HomeMy WebLinkAboutContracts & Agreements_112-2004_CCv0001.pdf AGREEMENT
THIS AGREEMENT, made and entered into this 20 ' day of July, 2004, 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 C.S, Legacy Construction, Inc.,of the City of Corona, 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 install
Owner furnished playground equipment and perform all other construction of the Park Playground
Improvements project, complete, all as shown, specified, and made a part of Contract No. 240300-
7150/47009.
2. For the Contract Sum of$337,500.00, 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 forty-five (45)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 Bond. Payment Bond, Plans and 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
By:
County of San Bernardino,California
ATTEST:
City)C clerk,City of ads
,!,auds
County of San Be r1rdino,California
C.S. Legacy Construction, Inc.
Name of Contractor
CONTRACTOR SEAL By:
Signa ize Agent Grego Strumpf
Presi7nt
Signatory's Title
Signature of Authorized Agent (if necessary)
Signatory's Title (if necessary)
826870 A, B, C-27
Contractor's License No.
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
Riverside ss.
County of
I
y .p 4 Nancy J. Mellon
On � - 2 , before me, Y ,
Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public")
I'
personally appeared Gregg Strumpf
Name(s)of Signer(s)
EN personally known to me
❑ proved to me on the basis of satisfactory ;
evidence
I`
i; to be the person(s) whose name(s) is/are
MELLONsubscribed to the within instrument and
NC mm.ANC
#14679630
NOTARY PUBLIC CALJFORNfA �„� acknowledged to me that he/she/they executed
; ` San Bernardm6 Cauntq , the same in his/her/their authorized
I'. My comm-explfes�on.s,2o08 capacity(ies), and that by his/her/their
signature(s)on the instrument the person(s), or
the entity upon behalf of which the person(s)
acted, executed the instrument. ;
I,
WITNESS my hand and official seal. i
I .
` Place Notary Seal Above Ig ture of No ary Public '
I'
f OPTIONAL
Though the information below is not required by law,it may prove valuable 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:
k. I
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name: _ —._.___. __-- ;i
` 0 Individual Top of thumb here
U Corporate Officer—Title(s): ;
" U Partner—Cl Limited ❑ General
C7 Attorney in Fact
0 Trustee
Guardian or Conservator
I '
Other:_�.-- — ------ -- --------
I. Signer Is Representing:
I;
01999 Naltonai Notary Assoctaton•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnolary.org Prod.No,5907 Reorder:Call Toit-Free 1.800-876-6827
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
ss_
Countyof Orange
On July 2s,2004 , before me, CYN(-\I0 tAko � r "_4 `1Lt L
Dow Nem"and Iwo of omwr(e.g..'.rens NOWY Pubkl I
personally appeared Kevin P.Reed
Nit s)or signer(:) +
®personally known to me
❑ proved to me on the basis of satisfactory
evidence
NANCY J. MELTON to be the person(s) whose name(s) is/are
Comm.#1467963 subscribed to the within instrument and
NOTARY PUBLICBernardino
County
-CALIFORNIA acknowledged to me that he/she/they executed
San Bernardino County
My Comm.Expires Feb.3,2008 'r 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 of which the person(s)
acted, executed the instrument.
WI NESS my hand and official seal.
Pk"r+orary seer Above of Nix Pueec
OPTIONAL
Though the irrformatron below is not required by law,it may prove valuable to persons reVing on the document
and could prevent finudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: Performance and Payment Bonds
Document Date: July 28,2004 Number of Pages: 2
Signer(s)Other Than Named Above: C.S.Legacy Construction,Inc.
Capacity(les)Claimed by Signer Kevin P.Reed
Signer's Name: MGM
'
0 Individual Top of tlTumb here
❑ Corporate Officer—Titie(s):
❑ Partner—❑Limited ❑General
® Attorney In Fad
❑ Trustee
❑ Guardian or Conservator
❑ Other.
Signer Is Representing: Arch Insurance Company
0 t444 Nano W No"Mmadnmt•MO G SW lea.Po.Boa 2002•Cha worlk CA 44313.24M•-Wwvdi�-ag PfO&Na SW MoMx:C41 TWR"t-80017"W
Ftendun: $8,437.00
PERFORMANCE BOND
WHEREAS, the City Council of the City of Redlands,State of California(hereinafter designated as City),
and C.S. Legacy Construction, hi-o., (hereinafter designated as Principal)have entered into an agreement
whereby Principal agrees, to instal and complete certain designated public improvements, which by said
agrees entdated July 20,2004.and identified as ContractNIo.240300-7150/47009,is hereby referred to and
made a part hereof, and
WHEREAS, under the terms of said agreement,Principal is required before emtering upon the performance
of the work, to furnish a good and sufficient faithful performance bond with the City.
