document carefully for proper notarial wording and attach this form if required Pages Document Date • State and County information must be the State and County where the document Number of Pa g signer(s)personally appeared before the notary public for acknowledgment. i� • Date of notarization must be the date that the signer(s)personally appeared which must also be the sane date the acknowledgment is completed. }fi (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. • ❑ Individual(S) helshe/hey,is lase)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording. 0 Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or fines. If seal impression smudges,re-seal if a • (Title) sufficient arca permits,otherwise complete a different acknowledgment form. • O Partner(s) • Signature of the notary public must match the signature an file with the office of the county clerk. • O Attorney-in-Fact } Additional information is not required but could help to ensure this O Trustee(s) acknowledgment is not misused or attached to a different document. O Other v Indicate title or type of attached doctanent,number of pages and date. . Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document = 1 2008 Version CAPA v12 10.07&00-873-9865 www.NotaryClasses_com EXECUTED IN DUPLICATE BOND NUMBER 024045047 PREMIUM INCLUDED IN PERFORMANCE BOND LABOR AND MATERIAL BOND Whereas, the City Council of the City of Redlands, State of California, and Christiansen Pipeline, Inc. (hereinafter designated as "Principal") have entered into an agreement whereby Principal agrees to install and complete certain designated public improvements, which said agreement, dated OCTOBER 16, . 2012, and identified as BROOKSIDE AVENUE WATER PIPELINE REPLACEMENT PROJECT, PROJECT NO. 71234 is hereby referred to and made a part hereof; and Wheremy, under the terms of said agreernnnt. Principal is required before entering upon the performance of the work, to file a good and sufficient payment bond with the City of Redlands 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 suroty, are held firmly bound unto the City of Redlands and all contractors, subcontractors, laborers, material men and other persons employed in the performance of the aforesaid agreement and referred to in the aforesaid Code of Civil Procedure in the sum of Two hundred eighty nine thousand six hundred sixty dollars and zero cents ($289,660.00) for materials furnished or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such work or |uhor. that said surety will pay the same in an amount not exceeding the amount hereinabove set forth, and also in case suit is brought upon this bond, will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the City of Redlands in successfully enforcing such ob|iguiion,to be awarded and fixed by the court, and to be taxed as costs and to be included in the judgment therein rendered. It is hereby expressly stipulated and agreed that this bond shall insure to the benefit of any and all prroono, 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 chungc, extension of time, alteration or addition to the terms of said agreement or the specifications accompanying the same shall in any manner affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition, In witness whereof, this instrument has been duly executed by the Principal and surety above named, on OCTOBER 16, . IU|2. (SEAL) (SEAL) CHRISTIANSEN PIPELINE, THE OHIO CASUALTY INSURANCE COMPANY (`�f� ���<���� ]F [� (|{l/`�{V/ ) BY: �Signutun} JEREMY PS�^ � »mn) ATTORNEY—IN—FACT f Addow 7tD0/I8E C1^' DRIVE SUITE 200 ORANGE, CA 92868 (Seal and Notarial Acknowledgment Telephone ( 7141—J534-3311 CD CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of RIVERSIDE On /0// 4 ��}- before me, R. NAPPI "NOTARY PUBLIC" t« (Here insert name and title of the officer) personally appeared JEREMY PENDERGAST who proved to me on the basis of satisfactory evidence to be the person(ewhose nameis/aFe-subscribed to the within instrument and acknowledged to me that he/shathey executed the same in histheraherir authorized capacity(464 and that by his/her/the,signature*on the instrument the persona-tor the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. R. NAPPI WITNESS my hand and official seal. I �; *•'. COMM.#1977782 NOTARY PUBLIC•CALIFORNIA �] `F le") RIVERSIDE COUNTY /6727/4., Corm CoExpires Jing T,2018 Signature of Notary Public �f (Notary Seal) • • ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form muss be F properly completed and attached to that document. The only exception is if a document is to be recorded outside of California.In such instances,airy alternative (Title or description of attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does nor require the notary to do something that is illegal for a notary in California(i.e. cert(fying the authored capacity of the signer). Please check the (Title or description of attached document continued) document carefuhyfor proper notarial wording and attach this form ifrequired Number of Fa es Document Date • State and County information must be the State end County where the document g signer(s)personally appeared before the notary public for acknowledgment. i • Date of notarization must be the date that the signers)personally appeared which A must also be the same date the acknowledgment is completed. a (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). • Print the name(s)of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual(s) he/she/ihey,-is Irma)or circling the correct forms.Failure to correctly indicate this information may lead to rejection of document recording_ ❑ Corporate Officer • The