HomeMy WebLinkAboutContracts & Agreements_35-2024PUBLIC WORK CONSTRUCTION CONTRACT
This Public Work Construction contract ("Contract") is made and entered into this 20th day of February,
2024, by and between the City of Redlands, a municipal corporation, organized and existing under the
laws of the State of California (hereinafter "City"), and Tiyco General Engineering, a California
corporation (hereinafter "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:
1. SCOPE OF WORK: Contractor shall furnish all materials and will perform all of the work for the
following: 2023 Citywide Sidewalk and ADA Ramp Replacement Project, complete all items as
required by the Contract Documents (as herein defined) and Specifications for City's 2023 Citywide
Sidewalk and ADA Ramp Replacement, Project No. 400025 (the "Work").
2, CONTRACT SUM: City shall pay Contractor the sum of one million dollars ($1,000,000) as
consideration for its performance of the Work in accordance with the terms and conditions set forth
in the Contract Documents. Pursuant to Public Contract Code Section 22300, Contractor has the
option to deposit securities with an escrow agent as a substitute for retention of earnings required to
be withheld by City pursuant to an escrow agreement as set forth in Public Contract Code section
22300,
. TIME FOR COMPLETION: The Work shall. be completed within One Hundred (100) working
day(s) as defined in Section 1-2 of the Standard Specifications for Public Works Construction
"Greenbook" from and after the date of City's issuance of a Notice to Proceed to Contractor,
4, LIQUIDATED DAMAGES: Contractor's failure 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, Accordingly, Contractor shall pay to City, or
have withheld from monies due to Contractor, the sum of Five Hundred dollars ($500) for each
working day as defined in Section 1-2 of the Standard Specifications for Public Works Construction
"Greenbook" in exeess of the specified time for completion of the Work. Execution of this Contract
shall. constitute agreement by City and Contractor that Five Uundred dollars ($500) per day is the
estimated damage to City caused by the failure of 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 Contractor if such delay occurs,
CONTRACT DOCUMENTS: This Contract incorporates by reference the following: Notice
inviting Bids, Instructions to Bidders, Contractor's Proposal, Bid Bond, Agreement, Performance
Bond, Labor and Material Bond, Plans, General Conditions, Special Provisions and Specifications,
and any addenda thereto (collectively, the "Contract Documents").
6. ATTORNEYS' FEES: In the event any action is commenced to enforce or interpret the terms or
conditions of this Contract, or the Contract Documents, the prevailing Party in such action, in
addition to any costs and other relief, shall. be entitled to recover its reasonable attorneys' fees,
including fees for use of in-house counsel by a Party.
7. RESOLUTION OF CONSTRUCTION CLAIMS: Claims by Contractor in the amount of time
hundred seventy five thousand dollars ($375,000) or 1.ess shall be made by Contractor and processed.
lAcrno \Agrccinonts\Tryco General Engincorius Public Work Contract FY23-0027.clocx-ms
by the City pursuant to the provisions of Part 3, Chapter I , 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. Nothing in subdivision (a) of Public Contract Code Section
20104,2 shall. extend the time limit or supersede the notice requirements provided in this case from
filing claims by Contractor.
. ELIGIBILITY OF CONTRACTOR/SUBCONTRACTOR: Contractor and all of its
subcontractors shall 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.
9. ASSIGNMENT OF AGREEMENT: No assignment by a Party of any rights or interests under
this Contract shall be binding on another Party without the written consent of the Party sought to be
bound.
10. SUCCESSORS AND ASSIGNS: City and Contractor each binds itself and their respective
successors and assigns in respect to all covenants, agreements, and obligations contained in the
Contract Documents.
11. 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 City and Contractor.
2
1: \elm\ Agreements \Tryco Cioncral Engineering Public Work Contract FY23-0027.docx-ms
IN WITNESS WHEREOF, the Parties hereto have executed this Contract the day and year first written
above.
(SEAL)
ATTEST:
Donaldson, City Clerk
CITY OF RE
By:
die Tejeda, Mayor
TRYCO GENERAL ENGINEERING
Name of Contractor
By:
Sign
Title
(SEAL)
re of Autho 'zed Ageki
_cie,,Jvvy
Signature of Authorized Agent (if necessary)
Title
960285
Contractor's License No.
3
l:\emo\Agreements\Tryco General Engineering Public Work Contract FY23-0027.docx-ms
WORKER'S COMPENSATION INSURANCE CERTIFICATION
Description of Contract:
City of Redlands
Municipal Utilities and Engineering Department
2023 Citywide Sidewalk and ADA Ramp Replacement Project
Project No, 400025
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 by one or more insurers 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.
CHECK ONE
✓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 and activities required or permitted under this Agreement.
(Labor Code § 1861).
I affirm that at all times, in performing the work and activities required or permitted under this
Agreement, I shall not employ any person in any manner such that I become subject to the workers'
compensation laws of California. However, at any time, if I employ any person such that I become
subject to the workers' compensation laws of California, immediately I shall provide the City with a
certificate of consent to self -insure, or a certification of workers' compensation insurance.
I certify under penalty of perjury under the laws of the State of California that the information and
representations made in this certificate are true and correct.
Dated this 7 day off, 2024.
TRYCO GENERAL ENGINEERING
Co tractor)
(Signature)
. e:4J
(Official Titl
(SEAL)
(Labor Code Section 1861 provides that the above certificate must be signed and filed by the Contractor with the
Owner prior to performing the work of the contract.)
