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Contracts & Agreements_145-2011_CCv0001.pdf
AGREEMENT THIS AGREEMENT, made and entered into this 2rq day of . 3O11. bvand 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 Regency-Pacific Development Corporation of the City of Beaurnont. County of Riverside. State of California, hereinafter referred to as the "Contractor." WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, agree as follows: 1. Scope of Work. The Contractor will furnish all materials and will perform all of the work to perform construction of REDLANDS COMMUNITY CENTER CDBG/NIP GRANT PROJECT, complete, all as shown, specified, and made a part of Prject No. 43003 2. For the Contract Sum of $242,700.00, in accordance with the terms and conditions of the Contract Documents. Pursuant to Section 22300 of the California Public Contract Code, Contractor has the option to deposit securities with an Escrow Agent as a substitute for retention of earnings requirement to be withheld by the City pursuant to and Escrow Agreement. 3. Time for Completion. All work involving the Gymnasium shall be completed within thirty(30)calendar days from and after the date of the Notice to Proceed, The remainder of the work shall be completed within forty- five calendar (45) days from and after the date of the Notice to Proceed. 4. Liquidated Damages. Failure of the Contractor to complete the work within the time allowed will result in damages being sustained by the City. Such damages are, and will continue to be, impracticable and extremely difficult to determine. The Contractor shall pay to the City, or have withheld from monies due it, the sum as set forth in the General Provisions for each consecutive calendar day in excess of the specified time for completion of the work. Execution of the contract shall constitute agreement by the City and Contractor that the liquidated damages amount per day is the minimum and actual damage caused by the failure of the Contractor to complete the work within the allowed time. Such sum is liquidated damages and shall not be construed as a penalty, and may be deducted from payments due the Contractor if such delay occurs. 5. Contract Documents. The complete contract includes all of the contract documents set forth herein,to wit; Notice Inviting Bids, Instructions to Bidders, Proposal and Bid Forms, Bid Bond,Agreement, Performance Bond, Payment Bond, other required documents, Federal Labor Standards Provisions contained in Part II of these Supplemental Specifications, Plans and Opaoifivatimne, all referenced specifications, and any Addenda thereto. 6. Attorney Fees. In the event any legal action is commenced to enforce or interpret the terms or conditions of this contract the prevailing party shall, in addition to any costs and other relief, be entitled to recovery of its reasonable attorney's fees. 7. Defense Obligation. The Contractor shall defend the City, its elected officials, officers, agents, and employees from and against any and all claims, losses, damages, and causes of action, including death, brought by any person or persons for or on account of any wrongful or negligent act or omission of the Contractor, its employees or agents in connection with the performance of the Contractor's obligation under this contract. 8. Insurance. All policies of general liability and business automobile insurance required by this contract shall name the City, its elected officials, employees, and agents as additional insureds. Any insurance required under this contract shall be primary with respect to the City and non-contributing to any insurance or self- insurance maintained by the City. 9. Resolution of Construction Claims. Claims made by the Contractor in the amount of$375,000.00 or less shall be processed by the City pursuant to the provisions of Part 3, Chapter 1, Article 1.5 of the Public Contracts code(commencing with Section 20104). All claims shall be in writing and include the documents necessary to substantiate the claim. Nothing in subdivision (a) of the Public Contracts Code Section 20104.2 shall extend the time limit or supersede the notice requirements provided in this case from filing claims by the Contractor. Pursuant to Public Contract Code section 9201, if the City receives a third party claim in relation to this Contract, the City shall timely notify the Contractor. The City shall be entitled to recover reasonable costs incurred in providing the notification required by Public Contract Code section 9201(b). 10. Eligibility of Contractor/Subcontractor. Contractor and any subcontractor agree to abide by California Public Contract Code Section 6109 and California Labor Code Sections 1777.1 and/or 1777.7 and certify that they are not debarred and are eligible to work on this project. 11. Assignment of Agreement. No assignment by a party hereto of any rights or interests under this agreement will be binding on another party without the written consent of the party sought to be bound. 12. Successors and Assigns. The City and Contractor each binds itself, its partners,successors,assigns and legal representatives in respect to all covenants, agreements and obligations contained in the contract documents. 13. Severability. Any provision or part of the contract documents held to be void or unenforceable under any law or regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon the City and Contractor. 'iferat EtAtfili*o*fiii''6WOffa'F''6ifeialtaiioft6""AW*I* ?"'''4---.edettabor 14. , Sfa'nitla*.--- V6t''''°;M;j41:P:10n''n:AOTQi,jAi-'AtWtio2O*j:<t,nr,a:A:greOtpqnt IN WITNESS WHEREOF,the parties hereto have executed this Agreement in duplicate on the day and year first written above. CITY SEAL p By: Mayor, City of-Redlands County of San Bernardino, California ATTEST: City Clerk, City of Re lands County of San Bernardino, California Jcy /i4c/FYc- batia tr,fimiAr Name of Contractor z/7 CONTRACTOR SEAL By: Signature oflAuthcrirized Agent Yt5siimwr Signatory's Title Signature of Authorized Agent (if necessary) Signatory's Title (if necessary) 5 cSci3C Contractor's License No. WORKERS' COMPENSATION INSURANCE CERTIFICATION REDLANDS COMMUNITY CENTER CDBG/NIP GRANT PROJECT Project No. 43002 Every employer except the 8tate, 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) ByseouhnQfnornthe Director ofIndustrial F|e|aduns. ace�i�cotaofconsent toea|f-|nsuna. either asan ' ' individual employer or as one employer in a group of employers, which may be given upon furnishing proof satisfactory to the Director of Industrial Relations of ability to self-insure and to pay any compensation that may become due to his or her employees. I am aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this contract. (Labor Code Section 1861) gig 6/ / - Date / 1") y — > )�4�*/ c/�/c /~��Jsuaz.oPmfirrT Name of Contractor By: ~/ Signature of Aufflorized Agent �� / '`6s/05/v7 Signatory's Title 5-5 cr3L Contractor's License No. Federal Labor Standards Provisions U.S. Department of Housing and Urban Development Office of Labor Relations 1.Applicability The project or program to which the construction work covered by appropriate), a report of the action taken shall be sent by HUD or this contract pertains is being assisted by the United States of its designee to the Administrator of the Wage and Hour Division, America and the following Federal Labor Standards Provisions are Employment Standards Administration, U.S. Department of Labor, included in this Contract pursuant to the provisions applicable to Washington, D.C. 20210. The Administrator, or an authorized such federal assistance, representative, will approve, modify, or disapprove every additional A. 1. (i) Minimum Wages.AU laborers and mechanics employed or classification action within 30 days of receipt and so advise HUD working upon the site of the work will be paid unconditionally and or its designee or will notify HUD or its designee within the 30-day not less often than once a week,and without subsequent deduction period that additional time is necessary. (Approved by the Office or rebate on any account (except such payroll deductions as are of Management and Budget under OMB control number 1215- permitted by regulations issued by the Secretary of Labor under the 0140.) Copeland Act(29 CFR Part 3),the full amount of wages and bona (c) In the event the Contractor, the laborers or mechanics to be fide fringe benefits (or cash equivalents thereof) due at time of employed In the classification or their representatives,and HUD or payment computed at rates not less than those contained in the its designee do not agree on the