notary seal impression most be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of 0 Partner(s) the county clerk. ❑ Attorney-in-Fact + Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached ton different document_ ❑ Other } Indicate title or type of attached document,number of pages and date_ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.I0.07 800-873-9865 www.NotaryClasses.com THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5309044 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. American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of ii the State of Ohio,that Liberty Metal insurance Company is a corporation duly organized under the laws of the State of Massachusetts,that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,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, ROSEMARY NAPP1 JEREMY PENDERGAST,MICHAEL D.STONG, i all of the city of RIVERSIDE ,state of CALIFORNIA each individually if there be more than one named,its true and lawful attorney-In-fact 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,recognizances and other surety obligations,in pursuance of these 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. i IN WITNESS WHEREOF,this Power ofAltomeyhasbeen subscribed by an authorized officer orofficial of the Companies and the oorporate seatscif theOempanies have been affixed thereto this i 11th day of April i 2012 r ,r ` .�, American Fire and Casualty Company -s, re , I The Ohio Casualty Insurance Company p f `r 4 y A Liberty Mutual Insurance Company m rZ r e t ` t F r t tar f € SEAL t k i' k si- Peerlesslnsprartc:eCompany 2 -_ ; Q .1412/4'4 V` = j ; VI West American Insurance Company c I I _ By: nil Gregory W Davenport,Assistant Secretary I ++"kers STATE OF WASHINGTON ss = 3 g COUNTY OF KING0 to i 0 tlyt On this 11th day of April 2012 before me personally appeared Gregory W.Davenport,who acknowledged himself to be theAssistant Secretary of American Fire and >W p 2 Casualty Company,Liberty Mutual insurance Company,The Ohio Casualty Company,Peerless Insurance Company and West American insurance Company,and that he,as such,being 1- >authorized so to do,execute the foregoinginstrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G E. r 41 IN WITNESS WHEREOF,I have hereunto my name and affixed my notarial seal at Seattle,Washington,on the day and yearfirst above written. ct to G By: 0 ets'' tai KD Riley, Public o Ic Ei. T• his Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance ', Lc+., Company Liberty Mutual Insurance Company.West American Insurance Company and Peerless Insurance Company,which resolutions are now in full force and effect reading as follows: =7 tits 0 c. A• RTICLE 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 >,tau I a C to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, . jei I E tai acknowledge and deliver as surety any and all underakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact,subject trite limitations set forth in their respective d I O R 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 >s3 ^ executed,such instruments shall 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-fact under cu 4 .. the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority, ,~ C ARTICLE XIII-Execution ofontracts--SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, r.e I Z 49 and subject to such limitations este e chairmrran or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, G c seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fat-subject to the imitations set forth in their u r I respective powers of attorney shall travefull to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. . When so 0<? executed such instruments shall tie as as if signed by the president and attested by the secretary, Certificate of Designation The President of the Company,acting pursuant to the Bylaws of the Company,authorizes Gregory W,DavenportAssistant Secretary to appoint such attomey-in-fact as maybe nemssaryto act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations.. I Authorization—By unanimous consent of the ny's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the I Company,wherever appearing upon a certifiedof any power of attorney issued by the Company in connection with surety bonds,shall be yard and biding upon the Company with the same force and effect as though manual affwee jI,David M.Carey,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,West American Insurance Company and Peerless Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,tate 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 seals of said Companies this 14,1th day of 0 CtO V- ,20 y f Al=het :xis a _ "` e $ _ i O fIiiiii- ':z Ate I U 1 1 i; ra j 45; K 9 , 1, `: ,I By: _ mAIDavid M.Carey,Assistant Secretary r ii` akin V.,'a«..., r. t ; .r :r'% 3.,r -\571''.. PP,-APCC,LMIC,OCIC,PIC&WAC LMS 12873041012 _____--.4„ CHRIS-1 OP ID: HG ACC:P R© CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) ,0/16/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 909-793-8118 NEACT Glenn Goodwin&AssociatesFax:909-793 4187 PHONE AX Insurance Services (AIC,No,Eat): (A1C,No): P.O. Box 1897 EMAIL Redlands, CA 92373 ADDRESS; Glenn T.Goodwin,CIC,CPIA,CRM INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Travelers Casualty&Surety Co :19038 INSURED Christiansen Pipeline, Inc. INSURER B: Chris& Debbie Christiansen 5198 Arlington Avenue,#215 INSURER C: Riverside,CA 92504 INSURER D: INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTYPE OF INSURANCE ADDLISUBR POLICY EFF !, POLICY EXP /NSR I WVD POLICY NUMBER (MMfDD/YYYY) I(MM/DDIYYYY) LIMITS GENERAL LIABILITY � 1 EACH OCCURRENCE