HomeMy WebLinkAboutContracts & Agreements_5-2005_CCv0001.pdf AGREEMENT FOR PUBLIC IMPROVEMENT PROJECT
This Agreement is made and entered into this 4`" day of January, 2005, by and betwee
of Redlands, a municipal corporation ("City") and Moore Flooring, Inc. ("Contractor"). n the City
In consideration of the mutual promises contained herein, City and Contractor agree as follows:
ARTICLE 1 - ENGAGEMENT OF CONTRACTOR
1.1 City hereby retains Contractor to install carpeting and/or clean and repair flooring at the A. K.
Smiley Public Library located at 125 W. Vine Street, Redlands, California (the "Services").
1.2 Contractor and its subcontractors shall possess the appropriate State Contractors License
required for the work to be performed as set forth in this Agreement and shall not be debarred
pursuant to California Labor Code sections 1777.1 and 1777.7.
ARTICLE 2 - RESPONSIBILITIES OF CONTRACTOR
2.1 The specific services which Contractor shall perform are more particularly described in Exhibit
"A," which is attached hereto and incorporated herein by this reference.
2.2 Contractor shall comply with all applicable Federal, State and local rules, laws and regulations in
the performance of this Agreement including but not limited
prevailing wage laws to all applicable Labor Code and
commencing at California Labor Code section 1770 et. seq. and non-
discrimination laws including the American's with Disabilities Act. Pursuant to California
Labor Code section 1773.2, copies of the prevailing rates of per diem wages as determined b
the Director of the California Department of Industrial Relations for each craft, classification, or
type of worker needed to execute this agreement are on file at the City of Redlands
Administrative Services Department, Civic Center, 35 Cajon Street, Suite 10 (P.O. Box. 3005
mailing), Redlands California 92373.
2.3 Contractor hereby waives any and all rights Contractor may have pursuant to California Labor
Code sections 1726 and 1781 in the event the Project is deemed a "public work" by an
governmental agency having authority to make such a determination, or by any court of
competent jurisdiction, such that the Project is subject to California Labor Code sections 1720 et
seg. and 1770 et seg. With respect to the foregoing waiver, Contractor further waives any and all
rights it may have pursuant to Civil Code section 1542 which reads "a general release does n
ot
extend to claims which a creditor does not know or suspect to exist in his favor at the time of
executing the release, which if known by his must have materially affected his settlement with
the debtor."
2.4 Contractor further understands that if it violates the California Labor Code as it relates to
prevailing wage, that City shall enforce the California Labor Code by Notice of the withholding
of contract payments to the Contractor or Subcontractor pursuant to Labor Code section 1771.6,
2.5 (:sntractor agrees that if it executes an agreement with a subcontractor to work on this Project,
t.tiat the Contractor shall comply with California Labor Code section 1775 and 1777.7 including
providing the subcontractor with copies of the provisions of Sections 1.771, 1775, 1.776, 1777.5,
1813 and 1.81.5 of the Labor Code. Contractor acknowledges that the statutory provisions for
penalties for failure to comply with state wage and hour laws and to pay prevailing wages will be
enforced by the City pursuant to labor Code sections 1775 and 1.81.3.
2.6 Contractor and any of its Subcontractors shall comply with the provisions of California Labor
Cede section 1776 regarding payroll records maintenance, certifications, retention and
inspection.
2.7 Contactor acknowledges that eight (8) hours constitutes a legal day's work pursuant to Labor
Code section 1810
2.8 Contractor shall comply with the provisions of Labor Code section 1777.5 as to apprenticeships,
and Section 1771, 1775, 1776, 1777.5 1813 and 1815 of the California Labor Code.
2.9 Contractor shall obtain a Labor and Materials Payment Bond pursuant to Civil Code section
3247 and shall execute the Payment Bond form attached hereto as Exhibit "B."