4
l:\cmo\Agrcements\Tryco General Engineering Public Work Contract FY23-0027.docx-ms
Bond No, GS29700124
Premium: $18,000.00
Premium Based on Final Contract Amount
- FAITHFUL PERFORMANCE BOND
Whereas, the City of Redlands ("City"), State of California, and 'Frye° General Engineering
(hereinafter designated as "Principal") have entered into an agreement dated February 20, 2024
("Agreement") whereby :Principal agrees to install and complete certain public improvements (the
"Work"), which said Agreement is identified as 2023 Citywide 'Sidewalk. and ADA Ramp
Replacement Project, Project No: 400025 and is hereby referred to and made a part hereof, and
Whereas, said Principal is required under the terms of the Agreement to furnish a bond for the
faithful performance of the Work, now, therefore, we, the Principal and,
The gray Casually,L8:Surety Company, as Surety, are held and firmly bound unto the City in the penal
sum of one million dollars (S1„000,000) lawful money of the United States, for the payment of which.
sum. we bind ourselves, and 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 Agreement and any alteration
thereof made as therein provided, on hi.s or its 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
fulfill the one-year guarantee of all materials and Nvorkmanship, and shall defend,
indemnify and save harmless the City and its elected officials, officers, agents and employees, as
therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in
forc.:;e and effect.
,A..s a part of the obligation secured hereby and in addition to •the :face al1101Mt specified therefor,
there shall be includedcosts and reasonable expenses and fees, including reasonable attorneys' fees,
incurred by the City in successfUlly enforcing such. obligations, all to be taxed as costs and included
in the judgment rendered.
As a condition precedent to the satisfactory completion of the Work, the above obligation
shall hold good fora period of one (1) year or longer if required by the .Agreement after the acceptance
of the work. by the City, during -which time if the .Principal shall fail to make full, complete, and
satisfactory repair and replacements and totally protect the City from loss or damage made evident
during this period from the date of completion of -the Work, and resulting from or caused by defective
materials or faulty workmanship, the above obligation in penal suni thereof shall remain in full :force
and effect. The obligations of Surety .hereunder shall continue so long as any obligation of the;
Principal remains,
'When.ever the Principal shall be, and is declared by the City to be, in default under the
Agreement, th.e City having performed the City obligations thereunder, the Surety shall promptly
remedy the default, or shall promptly, at the City's option:
1. Complete the Work in accordance with its terms and conditions; or
2. Obtain a bid or bids for completing the Work in accordance with its terms and
conditions, and upon determination by Surety of the lowest responsive and responsible bidder,
arrange for a contract between such bidder and the City, and make available as work. progresses
sufficient funds to pay the costof completion. of the Work less the balance of the A.greement price,
5
Benio\Agreements'aryeo General :Engineering Public Work Contract ITY23-0027.docx-ins
but not exceeding, including other costs and damages :for which. Surety may be liable hereunder, the
amount set forth above. The terns "balance of the Agreement price," as used in this paragraph, shall
mean the total amount payable to the Principal by the City under th.e Agreement and any modifications
thereto, less the amount previously properly paid by the City to the Principal.
Surety expressly agrees that the City may reject any contractor or subcontractor which may
be proposed by Surety in fulfillment of its obligations in the event of default by the Principal.
Surety shall not utilize the Principal in completing the Work nor shall Surety accept a bid from
the Principal for completion of the Work if the City, when declaring the Principal in default, notifies
Surety of the City's objection to the Principal's further participation in the completion of the Work.
No right of action shall accrue on the bond to or for the use of any person or corporation other
than the City named herein or the successors or assigns of the City. Any suit under this bond must
be instituted within the applicable statute of limitations period.
The said Surety, for value received, 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 any way 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.
No final settlement between the City and the Principal shall abridge the right of any
beneficiary hereunder whose claim may be unsatisfied.
The Principal and Surety agree that if the City is required to engage th.e services of any
attorney in connection with the enforcement of this bond, each shall pay the City's reasonable
attorneys" fees incurred, with or without suit, in addition to the above sum.
In witness whereof, this .instrument has been. duly executed by the Principal and Surety above
named, on February 13th , 2024.
Tryco General Engineering
(Contractor)
y4":f
(Signatur)
(SEAL)
(SEAL)
The Gray Casualty & Surety Company
(Sur ty)
By
(Signature) Pietro Micciche, Attorney -in -Fact
Address: P.O. Box 6202
Metairie, LA 70009
(Seal and Notarial Acknowledgment of Telephone ( 877 ) 857 6006_
Surety)
6
1::\cmo\AgreementsV1 vco General Engineering 1?ub:i. work Contract FY23-0027.ddocx-ms
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Los Angeles
}
On I L 4r4g 6'41�1021 before me, Angel Nunez, Notary Public
ate
personally appeared Pietro Micciche
Here Insert Name and Title of the Officer
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the persons) whose name() is/X
subscribed to the within instrument and acknowledged to me that hefxkedtbey executed the same in
his/ i4 AIK authorized capacity(, and that by hisiiiti tXCl6OI(signature(0 on the instrument the person(),
or the entity upon behalf of which the person(4) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
ANGEL NUNEZ
Notary Public - California
Los Angeles County
Commission # 2321675
My Comm, Expires Mar 14, 2024
Place Notary Seal Above
WITNESS my t�arid ar official seal.
Signatur
OPTIONAL
Signature of Notary Public
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Docurnent
Title or Type of Document: Document Date:
Number of Pages: Signers) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
Corporate Officer — Title(s): Corporate Officer — Title(s):
i Partner — ❑ Limi ,d C_; General
Individual Attorney in Fact
i Trustee C Guardian or Conservator
Other:
Signer Is Representing:
Partner — 1 1 Limited I.... General
l Individual Attorney in Fact
11 Trustee i Guardian or Conservator
Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
Bond No. GS29700124
Premium Included in Performance Bond
LABOR AND MATERIAL BOND
Whereas, the City Council of the City of Redlands, State of California, and Tryco General
Engineering (hereinafter designated as "Principal") have entered into an agreement (the
"Agreement") whereby Principal. agrees to install and complete certain designated public
improvements (the "Work"), which said agreement, dated February 20, 2024, and identified as 2023
Citywide Sidewalk and ADA Ramp Replacement Project, Project No. 400025 is hereby referred to
and made a part hereof; and
Whereas, under the terms of the Agreement, Principal is required before commencing th.e
performance of the Work, to file a good and sufficient Labor and Material bond with the City of
Redlands to secure the claims to which reference is made in Title 3 (commencing with Section 9550)
of Part 6 of Division 4 of the Civil Code of the State of California.