proposed classification and wage wage determination of the Secretary of Labor which is attached rate (including the amount designated for fringe benefits, where hereto and made a part hereof, regardless of any contractual appropriate), HUD or its designee shall refer the questions, relationship which may be alleged to exist between the Contractor including the views of all interested parties and the and such laborers and mechanics. Contributions made or costs recommendation of HUD or its designee, to the Administrator for reasonably anticipated for bona fide fringe benefits under Section determination. The Administrator,or an authorized representative, 1(b)(2) of the Davis-Bacon Act on behalf of laborers or mechanics will Issue a determination within 30 days of receipt and so advise are considered wages paid to such laborers or mechanics, subject HUD or its designee or will notify HUD or its designee within the 30- to the provisions of 29 CFR 5.5(a)(1 Xiv);also, regular contributions day period that additional time is necessary. (Approved by the made or costs incurred for more than a weekly period(but not less Office of Management and Budget under OMB Control Number often than quarterly) under plans, funds, or programs, which cover 1215-0140.) the particular weekly period,are deemed to be constructively made (d) The wage rate (including fringe benefits where appropriate) or incurred during such weekly period, determined pursuant to subparagraphs (1) (11)(b) or (c) of this Such laborers and mechanics shall be paid the appropriate wage paragraph, shall be paid to all workers performing work in the rate and fringe benefits on the wage determination for the classification under this contract from the first day on which work is classification of work actually performed, without regard to skill, performed in the classification, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics (iii) Whenever the minimum wage rate prescribed in the contract performing work in more than one classification may be for a class of laborers or mechanics includes a fringe benefit which compensated at the rate specified for each classification for the is not expressed as an hourly rate, the Contractor shall either pay time actually worked therein: Provided that the employer's payroll the benefit as stated in the wage determination or shall pay records accurately set forth the time spent in each classification in another bona fide fringe benefit or an hourly cash equivalent thereof. which work is performed. The wage determination (including any (iv) If the Contractor does not make payments to a trustee or additional classification and wage rates conformed under 29 CFR other third person, the Contractor may consider as part of the 5.5(aX1Xii)and the Davis-Bacon poster(WH-1321) shall be posted wages of any laborer or mechanic the amount of any costs at all times by the Contractor and its Subcontractors at the site of reasonably anticipated in providing bona fide fringe benefits under the work In a prominent and accessible, place where it can be a plan or program, provided,that the Secretary of Labor has found, easily seen by the workers. upon the written request of the Contractor, that the applicable (ii)(a)Any class of laborers or mechanics which is not listed in the standards of the Davis-Bacon Act have been met. The Secretary wage determination and which is to be employed under the of Labor may require the Contractor to set aside in a separate contract shall be classified in conformance with the wage account assets for the meeting of obligations under the plan or determination. HUD shall approve an additional classification and program. (Approved by the Office of Management and Budget wage rate and fringe benefits therefore only when the following under OMB Control Number 1215-0140.) criteria have been met: 2.Withholding. HUD or its designee shall upon its own action or (1) The work to be performed by the classification requested is not upon written request of an authorized representative of the performed by a classification in the wage determination;and Department of Labor withhold or cause to be withheld from the (2) The classification is utilized in the area by the construction Contractor under this contract or any other federal contract with industry;and the same prime Contractor, or any other federally-assisted (3) The proposed wage rate, including any bona fide fringe contract subject to Davis-Bacon prevailing wage requirements, benefits, hears a reasonable relationship to the wage rates which is held by the same prime Contractor so much of the contained in the wage determination. accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees (b) If the Contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and helpers,employed by the Contractor or any Subcontractor the full amount of wages required by the contract. In the event of and HUD or its designee agree on the classification and wage rate failure to pay any laborer or mechanic, including any apprentice, (including the amount designated for fringe benefits where trainee or helper, employed or working on the site of the work,all or part Previous edition is obsolete Page 1 of 4 HUD•4010(07/2003) ref.Handbook 1344.1 Page 4 of 43 of the wages required by the contract, HUD or its designee may, period has been paid the full weekly wages earned,without rebate, after written notice to the Contractor, sponsor, applicant, or owner, either directly or indirectly, and that no deductions have been made take such action as may be necessary to cause the suspension of either directly or indirectly from the full wages earned, other than any further payment, advance, or guarantee of funds until such permissible deductions as set forth in 29 CFR Part 3; violations have ceased. HUD or its designee may, after written (3) That each laborer or mechanic has been paid not less than notice to the Contractor, disburse such amounts withheld for and the applicable wage rates and fringe benefits or cash equivalents on account of the Contractor or Subcontractor to the respective for the classification of work performed, as specified in the employees to whom they are due.The Comptroller General shall applicable wage determination incorporated into the contract. make such disbursements in the case of direct Davis-Bacon Act (c) The weekly submission of a properly executed certification set contracts, forth on the reverse side of Optional Form WH-347 shall satisfy the 3. (I) Payrolls and basic records. Payrolls and basic records requirement for submission of the "Statement of Compliance" relating thereto shall be maintained by the Contractor during the required by subparagraph A.3.(li)(b). course of the work preserved for a period of three years thereafter (d) The falsification of any of the above certifications may subject for all laborers and mechanics working at the site of the work. the Contractor or Subcontractor to civil or criminal prosecution Such records shall contain the name, address, and social security under Section 1001 of Title 18 and Section 231 of Title 31 of the number of each such worker, his or her correct classification, United States Code, hourly rates of wages paid(including rates of contributions or costs (iii) The Contractor or Subcontractor shall make the records anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in Section I (b)(2)(B) of the Davis-bacon required under subparagraph A.3.