T 4 1,000,000 A X LoMt/EEC GENERA_LIABILITY X X DTECO5955N735 06/01/12 06/01/131PPEHIS=S([aEicvr nca' i i 300,000 LN, MERE I X I OCCUR i MED E[=(.Any one person) $ 5,000 _ PERSONAL s ADV INJUPY 11,000,000 X i Per Project Agg* GENERAL AGCREG.ATE $ 2,000,000 IGEN L AGO GEGA I E LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO s 2,000,000 POLICY FO' LOC Emp Ben. s 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I (Ea accident) $ 1,000,000 A ' X ! Ar.r 4ulo BA5955N735 06/01/12 ' 06/01/13 ,BODILY iNjUPr(Per person) I , A L O ,ii'JED SCHEDULED BODILY iN!UPY(Per accidon'. A .TOS AUTOS NON-OWNED OWNED i PROPERTY Y DAMAGE ------ E-HPA'JTi _X AUTOS!I (Per accident) C X UMBRELLA LIAB X 1 OCCUR EACH OCCURRE-NCE I s 1,000,000 A X EXCESS LIAB (-LAWS-MADE CUP5955N73 10/16112 06/01/13 AGGREGATE is 1,000,000 I DEC I X RETENTION$ 10,0001 $ WORKERS COMPENSATION II WC STATU- :0TH IX � TORY LIMITS ER T AND EMPLOYERS'LIABILITY YIN r EACH �____ A ANY F DPF ETOR PAR NERL)ECUTIVE X DTJUB5955N735 06/01/12 06/01/13 �E_ EAH ACCIDENT 1 s 1,000,000 JFFI U r1 I,CES EXCLUDED', ;N f A T I(Mandatory in NH) F._.DISEASE EA EMPLovo,-3 1,000,000 `Ye, cescr,be u r u r I — DCSCRr I Oil OE OPERATIONS bei.a. I E.L.DISEASE POLICY LI.i $ 1,000 ,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule.if more space is required) City of Redlands is named as additional insured as their interest may appear per the attached form #CGD246 including primary wording RE: Brookside Avenue Water Pipeline Replacement Project #71234 CERTIFICATE HOLDER CANCELLATION CITYRED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redlands ACCORDANCE WITH THE POLICY PROVISIONS. Municipal Utilities and Engineering Dept. AUTHORIZED REPRESENTATIVE PO Box 3005 Redlands,CA 92373-1505 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Policy Number: DTEC05955N735 COMMERCIAL GENERAL LIABILITY , THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL �������� ���~»��n� ���~ n INSURED ��������7�� �.��lF������� ,��� K n� n n�»~��� n "�pn'���� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section Ii) is amended c) The insurance provided to the additional in- to include any person or organization that you ourad does not apply to "bodily injury" or agree in a "written contract requiring xnuuruncn" "property domoQe" caused by "your work' � to include as an additional insured on this Cover- and included in the "products-completed op' . age Part, but: orations hazard" unless the "written contract a) Only with respect to liability for"bodily 1njury'', requiring insurance" specifically requires you "property damage" or"personal injury"; and to provide such coverage for that additional imuurod, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such ' damage is caused by acts or omissions of "bodily injury" or "property damage" that mc; youor your subcontractor in the performance curs before the and of the period of time for . of 'yourwork" tn which the 'written contract which the "written contract requiring insur- requiring insurance" applies. The person or once" requires you to provide such coverage organization does not qualify as an additional or the end of the policy peMnd, whichever is . insured with respect to the independent acts eadier, ' | or omissions of such person or organization. 3. The insurance provided to the additional insured i 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other inouranne", whether primery, ~_____. a) In the event that the Limits of Insurance of excess, contingent or on any other bueio, that is "� ,a this Coverage Part shown in the Declarations available to the additional insured for a loss we ~oos.. exceed the limits of liability required by the cover under this endorsement. Howevnr' if the — "written contract requiring maormnon'`. the in' "written contract requiring insurance" specifically --a. surance provided to the additional insured requires that this insurance apply on a primary .�� "m��c sha|| be limited to the limits of liability re- basis of a primary and non-oontdVutory basis, . quired by that "written contract requiring in- this insurance is primary to "other insurance" This endorsement shall not in- avai|ah|efn the additional insured which r:mvmcs .--�� crease the limits of insurance described in that person or organization as a named insured ° . Section III-Limits Of Insurance, for such loss, and we willwillnot share with that i„,=.�� "other insurance". But the insurance provided to b) The insurance provided the additional in' ' the additional insured by this endorsement still is °~- - sured doesnntap�dYto "bodily injury", excess over any valid and collectible "other in ey damage" or injury' arising out suramce" whetherexcess, contingentV/ ~��� of �U� rendering of, orfai|uro \o render, any ' primary, ' on any other basisthat iyavni|mNetathe aUdi' professional amhaa(ium|, engineering or sur- Uono] insured when that person or organization is . veyingincluding: ~~~~~ services, � an additional insured under such "other inaur- ~~~= i. The propmhng, eppmvimq, or failing to ance^. �� � prepare or approve, nn»ps, shop draw- 4. As a condition nf coverage provided to the ingo, op|niona, reports, uurvays. field or- additional insured by this endorsement — ders or change ordnrs, or the preparing. i.,___— ___ approving, or failing to prepare or ap- a) The additional insured must give us written ^...