Now, theretbre, said Principal and the undersigned as corporate surety, are held firmly bound
unto the City and all contractors, subcontractors, laborers, material men and other persons employed
in the performance of the Agreement and referred to in the aforesaid Code of Civil Procedure in the
sum of one million dollars ($1,000,000) 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 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 insure to the benefit of any
and all persons, companies and corporations entitled to file claims under Title 3 (commencing with
Section 9550) of Part 6 of Division 4 of the Civil Code, so as to give a right of action to them or then'
assigns in any suit brought upon this bond.
Should the condition of th.is 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 the 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 February 13th , 2024.
(SEAL)
Tryco General Engineering
(Contra 'tor)
(Si nature
(Seal and Notarial Acknowledgement of Surety)
(SEAL)
The Gray Casualty & Surety Company
(Surety)
BY:
(Signature) Pietro Micciche, Attorney -in -Fact
Address: P.O. Box 6202
Metairie, LA 70009
Telephone: ( 877) 857-6006
7
I:\emo\Agreements\Tryeo General Engineering Public Work Contract FY23-U027.docx-ms
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Los Angeles
On �i ( 64,2021 before me, Angel Nunez, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Pietro Micciche
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person%) whose name%) is/Xte
subscribed to the within instrument and acknowledged to me that he/006u executed the same in
hisik04130 authorized capacity(iX), and that by his/reallo;Xsignature(A) on the instrument the person(,
or the entity upon behalf of which the person%) acted, executed the instrument.
1 certify under PENALTY OF PERJURY under the laws
of the State of California that the forego,; • paragraph
is true and core
ANGEL NUNEZ
Notary Public - California
Los Angeles County g
Commission # 2321675
My Comm. Expires Mar 14, 2024
Place Notary Seal Above
WITNESS v hand a official se
Signatu
OPTIONAL
Signet - .f Notary Public
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Number of Pages: _ Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Corporate Officer — Title(s):
_? Partner — C Limi d l-`i General
Individual Attorney in Fact
Trustee
"-: Other:
Signer Is Representing:
G Guardian or Conservator
Signer's Name:
Corporate Officer — Title(s):
Partner -- I 1 Limited C:i General
_I Individual n Attorney in Fact
71! Trustee t..1 Guardian or Conservator
Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
['reicrrcd I3onding Services
12 07 2023 14: I I l 0-1959SO.4057o
THE GRAY INSURANCE COMPANY
THE GRAY CASUALTY & SURETY COMPANY
GENERAL POWER OF ATTORNEY
Boncl Number:&— l°7Oo12'j Principal (\( O (rev\e''1 Fn5ne,cr(n5
Project:ZQZ') C l'5 iU e,, 5►iz J 11<- An.k A-oA 2j rv? P e PIolccro cnfi Proj Ci-
?`ojc,01- 4U0,1I6opZ
KNOW :\1.1. 13Y'f1IESE PRESEN1 S. TIIAT The (fray Insurance Company and The (ira\ Casualty & Surety Company- corporations dui\
organized and existing under the Ia\\s of Louisiana- and ha\ ing their principal offices in Metairie. 1 ouisiana. do hcreb\ make- constitute. and
appoint: Patricia Zenizo, Elisabete Salazar, and Pietro :Weddle of Los Angeles, California ,jointly and severally on behalf of each of the
Companies named above its true and la \\ Cul Attorney (sl-in-Fact. to make. execute. seal and deliver. for and on its behalf and as its deed- bonds. or
other writings obligatory in the nature ora bond. as surety. contracts of curet\ ship as are or mat\ be required or permitted by lam. regulation.
contract or otherwise. provided that no bond or undertaking or contract of sanre1 ship executed under this authority shall exceed the amount of
$?-000.000.00.
I his Po\\cr of :\Borne) is (granted and is signed h\ facsimile under and b\ the authorit\ of die loll() \\ ing Resolutions adopted b\ the Boards of
1)ircctors of both rho Gra) Insurance Conrpan\ and The (ira) Commit\ & Surety C'umpan\ at meetings duly called and held on the 26'" day of
.tune. 2003.
--RI'.SOLVEU. that the President. Iaecuti\e Vice ('resident. an\ Vice President. or the Secretary be and each or and of ahem hereby is authorized to
execute a power ofAtt.irne\ quu1 I\ ino the attornec named in the gi\ en 1'o\\cr of A1tome\ to e\ccute on beivalf I. the C'ompans bonds.
undertakings. and all contracts ol.surcty. and that each or any of them is hereby authorized to attest to the e5sution of such Po\\ cr of Attorney- and
to attach the scal or the Company: and it is
IER RI:SOI.VNI). that the signature or such officers and the seal of the Contpan) n18\ be affixed to an\ such Po\\er oLAttorne\ or to an\
certificate relating thereto bs facsimile. and am such Polder of:\ttornc\ or certificate bearing such facsimile signature or facsimile seal shall he
binding upon the Company nay\ anti in the future \\hen so affixed \\ ith regard to an\ bond. undertaking or contract ofsuret\ to \\hich it is attached.
IN WITNESS WI IEREOF. The Gra\ Insurance Company and The (teal (.'astalt\ &. Burets C'ompun\ hale caused their oflieial seals to be hereinto
affixed. and these presents to be signed b\ their authorized officers this -t"' dos of No\ ember..2022.
t••• *N
,Cai'
�J.,;SEAL l
'Tti
'•
'Michael T. Ora)
President
The (ira\ Insurance Comp ri\
Culler, S. Piskc
President
The (iras Casualty & Suret) Company
Slate oilmuisittna
ss:
Parish of -Jefferson
On this -i'I' dad ol'Novcntber. 2022. before inc. a Notary Public. personally appeared Michael F. (tra). ('resident of the Gras Insurance
Company. and Cullen S. Piske. President of fhe (ita\ Casual') & Surety Cumpam. personalty knot\n to me. being duly s\\orn. aekno\\lcdgcd
that they signed the above Power of Attornc\ and affixed the seals of the companies as officers oL and ackno\\ lodged said instrument to he the
\oluntar\ act and decd. of their companies.
