HomeMy WebLinkAboutContracts & Agreements_74-09_CCv0001.pdf MUNICIPAL UTILITIES & ENGINEERING DEPARTMENT
MEMORANDUM
TO: N. Enrique Martinez, City Manager
FROM: Rosemary Hoerning, Director of Municipal Utilities & Engineering A4
DATE: May 18, 2009
SUBJECT: Agreement for Pump Station Airport 1, Well and Pump Rehabilitation
Project
Attached is the City Attorney prepared agreement executed by the contractor for your
approval and signature with South West Pump and Drilling Inc. for Pump Station Airport
1, Well and Pump Rehabilitation Project.
Staff solicited bid from six qualified contractors. Attached is the summary of the bids
received. South West pump was determined to be the lowest responsible / responsive
bidder in the amount of Thirty Five Thousand One Hundred Fifty Five Dollars
($35,155.00)
Staff is requesting approval of this agreement and authorization of a 10% construction
contingency.
After signing, please let me know when it is available for further processing.
Thank you.
RH/pb
Attachment: Agreement for Pump Station Airport 1, Well and Pump Rehabilitation
Project with South West Pump & Drilling Inc
Bid Tabulation
AGREEMENT FOR PUBLIC WORK PROJECT
This agreement for Pump Station Airport 1. Well and Pump Rehabilitation Project
("Agreement") is made and entered into this 12th day of May, 2009 ("Effective Date"), by and between
the City of Redlands, a municipal corporation ("City"), and South West Pump & Drilling Inc.
("Contractor"). City and Contractor are sometimes individually referred to herein as a "Party" and,
together, as the "Parties."
In consideration of the mutual promises contained herein, City and Contractor agree as follows:
ARTICLE I - ENGAGEMENT OF CONTRACTOR
1.1 City hereby retains Contractor to complete Pump Station Airport L, Well and Pump
Rehabilitation Project("Project").
1.2 Contractor and its subcontractors shall possess all appropriate State contractors' licenses required
for the work to be performed in connection with the Project, and shall not be debarred pursuant
to Labor Code sections 1777.1 and 1777.7.
ARTICLE 2 - RESPONSIBILITIES OF CONTRACTOR
2.1 The Project which Contractor shall perform is more particularly described in Exhibit "A," which
is attached hereto and incorporated herein by this reference. Exhibit "A" includes the Scope of
Work.
2.2 Contractor shall comply with all applicable Federal, State and local laws and regulations in the
performance of the Project including, but not limited, to all applicable Labor Code and prevailing
wage laws and non-discrimination laws, including the Americans With Disabilities Act.
Pursuant to Labor Code section 177').2, copies of the prevailing rates of per them wages as
determined by the Director of the California Department of Industrial Relations for each craft,
classification or type of worker needed to undertake the Project are on file at City's Municipal
Utilities and Engineering Department, located at the Civic Center, 35 Cajon Street, Suite 15A
(Mailing: P.O. Box 3005), Redlands, California 92373.
2.3 Contractor acknowledges that if it violates the Labor Code provisions relating to prevailing
wages that City may enforce such provisions by withholding contract payments to Contractor or
its subcontractors pursuant to Labor Code section 1771.6.
2.4 If Contractor executes an agreement with a subcontractor to perform work, on the Project,
Contractor shall comply with Labor Code sections 1775 and 1777.7, and shall provide the
subcontractor with copies of the provisions of Labor Code sections 1771, 1775, 1776, 1777.5,
1813 and 1815. Contractor acknowledges that the statutory provisions establishing penalties for
failure to comply with state wage and hour laws and to pay prevailing wages may be enforced by
City pursuant to Labor Code sections 1775 and 1813.
2,5 Contractor and its subcontractors shall comply with the provisions of Labor Code section 1776
Airport I agreement.doc
regarding payroll records maintenance, certifications, retention and inspection.
2.6 Contractor acknowledges that eight (8) hours constitutes a legal day's work pursuant to Labor
Code section 1810.