NOW,THEREFORE, said Princi _4";corpora e surety,are held and firmly bound
unto the City in the stan of M"wee fl!�� IITM S a n(N F i V e H u n3riad and Vol'ars
(S 337, e17(3 _)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 of this obligation is such that if the above bounded Principal, his or her 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 tic 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 obl;gation secured hereby and in addition the face amount specified thercA)r,there shall be
included costs and reasonable expenses and fees, including attorney's fees incurred by the City in
successfully enforcing staph obligation,all to be taxed as costs 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,
cans Py 28
l2004. Bond No. SM5009473
C.S. LE y ion, Inc.
{S 4L) Arch Instrance Cmparry (SEAL)
prinitial Surety
By, Kevlrs P.-Reed
Gre t UMP f sign
Pres' Address. 1941 D2rty Dive
Santa Ansa, CA 92705
(Notarial Acknowledgments of Priticip3i and Surety) Telephone: ( 714 .38
ffi&M
Pren-tim included with Perforrrix)ce l3crd
PAYMENT BONI)
WHEREAS, the City Council ofthe City of Redlands,State of Cal ifomis(hereinafter designated as"City"),
anti C.S. Legacy Construction,Inc.,(hereinafter designated as"Mricipal")have entered into an agreement
whcrcby Principal agrees to install and complete certain designated public improvements, which by said
agreementdated July 20.2004,and identified as Contract No.240300-7 150/47009,is hereby referred to and
made a part hereof-,and
VVMREAS, 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 material 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,matenalmen,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 Three HLn3red ThiThousand Five Rxited and 00/100 dollars
(S 337,500.00 )for materials furnished or labor thereon of any kind,or foramounts
due under the Unemployment Insurance Act with respect to such work or labor, that said surety will pay the
same in an atriount not exceeding the amount herein above set forth,and also incase 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 a>to give a right of action to them or their assigns in any suit brough,
upon this borid.
Should the condition of this bond be fully performed, then this obligation shall be-come nu',l and void;
otherwise it shall be and remain in full force and effect.
fhe surety hereby stipulates and agrees that no change,extension of tirne,alteration or addition to the terms
of the agreement or to thework to be perforated 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 cif the agreement or to the work ortothe specifications.
IN WIT: ESS WWRF0F, this instrument has been duly executed by the Principal and surety named,
011- July 28 7004. Bond No. SL 5073
C.S. Legacy ccr+rti � ---Inc. (SEAL) Arch InsLxance catuaiw (SE4L)
P1 incipal Surety
By: By:
SignatureG e r Mp Sipawre Kevin P. Reed
gf
P esil Address: I941 pgj;y pcia-_
Santa Ana, CA 92705
Notartai At knowledgrmnts or Frincipa;and Surety) Telephone: (_214J 389=6m
^
POWER OF A17ORNEY
Know All Men 8yThese Presents:
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its
principal office in Kansas City, Missouri(hereinafter referred to as the"Company")does hereby appoint
Kevin P. Reed ofSanta Ana, CA
its true and lawful Attomey(s)-in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and
mnits behalf aasurety, and aoits act and deed:
Any and all bonds and undertakings
EXCEPT/DN: NO AUTHORITY is granted to make, execute, seal and deliver bonds or undertakings that guarantee the
payment orcollection of any promissory note, check, draft orletter ofcredit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond
within the dollar limit ofauthority aaset forth herein.
The Company may revoke this appointment atany time.
The execution of such bonds and undertakings in pursuance of these reo t8 shall be as binding upon the said
Company omfully and amply toall intents and purposes, osifthe same had.�eenduly exeou�dand acknowledged byho
regularly elected officers mtits phncipa( office in Kansas City. Missouri. ' '
This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of
the Company on March 3, 2003, true and accurate copies of which are hereinafter set forth and are hereby certified to by
the undersigned Secretary aabeing infull force and effect:
"VOTED, That the Chobnnam of the Board, the President, orany Vice Preeident, or their appointees designated in writing
and filed with the Secretary, or the Secretary shall have the power and authority bzappoint agents and adonnaym'in-haut,
and to authorize them to execute on behalf of the Cornpany, and attach the seal of the Company thereto, bonds and
undartokimgm, renognizoncos, contracts of indemnity and other wriUngn, obligatory in the nature thereof, and any such
officers ofthe Company may appoint agents for acceptance ofprooems.°
This Power of Attorney is eignad, oasAad and certified by facsimile under and by authority of the following resolution
adopted by the unanimous.consent of the Board of Directors of the Company on March 3, 2003:
V[yTEO. That the signature of the Chairman of the Board, the Pnashjamt nrany Vice President, or their appointees
designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and
certifications by the Secretary, may be affixed by facsimile on any power ofattorney mrbond executed pursuant *mthe
resolution adopted by the Board of Directors on March 3" 2003, and any such power so executed. sealed and certified
with respect toany bond orundertaking to which it is attached,shall continue to be valid and binding upon the Company.