• .- =E
.'Jtary 11) 'lo. ;2€.53
t�z amp cd P.- Ish oi.;isi r,a
Lciah :\nnc I Icnican
Notar\ Public. Parish of Orleans State of Louisiana
\d\ Commission is for Life
1. Mark S. Manguno. Secretar\ of The Cira\ Insurance Compam. do hereby ecru;) that the aio\e and forgoing is a true anti correct cop) of
1'o\\cr of Attorney given h\ the companies. which is still ill 1 111 tierce and effect. IN \\ 1TNESS \\ I ILRE:OF. I have set m\ hand and
affixed the seals of the Company this 13 day of F flel 0;. .
I. Leigh Anne Henican. Secretary of fhc Gray Casualty- & Surety ('ompan\ - do hereby certil\ that the aho\ e and list;going is a true and correct
cum or Pm\cr oI Attorney gi\cn h_\ the companies. \\ Inch is still in lull farce and effect. I\ \1 1 1-Ni'.SS \VI Il:R[:OF. I ha\ c set in hand
and ailised the seals of the Company this 1314, day of pe 1(404 .2CL
Form
(Rev. October2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
See Specific Instructions on page 3.
1 Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank.
Tryco General Engineering
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1, Check only one of the
following seven boxes.
❑ Individual/sole proprietor or U C Corporation 0 S Corporation 1 Partnership Ill Trust/estate
single -member LLC
4 Exemptions (codes apply only to
certain entities, not individuals; see
Instructions on page 3):
Exempt payee code (If any)
MI Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC If the LLC Is classified as a single -member LLC that Is disregarded from the owner unless the owner of the LLC Is
another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
Exemption from FATCA reporting
code (If any)
is disregarded from the owner should check the appropriate box for the tax classification of Its owner,
III Other (see Instructions) !
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
PO Box 391
Requester's name and address (optional)
City of Redlands
8 City, state, and ZIP coda
Rimforest CA 92378
35 Cajon St 15A
Redlands Ca 92373
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entitles, it Is your employer identification number (EIN). If you do not have a number, see How to get a
_'
-
-
TIN, later.
Note: If the account is In more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
or
Employer Identification number
2
7
5
1
2
1
3
2
7
Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4, The FATCA code(s) entered on this form (If any) Indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all Interest and dividends on your tax return, For real estate transactions, Item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the Instructions for Part II, later.
Sign Signature of
Here u.s. person ►-�(��
General Instruc cons
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.lrs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
Identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (Interest earned or paid)
QC/ 4L
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage Interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Date ► le)
Cat. No. 10231X
Form W-9 (Rev. 10-2018)
CERTIFICATE OF LIABILITY INSURANCE
SR
A
D
C
E
GENERAL
X
rYPE OF INSURANCE
LIABILITY
'0 MERCIAL GENE L .IABILITY
A�
<
S ER
14 f.
111
._._ e01.1CYNl)MEgR
POLL
uii.!
04/1i
04/1(
06/20
00/17
04/20
LHA113869
BA040000067331
00142820
„CLAIMS•MADE i_",.=•� OCCUR
X
AUTOMOktiLE
WORKERS
AND
CNHIOFR/MEM
(Mandatory
II es
s _
Inland
MDRATE LIMIT
P LILY PRO-
LIABILITY
ANY AUTO
ALL AUTOS OWNED
HIRED AUTOS
UMBRELLA LIAR
EXcasa LIAR
COMPENSATION
EMPLOYERS' LIABILITY
ER EXCLNEIDE
In NH)
describe under
• • . + ' s • ,;,
Marine
TIQNS
AP
�L.0
SCHEDAUTOSULED
NON
AUTOS
LDS PER.
-OWNED
'
CCCUF1
I S.MA
ECUTIVt�
below
CST5025007
QT•660.2R597661-TIL•21
fDATE (MMIDDfYYYY)
02/12/2024
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(ios) 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
Delaney Insurance Agency, Inc.
8231 White Oak Ave,
Rancho Cucamonga CA 91730
INSURED
Tryco General Engi
PO Box 391
Rim Forest GA
2
ring
MattDogero. .,
HONE 1909) 481-7222
MAIL
• schelle?delaneyins,com
INLS.U1[{CR(91 AFFORDING CC ABAC
INSIIR $A: Landmark American Insurance Company
x c California Automobile Insurance Cornpany
N . F C; Benchmark InsuranceCom an
.INSURER D ; James River Insurance Company
E • Travelers Insurance Company,
1:
TIFICATE NUMBER:
R P:
909)481,7217
4av p aaaaea ►� 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.
�Y IEPI _ POLIC . IEXP
/202
04/19/2024
EACH OCCURRENCE
DAMAGE TO RENTED
PRPMISFS,(Fa nrrranr,- n)„^1
ICI;p EXP (Ay one ner;:,dn)_
..EVISONAL & ADV IN.)UF}Y
ERAL AGGREGATE
„pROWCU • COMP/OP Aq
2
$ 4,00U 000
$ 2,000 000
/202
/2023
/2023
/2024
04/19/2024
COMEiiNSE) SINGLE LIMIT
all
BODILY INJURY (Per person)
2,000 0 0
SODILY INJURY (Por accldonl)
PROPERTY DAMAGE
(Pat atsldnnt)
$
e,A,CN O,Q,CURR_,,F, CE
04/19/2024 AcoasgATE
06/17/2024
04/20/202
RIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attael ACORD 101, Additional Remake Schedule, If more epee Ia required)
x. T IRV T MIT$,
El,, EACH ACCIDENT
QT .