2.7 Contractor shall comply with the provisions of Labor Code section 1777.5 as to apprenticeships,
and Labor Code sections 1771, 1775, 1776, 1777.5, 1813 and 1815.
2.8 Contractor shall obtain, execute and deliver to City a Performance Bond and a Labor and
Materials Payment Bond, in the forms attached hereto as Exhibits "B" and"C."
2.9 Pursuant to Public Contract Code section 7104, if the Project involves digging trenches or other
excavations that extend deeper than four feet below the surface, Contractor shall promptly, and
before the following conditions are disturbed, notify City, in writing, of any: (1) material that
Contractor believes may be material that is hazardous waste, as defined in Health and Safety
Code section 25117, that is required to be removed to a Class 1, Class 11 or Class III disposal site
in accordance with provisions of existing law; (2) subsurface or latent physical conditions at the
Project site differing from those indicated by information about the site made available to
Contractor prior to entering into this Agreement; or (3) unknown physical conditions at the site
of any unusual nature, different materially from those ordinarily encountered and generally
recognized as inherent in work of the character provided for in this Agreement. City shall
promptly investigate the conditions and, if it finds that the conditions do materially so differ or
do involve hazardous waste and cause a decrease or increase Contractor's cost of, or the time
required for, performance of any part of the Project, and shall issue a change order under the
procedures described in this Agreement. If a dispute arises between City and Contractor as to
whether the conditions materially differ, involve hazardous waste, or cause a decrease or
increase in Contractor's cost of, or time required for, performance of any part of the Project,
Contractor shall not be excused from any scheduled completion date provided for by this
Agreement, but shall proceed with all work to be performed under this Agreement. Contractor
shall retain any and all rights provided either by this Agreement or by law which pertain to the
resolution of disputes between the Parties.
2.10 Pursuant to Labor Code section 6705, if the Project requires any trench five feet or more in
depth, Contractor shall submit, subject to City's approval, in advance of excavation, a detailed
plan showing the design of shoring, bracing, sloping or other provisions to be made for worker
protection from the hazard of caving ground during the excavation of such trench or trenches. If
the plan varies from the shoring system standards, the plan shall be prepared by a registered civil
or structural engineer.
2.11 Prior to and during any excavation, Contractor shall comply with Government Code section 4216
et seq.
2.12 Because this Agreement was exempt from competitive bidding, prior to commencement of the
Project. Contractor shall provide City with the information otherwise found in Public Contract
Code section 4104.
Airport 1 agreement.doc
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2.13 Pursuant to Public Contract Code section 7103.5(b), Contractor offers and agrees to assign to
City all rights, title and interest in and to all causes of action it may have under section 4 of the
Clayton Act (15 U.S.C. section 15) or under the Cartwright Act (Chapter 2 (commencing with
section 16700) of Part 2 of Division 7 of the Business and Professions Code), arising from
purchases of goods, services or materials pursuant to this Agreement
ARTICLE 3 - PERIOD OF SERVICE
3.1 Contractor shall commence the Project upon City's delivery to Contractor of a written"Notice to
Proceed."
3.2 Contractor shall complete the Project within forty-five (45)calendar days from and after the date of
the Notice to Proceed.
ARTICLE 4 - PAYMENT AND NOTICE
4.1 City shall pay Contractor the sum of Thirty Five Thousand One Hundred Fifty Five Dollars
($35,155.00) as complete compensation for the work Contractor performs on the Project.
4.2 Payments by City to Contractor shall be made within thirty (30) days after City's receipt and
approval of Contractor's invoice, by warrant payable to Contractor.
4.3 All notices shall be made in writing and shall be given by personal delivery or by mail. Notices
sent by mail shall be addressed as follows:
City:
Michael Taylor
Water Distribution Supervisor
City of Redlands
P.O. Box 3005
Redlands, CA 92373
Contractor:
Brian Jeffers
Branch Manager
South West Pump& Drilling Inc.