0OMLOO 13OUO3Q3
Page of Printed inU.S.A.
In Testimony Whereof,the Cornpany has caused this instrument to be signed and il s Corporate seal to be arced by their
authorized offices.this 29th day of April
Arch insurance Company
Attested and Certified
Q'IItts>n
Joseph 8.L44,ci®rwate SsctetarY ThottPLUWXMWM VRM President
STATE OF CONNEt TICUt' SS
COUNTY OF FAIRFlELD SS
I Melissa S.Gilligan,a Notary Public,do hereby certify that Thomas P_Luckstone I Joseph#s.Lats�personally known
to me to be the same persons whose names are respectively as Vice President and Corporate Secretary of the Arch
Insurance Company. a Corporatist organized and existing under the taws ofth� State of Missouri, subscribed to the
foregoing instrument, appeared before me this day in person and severally acknau�rledgod that they ging thereunto duly
authorized signed, sealed with the corporate seal and delivered the said Instrum t as the free and voluntary art of said
corporation and as their own free and voluntary acts for the uses and purposes then ' set forth_
fl ISA �t+10E8ry pUb6c
swoof
28, Mel►ss l►Seat,Notary Public
My commission eVires 2-28-05
CER-nFICATION
11.
Joseph S. Labell. Corporate Secretary of the Arch Insurance Company. do hereby certify that the attached Power of
Attorney dated April 29.2004 on behalf of the person(s)as listed abyve is a true and correct copy and that
the sane has been in full force and effect since the date thereof and is M full forced effect on the date of this certificate;
and 1 do further certify that the said Thomas P.Luckstone,who executed the Paws of Attorney as Vice President,was on
the date of execution of the attached Power of Attorney the duty elected Vice Pres' ent of the Arch insurance Company.
IN TESTIMONY W' IrOF, I have hereunto subscribed my name and affixed tut corporate seat of the Arch Insurance
Company on this28th day of JUIV 20
Joseo S ,Corgonge Smeary
This Power of Attorney limits the acts of tiuose named the to the bonds and specifically named thereim
u3rai they have no aumority 6a ttitul tho Company exp#in its rust and so theektont harshstated.
I
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Home Offrc' e:Kansas Clty.MO
ODMLOO13 00 03 03
Page 2 of 2 Printed In U.S.A,
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WORKERS' COMPENSATION INSURANCE CERTIFICATION
PARD PLAYGROUND IMPROVEMENTS
CONTRACT No. 240300-7150147009
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)
July 30, 2004
Date
C.S. Legacy Construction, Inc.
Name ofoutho
By:
Signaturent Gregg Strumpf
President
Signatory's Title
826870 A B C-27
Contractor's License No.
ACORD-., CERTIFICATE OF LIABILITY INSURANCE D�07/26/2404
PRODUCER 714-389-6797 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
KEVIN P. REED ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
SURETY& INSURANCE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
194 i DERBY DRIVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
{
i
SANTA ANA, CA 92705
INSURERS AFFORDING COVERAGE NAIL#
INSURED INSURER MT. HA',',ILEY INSURANCE COMPANY
C.S. LEGACY CONSTRUCT/OM .NC. INSURERS F°FIRST NATIONAL INSURANCE CO. OF
381 JENKS DRIVEINSURERC LEXINGTON INSURANCE COMPANY
INSURER STATE COMPENSATION INSURANCE
CORONA, CA 92880 ........
INSURER E
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�IN3RADD'L; TYPE OF IN ANCF POLICYNUMBER POLiCYEFFECTIVE `POLICY EXP€RATDATE IMMIODfYY) Yl LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X "DAMAGE-TO-RENTED
RENTED
X COMMERCIAL GENERAL LIABILITY MGLO136657 11/15/2003 11/15/2004 PREMG E-TO-RENTEence) $. 50.000
! .. . CLAIMS MADE X OCCUR , MED EXP(Any one person) ;.$ 5,000
_......... _ ; PERSONAL&ADV INJURY :$ ..1,000,000
._.._.. __... ..._.. _...