ARTICLE 3 - PERIOD OF SERVICE
3.1 Contractor shall perform the Services in a prompt and diligent manner.
ARTICLE 4 - PAYMENT AND NOTICE
4.1 For the performance of the Services, City will pay Contractor the sum of S 81,595.00.
4.2 Payments by City to Contractor shall be made within 30 days after receipt and approval of
Contractor's hereinabove invoice, by warrant payable to Contractor.
4.3 All notices, bills and payments shall be made in writing and may be given by personal delivery
or by mail. Notices, bills and payments sent by mail should be addressed as follows:
City:
Marjie Pettus
Administrative Services Department
City of Redlands
PO Box 3005
Redlands, CA 92373
Contractor:
Perry Moore, President
Moore Flooring, Inc.
5497 Vine Street
Chino, CA 917 10
When so addressed, such notices shall be deemed given upon deposit in the United States mail;
ir,. all other instances, notices, bills and payments shall be deemed given at the time of actual
delivery, Changes may be made in the names and addresses of the person to who notices, bills
and payments are to be given by giving notice pursuant to this paragraph.
ARTICLE 5 - INSURANCE AND INDEMNIFICATION
Contractor's Insurance to be Primar
5.1 All insurance required by this Agreement is to be maintained by Contractor for the duration of
this Project and shall be primary with respect to City and non-contributing to any insurance or
self-insurance maintained by City. Contractor shall provide City with Certificates of Insurance
and endorsements evidencing such insurance prior to commencement of work,
5.2 Workers' Compensation and Employer's Liability
A. Contractor shall secure and maintain Workers' Compensation and Employer's Liability
insurance for its employees throughout the duration of this Agreement pursuant to'
California Labor Code sections 3700 and 1860 and in an amount which meets the
statutory requirement with an insurance carrier acceptable to City as signed in attached
Exhibit "C." Such insurance shall be primary and non-contributing to any insurance or
self-insurance maintained by City, The insurance policy shall include a provision
prohibiting cancellation of said policy except upon thirty (30) days prior written notice to
Citv. Certificates of Insurance shall be delivered to City prior to commencement of
work.
B. Contractor expressly waives all rights to subrogation against City, its elected officials,
officers and employees for losses arising from work performed by Contractor for City by
expressly waiving Contractor's immunity for injuries to Contractor's employees and
agrees that the obligation to indemnify, defend and hold harmless provided for in this
Agreement extends to any claim, brought by or on behalf of any employee of Contractor.
This waiver is mutually negotiated by the parties. This shall not apply to any damage
resulting from the sole negli�:;ence of City, its agents and employees. To the exte'nt aiiv of
the damages referenced herein were caused by or resulted from the concurrent negligence
of City, its agents or employees, the obligations provided herein to indemnify, defend and
hold harmless are valid and enforceable only to the extent of the negligence of
Contractor, its officers, agents and employees.
Contractor shall sign the Worker's Compensation. Insurance Certification attached as
Exhibit "C"to this Agreement.
5.3 Hold Harmless and Indemnification. Contractor shall indemnify, hold harmless and defend City
and its elected officials, agents, and employees from and against any and all claims, losses or
liability, including attorney's fees, arising from injury or death to persons or damage to property
occasioned by any act, omission or failure of Contractor, its officer, agents and employees in
performing the Services required by this Agreement.
5.4 Assignment. Contractor is expressly prohibited from subletting or assigning any of the Services
descried in this Agreement without the express written consent of City. In the event of mutual
agreement between parties to sublet a portion of the Services, Contractor shall add the
subcontractor as an additional insured and provide City with the insurance endorsements prior to
any work being performed by the subcontractor. Assignment does not include printing or other
customary reimbursable expenses that may be provided in this Agreement.