El, DISEASE - EA EMPLOYEE
E.4. Di EASE - POLICY LIMIT
$50,000.00
$250,000.00
2 000 000
$ 2 0001000
$
$1,000,000
$1,,000,000.
$1,000,000
BPP
LBR
ity of Redlands Municipal Utilities and Engineering Department Project # 400025 2023 Citywide Sidewalk and ADA Ramp Replacement Project
ertiflcato Holder, the City of Redlands and their respective successors and assigns in respect to all covenants agreements and obligations
contained in the contract documents is named as Additional insureds. Endorsements are attached from the carriers
"Issuing agency will endeavor to mall 30 days written notice of cancellation; except 10 days notice of cancellation for
onjayment of premium."_
RTIFICATE HOLDER
City of Redlands
attn: Elva Arellanes
35 Cajon St., Suite 16A
Redlands, CA 92373
ACORD 25 (2010/06)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITFI THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
<Sw>
988.2010 ACORD CORPORATION, All rights reserved.
The ACORD name and logo are registered marks of ACORD
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
ADDITIONAL INSURED
BLANKET - YOUR WORK
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization: ny person or organization to whom or to which you are obligated by virtue
of a written contract or by the issuance or existence of a written permit, to
provide insurance such as is afforded by this policy.
SECTION II WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown In the SCHEDULE, but only with respect to liability for "bodily injury", "property damage" or
"personal and advertising Injury" caused, in whole or In part, by:
1. Your acts or omissions; or
2, The acts or omissions of those acting on your behalf;
In the performance of your ongoing operations; and/or "your work" defined for the additional insured(s) designated
above Included in the "products -completed operations hazard".
This endorsement effective 4/19/2023
forms part of Policy Number LHA113869
issued to TRYCO GENERAL ENGINEERING, INC ; TRYCO, INC.
by Landmark American Insurance Company
RSG 15017 0616 Include
opyrighted material of Insurance Services Office, Inc. 1984
with its permission
POLICY NUMBER: LHA11
COMMERCIAL GENERAL LIABILITY
CG 201112 19
THIS ENDORSEMENT CFIANOES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR
LESSORS OF PREMISES
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designation Of Premises (Part Leased To You):
ANY PREMISES REQUIRED BY WRITTEN CONTRA
AND B. BELOW
T OR AGREEMENT AND AS PER PARAGRAPHS A.
Name Of Person(s) Or Organization(s) (Additional Insured):
ANY PERSON(S) OR ORGANIZATION(S) REQUIRED BY WRITTEN CONTRACT OR AG
PER PARAGRAPHS A, AND B. BELOW
Additional Premium: $ iNCLUiDED
Information required to comPletn,this Schedule, if not shown above, willl be shown In th
A. Section II - Who Is An Insured Is amended to
include as an additional insured the person(s) or
organization(s) shown In the Schedule, but only
with respect to liability for "bodily injury",
"property damage" or "personal and advertising
Injury" caused, in whole or In part, by you or
those acting on your behalf in connection with
the ownership, maintenance or use of that part of
the premises leased to you and shown in the
Schedule and subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence" which takes place after you
cease to be a tenant in that premises.
2, Structural alterations, new construction or
demolition operations performed by or on
behalf of the person(s) or organizations)
shown In the Schedule.
However:
1. The insurance afforded to such additional
Insured only applies to the extent permitted
by law; and
EMENT AND AS
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional Insureds, the following is added to
Section III - Limits Of Insurance:
If coverage provided to the additional Insured Is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of Insurance:
1, Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
CG 2011 1219
Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: LHA113869
COMMERCIAL GENERAL LIABILITY
CG 201812 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
MORTGAGEE, ASSIGNEE OR RECEIVER
This endorsement modifies insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Names) Of Person(s) Or OrganIzatlon(s)
ANY PERSON(S) OR ORGANIZATION(S) REQUIRED
BY WRITTEN CONTRACT OR AGREEMENT AND AS
PER PARAGRAPHS A., B., AND C. BELOW
Designation of Premises
nation required to corpplete this Schedule, If not shown above, will be shown in the Declarations.
A. Section II M Who is An insured is amended to
include as an additional insured the person(s) or
organizations) shown In the Schedule, but only
with respect to their liability as mortgagee,
assignee or receiver And arising out of the
ownership, maintenance or use of the premises by
you and shown in the Schedule,
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
Insurance afforded to such additional Insured
will not be broader' than that which you are
required by the contract or agreement to
provide for such additional Insured.
B. This insurance does not apply to structural
alterations, new construction and demolition
operations performed by or for that person or
organization.
C. With respect to the insurance afforded to these
additional insureds, the following Is added to
Section III - Limits Of insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance;
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not Increase the
applicable limits of insurance.
CCU 20 18 12 19 p Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: LHA113869 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - AGGREGATE LIMITS OF INSURANCE
(PER PROJECT)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
The General Aggregate Limit under LIMITS OF INSURANCE (SECTION III) applies separately to each of your
projects away from premises owned by or rented to you.
CG 25 03 11 86
Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1
Policy Number: LHA11386 COMMERCIAL GENERAL LIABILITY
CG 20 01 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This Insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek. contribution
from any other insurance available to the
additional Insured.
CG 20 01 0413
O Insurance Services Office, Inc., 2012 Page 1 of 1
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Any Person or Organization As Required By Written Contract
The following Is added to SECTION IV .- CONDITIONS, 8. TRANSFER OF RIGHTS OF RECOVERY AGAINST
OTHERS TO US:
We waive any right of recovery we may have against the person or organization shown In the SCHEDULE above
because of payment we make for injury or damage arising out of your ongoing operations, "your product" or "your
work" done under a written contract with that person or organization and Included in the "product -completed
operations hazard". This waiver applies only to the person or organization shown in the SCHEDULE above.