— prove, drawings and specifications; and notice as soon as practicable of an ~oocur- ii. Supervisory, inspection, architectural or Fence" or an offense which may result in a claim. To the extent possible, such notice engineering should include: CG D2 46 08 05 0 2005 The St, Paul Travelers Companies, Inc. Page 1 n[2 COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" any provider of 'other insurance'which vioiild or offense took place: cover the additional insured for a loss we cover under this endorse �meni However, this ii. The names and addresses of any injured condition does not affect whether the inaup parsons and witnessesand ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other inour- domageuMs1n0outnytke ''oocurronne'' or wnoe" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: S. The following definition is added to SECTION V. i. Immediately record the specifies of the — DEFINITIONS: claim or"suit" and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement under which you are required to include a The additional insured must see to it that we person or organization as an additional in - receive written notice of the claim or "suit" as sured on this Coverage Part, provided that soon as practicablethe "bodily injury" and "property damage' no' c) The additional insured must immediately curs and the personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or ''sui1", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you: the claim or defense against the ''suit", and otherwise CQmp|Vwtth all policy conditions. b. While that part of the contract or agreement is in effect; and d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to n. Before the end of the policy period. Page 2 of 2 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 Policy Number: DTEC05955N735 COMMERCIAL GENERAL LIABiLITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsemenmodifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - Provisions A.-H. and J.-N. of this endorsement broaden noverage, and provision I. of this endorsement may limit coverage. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the PROVISIONS of this endorsement carefully to determine rights, Uutioo, and what is and is not covered. A. Broadened Named Insured H. Additional Insured-State or Political ubdivisiaiis B. Extension of Coverage-Damage To Premises I. Other Insurance Condition Rented To You J. Increased Supplementary Payments • Perils of fire, explosion, lightning, smoke, water • Cost of bail bonds increased to$2,500 • Limit increased to $300,000 • Loss of earnings increased to $500 per day C. BlanketVo�ermf8ubnugotion K. Knowledge and Notice of Occurrence or Offense O. Blanket Additional Insured- Managers or Lessors L. Unintentional Omission of Premises M. Personal Injury-Assumed by Contract E. Incidental Medical Malpractice N. Blanket Additional Insured-Lessor of Leased F. Extension of Coverage- Bodily Injury Equipment G. Contractual Liability-Railroads .==-7 PROVISIONS 3. This Provision A. does not apply to any per- A. BROADENED NAMED INSURED son or organization for which coverage is ex- cluded x' o|udedbyendornennent' 1. The Named Insured in Item 1. of the Dec|ara' �iunaiy �u�oU�um� B. EXTENSION OF COVERAGE - DAMAGE TO PREMISES RENTED TO YOU The person or organization named in Item 1. of the Declarations and any organization, 1. The last paragraph of COVERAGE A. BOD' other than a partnership, joint venture or |im- ILY INJURY AND PROPERTY DAMAGE LU' ited liability oumpWny, of which you maintain ABILITY (Section I - Coverages) is deleted ownership or in which you maintain the major- and replaced by the following: Offias� ity interest on the effective date of the policy. Exclusior C. through n. do not apply to darn- However, coverage for any such additional age to premises while rented to you, or tern- organization will cease as of the date, if any, pmrmni|y occupied by you with permission of during the policy pehod, that you no longer the owner, caused by: maintain ownership of, orthe majority interest a. Fire; in, such organization. b. Exp|onimo: 2, WHO IS AN INSURED (Section II) Item 4.a. is deleted and replaced by the following: c. Lightning; a. Coverage under this provision is affordedMm. d. Smoke �auNo�hnmsuch fire, explosion, onlyund| the 180th day after you acquire ' or or or form the organization o/ the end of the e. Water. policy periodwhicheverk�eo�i�r A separate limit of insurance applies to this coverage as described in Section Limits Of Insurance. CG D3 16 07 04 Copyright, The Travelers Indemnity Corripunly, 2004 Page 1 of 006085 COMMERCIAL GENERAL LIABILITY 2. This insurance does not apply to damage to 5. This Provision B. does not apply if coverage premises while rented to you. or temporarily for Damage To Premises Rented To You of occupied by you with permission of the COVERAGE A. BODILY INJURY AND owner, caused by: PROPERTY DAMAGE LIABILITY (Section | - a. Rupturm, bursting, or operation of pres- sure m»' �«»�'�0*u) ise��Ud�dby�nd�mement� aumomUefUn*iwes; C. BLANKET WAIVER OF SUBROGATION `� b. Rupture nrbun�ing due to expansion or "�� We waive any right of recovery we may have swelling of the contents of arty building or against any person or organization because of s1nuctuvu. caused by or resulting from wa- payments we make for injury or damage arising ter; out of: premises owned or occupied by or rented c. Explosion of steam boi|e/s, steam pipes, or loaned to you; ongoing operations performed steam engines. or steam turbines. by you or on your behalf, done under a non1ract with that person or organization; "your work"; or Paragraph 6. of LIMITS OF INSURANCE "your products". We waive this right where you (section III) is deleted and replaced by the have agreed to � o so as pm�ofa written contract, following: - ' executod by you before the "bodily injury" or Subject to 5. above, the Damage To Prem- "property damage" occurs