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AGREEMENT
THIS AGREEMENT, made and entered into this 1st day of December, 1998, 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 an individual trading as NBI General Contractors
of the City of Redlands, County of San Bernardino, State of California, hereinafter referred to as the
"Contractor".
WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, agree as follows:
1. SCOPE OF WORK: The Contractor will furnish all materials and will perform all of the work for the
following:
To perform construction of the Community Center Renovation Project, Phase 11, complete, all as shown,
specified, and made a part of Contract No. 23-6810-2960.
2. THE CONTRACT SUM OF: $145,000.00
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. 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.
5. ATTORNEY FEES: in the event any legal action is commenced to enforce or interpret the terms or
conditions of this Contract the prevailing party shall, in addition to any costs and other relief, be entitled
to recovery of its reasonable attorney's fees.
6. DEFENSE OBLIGATION: The Contractor shall defend the City,its elected officials,officers, agents,
and employees from and against any and all claims,losses, damages, and causes of action,including death,
brought by any person or persons for or on account of any wrongful or negligent act or omission of the
Contractor,its employees or agents in connection with the performance of the Contractor's obligation under
this Contract.
7. INSURANCE: All policies of insurance required by this Contract shall name the City, its elected
officials, employees, and agents as additional insured, and such insurance shall be primary with respect
to such additional insured and non-contributing to any insurance or self-insurance maintained by the
additional insured.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in duplicate on the day
and year first written above.
CITY'S SEAL,
By, .,
Mayor, Ci y of REDLAN
County of San Bernardino, California ji
ATTEST:
City Cle , City of RED r
Coun of San Bernardino, C ifornia
NBI GENERALQNTRACTORS
YneConctor
jf
f
CONTRACTOR'S SEAL By: I/
thorized Agent
Signatory's Title
Signature of Authorized.Agent (if necessary)
Signatory's Title (if necessary)
435915 Class B
Contractor's License No.
WORKERS' COMPENSATION INSURANCE STATEMENT
1, the undersigned and authorized agent for the Contractor, am aware of the provisions of Section 3700
of the Labor Code which requires every employer to be insured against liability for workers'
compensation or to undertake self-insurance in accordance with the provisions of that code, and I will
comply with such provisions before commencing the performance of the work under the City's Contract
No. 23-6816-2960.
NBI GENERAL CONTRACTORS
Name of Contractor
By:
Sigatu of Authorized Agent
Signatory's Title
435915 Class B
Contractor's License No.
DEPARTMENT OF ECONOMIC AND COMMUNITY DEVELOPMENT
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
CONTRACTOR'S CERTIFICATION
CONCERNING LABOR STANDARDS AND PREVAILING WAGE REQUIREMENTS
TO (Appropriate Recipient) DATE
Iz- za_ q?�
A PROJECT NUMBER (If any)
C City Contract No. 23-651{}-2960
PROJECT NAME
Community Center Renovations, Phase H
1. The undersigned, having executed a contract with the CITY OF REDLANDS, San Bernardino
County, California for the construction of the above-identified project, acknowledges that:
(a) The Labor Standards Provisions are included in the aforesaid contract.
(b) Correction of any infractions of the aforesaid conditions, including infractions by any of
his subcontractors and any lower tier subcontractors, is his responsibility.
2. He certifies that:
(a) Neither he nor any firm, partnership or association in which he has substantial interest
is designated as an ineligible Contractor by the Comptroller General of the United States
pursuant to Section 5.6(b) of the Regulations of the Secretary of Labor, Part 5 (29 CFR,
Part 5)or pursuant to Section 3(a)of the Davis-Bacon Act, as amended(40 U.S.C. 276a-
2(a)).
(b) No part of the aforementioned contract has been or will be subcontracted to any
subcontractor if such subcontractor or any firm, corporation, partnership or association
in which such subcontractor has a substantial interest is designated as an eligible
Contractor pursuant to any of the aforementioned regulatory or statutory provisions.
3. He agrees to obtain and forward to the aforementioned recipient within ten days after the
execution of any subcontract, including those executed by his subcontractors and any lower tier
subcontractors,a Subcontractor's Certification Concerning Labor Standards and Prevailing Wage
Requirements executed by the subcontractors.
4. He certifies that:
(a) The legal name and the business address of the undersigned are:
LvLf iLln-t t Oly
(b) The undersigned is:
A SINGLE PROPRIETORSHIP (3) A CORPORATION ORGANIZED IN
THE STATE OF
(2) A PARTNERSHIP (4) OTHER ORGANIZATION (Describe)
(c) The name, title and address of the owner, partners or officers of the undersigned are:
NAME TITLE ADDRESS
�l
(d) The names and address of all other persons, both natural and corporate, having a
substantial interest in the undersigned, and the nature of the interest are (if none, so
state):
NAME ADDRESS NATURE OF INTEREST
(e) The names, addresses and trade classifications of all other building construction
Contractors in which the undersigned has a substantial interest are (if none, so state):
NAME ADDRESS TRADE CLASSIFICATION
(Cqtr or
Date: ,®` �"
By:
WARNING
I.T.S. Criminal Code, Section 1010, Title 18, U.S.C., provides in "Whoever, . . . makes, passes,
utters, or publishes any statement, knowing the same to be false . . . shall be fined not more than$5,000
or imprisoned not more than two years, or both.
CERTIFICATION OF BIDDER REGARDING
EQUAL EMPLOYMENT OPPORTUNITY
INSTRUCTIONS
This certification is required pursuant to Executive Order 11246 (30 F. R. 12319-25). The implementing
rules and regulations provide that any bidder or prospective Contractor, or any of their -proposed
subcontractors, shall state as an initial part of the bid or negotiations of the contract whether it has
participated in any previous contract or subcontract subject to the equal opportunity clause; and, if so,
whether it has filed all compliance reports due under applicable instructions.