(i) available for inspection, Act), daily and weekly number of hours worked, deductions made copying, or transcription by authorized representatives of HUD or its designee or the Department of Labor, and shall permit such and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(eel Xiv)that the wages of any laborer or representatives to interview employees during working hours on the job. If the Contractor or Subcontractor fails to submit the mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in Section required records or to make them available, HUD or its designee 1(b)(2)(B) of the Davis-Bacon Act, the Contractor shall maintain may, after written notice to the Contractor, sponsor, applicant or owner, take such action as may be necessary to cause the records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under 4.Apprentices and Trainees approved programs shall maintain written evidence of the (i)Apprentices. Apprentices will be permitted to work at less than registration of apprenticeship programs and certification of trainee the predetermined rate for the work they performed when they are programs,the registration of the apprentices and trainees, and the employed pursuant to and Individually registered In a bona fide ratios and wage rates prescribed in the applicable programs. apprenticeship program registered with the U.S. Department of (Approved by the Office of Management and Budget under OMB Labor, Employment and Training Administration, Office of Control Numbers 1215-0140 and 1215-0017.) Apprenticeship Training, Employer and Labor Services, or with a (ii)(a)The Contractor shall submit weekly for each week in which State Apprenticeship Agency recognized by the Office, or if a any contract work is performed a copy of all payrolls to HUD or its person is employed in his or her first 90 days of probationary designee if the agency is a party to the contract,but if the agency is employment as an apprentice in such an apprenticeship program, not such a party, the Contractor will submit the payrolls to the who is not individually registered in the program,but who has been applicant sponsor,or owner, as the case may be, for transmission certified by the Office of Apprenticeship Training, Employer and to HUD or its designee. The payrolls submitted shall set out Labor Services or a State Apprenticeship Agency (where accurately and completely all of the information required to be appropriate) to be eligible for probationary employment as an maintained under 29 CFR 5.5(a)(3ei), This information may be apprentice. The allowable ratio of apprentices to journeymen on submitted in any form desired.Optional Form WH-347 is available the job site in any craft classification shall not be greater than the for this purpose and may be purchased from the Superintendent ratio permitted to the Contractor as to the entire work force under of Documents (Federal Stock Number 029-005-00014-1), U.S. the registered program. Any worker listed on a payroll at an Government Printing Office, Washington, DC 20402. The prime apprentice wage rate,who is not registered or otherwise employed Contractor is responsible for the submission of copies of payrolls as stated above, shall be paid not less than the applicable wage by all Subcontractors. (Approved by the Office of Management rate on the wage determination for the classification of work and Budget under OMB Control Number 1215-0149.) actually performed. In addition,any apprentice performing work on the job site in excess of the ratio permitted under the registered (b) Each payroll submitted shall be accompanied by a"Statement of Compliance,"signed by the Contractor or Subcontractor or his or program shall be paid not less than the applicable wage rate on her agent who pays or supervises the payment of the persons the wage determination for the work actually performed. Where a Contractor is performing construction on a project in a locality other employed under the contract and shalt certify the following: than that in which its program is registered, the ratios and wage (1) That the payroll for the payroll period contains the information rates (expressed in percentages of the journeyman's hourly rate) required to be maintained under 29 CFR 5,5 (a)(3)(i) and that specified in the Contractor's or Subcontractors registered program such information is correct and complete; shall be observed. Every apprentice must be paid at not less than (2) That each laborer or mechanic (including each helper, the rate specified in the registered program for the apprentice's apprentice, and trainee) employed on the contract during the level of progress,expressed as a percentage of the payroll Previous edition is obsolete Page 2 of 4 form HUD-4010(07/2003) ref.Handbook 1344.1 Page 5 of 43 journeymen hourly rate specified in the applicable wage 7. Contract termination; debarment. A breach of the contract determination. Apprentices shall be paid fringe benefits in clauses in 29 CFR 5.5 may be grounds for termination of the accordance with the provisions of the apprenticeship program. If contract and for debarment as a Contractor and a Subcontractor as the apprenticeship program does not specify fringe benefits, provided in 29 CFR 5.12. apprentices must be paid the full amount of fringe benefits listed on 8.Compliance with Davis-Bacon and Related Act Requirements. the wage determination for the applicable classification. If the All rulings and interpretations of the Davis-Bacon and Related Acts Administrator determines that a different practice prevails for the contained in 29 CFR Parts 1, 3, and 5 are herein incorporated by applicable apprentice classification, fringes shall be paid in reference in this contract accordance with that determination. In the event the Office of 9. Disputes concerning labor standards. Disputes arising out of Apprenticeship Training, Employer and Labor Services, or a State the labor standards provisions of this contract shall not be subject Apprenticeship Agency recognized by the Office, withdraws to the general disputes clause of this contract.Such disputes shall approval of an apprenticeship program, the Contractor will no be resolved in accordance with the procedures of the Department longer be permitted to utilize apprentices at less than the of Labor set forth in 29 CFR Parts 5,6,and 7. Disputes within the applicable predetermined rate for the work performed until an meaning of this clause Include disputes between the Contractor(or acceptable program is approved, any of its Subcontractors) and HUD or its designee, the U.S. (ii) Trainees. Except as provided in 29 CFR 5.16,trainees will not Department of Labor,or the employees or their representatives. be permitted to work at less than the predetermined rate for the 10.(I)Certification of Eligibility. By entering into this contract the work performed unless they are employed pursuant to and Contractor certifies that neither it(nor he or she)nor any person or individually registered in a program which has received prior firm who has an interest in the Contractor's firm is a person or firm approval, evidenced by formal certification by the U.S. Department ineligible to be awarded Government contracts by virtue of Section of Labor, Employment and Training Administration. The ratio of 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1)or to be awarded trainees to journeymen on the job site shall not be greater than HUD contracts or participate in HUD programs pursuant to 24 CFR permitted under the plan approved by the Employment and Part 24, Training Administration. Every trainee must be paid at not less .. (u) No part of this contract shall be subcontracted to any person than the rate specified in the approved program for the trainee's or firm ineligible for award of a Government contract by virtue of level of progress, expressed as a percentage of the journeyman Section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1)or to be hourly rate specified in the applicable wage determination.Trainees awarded HUD contracts or participate in HUD programs pursuant shall be paid fringe benefits in accordance with the provisions of to 24 CFR Part 24. the trainee program.If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits (iii) The penalty for making false statements is prescribed in the listed on the wage determination unless the Administrator of the U.S. Criminal Code, 18 U.S.C. 1001. Additionally, U.S. Criminal Wage and Hour Division determines that there is an apprenticeship Code, Section 1 01 0, Title 18, U.S.C., "Federal Housing program associated with the corresponding journeyman wage rate Administration Transactions", provides in part: 'Whoever, for the on the wage determination which provides for less than full fringe purpose of influencing in any way the action of such Administration benefits for apprentices. Any employee listed on the payroll at a makes, utters or publishes any statement knowing the same to he trainee rate, who is not registered and participating in a training false shall be fined not more than $5,000 or imprisoned not more plan approved by the Employment and Training Administration, than two years,or both." shall be paid not less than the applicable wage rate on the wage 11. Complaints, Proceedings, or Testimony by Employees. No determination for the work actually performed. In addition, any laborer or mechanic to whom the wage, salary, or other labor trainee performing work on the job site in excess of the ratio standards provisions of this Contract are applicable shall be permitted under the registered program shall be paid not less than discharged or in any other manner discriminated against by the the applicable wage rate on the wage determination for the work Contractor or any Subcontractor because such employee has filed actually performed. In