or the "personal injury" ises Rented To You Limit is the most we will or"advertising injury"offense is committed pay under COVERAGE Aforth� mum of �U D. BLANKET ADDITIONAL INSURED - WANAG' dammgam because of "property damage" to ERS OR LESSORS OF PREMISES any one premises while rented to you, or temporarily occupied by you with permission IS AN INSURED (Section II) is amended to o[theovmler. caused by: fire; explosion; |iQh� include as an insured any person or organization ning; smoke resulting from such fire, mxp|o' (/eheoed to below as "additional insured") with oion` or lightning; or water. The Damage To wNomyouhone agreed |navvdtboncontna��, ano- Premises Rented To You Limit will apply to all ou1aU before the "bodily iniury" or "property dam- , "pmpodydamogm" proximately caused by the age" occurs or the "personal injury" or '�dve�is- samm "occurrence", whether such damage |nQ injury" offense is committed, to name as an results from: fire; explosion; lightning; smoke additional insured, b�donly w�hrespect 10 liability resulting from such fire, explosion, or |ight' arising out of1ho owmarohip, maintenance or use ning; or water; or any combination of any of of that part of any premises leased to you, subject these causes. to the following provisions: The Damage To Premises Rented To You 1. Limits Cot Insurance. The limits of insurance Limit will be the higher of: afforded to the additional insured shall ho the limits which you agreed to provide in the writ- e. *3OUO0O' or ' ' ten contract, or the limits shown on the Decla- b. The amount shown on the Declarations rations, whichever are less. for Damage To Premises Rented To You 2. The insurance afforded to the additional in- Limit.. sured does riot apply to: 4. Paragraph a. of the definition of "insured C0fl "bodily Any inju0/' or "property damage" tract" (DEFINITIONS - Section V) is deleted that occurs, or"personal injury" o,~adva� following:andnep|aomdbythe ' using injury" caused by an offense which a. A contract for a lease of premises. How- is committed, after you cease to be a ten ever. that portion of the contract for a ant in that premises; lease of premises that indemnifies any b. Any premises for which coverage is ex- person or organization for damage to eluded by endorsement; or premises while rented to you, or tempn' redly occupied by you with permission of c. Structural alterations, nevvooxo1mciion or the ownar, caused by: fire; explosion; demolition operations performed by or an lightning; smoke resulting from such fire, boha|fnfouohaddiUuna| inoured� explosion, or lightning; Or water, is not an 3. The insurance afforded to the additional in- "insured contract"; aired is excess over any valid and co|loctJb|n Page 2 of 6 Copyright,The Travelers Indemnity Company, 2004 CG D3 16V7 04 COMMERCIAL GENERAL LIABILITY "other insurance" available to such additional together with all related acts or omissions in insured, unless you have agreed in the writ- the furnishing of the services described in ten contract that this insurance must be pri' paragraph 1. above to any one person will be mary to, or non-contributory with, such "other deemed one "occurrence". insurance". 5. This Provision E, does not apply if you are in E INCIDENTAL MEDICAL MALPRACTICE tile business or occupation of providing any of 1. The following is added to paragraph 1. Insur- ing ��e «er»ioeoday�hb�d in paragraph 1. above. Agreement of COVERAGE A. - BODILY 6. The insurance provided by this Provision E. INJURY AND PROPERTY DAMAGE LIABIL- shall be excess over any valid and collectible ITY (Section I-Coverages): "other insurance" available to the insured, "Bodily injury" arising out of the rendering of, whether primary, excess, contingent or on or failure to ronder, the following will be anyu���rAms|n. *�ne[dfnrinmurancet�etyVm deemed to be caused by an "occurrence": bought specifically to apply in excess ot the � Limits of Insurance shown on the Declare- m, Medical, surgical, dental, laboratory, x-ray tions of this Coverage Part. or nursing service, advice or inaUuc1inn, or the related furnishing of food or bevep F. EXTENSION OF COVERAGE - BODILY |�- aQmo� JU�`y b. The furnishing or dispensing of drugs or The definition of "bodily injury" (DEFINITIONS - medical, dmnto , or surgical supplies or Section \) is deleted and replaced by the follow* appliances; ing: c. First aid; or "Bodily injury" means bodily |n]ury, mental am' Qu��. mental injury, shock, fright, disability, hu' 'd' "Good Samaritan services.' As used in miliation, sickness or disease sustained by a per' , this Provision E.: "Good Samaritan ser- son, including death resulting from any of these at ' � vices" are those medical services ren- any time. dered or provided in an emergency and for which no remuneration is demanded G. �0NT��CTU&LL|A0KL|T9-�4|�RC3��D3 . or received. 1. Paragraph c. of the definition of"insured con- 2. Paragraph �,�.(1��) of WHO IS AN IN- Lr,—.... - Se��|mn V) is deleted ~~~�� GUREO (Section II) does not apply to any and replaced by the following: —� 0��� registered nurse, licensed practical nurse, c, Any ewsennontorlicense a0rmonnent; °� �� emergency medical technician or paramedic 2. Paragraph f.(1) of the definition of "insured ~== employed by you, but only while performing contract' (DEFINITIONS - Section V) is de' =�— the services described in paragraph 1. above leted. �~~~~ i-- ----- and while acting within the scope o���eir ern- e_ H. ADDITIONAL INSURED - STATE OR PCL|T|'�� p|uymnntbyyuu� Any 'emp|oyaea' ndo/iny = � "Good Samaritan services" will be deemed to CAL SUBDIVISIONS- PERMITS - be acting within the scope of their employ- WHO IS AN INSURED (Section II) is amended to �----- ---- ment by you. include as an insured any state or political subdi' ~� - 3. The following exclusion is added to paragraph vision, subieciio�h�yn|ynmAn� provisions: ~---~ ���� 2. Exclusions of COVERAGE A. 1.