5.5 Comprehensive General Liability Insurance. Contractor shall secure and maintain in force
throughout the duration of the Agreement comprehensive general liability insurance with carriers
acceptable to City. Minimum coverage of one million dollars (51,000,000) per occurrence and
two million dollars ($2,000,000) aggregate for public liability, property damage and personal
injury is required. City shall be named as an additional insured and the insurance policy shall
inchide a provision prohibiting cancellation of said policy except upon thirty (30) days prior
written notice to City. Such insurance shall be primary and non-contributing to any insurance or
self-insurance maintained by City. Certificates of insurance and endorsements shall be delivered
to City prior to commencement of work.
5.6 Business Auto Liability Insurance. Contractor shall have business auto liability coverage, with
minimum limits of one million ($1,000,000) per occurrence, combined single limit for bodily
injury liability and property damage liability. This coverage shall include all consultant owned
vehicles used on the project, hired and non-owned vehicles, and employee non-ownership
vehicles. City shall be named as an additional insured and a certificate of insurance shall be
delivered to City prior to commencement of work.
ARTICLE h - GENERAL CONSIDERATIONS
6.1 In the event any action is commenced to enforce or interpret any of the terms or conditions of
this Agreement the prevailing party shall, in addition to any costs and other relief, be entitled to
recover its reasonable attorneys' fees.
6.2 Contractor shall not sublet or assign any of the Services to be performed under this Agreement,
except with the prior written approval of City and in strict compliance with the terms, provisions,
and conditions of this Agreement.
6.3 ..11 documents, records, drawings, electronic data Files and data base, photographic prints and
negatives, designs and specifications, cost estimates, and other Project documents developed by
Contractor pursuant to this Agreement shall become the property of City and shall be delivered
to City upon completion of Services.
6.4 Contractor and City agree that Contractor is, for all purposes under this Agreement, an.
inc'ependent contractor with respect to the Services provided pursuant to this Agreement and not
an employee of City. All qualified personnel provided by Contractor pursuant to the provisions
of this Agreement are to be employed by Contractor for its account only, and in no event shall
Contractor or any personnel retained by it be deemed to have been employed by City or engaged
by City for the account of or on behalf of City. Nothing in this Agreement shall be considered to
create the relationship of employer and employee between the parties.
6.5 Unless earlier terminated as stipulated below, this Agreement shall terminate upon completion
and acceptance by City of the Services.
6.6 Upon receipt of a termination notice, Contractor shall (1) promptly discontinue all services and
(2) deliver or otherwise make available to City, copies of any data, design calculations, drawings,
specifications, reports, estimates, summaries, and such other information and materials as may
have been accumulated by Contractor in performing the Services required by this Agreement.
Contractor shall be compensated on a pro-rata basis for any work completed up until notice of
termination.
6.7 This Agreement, including the attachments incorporated herein by reference, represents the
entire agreement and understanding between the parties as to the matters contained herein and
any prior negotiations, proposals or oral agreements are superseded by this Agreement. Any
amendment to this Agreement shall be in writing and approved by the City Council of City and
signed by City and Contractor.
6.8 This Agreement shall be governed by and construed in accordance with the laws of the State of
California.
IN WITNESS WHEREOF, duly authorized representatives of the parties have signed in confirmation of
fh's A�yreeni-nt.
CITY CI~` REDLANDS ATTEST:
ayor Ci jR erk / IU
MOORE FLOORING, INC.
By — Date , E
t
T y 3
Aa
Ileo CSO 04 0?'"4'7p MOOR FLC)RING NC. 809-6?8-2324 P. 1
," ,"","Al1°••,••~� AT1 ENTION:MARGIE PETTUS
!, C� INC.
_ 1 LU# Rte STATE CONTRA(;t t)RS
607 1tINF_STREET,CHINO.CALIFORNIA 91710 LtC.F�SE II4724F,,
OFFICE (919)(j25-511 1 FA)((W9)628-2324
-COST C- levIC U LY THE T!K1�1C-4T PR i S"PEOPLE lLjANy L WF40 L C CJUAME IN�t?f E3LS�iPijTti THE �RASE GN HAS RUNNING
THE BEST S'i O Rt"'t t-3RFAn`t p THINK�GW
ASSUMPTION...