Where the certification indicates that the bidder has not filed a compliance report due under applicable
instructions, such bidder shall be required to submit a compliance report within seven calendar days after
bid opening. No contract shall be awarded unless such report is submitted.
CERTIFICATION BY BIDDER
Bidder's Name: NBI General,Contractors
Address and Zip Code: 1639 Sessums, Drive.
Redlands CA 92374
1. Bidder has participated in a previous contract or subcontract subject to Equal Opportunity Clause.
Yes N No El (If answer is yes, identify the most recent contract.)
2. Compliance reports were required to be filed in connection with such contract or subcontract.
Yes J4 No 0 (If answer is yes, identify the most recent contract.)
3. Bidder has filed all compliance reports due under applicable instructions, including SF-100.
Yes X No 0 None Required 0
4. If answer to item 3 is "No," please explain in detail on reverse side of this certification.
Certification - The information above is true and complete to the best of my knowledge and belief.
, <i'
I Name and Title of Signer (Please Type)
Date
Signature
CONTRACTOR'S CERTIFICATION OF COMPLIANCE
WITH DAVIS-BACON AND
RELATED ACT REQUIREMENTS
as Prime Contractor for
Contract No. 23-6810-2960, hereby make the following certification and acknowledgement with respect
to the applicability of Davis-Bacon and Related Acts Requirements:
t) By entering into this contract, I certify that I acknowledge that the above referenced project is
federally funded and I am solely responsible for complying with the Davis-Bacon and Related
Acts Requirements; and,
2) The Prime Contractor and all subcontractors are required to pay their laborers and mechanics
employed under this contract, a wage not less than the highest wage applicable to their work
classifications, as specified by the current and applicable Federal Wage Determination. If no
Federal work classification appears to apply, Prime Contractor shall make written request to
County to obtain applicable work classifications and wage rates prior to start of construction.
When the same classification appears in both the Federal and State wage decisions, the higher
wage must be paid for that classification. The Prime Contractor is responsible for ensuring
subcontractor compliance with Davis-Bacon and Related Acts Requirements.
Signat e, Prime Contractor
Title ner or President)
12 -- 2-au,
Date
pERFORTMANCE BOND Bond No. P2892106
Premium: $3,175-00
WHERFA,S, the City iv Council of the City of Redlands,State of California (hereinafter designated as"City"',
I r designated as have entered into an agreement whereb,'
and N131 General Contractors(hereinafter which by said agreemerl",
Principal agrees to install and complete certain designated public improvements, w
dated December 1,1998,and identified as Contract No.23-6810-2960,is hereby referred to and made a part
hereof; and
WHEREAS, under the terms of said agreement,Principal is required before entering upon the performance
of the work, to furnish a good and sufficient faithful performance bond with the City.
NOW, THEREFORE, said Principal and the undersigned as corporate surety, are held and firmly bound
unto the City in the sum of One Hundred and Forty Five Thousand and No/100*****do1Jars
145,0 6.00 ) for the payment of which sum well and truly to be made,we bind ourselves, our heirs,
successors, executors and administrators,jointly and severally, firmly by these presents.
The condition of this obligation is such that if the above bounded Principal, his or her heirs, executor
administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and
perform the covenants,conditions, and provisions in the said agreement and any alteration thereof made as
therein provided,or his or her part,to be kept and performed at the time and in the manner therein specified,
and in all respects according to their true intent and meaning,and Shan 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 fun force and effect.
As a part of the obligation secured hereby and in addition the face amount specified therefor,there shall be
included costs and reasonable expenses and fees,including attorney's fees incurred by the City in successfully
enforcing such obligation, all to be taxed as 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 acc ompanying the same shall
in anywise affect its obligations on this bond, and it does hereby waive notice of any such change, extension
of time, alteration or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named, on
December 24, ' 199 8
NBI General Contractors United Pacific insurance Compa EAL)
(SEAL) Surety
PV,cipal r
By:
Bv:
1gri urc S'Vaturc Steven R. Huratel-
k, Address: 700 N. Brand Blvd 125-0
Glendale, CA 91203
(Nota is Acknowleditments of Contractor and Surety} Telephone: 818} 240-6960
..........I, ................
rJ'r 1f' �,. �.
RELIANCE SURETY COMPANY RELIANCE INSURANCE COMPANY
UNITED PACIFIC INSURANCE COMPANY RELIANCE NATIONAL INDEMNITY COMPANY
ADMINISTRATIVE OFFICE,PHILADELPHIA, PENNSYLVANIA
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that RELIANCE SURETY COMPANY is a corporation duly organized under the laws of the State of Dei-
aware, and that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY,are corporations duty organized under the laws
of the Commonwealth of Pennsylvania and that RfUANCE NATIONAL INDEMNITY COMPANY is a corporation duty organized under the taws of
the State of Wisconsin (herein coliectivety called !the Companies") and that the Companies by virtue of signature and seats do hereby make,
constitute and appoint Steven R. Hu urtal,of trvine, Califarniir;their true and lawful Attorrley(s)-in-Fact,to make,execute, seat and deliver for and
on their behalf, and as their act and deed any and all bonds and undertakings of suretyship and to bind the Companies thereby as fully and to the
same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the
Companies and seated and attested by one oilier of such officers,and hereby ratifies and confirms all that thea said Attorney(s)-in-Fact may do in
pursuance hereof.
This Power of Attorney is granted-ander and by the authority of Article VII of the BY-Laws of RELIANCE SURETY COMPANY,
RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which
provisions are now in full force and effect, reading as follows:
ARTJW Vil-EXECUTION OF BONDS ANO UNDERTAKINGS
1. The Board of Directors.the President,the Chairman of the Board,any Senior Vice President any Vice Presidera or Assistant.vice President or other offww designated by the Board of
Directors shall have power and authority to(a)appoint AttomeyW-hiFact and to authorize them to execute on Behalf of Noe Company,bonds and undertakings,recognaatrces,contracts of indemnity
and other writings obliamory in the nature thereof,and to to r"we any such AttorneyW-in-Fact at any time and revoke the power and authority given to them.