53-381 Highway 111
Coachella, CA 92236
When so addressed, such notices shall be deemed given upon deposit in the United States mail;
in 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 whom notices are to
be given by giving notice pursuant to this section 4.3.
4.4 Pursuant to Public Contract Code section 22300, Contractor has the option to deposit securities
with an Escrow Agent as a substitute for any monies withheld by City to ensure Contractor's
Airport 1 agreement,doc
performance pursuant to Public Contract Code section 22300.
4.5 Pursuant to Government Code section 421'5, City assumes the responsibility for the timely
removal, relocation or protection of existing main or trunkline utility facilities located on the site
of the Project, if such utilities are not identified by City in the plans and specifications attached
as part of Exhibit "A." City shall compensate Contractor for the costs of locating, repairing
damage not due to the failure of Contractor to exercise reasonable care, and removing or
relocating such utility facilities not indicated in the plans and specifications with reasonable
accuracy and for equipment on the Project necessarily idled during such work. Contractor shall
not be assessed liquidated damages for delay in completion of the Project, when such delay was
caused by the failure of City or the owner of the utility to provide for removal or relocation of
such utility facilities. However, City is not required to indicate the presence of existing service
laterals or appurtenances whenever presence of such utilities on the Project site can be inferred
from the presence of other visible facilities, such as buildings, meter and junction boxes, on or
adjacent to the Project site, provided that City must identify main or trunklines in the plans and
specifications attached as part of Exhibit"A."
ARTICLE 5 - INSURANCE AND INDEMNIFICATION
5.1 Contractor's Insurance to be Primary. All insurance required by this Agreement shall be
maintained by Contractor for the duration of the Project, and shall be primary with respect to
City and non-contributing to any insurance or self-insurance maintained by City.
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 the Project pursuant to Labor
Code sections 3700 and 1860, in an amount which meets statutory requirements, with an
insurance carrier acceptable to City. The insurance policy shall include a provision
prohibiting the policy's modification or cancellation except upon thirty (30) days prior
written notice to City. Contractor shall execute and deliver to City a Worker's
Compensation Insurance Certification in the form attached hereto as Exhibit "D" prior to
commencement of the Project.
B. Contractor expressly waives all rights to subrogation against City and its elected officials,
officers and employees for losses arising from work performed by Contractor on the
Project by expressly waiving Contractor's immunity for injuries to Contractor's
employees. Contractor 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.
5.3 Hold Harmless and Indemnification. Contractor shall indemnify, hold harmless and defend City
and its elected officials, employees and agents from and against any and all claims, losses and
liability, including attorneys' fees, arising from injury or death to persons or damage to property
occasioned by any negligent or intentionally ivTongful act or omission of Contractor, and its
officers, employees and agents, in performing the Project.
Airport 1 agreement.doc
5.4 Assignment. Contractor is expressly prohibited from assigning any of the work associated with
the Project without the express prior written consent of City. In the event of agreement by the
Parties to assign a portion of the Project, Contractor shall add the assignee as an additional
insured to its insurance policies and provide City with the insurance endorsements prior to any
work being performed by the assignee. Assignment does not include printing or other customary
reimbursable expenses that may be provided for in this Agreement.
5.5 Comprehensive General Liability Insurance. Contractor shall secure and maintain in force
throughout the duration of the Project comprehensive general liability insurance, with carriers
acceptable to City, with minimum coverage of One Million Dollars ($1,000,000) per occurrence
and Two Million Dollars ($2,000,000) aggregate for public liability, property damage and
personal injury. City shall be named as an additional insured and the insurance policy shall
include a provision prohibiting its modification or cancellation except upon thirty (30) days prior
written notice to City. A certificate of insurance and endorsements shall be delivered to City
prior to commencement of the Project.