- BODILY This insurance applies only when required to INJURY AND PROPERTY DAMAGE LIABIL- be provided by you by an ordinance, law or ~— |TY(Somtion I Coverages):- ' building code and only with respect to operm "� � ' ~~~~ (This insurance does not a��|y��� "Bodily in' tines pe'fnnned by you or on your bebe/f for in- .,--. which nr "property damage" arising out of the which the state or political subdivision has is- jury" ---- au�de �armit� willful violation of a penal statute or ordinance " . relating to-the sale of pharmaceuticals corn- 2. This insurance does not apply to: ^ mitted by or with the knowledge or consent of a. 'Bodily injury," "property domage '' ''per' � the insured ' sonal injury" or "advertising injury" arising 4. For the purposes of determining the applica- out of operations performed for the state ble limits of insunanom, any act or omission or political subdivision: or CG D3 16 07 04 Copyright, The Travelers Indemnity Company, 2004 Page 3oY9 nn6ona CO11MERCIAL GENERAL LIABILITY b. ''Bodily injury" or "property damage" in- insured under any other policy* eluded in the "products-completed opera- including any umbrella or excess huts hazard". policy. I. �THE�|��W�q��E �Q��0(2m When this insurance is excess. we will have no duty under Coverages A A. COMMERCIAL GENERAL LIABILITY CON' or B to defend the insured against DITIONS (Section IV), paragraph 4. (Other any "suit" if any provider of''other in- Insurance) is deleted and replaced by the fol- sumnmm" has a duty to defend the in- lowing: sured against that "suit", If no pro- 4. Other Insurance vide/ of "other insurance" &eAands, we will undertake to do sobut we will If and collectible "other insurance" is available to the insured for a loss we be entitled to the insured's rights against all those providers of "other cover under Coverages A or B of this . |nsuranon` Coverage Part, our obligations are limited as follows: When this insurance is excess over "other insunanue'', we will pay only a. Primary insurance our share of the amount of the loss, if This insurance is primary except any, that exceeds the sum of: when b. below applies. If this insur- (1) The total amount that all such ance is phnnury, our obligations are "other immuronce" would pay for not affected unless any of the "other the loss in the absence of this in- insurance" is also primary. Then, we surance; ond will share with all that "other insur- ance" nuu� mnce° by the method described in c. �2) The total of all deductible and below. self-insured amounts under that "other insurance" ' b. Excess Insurance We will share the remaining loss. if This insurance is excess over any of any, with any"other insurance'that is the "other insurance". whether ph' not described in this Excess Insur- mary, axceea, contingent or on any ance provision. other basis: c, Method Of Sharing (1) That is Fire, Extended Covenege, Builder's Risk, Installation Risk, If all of the "other insurance" permits or similar coverage for "your contribution byequal shares. we will work"; follow this method also. Under this approach each provider of insurance (2) That is Fire insurance for prem- contributes equal amounts until it has ises rented to you or temporarily paid its applicable limit of insurance occupied by you with permission or none of the loss remains, which- of the ownac owner; ever comes first. (3) That is insurance purchased by If any of the "other inourenoe" does you to cover your liability as a not permit contribution by equal tenant for "property damage" to akures, we will contribute by limits. premises rented to you or tempo- Under tM3mfthod thmshare mfeach nod|y occupied by you with peper- providerofinmumn'--- is based on the mission of the owner; or ratio of its applicable limit of insur- (4) If the loss arises out of the main- ance to the total applicable limits of AoO8mmo or use of 8inoro8, insurance of all providers of inaup "mutos''. or watercraft to the ox~ ance, tent not subject to Exclusion B. The following definition ls added to DEFINITIONS Section I - Coverage A - Bodily (Se��n 'Property \0 Injury And Property Damage Li- ability; i' ' mbi|ity; or "Other insurance": (5) That is available to the insured a. Means inoumnma, or the funding of losses, when the insured is an additional that is provided by,through or on behalf of: Page 4 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D3160704 COMMERCIAL GENERAL LLAILITY . (1) Another insurance company; 2. Notice of an "occurrence" or of an offense (2) Us or any of our affiliated insurance oom' which may result in a claimwillbo deemed to p�mimm. except when the Non cumulation of as soon as practicable to us if ii is of Each Occurrence Limit section of given in good faith as soon as practicab to Paragraph 5 of LIMITS OF INSURANCE your workers' compensation insurer. This ap- (SwcUon III) or the Non cumulation of Per- plies only if you subsequently give notice of sonal and Advertising Injurer limit sections tile 'occurrence" oro��nmn to us as soon as of Paragraph 4 of LIMITS OF INSUR- practicable after you, one of your "executive ANCE (Section III) applies; officers" (if you are a norporetinn), one of your partners who is an individual (if you are a (3) Any risk retention group;' partnership), one of your managers (f you are (4) Any self-insurance method or program, a limited liability company), or an "employee" other than any funded by you