2. Attorneys)-in-Fact shot have Power and authority,subject to the terms and limitations of the Power of Attorney issued to them, to execute deifvw on behalf of the Company,bonds
,and undertakings,recogrizanc8s,Contracts of tndeMruty and other writings obligatory in the nature thereof. the corporate seat is riot rwcossary for the validity of any bonds and undwtakings.
recognizances,contracts of indemno and other writoW obkgatory in tate nature thereof.
3. Attoneyw4ft-Fact sthaN have power and authority to execute adfidavito required to be attached to bonds,re cog tancm contracts of endermnitY or ottw condition or Obligatory
undertakings and they shah also have power and authority to certify the financial statement of the Company and to copies of the By-Laws of the Company of any art cte or sectio thereof.
TMs Par of Attorney is signed and seated by facsanile under and by authority of the foflowbmg resolution adopted by the Exect&vs and Finance COmmtttew of the Hoards of erectors of Reliance
insurance Company,United PaCrfic ksurance Company and Reliance National indemnity Company by Unankmow Consent dated as of February 28, 1994 and by the Executive and Financial
Committee of the Board of Directors of Reliance Surety Company by Unanimous Consent dated as of March 31,1994.
'Resolved that.the signatwas of such diractofs and officers and the seat of the Company may:be affixed to any such Power of.Attorney or any cervfxafea reiatirng thertrto by
facsirffle;and any such Power of Attorney or Certdicate bow"vich facsimile signatures or facsimile seat shalt be valid and bkx+ling upon the Company and any such Power so
executed and certified by faeskm"signatures and facsimile seal shall be v4d and bindmgupon the Company,in the future with respect to any bond or undertaking to which it is
attached."
IN WITNESS WHEREOF, the Companies have caused these presents to be signed and their corporate seals to be hereto affixed, this July 19,
1996.
RELIANCE SURETY COMPANY
�+�._ COMPANY
s UNITED PPACMC INSNCEUURANCE RANCE COMPANY
t RELIANCE NATIONAL INDEMNITY COMPANY t
r
STATE OF Washington
COUNTY OF King
On this, July 19, 1996, before me, Janet Blankley, personally appeared Mark W. Alsup, who acknowledged himself to be the Vice President of
the Reliance Surety Company, and the Vice President of Reliance insurance Company, United Pacific Insurance Company, and Reliance National
Indemnity Company and that as such, being authorized to do so, executed the foregoing instrument fon the purpose therein contained by signing
the name of the corporation by himself as its duty authorized officer.
In witness whereof, i hereunto set my hand and official seal.
-:I' kRiARY .t
Ific
TON 4=tn aFfore Stateof WastN ton
W Residing at Puyall
I, Robyn Layng, Assistant Secretary of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMP-
ANY, and RELIANCE NATIONAL INDEMNITY COMPANY do hereby certify that the above and foregoing is a true and correct Copy of the Power
of Attorney executed by said Companies,which is still,In AA)force and effect.
24December 98
IN WITNESS WHEREOF, I have hereunto set my�h��arlO affixed-the seals of said Companies this day of 19
Assistant Secretary
Nam `
l
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
6
Y State of California
r�4
County of
Grange
r
Sherie L. Bell Notary Public
Date N~,ne a.r0-Tlfle_,Officer+ a. 'Jane Doe,Nciary Nbud i
personally appeared _-- Steven R. Rummel
s)of&g er=s,
ersonally known to me—O - _proved to me on the basis of satisfactory evidence to be the person �
whose n r e(s) is/ire subscribe=d to the within instrument
t and acknowledged to me that he/she/they executed the
t` same in his/her/their authorized capacity(ies),and that b .
his/her/theirsignature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted,
SHERIE L, BELL executed the instrument.
r
COMM. 111
�g�Y `IC CA,� ,q In WITNESS rt;y hand and official seal.
ACE GGI04
omf �EEX [)ec.I riga
J. S gnatrre o4 Nota b a
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 farm to another document.
91,
Description of Attached ovum t
Title or Type of Document:
t
Document Date: Number of Pages: � E.
Signer(s) Other Than Named Above:
pa ity(ies) Claimed by Signer(s)
`Z
;4 Signer's Name: Signer's Name,
Name,
`
(5 Individual Individual
r Corporate Officer Corporate Officer
Title(s)- T itle(s): 9,'
arty er i- Limited C eneral Partner- Limited :_i General
Attorney-in-Fact Attorney-ire-Fact
Trustee TrusteeE MR f
E
Guardian or Conservator ,, , Guardian or Conservator � ,
r Other Gtr; ;n
Signer Is Representing: Signer is Representing:
1 el
4
I
83
J 7555 Nat o nal Nota -soci.:#u._e '30-Rernmet A,,2.Pte,.ox 715 g Canoga Fa�k,CA 91309- rJ==�.NG 1,9G7 �e rimer oak,Rb-Free `-�:'e�v�5:'
Bond No. P2892106
PAYMENT BOND Premium: $ Included in Performancc
Bond
WHEREAS, the City Council of the City of Redlands,State of California (hereinafter designated as"City"),
and NISI General Contractors(hereinafter designated as"Principal")have entered into an agreement whereby
Principal agrees to install and complete certain designated public improvements, which by said agreernen I
dated December 1, 1998,and identified as Contract No. 23-6810-2960, is hereby referred to and made a part
hereof; and
WHEREAS, under the terms of said agreement, Principal is required before entering upon the perfor-nance
of the work, to furnish a good and sufficient labor and materials payment bond with the City to secure the
claims to which reference is made in Title 15 (commencing with Section 3082) of Part 4 of Division 3 of the
Civil Code of the State of California.