5.6 Business Auto Liability Insurance. Contractor shall secure and maintain in force throughout the
duration of the Project business automobile liability coverage, with minimum limits of One
Million Dollars ($1,000,000) per occurrence, combined single limit for bodily injury liability and
property damage liability. This coverage shall include all Contractor 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 the insurance policy shall include a provision prohibiting its
modification or cancellation except upon thirty (30) days prior written notice to City. A
certificate of insurance and endorsements shall be delivered to City prior to commencement of
the Project.
5.7 Liquidated Damages. Failure of the Contractor to complete the work within the time allowed will
result in damages being sustained by City. Such damages are, and will continue to be, impracticable
and extremely difficult to determine. Contractor shall pay to City, or have withheld from monies
due it, the sum of $500 for each consecutive calendar day in excess of the specified time for
completion of the Project. Execution of this Agreement shall constitute agreement by City and
Contractor that $500 per day is the minimum and actual damage caused by the failure of Contractor
to complete the Project within the allowed time. Such sum represents liquidated damages and shall
not be construed as a penalty, and may be deducted from payments due the Contractor if such delay
occurs.
ARTICLE 6 - 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, including fees for the use of in-house counsel by a Party.
6.2 All 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 for the Project shall become the property of City and shall be delivered to City upon
Airport 1 aggreement.doc
completion of the Project.
6.3 Contractor is, for all purposes under this Agreement, an independent contractor with respect to
the Project and not an employee of City. All personnel employed by Contractor to perform the
Project are 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.
6.4 Unless earlier terminated as provided for below, this Agreement shall terminate upon completion
and acceptance of the Project by City.
6.5 City may terminate this Agreement for any reason, at any time at its sole discretion, upon five (5)
calendar days prior written notice to Contractor.
6.6 Upon receipt of a termination notice, Contractor shall (1) promptly discontinue all work
associated with the Project 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
Project. Contractor shall be compensated on a pro-rata basis for any work completed up until
notice of termination.
6.7 This Agreement, including the exhibits incorporated by reference, represents the entire
agreement and understanding between the Parties as to the matters contained herein and any
prior negotiations, proposals and agreements relating to the subject matter hereof are superseded
by this Agreement. Any amendment to this Agreement shall be in writing and approved by City
and Contractor.
6.8 This Agreement shall be governed by and construed in accordance with the laws of the State of
California.
6.9 Claims by Contractor in the amount of Three Hundred Seventy-Five Thousand Dollars ($375,000)
or less shall be made by Contractor and processed by City pursuant to the provisions of Part 3,
Chapter 1, Article 1.5 of the Public Contract Code (commencing with section 20104). All claims
shall be in writing and include the documents necessary to substantiate the claim.
6.10 If any provision or of this Agreement is held to be void or unenforceable under any law or
regulation, it shall be deemed stricken, and all remaining provisions shall continue to be valid and
binding upon City and Contractor.
Airport 1 agreement.doc
IN WITNESS WHEREOF, duly authorized representatives of the Parties have signed in confirmation of
this Agreement.
CITY ED NDS ATTEST:
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Enri e in z City erk
City anager
SOUTH FEST PUMP & DRILLING INC.
By Date tZ
Brae 4""g= -?QV t`t 6wn-
Airport I agreement.doc
EXHIBIT "A"
Airport I agreement.doc
Bond #2303288
Premium: $387.00
Exhibit "B"
PERFORMANCE BOND
WHEREAS, the City of Redlands (hereinafter designated as "City"), and South West Pump & Drilling Inc.
(hereinafter designated as "Principal") have entered into an Agreement whereby Principal agrees to install and
complete certain designated public improvements, which by said agreement dated May 12, 2009, and identified
Pump Station Airport 1, Well and Pump Rehabilitation Project ("Project") is hereby referred to and made a part
hereof-, and
WHEREAS, under the terms of said agreement, Principal is required, prior to performance of the Project, to
furnish a bond for the faithful performance of said agreement.