This endorsement effective 4/19/2023
forms part of Policy Number LHA113869
issued to TRYCO GENERAL ENGINEERING, INC ; TRYCO, INC.
by Landmark American Insurance Company
RSO 14048 1008 Includes copyrighted material of Insurance Services Office, Inc. 1002
with its permission.
POLICY # BA040000052188
mis RSEPAENT CliANGE,S lain POLICY. P r RrAr, eAREPULLY.
Mercury Business Auto Broadening End riement
Tigs endorsement modifies Insurance provided untie:rifle following:
BOSINF.SS AUTO COVERAGE row
1.NEWLY ACQUIRE.D OR FORMED ENI1TY (BROAD F FLIVI NAMED INSURED)
IL EMPLOYEES AS, INSUREDS
AUTOIVIATIC ADDITIONAL INSURED
IV, EMPLOYEE HIRED AUTO LIABILITY
SUPPLEIVIENTARY PAYIVIENTS
'VI. FELLOW EMPLOYEE COVERAGE
VIL ADDITIONAL TRANSPORTATION EXPENSE
VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE.
IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE
X. LOAN/LEA $E GAP COVERAGE
XL GLASS.REPAIR DEDUCTIBLE WAIVER
XII. TWO OR MORE DEDUCTIBLES
XIIL. AMENDED DUTIES IN EVENT OF Accirgivr, CLAIM, SUIT OR LOSS
XIV. WAIVER OF SUBROGATION
XV.. UNINTENTIONAL ERROR, OM/SON, OR FAILURE TO DISCLOSE HAZARDS
XVI. WIN-MEE HIRED AUTO PHYSICAL DAMAGE •
XVIL PRIMARY AND NONCONTRIBUTORY IF REQUIRED 13Y CONTRACT
XVIIL HIRED AUTO — COVERAGE TERRITORY
XIX. • BODILY INJURY REDF.FINED TO INCLUDE RESULTANT MENTAL ANGUISH
Copyright 2.013 Mercury Insurance Services, 1.1.C$ All resolved.
NICA85101113 Includes copyrighted materiel cf insUreece Services Office, Inc; with b Perreimien
Page of
BUSINESS AUTO COVETIAGE FORM
NEWLY ACQUIRED OR FUR/VID ENTITY (13roed Form Nomad insured)
SECTION II - LIABILITY COVERAGE, A. Cbverage, 1. Who Is An Insured, the fallowing is added:
d. Any business entity newly acquired ar formed by you during the policy period
provided you awn SO% ar more of the business entity ¶Id the lausinoo entity is not
sepatately. insured for Business AO) Coverage. Coverage is Wended up tc3 ta
maximum of 180 days following acquisElort or formation of the business entity.
Covenage under this provision is afforded only until the end of the policy period.
Coverage does not apply to an "accident' which occun•ed belfore you acquired or
funned the organization,
SECnoil 11- LIABILTTV COVERAGE, A. Coverage, 1. Who Is An Inured, the following is added:
If EIVIPLOYEES AS INSUREDS
e, Any "employee" of yours is an 'insured" while using o covered °ado' you don't •
own„ hfre or borrow in Your business or your:personal affairs.
II . AMMO.= ADDITIONINSURED
SEcTIbN II LIABILITY COVERAGE, A. Coverage, 1...111/he Is An Insurthe ed, following Ts added:
AL
f. My person or organization that you ore required .1)3 include es additional insured
on the Coverage Form In a written contract or agreement that is signed and
executed by you before the "bodily luPury" or "property damage" occurs aru3 that Is
In effect during the policy period is an "insured° for Liability Co)ferage; but only for
damages to which this hIsuronce applies and only to the extent that person or
orgoniration qualifies as an "Insured" underthe Who Is An Insured pnivisfon
conisdned ri Section II.
• IIV; F.JVIPLOYEff HIKED AUTO LIABILITY
SECTION II LIARILTFY COVERABEA Coverage, 1. VI/Ito is An insured, the following Is addd:
g. An "employee" of yours is an 'Insured" while operating an 'iauto " hired or rented
under a contract or osTeement in that 'employee& name, with your permission,
while performing duties related to the conduct of your business.
SUPPLEMENTARY PAIUTE/SM. .,
SECTION lig. LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, 0. StiPPlernettuY
Pal/Maas/ Subparagraphs (2) and (4) are'replacecl bytrla following:
(2) Up to $3,000 for cost (OITA bonds (Including bends for related trafficiaw
violations) required becapse of an °accident" we cover. We are not obligated to
furnish these bands.
(4) All reasonable expenses Incurred by the "Insured9 ot our request, Including
actual loss of earnings up to $S00 a day bean= °Virile off from work.
FELLOW EMPLOYEE COVERAGE!
SECTION II — /TARIM COVERAGE., B. Exclusions., Fellow Employee
this exclusion does not apply lf You have workers' coMpensatrorx Insurance trkforce covering all df. .
your "employees'', Coverage is excess over any other collectible insurance.
Copyright2019 Mercury Insurance Senticeg, !LC, All right mewed,.
MCA0510.12111jnr.k15copyrighted material a insurance Swift:es Office, Inc, with Ifs Perinlsnion Page 2 of CS
1/11; ADDUIONAL TRANSPORTATION EXPENSE
SECTION ill - PHYSICAL DAMAGE COVERAGE, A. i:overage, 4Coverage Extensions, a, Transportation
Expenses, Is replaced with the following:
Vile will pay up to $50 per day to a meimtun of $1000 for temporary transportation
expense incurred by you because artily. total theft of a covered "auto" of the private
passenger type. We will pay only for those covered "autos" for which you carry either
Comprehensive or Specified Causes.of 1.0s Coverage. We will pay for tern porarY
trensportation expanses Incurra duringthe period begInning 48 hours after the theft and
entlIng, regardless of the policy's expiration, when the covered "auto" Is returned to use or
We pay for its loss". if your business shown In the DeCiaritiar10 is other than an auto
dealersblP, We will also pay up to $1,000 fur reasonable and necessary costs Incurred by
you to return a stolen covered auto NM the Place where it fa recovered to Its mud
garaging locetton.