NOW, THEREFORE, said Principal and the undersigned as corporate surety, are held and firmly bound
unto the City and all contractors,subcontractors, laborers,materialmen,and any other persons employed in
the performance of the aforesaid agreement and referred to in the aforesaid Civil Code of the State of
California in the sum of One Hundred and Forty Five 'Thousand*****************dollars
145,000.00 for materials furnished or labor thereon of any kind, or for amounts due under the
Unemployment insurance Act with respect to such work or labor, that said surety will pay the same in an
amount not exceeding the amount 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 reasonabic
attorney's fees, incurred by the City in successfully enforcing such obligation, to be awarded and fixed by the
court, and to be taxed as costs and to be included in the judgement therein rendered.
It is hereby expressly stipulated and agreed that this bond shall inure to the benefit of any and all persons,
companies and corporations entitled to file claims under Title 15 (commencing with Section 3082) of Part 4
of Division 3 of the Civil Code,so as to give a right of action to them or their assigns in any suit brought upon
this bond.
Should the condition of this bond be fully performed, then this obligation shall become null and void;
otherwise it shall be and remain irl full force and effect.
The surety hereby stipulates and agrees that no change,extension of time, alteration or addition to the terms
of the agreement or to the work to be performed thereunder or the specifications accompanying the same shall
in anywise affect its obligations on this bond, and it does hereby waive notice of any such change, extension
of time, alteration or addition to the terms of the agreement or to the work or to the specifications.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principal and surety named, on
December 24, ' 199 8
NBI General Conty. ctorsUnited Pacific Insurance Cor�
(SEAL)
ph�c-ipal Surety
B v:
Sign urc Signature Steven R. Hunel
N. Brand Blvd. , Ste# 1250-
Address:
Glendale, CA 91203
(Notarial Acknowledgments of Contractor and Surety) Telephone: (UL) 240-6960
[:i��T+T�•�3 t._:=�■T*I1i'i�.l[i:1�I<i�•I�+1T�■Tf_T*T:Cr3:i►ITT:]�I+.:I'T,y�t���x:
RELIANCE SURETY COMPANY RELIANCE INSURANCE COMPANY
UNITED PACIFIC INSURANCE COMPANY RELIANCE NATIONAL INDEMNITY COMPANY
ADMINISTRATIVE OFFICE, PHILADELPHIA, PENNSYLVANIA
i
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that RELIANCE SURETY COMPANY is acorporation duly organized under the laws of the State of Del-
aware, and that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, are corporations duly organized under the taws
of the Commonwealth of Pennsylvania and that RELIANCE NATIONAL INDEMNITY COMPANY is a corporation duly organized under the laws of
the State of Wisconsin (herein collectively called `the Companies") and that the Companies by virtue of signature and seals do hereby make,
constitute and appoint Steven R. Hummel,of Moine, Cafrfomfa their true and lawful Attorneys)-in-Fact, to make,execute, seal and deliver for and
on their behalf, and as their act and deed any and all bonus and undertakings of suretyship and to bind the Companies thereby as fully and to the
same extent as if such bonds and undertakings and other writings obligatory in the nature thereof were signed by an Executive Officer of the
Companies and sealed and attested by one other of such,officers,and hereby ratifies and confirms all that their said Attorneys)-in-Fact may do in
pursuance hereof.
This Power of Attorney is granted under and by the authority of Article VII of the By-Laves of RELIANCE SURETY COMPANY,
RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which
provisions are now in full force and effect, reading as follows:
ARTICLE vii-EXECUTION OF BONDS AND UNDERTAKINGS
1, The Board of Directors,the President,the Chairman of the Board,any Senior Vice President,any vice President or Assistant nice Prestclam or other officer designated by the Board of
Directors slue#have power and authority to tai appotat Attorneyts)-in-Fact and to authorize them to execute on behalf of the Company,bonds and undertakings,recognizaruas.contracts of indemnity
and other writaVs obligatory in the nature thereof,and(b)to remove any such Attomeyisi-in-Fact at any time and revoke the power and awhorlty given to them.
2. Attorney(s)-in-Fact shall have power and authority,subject to the terms and limitations of the Poww of Attorney issued to thein, to execute deliver on behalf of the Company,bonds
and undertakings,recognizancesf contracts of indemnity and other writings obligatory in the nature thereof. The corporate seal is not necessary for the vakkty of any bonds and undertakings,
recogndzanoes,contracts of indemnity and other writings obligatory in eta nature thereof.
3. Attorneyfsf-twFact shati have pourer and authority to execute affidavits required to be attached to bonds,recognizances,contracts of rndemnrty or other conditional or obtigatory
unclortakings and they shah also have power and authority to certify the financial statement of the Company and to copies of tate By-Laws of the Company or any amide or section thereof.
this Porwr of Attorney is signed and seated by tacwnile under.and by authority of the following resolution adopted by the Executive and Finance Committees of the Boards of Directors of Reliance
insurance Company, United Pacific insurance Company and Reliance National Indemnity Company by Unanimous Consent dated as of February 28, 1994 and by the Executive and Financial
Committee of the Board of Directors of Reliance Surety Company by Unanimous Catsent dated as of March 31,1994.
"Resolved that the signatures of such directors and officers and the seal of the Company may he affixed to any such Power of Attorney of any certificates relating thereto by
feesirniie,antd any such Power of Attorney or cetti£cate bearing such faealmile silrtatures or faWman seal shaft be valid and binding upon the Comp"and any such Power so
executed and certified by facsimile signatures and facaim'rts sea!SII be valid and binding upon the Company,in the future-with respect to any bond or unci rtakdng to which it is
attached.'