NOW, THEREFORE, said Principal and the undersigned as corporate surety, are held and firmly bound unto City
in the penal sum of, Thirty Five Thousand One Hundred Fifty Five Dollars($35,155.00), lawful money of the
United States, 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 its 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, on his or their part,to be kept and perfon-ned at the time and in the manner therein specified, and in all
respects according to their true intent and meaning, and shall indemnify and save harmless City, its officers,
agents and employees,as therein stipulated,then this obligation shall become null and void;otherwise it shall be
and remain in full force and effect.
As a part of the obligation secured hereby and in addition to the face amount specified therefore,there shall be
included costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by City in
successfully enforcing such obligation, all to be taxed as costs and included in any judgment rendered.
The surety hereby stipulates and agrees that no change,extension of time, alteration or addition to the terms of the
agreement or to the work to be performed thereunder or the specifications accompanying the same shall in
anywise affect its obligations on this bond, and it does hereby waive notice of any such 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 May 13, 2009. Bond No. 2303288
(SEAL) (SEAL)
SOUTH WEST P0,4P & DRILLING INC INSURaE MTANY OF THE WEST
for (S
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14 AM-11;Any%00a.—4 BY: (44-40 ignatu or
Ann Wil and (Signature) Attorney—in—Fact
*t CAUA. 1DVX9- Address: 77-564 Country Club Dr. #3401
— Palm Desert, Ca, 92211
(Seal and Notarial Acknowledgment of Surety) Telephone( 760 )3LD--47-0fl—
Airport I agreement
Exhibit"C"
LABOR AND MATERIAL BOND
Whereas, the City of Redlands ("City") and South West Pump &Drilling Inc. (hereinafter designated as
"Principal") have entered into an agreement whereby Principal agrees to install and complete certain (fesignated
public improvements, which said agreement, dated May 12,2009, and identified as Pump Station Airport 1, Well
and Pump Rehabilitation Project("Project")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
Project, to file a good and sufficient payment bond with 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.
Now, therefore, the Principal and the undersigned as corporate surety, are held firmly bound unto City and all
contractors, subcontractors, laborers, material men and other persons employed in the performance of the
aforesaid agreement and referred to in the aforesaid Civil Code in the sum of Thirty Five Thousand One Hundred
Fifty Five Dollars ($35,155.00), 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 reasonable attorneys'
fees, incurred by 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 judgment therein rendered.
It is hereby expressly stipulated and agreed that this bond shall insure to the benefit of any and all persons,
companies and corporations entitled to file claims under Title 15 (commencing with Section 3082) of Part 4 of
Division 3 of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon this
bond.
Should the condition of this bond be fully performed,then this obligation shall become null and void, otherwise it
shall be and remain in full force and effect.
The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of
said agreement or the specifications accompanying the same shall in any manner affect its obligations on this
bond, and it does hereby waive notice of any such change,extension of time, alteration or addition.
In witness whereof, this instrument has been duly executed by the Principal and surety above named, on
May 13, -,--. 2009.
PUN (VSE ) (S EIA L)
C
C
SOUTH WEST P & DRILLING, INSURAXqE COMPANY OF THF' WEST
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BY:
(Signa ure) Ann -QI-kand (Signature) Attorney-.in-Fact
bmnt� Address: 77-564 CountrY Club #B401
Palm Desert, Ca. 92211
(Seal and Notarial Acknowledgment of Surety) Telephone( 760) 360 4700
Airport 1 agreement
No. 00004214
ICW GROUP
Power of Attorney
Insurance Company of the West
Explorer Insurance Company Independence Casualty and Surety Company
KNOW ALL MEN BY THESE PRESENTS: That Insurance Company of the West,a Corporation duly organized under the laws of the State of California, Explorer
Insurance Company,a Corporation duly organized under the laws of the State of California,and Independence Casualty and Surety Company,a Corporation duly organized
under the laws of the State of Texas,(collectively referred to as the"Companies"),do hereby appoint
PAUL W.LEWIS,ANN WILLARD,DIANE M.NIELSEN,VAN G.TANNER
their true and lawful Attomey(s)-in-Fact with authority to date,execute,sign,seal,and deliver on behalf of the Companies,fidelity and surety bonds,undertakings,and other
similar contracts of suretyship,and any related documents.