and over (such as an insurance, loss control or risk vvhichthis Coverage Pad applies; or manager or administrator) designated by you � (5) Any similar risk transfer or risk manage- W give such notice discovers that the `onomr- merdmethod. rence" or offense may involve this policy, b. Does not include umbrella insuranca, or ex- 3. This Provision K. does not apply as respects cess insurance,that you bought specifically to the specific number of days within which you apply in excess of the Limits of Insurance mr» required to notify us in writing of the shown on the Declarations of this Coverage abrupt commencement of a dinohm/ge, re- Part. lease or escape of "pollutants" that causes ''bodily injury" or "property damage" which J. INCREASED�K �P�EKE�TA�Y PAYMENTS may otherwise be covered under this policy, Paragraphs 1.b. and 1.d. of SUPPLEMENTARY L. UNINTENTIONAL OMISSION � PAYMENTS — COVERAGES A AND B (Section I | Coverega�) onaannendedashn||nwn� The following is added to COMMERCIAL GEN- - ERAL LIABILITY CONDITIONS (Section |V) 1. In paragraph 1.b., the amount we will pay for paragraph G. (Representations): ' the cost of bail bonds is increased to $2500. .��� The unintentional omission of, or unintentional ,...= �' In paragraph 1.d.. tho amount will pay error in, any information provided by you which ---- loss of earnings is increased to S500 a day. we relied upon in issuing this policy shall not —== K. KNOWLEDGE AND NOTICE OF OCCUR- prejudice your rights under this insurance. How- ,,,,= RENCE OR OFFENSE ever, this Provision L. affectour does not � 1' The following is added to COMMERCIAL collect additional premium or to exercise our right 0QENER�.LLL48|L|TYCON�|T|(]NG (Section cancellation or nonrenewal in accordance with 0— . IV), paragraph 2. (Duties In The Event nfOu' applicable stale insurance laws, codes or regula- tions. �� ournonom Of�nme [�|aimorSu|�� =���� . . � ~� —� Notice of an "occurrence" or of an offense M. PERSONAL INJURY — ASSUMED BY CON- „-- --. , whioh nmoyresult in a claim must be given as TRACT soon as practicable after knowledge of the 1. The following is added to Exclusion e. (1) of — "occurrence” or offense has been reported to Paragraph 2., Exclusions of Coverage B. ---_ _--- you, one of your "executive officers' (if you Personal Injury, Advertising Injury, and are a uorpont|on), one of your partners who Web Site Injury Liability of the Web XTEND is an individual (if you are a partnership), one Liability endorsement: n—�� of your managers (if are a limited liability Solely for the purposes of liability 8nsumud in " company), or an "employee" (Such as an in- an 'insured contract", reasonable attorney surannm. |noocnntn)| orriok manager �d' fees and necessary litigation expenses u..,— in- ministrator) designated by you to give such N. no{ine� curred by or for a party other than an insured are deemed to be damages because of "per- Knowledge by any other "ernp/oyee" of an sonu| injury"provided: "occurrence" or offense does not imply that (a) Liability to such party for, or for the cost � you also have such knowledge of, that po�y'odefense has also been as- CG D3 16 07 04 Copydgbt, The Travelers Indemnity Company, 2004 Page 5 of 6 nosoor COMMERCIAL GENERAL LIABILITY oumod in the same "insured contract''; N. BLANKET ADDITIONAL INSURED — LESSOR and OF LEASED EQUIPMENT (b) Such attorney fees and litigation ex- WHO IS AN INSURED (Section II) is amended to penses are for de/en,e of that party include as an insured any person or organization against a civil or alternative dispute reso- (referred to below as "additional insured') with lution proceeding in which damages to whom you have agreed in a written contract, exe' wh|ohth|minmuronne applies are alleged. cuted before the "bodily injury' or "property dam- 2. Paragraph 2,d. of SUPPLEMENTARY PAY- age'' occurs or the "personal injury" or ''adveAis' MENTS — COVERAGES A AND B (Section I ing injury" offense is oommitted, to name as an — Coverages) is deleted and replaced by the additional insured, but only with respect to their following: ability for 'hodily injury", "property damage". "per- sonal injury" or "advertising injury" caused; in d. The allegations in the ''yuit" and the in- whole or in part, by your acts or Omissions in the formation we know about the "occur- maintenance, operation or use of equipment m:moe, or offense are such that rio conflict leased to you by such additional insuredsubject to exist between the interests of 10the tvUovv|ng provisions: the insured and the interests ot the in- demnitee1. Limits of Insurance. The limits of insurance ' afforded to the additional insured shall be the 3. The third sentence of Paragraph 2 of SUP- limits which you agreed to provide in the writ- PLEMENTARY PAYMENTS — COVERAGES ten contract, or the limits shown on the Dwolo' A AND B (Section I — Coverages) is deleted rations, whichever are less. and replaced by the following: 2. The insurance afforded to the additional in- Notwithstanding the provisions of Paragraph sured does not apply to any "bodily injury" or 2.b.(2) of Section X~ Coverage A — Bodily In- "property damage" that occurs, or "personal jury And Property Damage L|ahUity, or the injury" or "advertising injury" caused by an of- provisions of Paragraph 2.e.