IN WITNESS WHEREOF, the Companies have caused these presents to be signed and their corporate seals to be hereto affixed, this July 19,
RELIANCE SURETY COMPANY
RELIANCE INSURANCE COMPANY
Soo
UNITED PACIFIC INSURANCE COMPANY
RELIANCE NATIONAL INDEMNITY"COMPANY
STATE OF Washington }
COUNTY OF King } ss,
On this, July 19, 1996, before me, Janet Blankley, personally appeared Mark W. Aisup, who acknowledged himself to be the Vice President of
the Reliance Surety Company, and the Vice President of Reliance Insurance Company, United Pacific Insurance Company, and Reliance National
Indemnity Company and that as such, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing
the name of the corporation by himself as its duly authorized officer.
In witness whereof, i hereunto set my hand and official seal. �t +j<
h
k+ti .c
( � FiJt3L1�
I .� ,z-x�� � E
No Public in and for the State of Wash1910
n
Ws Residing at Puyallup [
1, Robyn Layng, Assistant Secretary of RELIANCE SURETY COMPANY, RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMP-
ANY, and RELIANCE NATIONAL INDEMNITY COMPANY do hereby certify that the above and foregoing is a true and correct copy of tate Power
of Attorney executed by said Companies, w*ch is4fJl1-nJull force and effect.
IN WITNESS WHEREOF, i have hereunto hand andd af5eed the seals of said Companies this 24 day of December 19 9$
�., � �►'�L' 1 fi
Assistant Secretary
1TRI
• r ■ • ae s r r r
CALIFORNIAALL-PURPOSE ACKNOWLEDGMENT
i^r
6
io
State of
California
County of
Orange
December ?4, 1998 Sherie L. Bell, Notary PublicOn before me
DaSe Na me and T Ve of Of'soer ie g-,'Jare Doe,Notary r 6I=:."
Steven R. Hummel
personally appeared
Name"sl ol S gncr;3
' aersonally known to me— proved to me on the basis of satisfactory evidence to be the person(s' �!
whose name(s) is/are subscribed to the within Instrument
and acknowledged to rye that he/she/they executed the �
n same in his/her/their authorized capacity(ies),and that by �'
,
k his;herithe€r signatures} on the instrument the person(s), }X.
SH
Eu B '
or the entity upon behalf of which the persons; acted, K.
t
COMM.*14f$ executed the instrument.
is 2
W O^ E Y ; WITNESS my hand and official seal.
YC x
,,tt Sig atur .-e 4otary �uoic z
{3
OPTIONAL ?
s Though the information below is not required by law, it maks prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this terra to another document.
Description`! of Attached Document
6
Title or Type of Document:
Document Date: Number of Pages.
41
Signer(s) Other Than Named Above:
apa it (les) Claimed by Signer(s)
XE
t Signer's Name: Signer's fame:
Individual Individual
Corporate Officer Corporate Officer
r; w
Titie(s ; TRtle(s':
V Partner - Limited General Partner Limited ----, General
ttorney-in-Pact Attorney-i -Pact f
Trustee Trustee
Guardian or ConservatorGuardian or Clonse,Othvator � r
t 771*_; u
fi Other uht e
X,
d C
Signer Is representing. Signer Is Representing:
t
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G95 Nation_.N,ofa tAssociation=82Y tge,,-ret Ave..r..0,Box r 184 Canoga Park, 912,09-7184 ca.No 5907 Reorder:Coil -6ree -800-876-6827
THIS SIDE FOR CONTRACT COMPLIANCE USE ONLY
Percent Minorities of Total SMSA Percent Does Contractor Meet SMSA Percentages? 0 Yes 0 No
Warning Letter Issued Reviewed By
Date Contract Compliance Officer
CONTRACTS PROCESSED
Annual Qualification Dates Date Project Dollar Amount
EFrom To
x
i
Contract Compliance
Qualifying Report
For
Non-construction
Contractors
and
Vendors
t
Comments
l
}i
ja
A. CONTRACT COMPLIANCE QUALIFYING REPORT B. CURRENT WORK FORCE
FOR NON-CONSTRUCTION CONTRACTORS AND VENDORS ALI, EMPLOYEES MINORITY EMPLOYEES
Contractor/Vendor agrees to comply with the provisions of the MALE FEMALE
CUPATIONAL TOTAL
Affirmative Action Compliance Program of the implementing entity and OCCATEGORY
rules and regulations adopted pursuant thereto, Executive Order 11246 TOTAL MALE FEMALE 7 =7 MINORITY
and 1137 5, Title V11 of the Civil Rights Act of 1964, the California Fair
Employment Practices Act, and other applicable Federal and State laws
and regulations relating to equal employment opportunity, including laws
and regulations hereafter enacted. Administrators 2-
Contractor/Vendor also hereby agrees to furnish to implementing Professional
entity's Contract Compliance Office any access and information that they
may request to assist in determining compliance with the Program. Technical
I declare under penalty of perjury that the statistical information
submitted herein is true and correct. Sales
1 2 — 2� -
Clerical
Date Name(Please Print) Skilled
V11—C Operatives
tore u
Or
OR Title (Semiskilled)
Name of ContractorlVendor (Unskilled)
S, C s Se,vka Workers
-b-5-kilkill-s—�Lr- —
Address �1 R TOTAL
0C ]:L
(Ame Code)Phone Number
Type of Business
JOB CATEGORY DEFINITIONS result in or contribute to the comfort, convenience, upkeep and care of
Administrators: Occupations which require that employees set broad Sales:Occupations in which the act of selling takes place: exchange buildings, facilities or grounds of public property. Workers in this group
Policies, exercise overall responsibility for execution of these policies, of property of any kind, or of services, for an agreed sum of money or may operate machinery.
direct individual departments or a special phase of the Contractor's other valuable consideration. One employed as a traveling agent or Includes: Chauffeurs, laundry and dry cleaning operations, truck
operations, or provide specialized consultation on a regional, district or representative to sell goods or services. drivers, bus drivers, garage laborers, custodial personnel, gardeners and
area basis. Office and Clerical: Occupations in which workers are responsible for groundkeepers, refuse collectors, construction laborers.