Joll< F A.it $fiAILEY PUSLIC LIBRARY
NAM
DID DATE NOV.1�,1y2GlM
MOORE FLJORING ESTIMATOR ------ -
LUtCGWO LOURENCO
TRADE FLOORING
XXX FURNISHED
XXA INSTALLED
XXk TAXINCLUDED
BID PRICE: $IX,409.00 WITH OiTY ARCNtVES DEPT
ALTERNATE P�Ri -__Iki,59" WITH ARCHIVES DEFT.
NOTES: WE WILL INSTALL J J BROADLOOM CARPET STYLE IMPULSE COLOR#8400 TAKE A TRIP --
IN Ct3>wIPUTER WING,REPFRANCE AREA.LITERACY OFFICES,FRIENDS OF THE LIBRARY
AREA,ARCHIVES AREA,&ADMINISTRATION.WE WILL INSTALL J&J CARPET TILES STYLE
-�
IMPULSE COLOR#8400 TAKE A TRIP IN ADMINISTRATION&FRIENDS OF THE LIBRARY.
WILL 8L INSTALLING J&J{NVI±iIQN CARPET TILES STYLE CROSSING THE LINE CKOR
EAST WEST IN CHILDREONS WING WITH MANNINGTON SHEET VINYL INSTALLED IN ENTRY
SATHROOM,BATHROOM ENTRY,AND SOUTH ENTRANCE.
FURNITURE MQVUNG 19 INCLUDED,
REMOVAL OF EXSISTIING FLOOR IS INCLUDED.
MOORE FLOORING WILL COORDINATE WITH LIBRARY ON AREAS TO RE DONE.
L18RARY IS RESPONSIBLE F{}Fc MdVINCi COiIIPUTER EgUIPINENT&ROOKS FROM SHELVES _
AS SPECIFIED DURING.10$WALK.
ANY MIAJOR UNFORSEEN FLOOR PREP � -
MARBLE POLISHING 13 INCLUDED CONSISTING OF GRINDING,POLISHING,&SEALING,
.... EXHIBIT "A" _ __
"BOND ISSUED IN TWO (2) COUNTERPARTS" BOND#: 557721P
PREMIUM: $881
Exhibit „�„ PREMIUM IS FOR CONTRACT TERM
AND IS SUBJECT TO ADJUSTMENT
PA Ylb EM' BONI) BASED Ott FINAL CONTRACT PRICE
WHEREAS, the City Council of the City of Rcrlimncis, State, of California (horeinafter designated a, "City"), and
MOORS FLOORING, INC. (lteruirtafler designated as "Prirasi pal"' have.
t ) entered into rut agreement whereby
Principal agrees to install and complele certain designated public improvements, which by said rcl;rcement dated * 1
QWUL5,arid identified us Contrtct No. A.K. (2) is hcrcby referred to and nettle to paxt hereof;and
WHEREAS, under the tet'uts of said ngrcoment, Principal is required hcfore entering upon tart. performance of the work, it,
furnish a good trod sul'ficicnt Lrht>r and materials paytttcnt band with the City to Secuie the claims In which rel'crenci_ is mtule
iti Title 15 (commancing with Section 3082)of Part 4 of T)ivision 3 of the Civil Code of the State o!'Califot trio.