In witness whereof,the Companies have caused these presents to be executed by its duly authorized officers this Ist day of November,2005.
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#acr4 �� ++�p 1 � � � INSURANCE COMPANY OF THE WEST
j o`saSEAL 1 a EXPLORER INSURANCE COMPANY
+ '4.0 +'� �;i Z� a INDEPENDENCE CASUALTY AND SURETY COMPANY
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Jeffrey D.Sweeney,Assistant Secretary John L.Hannum,Executive Vice President
State of California
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County of San Diego ss.
On June 5,2006 before me,Mary Cobb,Notary Public,personally appeared John L.Hannum and Jeffrey D.Sweeney,personally known to me to be the persons
whose names are subscribed to the within instrument,and acknowledged to me that they executed the same in their authorized capacities,and that by their signatures on the
instrument,the entity upon behalf of which the persons acted,executed the instrument.
Witness my hand and official seal.
"Namocotwry
� ER SQA.
Mary Cobb,Notary Public
RESOLUTIONS
This Power of Attomey is granted and is signed,sealed and notarized with facsimile signatures and seals under authority of the following resolutions adopted by the respective
Boards of Directors of each of the Companies:
"RESOLVED: That the President,an Executive or Senior Vice President of the Company,together with the Secretary or any Assistant Secretary,are
hereby authorized to execute Powers of Attorney appointing the person(s)named as Attomey(s)-in-Fact to date,execute,sign,seal,and deliver on
behalf of the Company,fidelity and surety bonds,undertakings,and other similar contracts of suretyship,and any related documents.
RESOLVED FURTHER: That the signatures of the officers making the appointment,and the signature of any officer certifying the validity and
current status of the appointment,may be facsimile representations of those signatures;and the signature and seal of any notary,and the seal of the
Company,may be facsimile representations of those signatures and seals,and such facsimile representations shall have the same force and effect as if
manually affixed. The facsimile representations referred to herein may be affixed by stamping,printing,typing,or photocopying."
CERTIFICATE
I,the undersigned,Assistant Secretary of Insurance Company of the West,Explorer Insurance Company,and Independence Casualty and Surety Company,do hereby certify
that the foregoing Power of Attorney is in full force and effect,and has not been revoked,and that the above resolutions were duly adopted by the respective Boards of
Directors of the Companies,and are now in full force. lark
a �/
IN WITNESS WHEREOF,I have set my hand this day of �I
Jeffrey D.Sweeney,Assistant Secretary
To verify the authenticity of this Power of Attorney you may call 1-800-877-1111 and ask for the Surety Division. Please refer to the Power of Attomey Number,the above
named individual(s)and details of the bond to which the power is attached. For information or filing claims,please contact Surety Claims,ICW Group, 11455 EI Camino
Real,San Diego,CA 92130-20-45 or call(858)350-2400.
STATE OF CALIFORNIA
COUNTY OF RIVERSIDE
ON 2009 BEFORE ME, LINDA ROCHA, Notary Public
PERSONALLY APPEARED: ANN WILLARD
who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to
the within instrument & acknowledged to me that she executed the same in her authorized capacity,
and that by her signatures on the instrument the person, or the entity upon behalf of which the person
acted, executed the instrument.
I certify under penal of perjury under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS mv hand and official seal. LINDA ROCHA
commission # 1777932 t
Notri Public -California
Riverside County
Signatu�e:
`inda Rocha, Notary
ALL PURPOSE ACKNOWLEDGMENT
Exhibit "D"
WORKERS' COMPENSATION INSURANCE CERTIFICATION
Project: Pump Station Airport 1, Well and Pump Rehabilitation Project
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 Agreement. (Labor Code §1861).
South West Pump &Drilling Inc. Date: N kf-t74
B 2,oe 00
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Contractor's License No.
U"b VWCAUA W-EStbekM
Airport I acyreernent.doc