Includes: Directors,deputy directors,department heads,controllers, internal and external communication, recording and retrieval of data and/or
foremen, supervisors, inspectors, and kindred workers. information and other paperwork required in an office. ETHNIC CATEGORY
Professional: Occupations which require specialized and theoretical Includes: Bookkeepers, secretaries, office machine operators, clerk White(not of Hispanic origin): All persons having origins in any of the
knowledge which is usually acquired through college training or through typists, stenographers, statistical clerks, dispatchers, payroll clerks, original peoples of Europe, North Africa, the Mid East, or the Indian
work experience and other training which provides comparable knowledge. messengers, and kindred workers, subcontinent.
Includes: Personnel and labor relations workers, social workers, Skilled: Occupations in which workers perform jobs which require Black(not of Hispanic origin): All persons having origins in any of the
doctors,psychologists, registered nurses,economists, dieticians, lawyers, special manual skill, a thorough and comprehensive knowledge of the black racial groups.
system analysts, accountants, engineers, employment and vocational processes involved in the work which is acquired through on-the-job Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or
rehabilitation counselors, teachers or instructors and kindred workers, training, experience, through apprenticeship or other formal training South American, or other Spanish culture or origin regardless of race.
Technical: Occupations which require a combination of basic scientific programs. Asian or Pacific Islanders: All persons having origins in all of the
or technical knowledge and manual skill which can be obtained through Includes: Mechanics and repairmen, electricians, heavy equipment original peoples of the Far East, Southeast Asia, or Pacific Islands. This
specialized post-secondary school education or through equivalent on-the- operators, stationary engineers, skilled machinist occupations, carpenters, area includes, for example, China,Japan,Korea,the Phillipine Islands, and
job training, and compositors and typesetters, and kindred workers. Samoa.
Includes: Computer programmers and operators, draftsmen, Operative (Semiskilled): Occupations in which workers are partly American Indian or Alaskan Native: All persons having origins in any
surveyors, licensed practical nurses, photographers, radio operators, skilled, or doing manual work that requires only limited training, experience of the original peoples of North America.
technical illustrators, highway technicians, technicians (medical, dental, or knowledge,
electronic, physical sciences), assessors, inspectors, and kindred workers, Laborers (Unskilled): Occupations in which a worker performs a
variety of manual work in the maintenance, repair and construction of
highways, buildings, and other facilities; an unskilled worker who brings
materials to,and does preparatory work for, skilled workers in a trade,
Service,Workers:Occupations in which workers perform duties which
THIS SIDE FOR CONTRACT COMPLIANCE USE ONLY
Percent Minorities of Total SMSA Percent Does Contractor Meet SMSA Percentages? ❑ Yes El No
Warning Letter Issued _ Reviewed By
Date Contract Compliance Officer
CONTRACTS PROCESSED
Annual Qualification Dates Date Project Dollar Amount
From To
Contract Compliance
Qualifying Report
For
Construction
Contractors
and
Vendors
Comments
CONTRACTOR'S AFFIRMATIVE ACTION REPORT
A Contractors will be teclunrof to complete the distribution report when: B. Contractor agrees to comply with the provisions of the Affirmative Action Compliance Program of the County of San Bernardino,
• The department designee has devicnined that the contractor is the low bidder;or and rules and regulations adopted pursuant thereto, Executive Orders 11246, 11375, 11625, 12138, 12432, 12250,Title VII of
• The Board of Supervisors has decided to waive the competitive bidding process in lieu of being a sets source Contractor. the Civil Rights Act of 1964, the California Fair Employment Practice Act,California Public Contracts Code Section 2000 and the
San Bernardino County MWBE Policy No, 11-15,and other applicable Federal, State and County laws,regulations and policies
;1SOCIAl. SECURITY' NO, 7_;!)�71 12. DATE I Z12i3, relating toequalemployment opportunity including laws and regulations hereafter enacted,
,rd Convacto"s Hurs'noso
Attached is the loaltarrent or Contractor's Affirmative Action Policy, The Contractor agrees to make a good faith effort to meet
the goals of the plan as part of these contract obligations.
2. Address jS3,S L,t�-n_S D tl 0e, Contractor understands that this plan will become a part of Contractor's comprehensive management policy
3, City Qttld State—CA Zip Code0l 2,3-2 Contractor agrees to insert in all subcontracts on the project bid herewith a provision that said subcontractors will comply with the
4. 1
TelepIlona Number I q - provisions of the San Bernardino County Affirmative Action Compliance Program and rules and regulations adopted pursuant thereto,
4 (4-5;55 Executive Order 11246, 11375, 11625, 12138, 12432, 12250, Title VII of the Civil Rights Act of 1964, the California Fair Employment Practice Act,and other applicable Federal and State laws and regulations relating to equal employment opportunity,
5. Type of Business C, including laws and regulations hereafter enacted.
Contractor agrees to furnish to the MWBE office the name of each MWBE business that will furnish supplies, goods or services in
excess of$10,000 individually, Said names shall be furnished prior to the time the MWBE business commences work.