NOW,THEREFORE, said Prinripol and the undersigtn:d us corporate surety, are held aril firmly bound unto the City and
all contractors, nuhcrnvractors, laborers, titateriultnen, and nny other persons employed in Ihc, perinrmance of tits uforesuid
agreement and referred rn in (fie uforutiaid Civil Code of the State of Calilonria it) the ~urn of
dollars ($EIGHTY—ONE*(3) ) for materials furnished or labor therron of any kind, or for apnsunts, (lite tinder the
Unemploytttent Insurance Act with respect to Such work or lahnr, that said surety will Puy the same in an amount not
exceeding,the amrrount herein above sat forth, turd also in cast.suit is brought upon this bond, will fray, in addition to the lace
arrtumnt Iherc:of, costs and reasonable expenses; and fees, includipg ieusonablc uttnrnry'S fees, incurred by the City in
successfully enforcing such nbligatinet, Iu k,r,awarded and fixed by the court, and to be taxed as cods alta to be included in
the judgment therein rendered.
h is hurrhy expressly stipulated and agreed that this hand shall inure to the benefit of any imul Al persons, compastit:N and
corpor .lions antitled to file claims under Title: 15 (eurnmenein^ with Section 3092)r,f poet t of Division 3 of the Civil Code,
sn as to give a right of action Ip than or their assigns in any suit brought uprm,Ihis band.
Should the cunditiun of this hontl he, fully performed, then this obligation shall become null and void; ot)tw-wise: it sahall be
anti remain in full force and effect.
The surety hereby stipulates and agrees that no change,extension of tithe,alteration or addidon to the terms of the agNunscnt
or to the work to be performed,hcrcundor nr the specifications accumpanying the same shall in urnosia affect its obligations
on this bund,and it docs hernhy waive notice of any such change,extension of nitre, ;alteration or addition to the terms of the.
ageement or to the work or to the specificatiotls.
rN WITNESS WHEREOF,this insnnrment his been duly executed by[lie principal and sure.ty name!,
r,n DECEMBER 28. 2004 R+05, Bond No,557721P
DEVELOPERS SURETY AND
MOOR . FLOORING, INC. (SEAL) INDEMNITY COMPANY (5'EAL)
Psirtcittih! Surety
Signature Jsy.
_ S itvullu,Y. KENZIE K. THOMPSON,
ATTORNEY—IN—FACT
Address:
FIVE CENTERPOINTE, STE. 530
LAKE OSWEGO, OR 97035
(Matarinl Act nowlad;.n:a,ls ul F tiucitxtl and tiuretY� TClcphetrte_, ( 800 ')223-2451
1�mhpf,rtt':u thtl.,g Ld„aiy LLv"d
*(1)JANUARY 4, 2005
*(2)SMILEY PUBLIC LIBRARY 7
*(3)THOUSAND FIVE HUNDRED NINETY—FIVE AND 00/100 ($81 ,595.00)
a
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
:y� ���„°1-{r�c����Y'.���' �'������'� ",���.c�,�^-C'�-•o�-rr-yrs-,c-�,
State of California
ss. )
County of _ San Bernardino
On �� Wbefore me, Kristine M. . Lund, Notary PubXic
Date Name and Title of Officer(e.g.,'Jane Doe,Notary Pubiicl
personally appeared Ronald J. Moore
Names)of Signer(s)
CXpersonally known to me
❑ proved to me on the basis of satisfactory
evidence
" d6— - - to be the person( whose name(Eh is/aye
I RISlll!�Ni LUND subscribed to the within instrument and
CommUion#1471966 acknowledged to me that he/o/tVq( executed
NokoY RdAc-CW*nio the same in his1V9(rAV91 V authorized
Son"Morcor*cola* capacityVQand that by his/04r/tord
MV Comm.EVkw Mar 24,2008
signature(§) on the instrument the personVy or
the entity upon behalf of which the person(hy
acted, e cute e instrument.
WIT my hand nd official seal.
Signature of Notary Public
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:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual Top of thumb here
❑ Corporate Officer—Title(s):
❑ Partner—❑ Limited ❑General
❑ Attorney-in-Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
0 1599 National Notary Association•9350 De Soto Ave.,P.O-Box 2402•Chatsworth,CA 91313.2402•www-natlonatnotary.org Prod.No.5907 Reorder.Call Toll-Free 1-800-87&6827
1 scgb1CO
f o jMr i
DISCLOSURE RIDER
Terrorism Risk Insurance Act of 2002
The Terrorism Risk Insurance Act of 2002 created a three-year program under which the
Federal Government will share in the payment of covered losses caused by certain events of
international terrorism. The Act requires that we notify you of certain components of the Act, and
the effect, if any, the Act will have on the premium charged for this bond.