the event the Employment and Training any complaint or instituted or caused to be instituted any Administration withdraws approval of a training program, the proceeding or has testified or is about to testify in any proceeding Contractor will no longer be permitted to utilize trainees at less under or relating to the labor standards applicable under this than the applicable predetermined rate for the work performed until Contract to his employer. an acceptable program is approved, (iii) Equal employment opportunity. The utilization of B. Contract Work Hours and Safety Standards Act. The apprentices, trainees and journeymen under 29 CFR Part 5 shall provisions of this paragraph B are applicable only where the be in conformity with the equal employment opportunity amount of the prime contract exceeds $100,000. As used in this requirements of Executive Order 11246, as amended, and 29 CFR paragraph,the terms"laborers"and"mechanics"include watchmen Part 30. and guards, 5. Compliance with Copeland Act requirements. The (1) Overtime requirements. No Contractor or Subcontractor Contractor shall comply with the requirements of 29 CFR Part 3 contracting for any part of the contract work which may require or which are incorporated by reference in this contract. involve the employment of laborers or mechanics shall require or 6. Subcontracts. The Contractor or Subcontractor will insert in permit any such laborer or mechanic in any workweek in which he any subcontracts the clauses contained in subparagraphs 1 or she is employed on such work to work in excess of 40 hours in through 11 of this paragraph A and such other clauses as HUD or such workweek unless such laborer or mechanic receives its designee may by appropriate instructions require, and a copy of compensation at a rate not less than one and one-half times the the applicable prevaNing wage decision, and also a clause basic rate of pay for all hours worked in excess of 40 hours in such requiring the Subcontractors tri include these clauses in any lower workweek, tier subcontracts. The prime Contractor shall be responsible for (2) Violation; liability for unpaid wages; liquidated damages. the compliance by any Subcontractor or lower tier Subcontractor In the event of any violation of the clause set forth in subpara- with all the contract clauses in this paragraph, graph(1)of this paragraph,the Contractor and any form HUD-4010(07t2003) Previous edition ts obsolete ref.Handbook 1344,1 3 of 4 Page 6 of 43 Subcontractor responsible therefore shall be liable for the unpaid (4) Subcontracts. The Contractor or Subcontractor shall Insert wages. In addition, such Contractor and Subcontractor shall be in any subcontracts the clauses set forth in subparagraph (1) liable to the United States(In the case of work done under contract through (4) of this paragraph and also a clause requiring the for the District of Columbia or a territory,to such District or to such Subcontractors to include these clauses in any lower tier territory), for liquidated damages. Such liquidated damages shall subcontracts, The prime Contractor shall be responsible for be computed with respect to each individual laborer or mechanic, compliance by any Subcontractor or lower tier Subcontractor with including watchmen and guards, employed in violation of the the clauses set forth in subparagraphs (1) through (4) of this clause set forth in subparagraph(1) of this paragraph, in the sum paragraph, of$10 for each calendar day on which such individual was required C. Health and Safety. The provisions of this paragraph C are or permitted to work In excess of the standard workweek of 40 hours applicable only where the amount of the prime contract exceeds without payment of the overtime wages required by the clause set $100,000. forth in sub paragraph(1)of this paragraph. (1) No laborer or mechanic shall be required to work in (3) Withholding for unpaid wages and liquidated damages. surroundings or under working conditions which are unsanitary, HUD or its designee shall upon its own action or upon written hazardous, or dangerous to his health and safety as determined request of an authorized representative of the Department of Labor under construction safety and health standards promulgated by withhold or cause to be withheld, from any moneys payable on the Secretary of Labor by regulation. account of work performed by the Contractor or Subcontractor (2) The Contractor shall comply with all regulations issued by under any such contract or any other federal contract with the the Secretary of Labor pursuant to Title 29 Part 1926 and failure same prime contract, or any other federally-assisted contract to comply may result in imposition of sanctions pursuant to the subject to the Contract Work Hours and Safety Standards Act Contract Work Hours and Safety Standards Act,40 USC 3701 et which Is held by the same prime Contractor such sums as may be se determined to be necessary to satisfy any liabilities of such (3) The Contractor shall include the provisions of this paragraph Contractor or Subcontractor for unpaid wages and liquidated in every subcontract so that such provisions will be binding on damages as provided in the clause set forth in subparagraph (2)of each Subcontractor. The Contractor shall take such action with this paragraph, respect to any subcontract as the Secretary of Housing and Urban Development or the Secretary of Labor shall direct as a means of enforcing such provisions. Previous edition is obsolete form HUD-4010(07/2003) ref.Handbook 1344.1 4 of 4 Page 7 of 43 CONTRACTOR'S CERTIFICATION OF COMPLIANCE WITH DAVIS-BACON AND RELATED ACTS REQUIREMENTS |. L)aifi,4cy- /~/Jc//=/c_ CA-V,' . asPrime Contractor for Project: U�oLAN oS CmN`uw'rY C-4 Ai TEIL C..DB G7 /el (d? T Pg03oc�1" */o. 143coz hereby make the following certification and acknowledgment with respect to the applicability of Davis-Bacon and Related Acts Requirements: 1) By entering into this Contract, | 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 donoificatione, 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 deoioiono, 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. IF THE COMPANY IS A CORPORATION, CORPORATE OFFICERS ARE AS FOLLOWS: [_s0 President Vice-President /izL/cY K,wis^xfik, Secretary/Treasurer ~' __ Signature', PriytuContnantor g5»/()INT Title(Owner or President) Sr- �/ Date 7 / Page oofm ' . SAN BERNARDINO COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ANO HOUSING MINORITY AND WOMEN OWNED BUSINESS ENTERPRISE PARTICIPATION This form is designed to assist the County of San Bernardino in assessing and reporting the proposition and amounts of contracts and subcontracts awarded to Minority and Women Owned Business Enterprises (WMBE'S)for the project named below. Include information on all Subcontractors and suppliers if the total bid amount exceeds$10,000. 'Minority owned or controlled" means that 51% or more of the company's ownership or controlled interest In the company Is held by one or more Black Americans, Native Americans (Including American Indians, Eskimos, Aleuts, and Native Hawaiians), Hispanic Americans, or Asian/Pacific Americans (including persons whose origins are from Japan, China,the Philippines,Vietnam, Korea, Samoa, Guam,the United States Trust Terrttoriee of the Pacific, Northern Marianas, Laos, Cambodia and Taiwan), or any other group of natural persons Identified as minorities In the project specifications by the County. `Female owned or controlled'means that 51%or more of the company's ownership or controlled interest in the company Is held by one or more female persons. PROJECT Redlands Community Center 43002 Project Name Project Number $ 2 in 1700 Federally funded or assisted? ❑Yes ❑No Total Bid Amount CONTRACTOR Regency-Pacific Development Corp. 1440 Beaumont Avenue, STE A2-300 Contractor's Name Address 33-0261128 Beaumont CA 92223 Federal I.D.Number City State Zip Code $ 2.q2/700 Minority owned/controlled? ❑Yes ❑No If so,what Minority? Portion of Bid Amount to be Female ownedkanlroted? ❑Yes ❑No performed by Contractor SUBCONTRACTORS 1) Hur Flooring Co. 8930 Independence Avenue Subcontractor's Name Address 95-4579306 Canoga Park, CA 91304 Federal 1.0.Number City State Zip Code $ 101,680.00 Minority owned/controlled? ❑Yes ®No Subcontract Bid Amount If so,what Minority? Female owned/controHed? ❑Yes 2 No 2) • Subcontractor's Name Address Federal 10.Number City Slate Zip Code $ Minority owned/controlled? ❑Yes ❑No Subcontract Bid Amount It so,what Minority? Female owned/controlled? ❑Yes D No I or 2 Pap 9 of 43 09/26/2011 09:59 9516007294 GALLANT:LAMTECH PAGE 02/02 sAN BENitAttuNO cOlAITY OF:PAarmENT OF COMAILINtTY DEVELOpmENT AND HOLISM MINORITY AND WOMEN OWNED BUSINESS ENTERPRISE l'ARTICEPATION This form is designed to assist the County of San Bernardino in assessing and reporting the proposition and amounts of contracts and subcontracts awarded to Minority and Women Owned Business Enterprises (WMBE'S)for the project named below. Include Information on all Subcontractors and suppliers If the total bid amount exceeds S10,000. 