6, Average Annual Sales or Receipts for preceding three years l, D b� 0-00
Contractor also hereby agrees to provide the San Bernardino County MWBE Program Office any access and information that they
e
The distribution report shall be reviewed and approved by the County Affirmative Action Office for affirmative action compliance. may request to assist in der\rmining complianc,,th the Pro ram.
of
0 Approved I declare under penaltypoll that the follow 9 r)""riffsarrect.
Reviewed by D Disapproved 4 "U
Z, "I Ith
Comments DATE SIGNATURE
TITLE
CURRENT WORK FORCE
ALL EMPLOYEES MINOFATY EMPLOYEES UNDEAUTILIZATION
RECOMMENDED MMNG GOALS
MALE FEMALE MINORITY FEMALE
OCCUPATPONAL TOTAL
MMORTIES
CATEGORY TOTAL MALE FEMALE `"i.. A—i— A.1- A—il— MNndtY SMSA,1990
Bads NMRanio s Indl-s BMw4 Mkps,b s Imsm w YES NO YES NO
Pc Pdfi. Aj.k- ANA- F Pope %
N.W.IdmdY . 1.1-dN.Ov.
Administrators At Am 5.90
Professional H,p 24,80
Technical Nix A-
Sales —If
Clerical
Skilled
Operatives (Semiskilled}
tr Laborer(Unskilled)
Service Workers
tiT07 At,
AFFIRMATIVE ACTION POLICY FOR
CONTRACTORS AND VENDORS
NBI GENERAL CONTRACTORS
NAME OF CONTRACTOR
adopts this plan to affirm its support of a program of equal employment opportunity,and to assure compliance with Executive Order Numbers 11375,Title VII of
the Civil Rights Act of 1964,Section 503 of the Rehabilitation Act of 1973;the California Fair Employment Practice Act,and the implementing entity's Affirmative
Action Compliance Program. This Contractor agrees to assert leadership within the community and to put forth good faith efforts to achieve full employment and
utilization of the capabilities and productivity of all our citizens without regard to race,age,color,sex,religion,ancestry,national origin,marital status,or handicap,
This Contractor further recognizes that the effective application of a policy of equal employment opportunity involves more than just a policy statement and will,
therefore,undertake affirmative action to make known that equal opportunities are available on the basis of individual merit,and to encourage advancement on
this basis.
The following Affirmative Action Program is hereby established as the policy and practices of our company:
Instructions: Indicate your policy by circling the applicable letter to the left of each item below. The letters are to be interpreted as follows:
A This is now a practice of our company.
B Our company will adopt this policy.
C Our company cannot or will not adopt this policy,
If C is circled,explain reason. Use separate sheet if additional space is needed.
Our company shall recruit and hire all employees without regard to race,age,color,sex,religion,ancestry,
national origin,marital status,or handicap, and will treat all employees equally in respect to compensation
and opportunities for advancement,including upgrading and promotion,
C Explain:
2. Our company will actively use recruitment sources such as employment agencies,unions,and schools which
have a policy of referring applicants on a nondiscriminatory basis.
B
C Explain:
3. Our company will disseminate its affirmative action policy externally by informing and discussing it with all
recruitment sources, by advertising in news media, specifically including minority news media, and
8 by notifying and discussing the policy with all local minority,handicapped,and women's organizations and
subcontractors and shall maintain records of the organizations'responses.
C Explain:
J,O-A 4. Our company shall make specific and constant personal, written, and oral recruitment efforts directed at all
local minority, handicapped, and women's organizations, including schools, recruitment, and training
B organizations.
I
C Explain:
5. Our company shall make specific efforts to encourage present minority,handicapped,and women employees
to recruit their friends and relatives whose status also comes under that of minority,handicapped,or women,
C Explain:
6. Our company will maintain a file of the names and addresses of each minority applicant and female applicant
referred to the company for hiring,and if the applicant is not considered for employment or was not employed,
the company's file should document this and the reasons therefor,
C Explain-
7. Our company shall notify the implementing entity Contract Compliance Officer when the union or unions with
whom our company has a collective bargaining agreement have not referred to the company a minority,
handicapped,or female worker sent for by the company or the company has other information that the union
referral process has impeded the company's effort to meet the established goals of affirmative action.
C Explain:
8. Our company will actively take steps to integrate any positions,departments,or plant locations which have
no women or minorities or are almost staffed with one particular group.
B
C Explain:
9. Our company shall insure that all employee specifications, selection requirements,tests,and other employee
recruitment or evaluation procedures do not discriminate against minorities,handicapped,or women,
B
C Explain:
10. Where reasonable,our company shall develop or finance on-the-job training opportunities and participate and
assist in any association or employee group training programs relevant to the company's employee needs.
B
C Explain:
Our company shall continually inventory and evaluate all minority,handicapped,and female personnel for
promotion opportunities and encourage minority and female employees to see such opportunities.
C Explain:
CID 12. Our company shall make sure that seniority practices,job classifications,rates of pay,and other forms of
compensation, and other employee practices and classifications do not have an unlawfully discriminatory effect
B on handicapped,minority,or female employees.
C Explain:
13. Our company will make certain that all facilities normally used concurrently by all company activities are
nonsegregated,
B
C Explain:
14. Our company shall make certain that all subcontractors are in compliance with the Affirmative
'D Action Compliance Plan of the implementing entity,and that all project subcontractors have an approved
B Affirmative Action Plan.
C Explain:
15. Our company shall solicit bids for subcontracts from minority subcontractors and female subcontractors subject
to availability.
B
C Explain:
cw) 16. Our company shall make every effort to provide after-school,summer,and vacation employment to minority
youths.
B
C Explain:
17. Our company shall continually monitor all personnel activities to insure that the implementing entity's
Affirmative Action Policy for Contractors and vendors is carried out.
B
C Explain:
DATE N TUBE
ffaxr7
TITLE
ACDRD CERTIFICATE OF LIABILITY INBURANCkIID SH I DATE(MMIDDJYY)
IGE-1 12/28/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wasserman & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Insurance Brokers, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
1029 56th Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sacramento CA 95819-3915
Phone: 916-739-0254 Fax:916-733-0622 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Clarendon National Ins. Co.