GENERAL AGGREGATE $ 2,066„066
GEN'LAGGREGATE LIMIT APPLIES PER
: PRODUCTS>COMPtOPAGG $ 1,000,000
POLICY X PRO, LOC _..
JECT
I AUTOMOBILE LIABILITY
B X X ANY AUTO 25-22-005996-1 2/1312004 2113/2005 (Ea accidentSINGLE LMiT $ 1,000,000
ALLOWNED.AUTOS
-
I ' SCHEDULED AUTOS BODILY INJURY(Per person)
' X HIRED AUTOS __. ,.. _.. .....
BODILY INJURY
f X NON>OWNEDAUTOS (Per accident) $
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY)EA ACCIDENT $
ANY AUTO --_---- --- w- __ _.
OTHER THAN EA ACG $
AUTO ONLY: AGG i'$ _.
EXCESSiUMBRELLALIABILITY EACH OCCURRENCE $ 2,000,000
C XXEBU3653402 2115/2004 2115/2005 -
I. ._ OCCUR _.. ;CLAIMS MADE AGGREGATE .._.. $ ..2.000,000_...
�. ..... $
DEDUCTIBLE
_.X RETENTION $10,000
WORKERS COMPENSATION AND - WC STATU, OTH,
D EMPLOYERS'LIABILITY ORIGINAL CERTIFICATE 1111512003 1111512004 X TORY LIMITS:_
ANY PROPRIETOR/PARTNER/EXECUTIVETO FOLLOW FROM EL EACH ACCIDENT i$ 1,000,000
l: OFFICERtMEMBER EXCLUDED? `-
iE L DISEASE>EA EMPLOYEE S1.000.000
ttyes describe under INSURANCE COMPANY
SFECSAL PROVISIONS below E.L.DISEASE,POLICY LIMIT $ 1.000,000
OTHER
I � !
DESCRIPTION OF OPERATIONS I LOCATIONS€VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS
RE: CONTRACT NO. 240300-7150/47009: PARK PLAYGROUND IMPROVEMENTS
CITY OF REDLANDS IS INCLUDED AS ADDITIONAL INSURED.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
I DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 45 DAYS WRITTEN
CITY OF REL LANDS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
P.O. BOX 0005 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REDLNDS, CA 92373 REPRESENTATIVES..
AUTHORIZED REPRESENTATIVE /.
ACORD 25(2001/08) ACORD CORPORATION 1988
POLICYHOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
RU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 07-29-2004 GROUP: 000046
POLICY NUMBER: 13505-2003
CERTIFICATE ID: 18
CERTIFICATE EXPIRES: 11-15-2004
11-15-2003/'11-IS-2004
CITY OF REDLANDS
PUBLIC WORKS DEPT
P 0 BOX 3005
REDLANDS CA 92373 JOB: PARK PLAYGROUND IMPROVEMENTS
CONTRACT #2403007150 4709
This is to certify that we have issued a valid Worker's Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the
policies listed herein.Notwithstanding any requirement,term or condition of any contract or other document with
respect to which this certificate of insurance 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.
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1, 000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - GREGG STRUMPF, PRESIDENT TRE - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-15-2003 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
C S LEGACY CONSTRUCTION, INC
381 JENKS DR
CORONA CA 92880
R Gd
MSE 07-29-2004
SCIr 10262E R
Accept this certificate only if you see a faint watermark that reads STATE FUND DOCUMENT" PAGE 1 OF I
Company Profile Ins mace
ARCH INSURANCE COMPANY
100 FIRST STAMFORD PLACE, STE. 325 SUITE 5111
STAMFORD, CT 06902
800-821-5546
Former Names for Company
Old Name: FIRST AMERICAN INSURANCE COMPANY DBA Effective Date: 1.1-06-2002
AMERICAN FIRST INSURANCE COMPANY
Old Name: FIRST AMERICAN INSURANCE COMPANY Effective Date: 01-05-1987
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 Sery ce of Process?
Reference Information
NAIC #: 11150
NAIC Group #: 1.279
California Company ID #: 3005-6
Date authorized in California: July 19, 1985
License Status: UNLIMITED-NORMAL
Company Type: Property& Casualty
State of Domicile: MISSOURI
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 glossary..
AUTOMOBILE
BOILER AND MACHINERY
BURGLARY
COMMON CARRIER LIABILITY
DISABILITY
FIRE