vjL IVIED AUTO PkINSICAL DAMAGE COVERAGE
SECTION III — PHYSICAL DAMAGE COVERAGE, A. overeg0. 4. Cov sions, the followink Is
added.:
c. If hired "autos" are covered "autos" for Liability Cciverage In this policy and
ComprehensTve, Specified causes of Lase,..,Or Collision coverages are provided, 'under
this coverage form for any auto" you Qum, then the Physical Damage Coverages
prided are extended to "autos" you hire, subject to the following lirniti
(a) The most we will pay for "loss" to any Wed "auto" Is $stono or Actuai
Cash Value or Cost of gepalr, whichever is less
(2) sE00 deductible will apply to any toss under this overage extenslon,
except that no deductible shall apply to loss" caused by fire or lightning
Subject:to the above limit and deductible we will provide coverage equal to the
broadest coverage applicable to any covered ''auto" you own of strollarsize and
type. This coVertigs extension 1,13 aceSS coverage over any other collectible •
Insurance,
ACCIDENTAL mom DEPLOYMENT COVERAG5
SECTION 111 PHYSICAL liAlVIAGE COVER/WE, a. Exclusions, 9.., is amended to add t.he following;
This exclusion does not apply to the accidental discharge of an airbag.
Copyright 2013 Mercury Insurance Son/Icea, LLC. All rights reserverir
MCA061.012-13 Includes copyrighted material of insurance Services Office, in F.; with its Permission
Page 4 of S
LOAN/LEASE GAP COVIMAGB
SECTION In - PHYSICAL PANIAGfi COVERAGE C. Limit of Insurance, the 'follovving is added:
4. In the event of a 'total loss" to a covered "auto" shown in the schedule or declarations for
which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on
the lease rat loan for that covered 'auto,'
a. The 'smolt -it mad Under the Physical Damage Coverage Section ofthe
Policy; and
b. Any4
(1) Overdue lease/loan payments at the time of the 90s9d;
(2) Financial penalties imposed under a loose for excessive use., abnormal wear
• and tear or high mileage.
(3) Security deposits not returned by the lessor;
(4) Cos for extended warranties, Credit Life Insurance, Health, Accident or
Disability Insurance purchased with the loan or lease; and
(S) Carry-over balances from previous loans or leases.
MASS REPAIR — DEDUCTIDLE WMWR
SECTION RI - PHYSICAL DAMAGE COVERAOE, D. DE:audible., the following is raided:
No deductible applies to glass damage if the glass Is revoked rather than replaced.
xi!, IWO OR MORE DEDUCTIBLES
SECTION nt-PHYSICAL DAMAGE coVERAGE, D. Deductibla, the following I's added:
tf two or more "csanpany" p Ales or coverage forms Evilly to 'the same accident:
• :L Ifthe applicable Business Auto deductible Is the smatiest, it will be waived. or:
2, if the applicable'Business Auto deductible is not the smalles1,. ityvill be reduced by
then amount, of the smallest decliactIble; or
S. if the loss bivalves two or more'Business Auto coverage farms or policies the
smallest rieductibfe will be waived. " •
For the purpose ofthis endorsement PCOMPEine means the 'company providing this
insurance end any ofthe affiliated members of the Mercury insurance Group of comprifes.
XIII, AlVIKODED DUTIP IN EVENTOFACCIDENT., CLAM SUITOR KISS
• • 'The requirement in -SECTION IV, BUSINESS AUTO colvorrims, A. Loss Conditions, 2. Duties in The
Event Of Accident, Llaitn, Suit, Or Loss, a, in the event of 'accident", you must notify us'of on
I/Am:Were applies onlywhen the "acctclent" is known tg:
(L) you, if you ore an inaviclual;
(2) Aparther, tf you am a portnershlp;
(S) A member, if you are a limited ITabJIYcompany; or
(4) An executive officer or Insurance manager, if you ara 9co oration.
tviCA8Sia12.3
Copyright:2013 Me ra4 insttranbe Services, 1.1.C."-A11 *file reserved.
includes copyrighted material of InsEtranca SeiVices Office, inc.,' with Its Pants:ha Paga 4 of a
xv.
XIV. WAIVER OF SUBROGATION
SECTION IV- BUSINESS AUTO CoNDITIONS, A. Loss Con ditto . 1-anfr tf Righ • �Reovery
,Against Others To Us, section is replaced by the following:
5. Transfer Of Rights Of Recovery Against Others lb Us
We waive any right of recovery we may have against any person or organization to
the ext9nt required of you by a writtP,n contract executed prior to aneaccident" ar
contemplated by such contract. The waiver applies only to the person or
organization designated in such contract.
UNINTENTIONAL ERROR, OMISSION, OH FAILURE TO oiscLosr; lawns
SECTION IV- BUSINESS AVID CONDITIONS, 11..General Condigons, 2. Concealment,
Misrepresentation, or Fraud, the following fa added:
Any unintentional omission of or error In information given by you, or unintentional failure
to disclose all exposures or hazards existing as ofthe effective date or at anytime during
thevolicy pertocrsheli not invalidate or adversely Elffed the coverage forsuch exposure or
hazard or Prqludice your rights under this insurance. However, you must reportthe
undisclosed exposure' or hazard to EIS EIS span as reasonably possible AfteN its discovery.
This provision does not affect our right to,,collect additional premium ar exercise, our right
of cancellation or non -renewal. '
XYLEVIPLOYEE tom AUTO FINSICAI, DAIVIAGE
SECIION IV— BUSINESS AUTO CONDITIONS, B. Conon! CodWan, 5. Other 1rflzcE, b. For Fired
Auto Physical Opmege Coverage, is replaced by the following:
b. For Hired Auto Physical Damage:Coverage, the following are deemed to be covered
"autos" you own:
1. Any covered 'auto u you lease, hire, ran or borrow; and
2. My covered "auto' hired or rented by your "employee" under a contract in
that individual nemployeels" name, with your permission, while performing
duties related to the conduct of your husiness,
However, any 'onto" that Ls leased, hired, rented or borrowed with a driver is note covered
°auto'.