INSURER S:
NBI General Contractors
415 Tennessee Street #R INSURER C:
P O Box 8580 INSURER D:
Redlands CA 92375
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE 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.
INSRLTR, TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MMIDDIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one tire) $
CLAIMS MADE T OCCUR MED EXP(Any ane person) $
PERSONAL A ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER `# �}{) _ PRODUCTS-COMPIOP AGG S
POLICY JECOT LOC J7 0J1
AUTOMOBILE LIABILITY PlIblic � J COMBINED SINGLE LIMIT(Ea
{Ea accident}
ANY AUTO
ALL OWNED AUTOS P BODILY INJURY
SCHEDULED AUTOS (P- ) _
HIRED AUTOSBODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Peraceident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $ �—
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR T CLAIMS MADE AGGREGATE
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND i TORY LIMITS ER I
A ;EMPLOYERS'LIABILITY 02KR4978198 01/01/99 01/01/00 E.L.EACH ACCIDENT $1,000,000
EA.DISEASE-EA EMPLOYE&$1,000,000
I E.L.DISEASE-POLICY LIMIT I $1 0 0{)1000
OTHER
1 I
DESCRIPTION OF OPERATIONSILOCATIONSIVEHtCLEStEXCLUSIONS ADDED BY ENDORSEMENTiSPECIAL PROVISIONS
*30 Days Notice to Certificate Holder applies except .for Non-Payment of
Premium, which is 10 days. All California. Operations.
CERTIFICATE HOLDER i N I ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION
REDLA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
City of Redlands NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Public Works IMPOSE NO OBLIGATION OR�UTY ANY KIND UPON THE INSURER,ITS AGENTS OR
Attn: Alan Griffiths
35 Cajon St. REPRESENTATIVES.
Redlands CA 92373 AUT14ORIZED REPRESENTS+
"f J
ACORN 25-S(7/97) ACORD CORPORATION 1991
CERT1FCa4TE LSF ��UFANE
1/12/1999
PRODUCER .:::... _......_ THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Andrein.i & Company DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
2737 Campus Drive POLICIES BELOW.
Irvine, CA 92612 COMPANIES AFFORDING COVERAGE
License No. 0208825
.. .......... ..
CowANY
A MT. HAWLEY 'XNSURANCE COMPANY
ETTER
CMPANY 8 Q
_....-- _......-.-.. _. .......... .... ...._.. . _ LETTER
INSUMM
NBI GENERAL CONTRACTOR COWANY C
LETTER
1639 SESSUMS DRIVE
REDLANDS, CA 92374 COMPANY D
LETTER
COwANY E
LETTER
CGVERAGn
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED I AMED 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. _
COR- TYPE OF INSURANCE POLICY NUMBER POLICY DATE (EFFECTIVE POLICE(�TION LIMITS
A GENERAL LIABILITY GENERAL AGGREGATE s 2, 000, 000
%..;COMMERCIAL GENERAL.LvslLm MGLO123110 PRODUCTSCfXMPbP AGG $ 1, 000, 000
CLAIMS MADE g °ccuR. :08/17/97 08/17/98— "AL a ADO. IN xIRY --, 000
OWNER'S&CONTRACTCfM PROT. EACH OCCURRENCE s 1, 000, 000
FIRE DAMAGE(Any one fire) $ 50, 000
.......... ....... MED.EXPENSE(Any one person)$ 1, 000
AUTOMOBILE LABILITY COMBINED SINGLE s
_._ .ANY AUTO
--.........
ALL OWNED AUTOS BODILY INJURY :S
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY =
NON-OWNED AUTOS (Per acc dent)
GARAGE L1ABLtTY
_.... PROPERTY DAMAGE $
EXCESS LABILITY EACH OCCURRENCE $
UMBRELLA FORM 'AGGREGATE s
OTHER THAN UMBP£a.LA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT $
AND ___ _ _...._.. ..............
i)ISEYSE-Rai GY LIMIT $
EMPLOYERS'LIABILITY - .. ... ..
DISEASE-EACH EMPLOYEE $
__.-......_._._ _..........._...--... ....
__. ...-....._.......__....._,._-._._... _ __ _......... .....__...
OTHf t
DESCRIPTION OF OPERAflON&WCA UAL ITBIS
CERTIFICTE HOLDER IS NAMED AS ADDITIONAL INSURED WITH REGARD TO
OPERATIONS PERFORMED BY THE NAMED INSURED'.
RE: COMMUNITY CENTER RENOVATIONS PHASE II - CITY OF REDLANDS
*EXCEPT 10 DAYS FOR NONPAYMENT OF PREMIUM
?z SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAID 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
CITY OF REDLANDS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ATTN: ALAN G"RIFFITHS LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
35 CAJON STREET AUTNOR ATNF
REDLANDS CA 92373
1ECflRD.25.8:(Tlie] 40RD eOtlt ► .#.998
STATE P.U. BOX 420807,SAN FRANCISCO,CA 94142-0807
06MPENSATION
INSURANaE
IU N D. CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
DECEMBER , 1998 2-9`3 UNIT 10013948
POLICY NUMBER: 1-I
=k CERTIFICATE EXPIRES:
CITY OF REDLANDS `
ATTN: PUBLIC WORKS
35 CAJON STREET, STE 22
REDLANDS CA 92373 JOB; REDLANDS COMMUNITY CENTER
RENOVATIONS, PHASE 2
111 WEST LUGONIA
L REDLANDS, CA. 92374
This is to certify that we have issued a valid Workers' 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 ten days'advance written notice to the employer.
We will also give you TEN 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 it 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.
EMPLOYER
ALLSPORT FLOORING, INC.
P.O. BOX 1107
NATIONAL CITY CA 91951 NR
l