(1) of Section I — tense which is committed, after the equipment Coverage B — porsona| Injury, Advertising In- lease expires. jury And Web Site Injury LioN|[ty, such pay- ments will uymentowiU not be deemed to be damages for 3. The insurance afforded to the additional in- "bodily injury" and "properly doonage", or sured is excess over any valid and on||eohbie damagesfor "personal injury", and will not "other insurance" available to such additional re- duce the limits of insurance, imywr:d, unless you have agreed in the mit- ten x|iten contract that this insurance must be pri- 4. This provision M. does not apply if coverage mary to, or non-contributory with, such 'other for "personal injury" liability is excluded by insurance'. endorsement. TRAVELER ' WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY liARTFoRD, CT 06183 ENDORSEMENT WC 99 03 76 ( A)- 001 POLICY NUMBER; DTJUB5955N736 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy We will hot enforce our right against the person or organization named in the Schedule, The additional premium for this endorsement shall be 3 .00 0/© of the California workerscompensation pre- nnitirrk Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to wtiicti it 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 Policy No. Endorsement No, Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 06-17-11 ST ASSIGN: Page 1 of 1 Form W-9 Request for Taxpayer Give Form to the (Rev.January 2011) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax retum) Christiansen Pipeline, Inc. c•i Business name/disregarded entity name,if different from above a) on Ca 0- Check appropriate box for federal tax ° classification(required): 11 Individual/sole proprietor El C Corporation [ ] S Corporation [jj] Partnership Trust/estate c ra. 0 u Limited liability company.Enter the tax classification(C-,C corporation.S=S corporation,P=partnership)II. [I]Exempt payee 0 F. c aEl Other(see instructions)Ow C.) F Address(number,street,and apt.or suite no.) Requester's name and address(optional) 0 a' 5198 Arlington Ave., #215 City of Redlands cn City,state,and ZIP code 35 Cajon St., Suite 15A us Riverside, CA 92504 Redlands, CA 92373 List account number(s)here(optional) UM Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. 1 3 — 4 2 3 9 9 7 7 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply. For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally, payments other than interest and dividends,you are not required to sign the certification, but you must provide your correct TIN.See the instructions on page 4. Sign Signature of , A Here U.S.person - - Rai / ., . ) /1 Date 10- Occober 16, 2012 General Instructions Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident Special rules for partnerships.Partnerships that conduct a trade or alien),to provide your correct TIN to the person requesting it(the requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person. 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S. person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee. If applicable,you are also certifying that as a U,S,person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No,10231X Form W-9(Rev. 1-2011) 909 748 6411 Treasury 08:58 07 a ,Il 10-115-2012 1 /1 ,-,,o1,..... CITY OF REDLANDS .. -,...i..-_:, % r' , LA --- Finance Department-Revenue Division PAYMENT DUE 35 Cajon Street,Suite 1513•P.0.Box 3005 Redlands,CA 92373-1505 Pnone: (909)798-7557 12./31/2011 BUSINESS CERTIFICATE RENEWAL NOTICE Penalties Apply After Ck,....ri.. . 9 New License Period Is: 07/C1/3-0 I 2 — 0 q3C):..) 0 i 3 01/31/2012 ---, BUSINESS LICENSE NO. 0185613 EXPIRATION DATE 12.231/2006 Ends,nets of 5sigrz Business Christiansen Pipeline Inc Phone No, (951)687-0650 Name and Job Site *Fax No, (951)687-1594 Location '' Redlands, CA 92373 Start Date 05/16/2005 CI,"Contracto;),,4-'No work In the Cltin.- ;"" of Redlands alVas tirrraf,`. --:', Rate Type 2242.1 Mailing CHRISTIANSEN PIPELINE INC SIC Code 1629001 Address --.- - --- - - -. --e , — ; ( NAIC Code 237990 RIVERSIDE CA 92504 Ownership Corporation P -\; ---) 4 ) . Email Address State License No. 763546 /1-01L1-16-2(li 7r1f"..)---HIYRSi.'1I-Cif i CIL' .(Ls'Ir)License Type A Description of Business Ger Canal Expiration Date (1',.',)1 k 3 Federal ID No. 30-423977 State ID No, Resale No. Owners, Partners, or Corporate Officers Please make any necessary corrections. j Name Chris Christiansen Title Pres Date of Birth Address 3518 Scsan St Phone#1 (951)667-0650 Driver's Oc PI Riverside,CA 92504 Phone#2 SSN 4 Emergency Contact-Police & Fire use this contact for after hours emergencies not applicable for Home Occupations) Name Deborah Christianson Title Phone No. {951)687-0650 Address 3518 Susan St Riverside, CA 92504 Payment is now due for y,-.),.,r 2012 City of Redlands Business Tax PLEASE COMPLETE THE FOLLOWING: in the amount of$100 00 plus the renewal processing fee of$2000. _ Actual Gross Receipts $ N/A (1 The Total Amount Due is $120.00. \ ----' 4 of Employees — If there are any changes to the InformatiOn above,please make corrections on this form and return it to (Os office with your payment. Previous Balance $0 00 If you are no longer doing business in this City, please note that fact in the (rnciudes Pen;or,,, box at the top right of this form and return this notice or contact our office Business Tax IL ).:--' , (.)() immediately. DRBA NrA If you have any quest any, pease call(909)798-7557. L.A. Fee I ''t Other 0..) '.;...',,, Penalty NPDES 11111111111111111111 rIC, I ri HI? Renewal Fee `- .-• ,,, -,,- TOTAL AMOUNT DUE 1- i (- , ( ) ,...-ii I '.,)! ... ...;',,,.:---,,D,-.3 1 I, :.. ,, ;:fr Lir° LJ Cash (Li Check e ]Money Order I declare, under 7nalty that the infrill4p.lon provided herein is true and correct , \ , J(.)()Z //::2, -..„, iz-, 7) )±7 ' lja 1 (1,:( )--10 i ) ) ,, ',"--;- ) I /,/22) , ID, ie ' I natuie cif'Ciiviiier or 1-;:ii? e"sentative • RETURN COMPLETED RENEWAL NOTICE TO ABOVE ADDRESS WITH A CHECK PAYABLE TO CITY OF REDLANDS, Printed 10/16)2012 9 26 am