'Minority owned or controlled` means that 51% or more of the company's ownership or controlled interest in the company is held by one or more Black Americans, Native Americans (Including American Indians, Eskimos, Aleuts, and Native Hawaiians), Hispanic Americans, or Asian/Pacific Americans (including persons whose origins are from Japan, China,the Philippines,Vietnam, Korea, Samoa, Guam,the United States Trust Territories of the Pacific, Northern Marianas, Laos, Cambodia and Taiwan), or any other group of naturat persons identified as minorities In the project speoifications by the County. Tamale owned or cOntrolleor meant!that 51%or more of the company's ownership or controlled interest in the company Is held by one or more female persons, PROJECT Redlands Community Center 43002 Project Name Project Number s 2. 00 Federally funded or assisted? 0 Yes No Total Bid Amount COUIWCOM Regency-Pacific Development Corp, 1440 Beaumont Avenue, STE A2-300 Contractor's Name Address 33-0281126 Beaumont CA 92223 Federal 1.0.Number City Slate Zip Code $ 9-10.700 Minority owned/corrtrolled? 0 Yes El<te tt SO,what Minority? Portion of Bid Amount to be Female waled/controlled? rj-Yes rif6N0 performed by Contractor SURCONTRACTORS 1) Lam-tech Corp. 45630 La Cruz Drive, Temecula, Ca. Subcontractor's Name Address 8 8-4 3 9 0 3 4 1 Temecula, Ca. 92590 Federal W.Number City State Zip Code $ $16, 145. 00 Minority awned/controtted7 Et[Yes DNa Subcontract Bid Amount If so,wtiat Minority? Native American Female owned/controlled? Q Yes LI No • 2) Subcontractor's Name Address redorsild,Number City State Zip Code Minortty ownedicontrorted? 0 Yes U No Subcontract Bid Amount If so,what Minority? Female owned/controtied? I Yes No 102 P11(000141 CERTIFICATION OF BIDDER REGARDING EQUAL EMPLOYMENT OPPORTUNITY Project Name: 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 Rt115/.1 - JA c(P ! vEt-oPMENT Address&Zip Code III qC 3;AomoNi-r- A #A2 aD 1- 6.Atim 0,4 r CA ° 2223 1. Bidder has on-file an affirmative action program pursuant to Part 60-2 (applies to non-construction contracts). Yesfl No 2. Bidder has participated in a previous contract or subcontract subject to the Equal Opportunity Clause. Yes 3 No 0 (If g)swer is yes, identify the most recent contract.) C DUN-7'1 OF v 612.51 brf EDA (If answer is no, Contractor may be required to submit an EEO-1 survey or other reports to the Equal Employment Opportunity Commission, contact the EEOC at 800- 669-4000 or inquire online at http://www.eeoc.00vleeolsurvey/index.html. 3. Compliance reports were filed in connection with such contract or subcontract with the Joint Reporting Committee,the Deputy Assistant Secretary or the Equal Employment Opportunity Commission. Yes 0 No El None required Certification:The information above is true and complete to the best of my knowledge and belief. LE 0. Th Kg 642 Name and Title of Signer(Please Type) / 4101( I 1 Signature , I Date ' Page 11 of 43 CERTIFICATION BY PROPOSED SUBCONTRACTOR REGARDING EQUAL EMPLOYMENT OPPORTUNITY Name of Prime Contractor: Regency-Pacific Development Corp. Froect Name: Redlands Community Center INSTRUCTIONS This certification Is required pursuant to Executive Order 11246 (30 F.R. 12319-25), The implementing rules and n ulations provide that any bidder or prospective Contractor, Cr 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 Subcontractor has not filed a compliance report due under applicable instructions, such Subcontractor shalt be required to submit a compliance report before the owner approves the subcontract or permits wort to begin under the subcontract. SUBCONTRACTOR'S CERTFIGATI�N��_. �._ Subcontractor's Name: Hur Flooring Co. Address Zip Code: 8930 Independence Avenue, Canoga Park, CA 91304 1, Bidder has on-file an affirmative action program pursuant to Part 60-2(applies to non-construction contracts). Yes [J No 2. Bidder has participated In a previous contract or subcontract sub;act to the Equal Cper ,;;nit}Clause, Y.e ki NI [ ,` s2nswer is yes,identify the most recent contract.) w/�t{{rrii�� 5 uiu (If answer is no, Contractor may be required to submit an EEO4 survey or other reports to the Equal Employment opportunity Commission, contact the EEOC at 800- 66P-400,0 or inquire online at ltIt./,a'vrv,e oc.'©ta`e-cls.Jrve;/t dcx.hlml. 3. Compliance reports were Yen in connection e th such contract cr subcontract yiith the Joint Reporting Committee,the Deputy Assistant Secretary or the Equal Employment Opportunity Commission. Yes LI No U None requited$j Certfwetoi7 The information above is true and complete to the Nest of my knevrlecke and belief. Michael Hur, Owner Nemo and Title of Signer(Pie©sc Type) 9/26/2011 a natrr0 Dale NO FE- Ti-r1.3 FORM MUST BE FILLED OU#BY EACH OF THE EIODER'S SUaCO TR c i-oRs. Page 12 of 43 09/26/2011 09:59 9516007294 GALLANT:LAMTECH PAGE 01/02 CERTIFICATION BY PROPOSED SUBCONTRACTOR REGARDING EQUAL EMPLOYMENT OPPORTUNITY Name or pane contractor Regency-Pacific Development Corp. project Nam: Redlands, Community Center 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 Subcontractor has not filed a compliance report due under applicable instructions, such Subcontractor shall be required to submit a compliance report before the owner approves the subcontract or permits work to begin under the subcontract. SUBCONTRACTORS CERTIFICATION Lam—tech Corporation subcontrictaea Name: Address a Zp Code; 4 5 6 3 0 La Cruz Drive, Temecula, Ca. 92590 1. Bidder has on-fife an affirmative action program pursuant to Part ao4(applies ta trea-coaskuctiort contracts), Yea4 No Ej 2, Bidder has participated in a previous contract or subcontract subject to the Equal opportunity Clause. Yes 4 No Or of gn,swer yes, entify the most recent contract.) Indio LI School Or answer Is no, Contractor may be required to submit an EEO-1 survey or other reports to the Equal Employment Opportunity Commission, contact the EEOC at 500- MB-4000 or LnquIne online at httbV/wwweeoo.boffeeolsuneeditxtex.Nml. 3. Compliance reports were flied In connection with such contract or subcontract with the Joint Reporting Committee,the Deputy Assistant Secretary or the Equal Employment Opportunity Commission. Yes iI No U None required C] Certification: The information above 14 true and complete to the best of my knowledge and belief. Tim Gallant President Name and Title of= - (Reese Type) : -.°11.11111117,1 Sept 26, 2011 41.11r4 Date f, . NOTE- rills FORM MUST aE FitLED our/NEAGH OP TI-M alopER's SOCCNITRACTORS. Page 12 or 43 EXECUTED IN TRIPLICATE BOND NO. 2142730 PREMIUM: $4,641.00 Premium le For contract Term PERFORMANCE BOND And Is Subject To Aust ent Based On Final Contract Price WH thecil of the City of Redlands, State of California(hereinafter designated as"City"), and MENf ORPORATION (hereinafter designated as"Principal")have entered into an agreement whereby Princi al agrees to install and complete certain designated public improvements,which g by said agreement dated ' ,12011,and identified as Contract No, 43002,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, sai iq o _ i apd �g rporate surety, are held and firmly bound i unto the City in the sum of AF,I\ Eb 1iO Y .S ($2.42,700k0o) for the payment of which sum well and truly to be made, we bind ourselves, our heirs, successors, executors and administrators,jointly and severally,firmly by these presents. The condition of this obligation is such that if the above bounded Principal, his or her heirs, executors, administrators,successors or assigns,shall in all things stand to and abide by,and well and truly keep and perform the covenants,conditions, and provisions in the said agreement and any alteration thereof made as CALIFORNIA o es ° OPTIONAL SECTION a z CAPACITY CLAIMED BY SIGNER SAN DIEGO I Though statue does not require thee ar y tc ;{ z ft{ in the data Wow. U-o,na so met) prove invaluable to persons ving on he document. 9127/2011 DEBORAH D. DAVIS, NOTARY PUBLIC D INDIVIDUAL On __... before ate, 41 0 CORPORATE OFFICERS) person Ii7 appeared 4. 