Under this program, the Federal Government will cover 90% of the amount of covered
losses caused by certified acts of terrorism, as defined by the Act. The coverage is available only
when aggregate losses resulting from a certified act of terrorism exceed $5,000,000.00. Insurance
carriers must also meet a variable deductible established by the Act. The Act also establishes a
cap of$100 billion for which the Federal Government or an insurer can be responsible.
Participation in the program is mandatory for specified lines of property and casualty
insurance, including surety insurance. The Act does not, however, create coverage in excess of
the amount of the bond, nor does .it provide coverage for any losses that are otherwise excluded
by the terms of the bond, or by operation of law.
No additional premium has been charged for the terrorism coverage required by the Act.
Developers Surety and Indemnity Company
Indemnity Company of California
17780 Fitch,Suite 204
Irvine,CA 92614
(949)263 3300
www.inscoD!co.com
ID-1498(Rev,5/03)
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
State of California
County of S.-n Bernardino
On Decef-ber 28, 2004 before me Raquel L. Soto, Notary Public
Personally appeared Kenzie K. Thompson
[X] personall./ known to me - OR pr-oved to me on the basis of satisfaeteff evidenee
to be the person whose name is subscribed to the within
instrument and acknowledged to me that she executed the
same in her authorized capacity, and that by her signature
on the instrument the person, or the entity upon behalf of
which the person acted, executed the instrument.
L. SOTO
COMM,#1452344 r)
NOTARY PUBLIC-CALIFORNIA 7-"
'AN BERNARDINO COUNTY
WITNESS my hand and official seal.
f-j1Y GOMM EXP,Nov.21,2007
L V LJ--'41 L-'
OPTIONAL
Though the data below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent reattachment
of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
lND1NTlDU'kL
CORPORATE OF-FIGER
Pavment Bond
Title(s) Title or Type of Document
PAR4NERS. LIMITED
GENERAL ----
[X] ATTORNEY-IN-FACT Number of Pages
TRUSTEE(S)
GUARDIAN/GONSERVATOR
OT14ER: December 28. 2004
Date of Document
SIGNER IS REPRESENTING:
Developers Surety and Indemnity Company Moore Flooring, Inc.
Signer(s) other than Named Above
POWER OF ATTORNEY FOR
DEVELOPERS`URETY AND INDEMNITY COMPA Y
INDEMNITY"COMPANY OF CALIFORNIA
P013OX 197-25,IRVINE::,CA 9262' (04912631-1,300
KNOW,ALL MEN BY'THESE PRESENTS, il,E€t cxc-,pt as cxprc�slv hinitod, D `:FLOPERS SURFIN' ND INDEVINI"tY COMPANY and INDE NINIT
COMPANY OF CALIFORNIA,do each.hereby rttakc cclllstitilic rl l 2appolllt:
***Peter M. Davis, Kenzie K. Thompson, Shannon Lopez, Martin M. Davis, George A. DeCristo, Gale Delo,
jointly or severally***
illi their trueand lawful Allot -in-Fact.(O make.@Xt'.0 lite,Cfell\'eI'and acknowledgae,fol'and 011 behalf of said cofport ltions,Cls sureties,bonds,undertakings
iuuf contracts of suretyship Ltiviup and g;rantinP urlto said Attorney(s)-in-Fact full Rower ful d authority to do and to perform every act necessary,requisite or proper
to be done in connection therewith as each of said corporations could do,but reserving to each of said corporations full Power of substitution and revocation.and
all of the=lets of said Attorneys)-in-Fact.Pursuant to these presents.arc hereby ratified and confirmed.