MCA861.01213
Piiiii/IARYAND Nolucoantiourov IF REQUIRED BY coArrutAcT
SECTION IV-- BUSINESS AUU CONDITIONS, B. General Conditions, S. Other Insurance, the
following is added end supersedes any prevision to the celltrailf:
e. This insurance islprimary to and will not seek contribution from any other Insurance
available to an additional insured under your policy provided that:
(LJ The additional Insured Is A Named Insured undersuch other Y11011311GO; and
(2) You have agreed In writing in a contract or agreement that this insurance
would be primary and would not seek contribution from any other
insurance available to the additiorial insured.
Copyright 2013 Mercury Maur/moo Seruiceg, LIM AU right; reserved,
Includes copyrighted material' of loan Woo services Office., Ina, with Ma Perrnission Page of 6
XVIII. 1iREC7 AUTO - CO ERAWR TERRITORY
SECTION IV- BUSiNESS AUTO CONDIT1QNS, R. Eener el Conditions, 7. Policy Parind, coverage
Territory, e. Anywhere, in the world if; Cs replaced by the foltawmng:
e, Anywhere in the world If;
(i.) A covered "auto" h leased, hired, rented arborrowed withaula driver for a
period of30 days or loss; and
(2) The "Insured's" responsibility to pay damages is determined in a "suit" on
the merits, in the United rotes Qf America, the fierrltaries and possessions
of the UJnitedStates of America, Puerto Rico, or Canada or In asettiernant
we agree to.
XiX. i3ADU.Y INJURY REDEFINED TO XNCLUDE RESULTANT MENTAL ANq?Ui H
SECTION V— DEFINITIONS, G "I3ndily tnluryu is amended by adding the follnwingc
"iirjddy injury" also includes mental anguish luitonlywhen the mental anguish arises roar
other bodily ird'ury, sickness, or disease.
Copyright 2013 Mercury insurance Services, LLC. AU rights reserved.
. MCAS52n fncluch s copyrighted materiel of Intuit nc, Services Office, Inc, with its i ernitszfoh rage Oaf 6
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE; POLICY
WC 04 03 06
(Ed. 04.84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA
We have the right to recover our payments frorn anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us,)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged In the
work described In the Schedule.
The additional premium for this endorsement shall be Z% of the California workers' compensation premium
otherwise due on such remuneration,
Schedule
Person or Or anIzation Job Description
Any person or organization as required by written corttraot
This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated.
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective Date; 06/17/2023 policy No.: CST6026607 Endorsement No,
Policy Effective Dates; 06/17/2023 - 06/17/2024
Insured: Tryco General Engineering
Carrier Name / Code: Benchmark Insurance Company A
WC 04 03 06 Countersigned by
(Ed, 04-84)
® Copyright 1984 National Council on Compensation Insuranso, Inc.
Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE
WC040601B
(Ed. 01-22)
CALIFORNIA CANCELATIQN ENDORSEMENT
Thls endorsement applies only to the Insurance provided by the policy because California Is shown in Item 3,A. of the Information
Page.
The consolation condition In Part Six (Conditions) of the polloy Is replaced by these conditions:
Canoetation:
1, You may cancel this policy. You must mall or deliver advance written notice to us stating when the cancelation Is to take
effect.
2, We may cancel this policy for one or more of the following reasons;
a. Non-payment of premium;
b. Failure to report payroll;
a, Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy Issued by us;
d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any
previous polloy Issued by us;
e. Material misrepresentation made by you or your agent;
f. Failure to cooperate with us In the investigation of a claim;
g. Material failure to comply with federal or state safety orders or written recommendations of our designated loss control
representatives;
h. The occurrence of a material change in the ownership of your business;
I. The occurrence of any change In your business or operations that materially Increases the hazard for frequency or
severity of loss;
J. The occurrence of any change in your business or operation that requires additional or different classlfloalion for
premium calculation;
k. The occurrence of any change In your business or operation which contemplates an activity excluded by our reinsurance
treaties.
3 If we cancel your policy for any of the reasons listed In (a) through (f), we will give you 10 days advance written notice,
stating when the cancelation Is to take effect, Mailing that notice to you at your marling address shown In Item 1 of the
Information Page will be sufficient to prove notice, If we cancel your policy for any of the reasons listed In Items (g) through
(k), we will give you 30 days advance written notice; however, we agree that In the event of oancolation and relssuanco of a
policy effective upon a material change In ownership or operations, notice will not be provided,
4, If we mall the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 6 days if
the place of mailing and your mailing address Is within California, 10 days if the place of mailing or your mailing address Is
outside of California and 20 days if the place of mailing or your mailing address Is outside of the United States,
6. The policy period will end on the day and hour stated in the cancelation notice.
This endorsement changes the policy to whloh It Is attached and Is effective an the date Issued unless otherwise stated,
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effeotive Date; 06/17/2023
Insured; Tryco General Engineering
Insurance Company; Benchmark Insurance Company A.
WC060401B
(Ed, 01-22)
Policy No.: CST5025607
Countersigned by
Endorsement No,
Premium; $44,284
Benchmark insurance Company Page 1 of 1
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TERMS
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02/07/2024 16138384 5009 STANDARD 457301 COW MIX 318 SC8 T I 6.07 110.00 667.71
STANDARD ENUFF_E Environmental Fee -Agg & Asphalt I L 1.00 10_00 10_01
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TAX EXEMPT ID.
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TAXES: PERCENT: AMOUNT: l
1 CALIFORNIA 6.00% 40.661
1SAN BERNARDINO 1 25% 8.471
TRANSACTIONS AND USE TAX 1.00% 6.781
1TRANSPORTATION AUTI-IORITY 0.5G% 3.391
PONUMBER REF
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