11_._ 4, _ *• . pl TITLESo t>n me on the basis of satisfactory evi nne to person(s)w whose name(s) € ?' reP RTN Rt5 1t SO tit subscribed to the within instrument and acknowledged r"1.1GENERAL fli to me thathe sihe/the` executed the same in hicry � ATTORNEY-IN-FACT their authorized aoa h t eat, and to t tt hid/her/their sign€ntur ,5)on theinstrument thepersona) or the entity 0 TRUSTEE(S) upon behalf of which the person(s) acted, executed the 0 Su RD N/CONS P A CH yy } {yry� rq y£` t¥ strume'nt, OTHER: J" DEBORAH DAVIS b; :�v'rt i°y �t§€tet r Prold LI ..i5 1'�L,.Y1JU7 under t$€v Ib"F Y��+ 'v'lii i, w i t ROTARY PUBUC-CAUFORNin r the State of Canto nia that the foregoingparagraph i __�,� SA DIE COUNTY 3 true and deftest c 1,,1\--kV,---54,v M Gomm raa APRIL2i,?Ohh , SIGNER ISP ESENTI G t s � 'r PI SS my Via: and official tt ai, c NAME r.ENSO�tr >CR.Orr 7 "tic tj Yi mOFMEfriff RTi h # MUST BE A IAC E t `r LE �Et" a DESCRiBED ATRIGHT: _ '-_. _ NUMBER FPAGr DATE FDOCUMENT 4 e u Y .de requested h-we is no r ,mo p a et a ash Deco frauule reattac n,e o Ibis yhn:. S. NIEE( , CO En THAN NAMED mBO` M .crag a 4 CD-5 • • EXECUTED IN TRIPLICATE BOND NO. 2142730 PREMIUM: $4,641.00 Premium is For Contract Term PERFORMANCE BOND And is Subject To Adjustment Based On Final Contract Price WH �x .0,; Cj cp pcii of the City of Redlands,State of California(hereinaftedesignated as"City"), r and MEN r�� RATION (hereinafter designated as"Principal")have entered into an agreement whereby Princi alas to install and complete certain designated public improvements,which by said agreement dated T ER2O11,and identified as Contract No. 43002, 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, sal it �t d a II.. �• = ig� ••rate surety, are held and firmly bound , ,V unto the City in the sum of F I.E, Id is I/. • ($242,700.00) 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, executors, administrators,successors or assigns,shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions, and provisions in the said agreement and any alteration thereof made as therein provided, or his or her part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their true intent and meaning, and shall defend, indemnify and save harmless the City, its elected officials,officers,agents,and employees,as therein stipulated,then this ie obligation shall become null and void; otherwise it shall be and remain in full force and effect. As a part of the obligation secured hereby and in addition the face 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 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 SEPTEMRFR 27 , 2011. Bond No. 2142730 REGENCY — PACIFIC NORTH AMERICAN SPECIALTY DEVELOPMENT CORPORATION (SEAL) INSURANCE COMPANY (SEAL) Principal Surety �/f_ / By: " p By: /"(4141 0 . Signature Signature MARK p,. IATAROLA, ATTORNEY--IN-FACT Address:701 SOUTH PARKER STREET, SUITE 3800 ORANGE, CA 92868 (Notarial Acknowledgments of Principal arid Surety) Telephone: ( 714 ) 550-7799 CD-5 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: JOHN G.MALONEY,HELEN MALONEY, MARK D.IATAROLA and DEBORAH D.DAVIS JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact,to make,execute,seal and deliver, for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION($50,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 241h of March,2000: -RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." 01 By OP liONAZ *4<fe • SEAL lc). siewea P.Anderson,President&Chief Executive Officer of Washington International Insurance Company fi SEAL°A 1573 wigs?... &Senior Vice President of North American Specialty insurance Company or V.,!-?!•„ ° . . "N*014 By David Ni.Layman,Senior Vice President of Washington International Insurance Company &Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 15th day of September ,201 1 North American Specialty Insurance Company Washington International Insurance Company State of Illinois ss: County of Cook On this l5th day of September ,20 11 ,before me,a Notary Public personally appeared Steven P.Anderson ,President and CEO of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman. Senior Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies, OFFICIAL SEAL D JILL NELSON NOTARY PUBLIC',STATE OF ILLINOIS D.lit(Nelson,Notary Public Ire COMMON EXPRESZAW12 I, James A.Carpenter , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. 11 IN WITNESS WHEREOF,[have set my hand and affixed the seals of the Companies this2 7THday of SEPTEMBER •20 dab , )4-76 lames A Carpenter,Vice President&Assistant Secretary of Wnhington International Imerance Company& North Amerman Specialty insurance Company CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Ri ( `1 , at On J� fc::2- D i f before me, (34.1-o i..-j . Dtl ' e i&and t: /41,' Cate Here Insert Warne of Ire personally appeared i / A a Names)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person whose name )ie subscribed to the i w�tth�hiin�� instru ent and acknowledged to me that 0sh y executed the same i i erittier authorized capacity(Les), and that b er, etr signature on the CAROL.J.JONES instrument the person, or the entity upon behalf of i. . NOT A#�488�ORNiA which the person( acted, executed the instrument. .i SAN LINO COUNTY = fly Cormmxpres JUNE 7,2013 I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS y d and of" s:141. / Signat a +A!I� Place Notary seal Above •' -� ublIc OPTIONAL V 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: – `POT' • a. Document Date: 5 -+p4' „9.:2 c . 0 / Number of Pages: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Individual 0 Individual ❑ Corporate Officer—Titie(s): 0 Corporate Officer—Title(s): ❑ Partner---❑ Limited ❑ General AicHrz++ur.Ts>�iriT 0 Partner--❑ Limited 0 General R;ci LTTHUi BFfZr,T ❑ Attorney In Fact ❑FsrcrrER 0 Attorney in Fact CFsiGrlaR ❑ Trustee Top of thumb here ❑Trustee Top of thumb here ❑ Guardian or Conservator 0 Guardian or Conservator ❑ Other: 0 Other: Signer Is Representing: Signer Is Representing: �'N.tlV.Y'^�/Y• }`f�QT`F��t- .HVSW/:H•.N, •-'w.e•.N;.H-re• L• •lis er•Y-Pp.•Y'rer'-� '�H.Jaw, H '� SYG�Vs�Gv Ct2007National Notary Assec/anon•2350 Be Soto AVG.,PO,Box 2402•Chatsworth,CA 91313-2402•www.NettonelNotaryorg Item f5907 Reorder:Ca3Tot-Free 14W-876-S827 EXECUTED IN TRIPLICATE t BOND NO. 2142730 PREMIUM LNCLUDED IN PERFORMANCE EO?rI) LABOR AND MATERIALS BOND WHE7 a C' • cit of the City of Redlands, State of California(hereinafter designated as"City"), and a MEN D• •,RATION (hereinafter designated as"Principal")have entered into an agreement whereby Prin RIN tes to install and complete certain designated public improvements,which by said agreement dat • , , 2011, and identified as Contract No. 43002, 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 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 qse ' Nmcgrt.a Or V #A it foresail Civil Code of the State of California in the sum of NTINT)RFT) ANT) N071 OR DOLLARS (2t42.700.00) 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 herein above 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 attomey's fees, CALIFORNIAPo 512V € State of q. California `yap.` ,.' .''..._. V 3 ira?.�.e tT o ) SECTION ii a, CAPACITY CLAIMED BY SIGNER C u d SAN DIEGO" ') Though ugh statute rices of require the=9ct.:;to,, rit in the data below, doing may tY prove J i, � -a.uabl torso.s e ging on the occur document, A On 9/27/2011 before; e, DEBORAH D. DAMS NOTARY PUBLIC 0INDIVIDUAL 9 personally appeared MARKDIATAROLACORPORATEOM i (Stam who proved to r e n the basis f satisfactory e i nc . bethe personwhose nay nae(s) i ,' r T _-- F "AR NRSs I ," IT�I subscribed to the within instrument and acknowledged El GENERAL to me that he/she/They executer! the same in his/her! their authorized ca acitvtiesl andthat by hi -ler/their ATTORNL iN t E signature(s)on the instrument the personK or the entity 9 TRUSTEE(S) ~ upon behalf of aamint the person(s) acted, executed the 9 GUARD AN,CJ"S RV TC , -e. .'= ::��., _ ;,,, ._,...