This Power of,Atiorney is granted and is si,:ned by filcsiolile Under and by authority of the following resolutions adopted by the respective Board of Dii-ectot-s of
DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA,effective as of'November 1,1000:
RESOLVED,that the Chairman of the Board.the President and any Vice President cif the corfxxaiion be,and that each of them hereby is,a1-10101-iacd to
execute Powers ofAttorncy,qualifyillg the,ttorney(s't named fit the Power's cif Attttf lay to execute,on bellalfof tlic corporations.bonds,undertakings and contracts
ot'suretyship;and that the Secretary of any Assistant Secretary of the corporations he,and eacll of them hereby is,authnilred to attest the execution of any such
Power of Attorney,
RESOLVED, FURTI IER,that the signiltures of such officers may be,lffixecd to:111y Stich 1'0%wei of Attorney m to any certificate relating tllcieto by
flesinlile,and any such Power of Attorney or certificate hed,11 c such frC>itlIIIC signatares"hall be vailid and hindillg ulxtll the corporation when so affixed and in
life fLlTtni7 with rcspcct to any bond,undertaking or contra t of,ulctyshill To which It is attached.
IN WITNESS WFIERFOF,DEVELOPERS SURETY AND INDEMNITY COMPANY and INt)FVI NI TY COMPANY OF CALIFORNIA have severally caused
these presents to be signed by their respectise EVecttUle Vice President and attested by their reespecti%e Secretary this I st day of October:2003.
By: _ tA NJT O PANYO�
David 11.Rhodes,Executive Vice-President ;`� .3' Pt7R '-, F 's yt a4pDJ7q 0
�a ,. OtZ giro
W=` OCT, .< z OCT.5
--
10 ct m vwt1 1967 DO
a o"
'�`• 1936 =�'`
By: O O1vP 2
Waltei-A-CronW
-cll-4cc€etasu u'T'•' ?Ois LI R
STATE.OF CALIFORNIA }
TSS.
COUNTY OF ORANGE' )
Oil October I,2003,before rile,Diane.1. Klawata,personally appeared David H. Rhodes and Walter A.Crowell,personally known to me(or proved to
rile ort the birsis of satist'2ictory evidence)t0 be the Persons whose rallies are subscribed to the withill instrument find acknowledged to file that they executed the
same in their atithorizcd capacities,and thiit by their signatures oil the instrument the entity upon behalf of which the persons acted,executed the Instrumetlt,
WITNESS my hard and official seal, DIANE J.KAWATA Y
COMM.N 1334746 c
Notary Public - Californias
ORANGE COUNTY
My Comm.Expires JAN.&,2006
CERTIFICATE:
The undcrsigncd,as Senior Lice-Presicfcnit.U€lcdcl-wiiting of DEV EL)PERS SURE::TY ANN)1NDFMNI 'IY COMPANY and INDE_MN'ITY COMPANY
OF CALIFORNIA,Ciera hereby certify t§,a the Fol-e oin Pow , tf'Ano ii c�relit i is ill Full fora and f 1,no been res ked, ft it)ledtl ctr ,that fit--provision,
of the€'e,olutions ofthe res}rectae-e Boards ofDirectors of said tioratoratiolls Set fO th in the 1'ov er ot'Atforncy.are ill force as of the date of this Certiticate.
`" DECEMBER 20(}4
Tl1is Certific,itc is;xecci4ed to€lie Cit}'o;#fruir?c.California,fire 287111 1�iJ{1j�t,f _-- —.-
[IV
Wesley fV Cowling-"chlor Vice-Presider€,Under;vri r n
I D-1390 t Rev. 10"(11"i
Exhibit "C"
WORKERS' COMPENSATION INSURANCE CERTIFICATION
Contract No.
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 em-plovers, 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 §1861).
Date
-/moo
Name of Contract
By:
'nature o uthorized gent
j,14
j
j
J,
Signatory's Title
3
Contractor's License No.
Date