�—...tw_.. instrum t OT _ TI 4 N . DEBORAH DDAVISrk ` l 1 Nems y rider PENALTY C: PERJURYunder the lags of E4 ,x--f- ;, COMM.4 41929973 ;11 'I tt/ -, u IC CA#FCSvo V tis Rtat llf`a'n i tilaE rue ;c1 egcar= r te?f is N \-,,t-m37,- M>rzmm Etr APRlr21 2015 a> rue,a d correct SIGNER IS WITNESS my handand al sea, ------ : 1 Signature of Notary O i OPTIONAL SECTION 3 ,c THIS CERTIFICATE MUST BE AI IACHEDT OR TYPF NO Doss WENT Y IA THE JC",SIE=1T DESCRIBED AT RIGHT VI NUMBER OE PAGEs NATE As DOC/Ms-NT A Xi T. Though the data requested Rere is not required by P> could preventfraudulent raartachment of this form_ S€ 7 NAMED ABOVE CD-6 EXECUTED IN TRIPLICATE BOND NO. 2142730 PREMIUM INCLUDED IN PERFORIVLINCE SO ND LABOR AND MATERIALS BOND WHE a C` • cil of the City of Redlands,State of California(hereinafter designated as"City"), and V2� MENt s (RATION (hereinafter designated as"Principal")have entered into an agreement whereby Pep ' sSea to install and complete certain designated public improvements,which by said agreement dat , 2011, and identified as Contract No. 43002, 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 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,THEREFO , 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 afor ra ce ! a 0referred irl tj foresaid Civil Code of the State of TwoCalifornia in the sum of_ �sR .' AND Nn 00 DOLT RS 42.700.00) 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 herein abve set forth, and also in case suit is brought upon this bond,will pay, in addition to the face amount thereof, costs and reasonable expenses and fees, including reasonable attorney's fees, incurred by the City 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 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 beard remain in full force and effect. The surety hereby stipulates and agrees that no change, extension of time, alteration or addition to the 1 terms of the agreement or to the work to be performed thereunder or the specifications accompanying the 3 same shall i ► agnosia affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms 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, SEPTEMBER27 on , 2011, Bond No. 21470 REGENCY — PACIFIC NORTH AMERICAN SPECIALTY DEVELOPMENT CORPORATION (SEAL) INSURANCE COMPANY (SEAL) Principal Surety By: , By: Signature Signature MARE D, IATAROLA, ATTORNEY—IN—FACT Address: 701 :ROUTH pARKFR STREET SUITE 3800 ORANGE, CA 92868 (Notarial Ase exits of Principal and Surety) Telephone: ( 714 ) 550-7799 CD-6 NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Manchester,New Hampshire,and Washington International Insurance Company,a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg,Illinois,each does hereby make,constitute and appoint: JOHN G.MALONEY,HELEN MALONEY, MARK D.IATAROLA and DEBORAH D.DAVIS JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION(550,000.000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 24's of March,2000; "RESOLVED,that any two of the Presidents,any Managing Director,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to attached"whio.r?c16iitrli,Nsz.,4 4ir By ,%..a. I SEAL Steven P.Anderson,President&Chief Executive Officer of Washington International Insurance Company SEAL'\:S1 :n7 1973 ,,i &Senior Vice President of North American Specialty Insurance Company 'Nhupeit4 'Nit/1111W° By David SI.Layman,Senior Vice Presides of Washington International Insurance Company &Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF,North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this 15th day of September ,201 I North American Specialty Insurance Company Washington International Insurance Company State of Illinois ss: County of Cook On this 15th day of SePtelnber ,20 I ,before me,a Notary Public personally appeared Steven P.Anderson ,President and CEO of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M.Layman, Senior Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. i) OFFICIAL SEAL ce. 0 JILL NELSON NOTARY Mkt STATE CC&LAOIS D.Jill'Nelson,Notary Public cammissoN DPRES1EPIV12 James A,Carpenter_, the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company,do hereby certify'that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company,which is still in full force and effect. 27TH S EPTR413 ER 1 IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this day of_ ,20 ,larne A.Carpenter,Vico President&Assistant Secretary of Washington Iniamationallsurapze Company& North American Specialty Insurance Company CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California 400 County of A efs'5 f' On ef-ilJae)] before me, L - ones A 0 Date Hero Insert Name and o the Officer personally appeared 04.e . Kr Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person( ) whose name(e)Oara-eubscnbed to the within instrument and acknowledged to me that e -- executed the 9erlie in a efrOteir authorized capacity(iand that b141 -14-. signature0) on the instrument the person(?), or the entity upon behalf of :410 JONES which the person(?) acted, executed the instrument VI; vv7 4!fit aftli 4 _ I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correc WITNES y nd and offici. re Place Notary Seal Above Signet 4" public OPT1ONA ari' Though the information below is not required by law, it may prove valuable to persons -yin« the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: C 'eV _J3_4 Document Date: S yopf 9-- c9--C 1 I Number of Pages: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: Signer's Name: O Individual 0 Individual O Corporate Officer—Title(s): 0 Corporate Officer—Title(s): 0 Partner 0 Limited 0 General 0 Partner *LiLimited 0 General Attorney in Fact OPSIGNER' ' 0 Attorney in Fact. RIM atTFTHspotEirRRINT: 0 Trustee Top of thumb here 0 Trustee TOP of thumb here O Guardian or Conservator 0 Guardian or Conservator O Other: El Other: 1 Signer is Representing: Signer Is Representing: v v vvv sv 4,4w. v v vsv,, v v"%tr" 7-t 2G07 NatIonal Notmy Mac-dation.01360 De Soto Ave.,CO Sax 2402.Chateworie,OA 9 t 313-2402w www NatfonaiNceatyoq tern#5907 Reorder:Can -6004376-6827 CERTHOLDER COPY SG STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 I N s U +-i A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-23-2011 GROUP: POLICY NUMBER: 1222058-2011 CERTIFICATE ID: 86 CERTIFICATE EXPIRES: 07-01-2012 07-01-2011/07-01-2012 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 85 DATED 09-23-2011 CITY OF REDLANDS SG 35 CAJON ST STE 15A REDLANDS CA 92373-4746 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 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed here n. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative ' President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1800 - LEO KRAMER PRES - EXCLUDED. ENDORSEMENT #1600 - STEVEN KRAMER VP - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1992 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-09-23 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF REDLANDS EMPLOYER REGENCY-PACIFIC DEVELOPMENT CORPORATION SG 1440 BEAUMONT AVE. # A2-300 BEAUMONT CA 92223 ICES,CNJ PRINTED : 09-23-2011 (REV.s-20101 POLICYHOLDER COPY SG STATE COM PE NSATIOry P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-23-2011 GROUP: POLICY NUMBER: 1222058-2011 CERTIFICATE ID: 86 CERTIFICATE EXPIRES: 07-01-2012 07-01-2011/07-01-2012 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 85 DATED 09-23-2011 CITY OF REDLANDS SG 35 CAJON ST STE 15A REDLANDS CA 92373-4746 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 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy 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 to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative ' President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - LEO KRAMER PRES - EXCLUDED. ENDORSEMENT #1600 - STEVEN KRAMER VP - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-1992 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-09-23 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF REDLANDS EMPLOYER REGENCY-PACIFIC DEVELOPMENT CORPORATION SG 1440 BEAUMONT AVE. # A2-300 BEAUMONT CA 92223 (CES,0N] (REV.8-2010l PRINTED : 09-23-2011 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1 . Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job : $5 , 000 . 00 Sample Rate : 13 . 30% Regular Premium equals : $ 665 . 00 Surcharge : 3 . 00% - - - Additional Waiver charge : $ 19 . 95 Total premium equals $ 684 . 95 (665 . 00 + 19 . 95) �—.4p REGEN-7 OP ID: SL „ 09/26 oR© CERTIFICATE OF LIABILITY INSURANCE DAT 09/26/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 916-630-8643 CONTACT Powers and Company `FAX _PHONE N Insurance Agents and Brokers 800-783-0083 (A/CyNo,Ext): P.O. Box 619043 Lic#0H38004 EMAIL I4 C No): Roseville, CA 95661-9043 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC II INSURER A Tower Select Insurance Company 44300 INSURED Regency- Pacific Development INSURER B: Corporation INSURER C: 1440 Beaumont Ave#A2-300 Beaumont, CA 92223 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL7R TYPE OF INSURANCE IADDL;SUBR,1 ' POLICY EFF POLICY EXP ------------ INSR:WVD I POLICY NUMBER '(MMIDD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY , I ` i EACH OCCURRENCE $ 1,000,000 )-- A X i COMMERCIAL GENERAL LIABILITY X CGLCTO133911 04/10/11 04/10/12 , DAMAGE TO RENTED � i j PREMISES(Ea occurrence) i $ 100,000 I i CLAIMS-MADE , , OCCUR r MED EXP(Any one person) $ 5,000 , I PERSONAL&ADV INJURY $ 1,000,00& GENERAL AGGREGATE ' $ 2,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG T$ 1,000,000 '' PRCT-O � - — ----____. j X POLICY I JFLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED AUTOS AUTOS I BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS ' i AUTOS (Per accident) $ $ UMBRELLA LIAB OCCUR 1 EACH OCCURRENCE $ EXCESS LIAB _: CLAIMS-MADE ;AGGREGATE $ DED RETENTIONS 1 Ii $ WORKERS COMPENSATION ! _ 1 WC STATU- I 0TH-. ' AND EMPLOYERS'LIABILITYYN €TORY LIMIT$_ ER ANY PROPRIETOR/PARTNER/EXECUTIVE I € I E-L.EACH ACCIDENT $ OFFICER:MEMBER EXCLUDED? N/A: ! -- _._-___ ,____ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE) $ If yes.describe under I ------- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Certificate holder is included as an Additional Insured under Commercial General Liability policy per endorsement CG9 20 03 07 08, subject to a written contract between the Named Insured and the Additional Insured. Sample endorsement attached.*'Subject to company approval. CERTIFICATE HOLDER CANCELLATION CITYOFR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redlands ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Tim Wilson 35 Cajon St. Ste 15A AUTHORIZED REPRESENTATIVE Redlands, CA 92373 ii, aillb - 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ° BLANKET ADDUTIONAL INSUREDS — ���� LESEES OR CONTRACTORS ����o���n�*�x ����o� nn�x�x�, n ���ww� This endorsement modifies insurance provided under the following: COMMERC/ALGENERALL|AB|LITYCQVERAGEPART SCHEDULE Po|ioyNumber:CGLCT0133911 Endorsement Effective: 04/10/2011 Name Insured Countersigned By: Regency-Pacific Development Corporation DBA: Regency Pacific Development Corporation SCHEDULE Name of Person or Organization: City of Redlands 35 Cajon St. Ste 15A Redlands, CA 92373 Location: (If no entry appears abnvw, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedu|e. but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insured(s), the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury' or"property damage" occurring after; (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of 'your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words"you" and "your' refer to the Named Insured shown in the Declarations. D. ~Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations, prknn'yvVnvminQ If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insu,ance, and any insurance or aetf'insu/ance maintained by the above additional insured(s) shall be excess of the insurance afforded to the name insured and shall not contribute to it Waiver of Subrogation If required by written contract or agreement We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of"your work"done under a contract with that person or organization CG9 20 03 07 08 Cnpyright, Tower Group Companies, Inc., 2008 Page 1 of 1 AC EVIDENCE OF PROPERTY INSURANCE DATE IMM/DD/YYYY) 09/28/2011 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE OF PROPERTY INSURANCE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AGENCY ' PHONE --- --- - LLA/C,No.Ext)__ COMPANY USASSURE INSURANCE SERVICES OF FLORIDA, INC/D/B/A INLINK American Zurich Insurance Company INSURANCE SERVICES P.O. BOX 10610 JACKSONVILLE, FL 32247-0120 -------- — -- ----FAX pos owersandcom _iAJC,N�1 ADDREsE-MAILs: wer @p pany.com CODE:A0009847 SUB CODE: -- ---------- AGENCY ..._..._.__.__._._._- _. CUSTOMER ID INSURED LOAN NUMBER POLICY NUMBER Regency-Pacific Development Corporation ER70593894 1440 Beaumont Ave Suite A2-300 EFFECTIVE DATE EXPIRATION DATE Beaumont,CA 92223 10/01/2011 04/01/2012 CONTINUED UNTIL TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION 111 W Lugonia Redlands,CA 92373 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE Builders Risk Coverage Form $1,000 Renovations and Improvements $245,000 • • All Covered Property at all Locations $245,000 • • REMARKS(Including Special Conditions) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ADDITIONAL INTEREST NAME AND ADDRESS MORTGAGEE ADDITIONAL INSURED City of Redlands K LOSS PAYEE 35 Cajon Street LO,N Redlands,CA 92373 AUTHORIZED REPRESENTATIVE ACORD 27(2006/07) 0 ACORD CORPORATION 1993-2006. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORLY CERTIFICATE OF LIABILITY INSURANCE DATE IMM DDIVYYY) `.---- 09126/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Delia Kinkey Little & Son's Insurance Services Inc. PHONE :FAX 1025 W. Ramsey EARA Lo, Ext1 951-849-6738 ,(AIC,Nn) 951-849-9331 ADDRESS: d.kinkey@littleinsurancegroup.com Banning , CA 92220 License #: OD99201 INSURER(S)AFFORDING COVERAGE NAIC p INSURER Mercury Casualty Company INSURED INSURER B: Regency Pacific Developement Inc INSURER C: 1440 Beaumont Avenue Ste A2-300 INSURERD: Beaumont, CA 92223 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00005393-0 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR` ADDL SUBR : POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR;WVD I POLICY NUMBER ;IMM/DD/YYYY) (MM/DDlYYYY)' UMITS i GENERAL LIABIUTY ! EACH OCCURRENCE 15 D• AGE i•R NT — — COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) j CLAIMS-MADE i j OCCUR 1 MED EXP(Any one person) -$ ;-- . - PERSONAL R.ADV INJURY '$ I GENERAL AGGREGATE s$ GENII AGGREGATE LIMIT APPLIES PER: 1 _PRODUCTS-COMP/OP AGG S POLICY ECT LOC I c — AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT ` A Y Y ! CCA0005713 01/11/2011 01/11/2012 (Ea accident) 's 1,000 000 ANY AUTO i I BODILY INJURY(Per person) 'S ALL O'ANEC X 1 SCHEDULED BODILY INJURY(Per accident)) $ AUTOS PROPERTY DAMAGE IIA HIRED AUTOS X 'NON-OWNED AUTOS (Per accident) $ X: Liabilty S j UMBRELLA LIAB i OCCUR I EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADEAGGREGATE 1$ DEC I 1 RETENTIONS $ WORKERS COMPENSATION AC STATU- = IOTH-1 AND EMPLOYERS'LIABIUTY Y I N I 1 j __ 'TORY LIMITS: __ _�R .-.-.- ANY PROPRIETOR/PARTNER/EXECUTIVE ) I , I E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? :N/A; - ------ --- . ---- _- _. I (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S I It yes,describe under _ -- -- DESCRIPTION CF OPERATIONS below EL DISEASE-POLICY LIMIT;$ j DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) *The company gives a 10 day notice of cancellation for non payment of premium. Project Redlands Community Center, 111 W. Lugonia, Redlands Ca 92374 CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED NAMING THE CITY OF REDLANDS, ITS DIRECTORS,OFFICIALS,OFFICERS, EMPLOYEES AGENTS AND VOLUNTEERS ARE NAMED AS (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Redlands ACCORDANCE WITH THE POLICY PROVISIONS. 35 Cajon Street, Suite 15A Redlands, CA 92373 AUTHORIZED REPRESENTATIVE //7" / r J (DMK) 1988-2110 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Printed by DMK on September 26,2011 at 12:35PM AGENCY CUSTOMER ID: 00005393 LOC#: ACCM C) ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Little&Son's Insurance Services Inc. Regency Pacific Developement Inc POUCY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) ADDITIONALLY INSURED IN RESPECTS TO THE AUTO LIABILITY THE INSURANCE IS DEEMED PRIMARY AND CERTIFICATE HOLDERS INSURANCE SHALL BE NON-CONTRIBUTORY WITH THE WAIVER OF SUBROGATION ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by DMK on September 26,2011 at 12 35PM CITY OF REDLANDS TE RARY BUSINESS TAX 1? • RECEIPT • DATE 4-67 / AMOUNT 1 ke dq-Pat i r ��► Name of Busines% tap Expiration Date --- JI / / eznsiv Business Description__ _ r ` Comments; dda Si 16 PAID SEP 2 9 CITY I201i TY 3 INITIALS POLICY CHANGES Poky Change Number P ° C NUM-Z POLICY NGS COMPANY EFFECTIVE CCA0005713 9/24/11 Mercury Casual Company Polley " rm 1/141 1 /14112 ED INS E AUTHORIZED R NTATIV= Regency Pacific etoprnent COVERAGE PARTS AF CGES It is agreedand understood t the following are listed as additional Insureds as coveredby this policy: City of Redlands, its direvetors, officials, officers, employees, agents and volunteas 35 Cajon Street, Suite 15A Redlands, CA 92373 1 Autharted .444- Signature 2 01 11 85 COcyright„ ce Servi Ores, Inn,., 1983 Pagel o POLICY Polley Chmge b er POUCY NUMBER POLICY CHANGES COMP- `= EFFECTIVE CCA0005713 W24/1Mercury Casualty Company Policy Term: 1/14h -1/14/12 ED INSURED AUTHORIZED ESENTATIVE Regency Pacific Development COVERAGE PARTS AFFE CHANGES IT required by written - ract or agreement, we waive any right of recovery we may have against an entity that Is on additional Insured per the to of this endorsement because of payments we make for injury or damage arising out of#your work" done under a contract with that borsch br organization, { -- 21 01 11 85 C0pyrkght, Insurance SwF f ,, Inc., 1983 Page 1 of