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HomeMy WebLinkAbout2017 CON LB Civil Construction - 24th Street Community Gateway CIP No. 17-21OWNER - CONTRACTOR AGREEMENT 24T" STREET COMMUNITY GATEWAY, CIP NO. 17-21 This Owner -Contractor Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and LB Civil Construction, Inc. ("Contractor"), 324 E. Valley Pkwy, Escondido, CA 92025 on the 19th day of December, 2017, for the construction of the above referenced Project. In consideration of the mutual covenants and agreements set forth herein, the Owner and Contractor have mutually agreed as follows: 1. CONSTRUCTION The Contractor agrees to do all the work and furnish all the labor, services, materials and equipment necessary to construct and complete the Project in a turn -key manner in accordance with this Agreement and all documents and plans referenced in Exhibit "A", (hereinafter "Contract Documents"), in compliance with all relevant Federal, State of California, County of San Diego and City of National City codes and regulations, and to the satisfaction of the Owner. 2. CONTRACT PRICE Owner hereby agrees to pay and the Contractor agrees to accept as full compensation for constructing the project in accordance with these Contract Documents in an amount not to exceed the contract price as set forth in Exhibit "B" attached hereto and incorporated herein by reference. Payments to the Contractor shall be made in the manner described in the Special Provisions. 3. TIME FOR PERFORMANCE Time is of the essence for this Agreement and the Contractor shall construct the project in every detail to a complete and turn -key fashion to the satisfaction of the Owner within the specified duration set forth in the Special Provisions. 4. NON-DISCRIMINATION In the performance of this Agreement, the Contractor shall not refuse or fail to hire or employ any qualified person, or bar or discharge from employment any person, or discriminate against any person, with respect to such person's compensation, terms, conditions or privileges of employment because of such person's race, religious status, sex or age. 5. AUTHORIZED OWNER REPRESENTATIVES On behalf of the Owner, the Project Manager designated at the pre -construction meeting shall be the Owner's authorized representative in the interpretation and enforcement of all Work performed in connection with this Agreement. 6. WORKERS' COMPENSATION INSURANCE a) By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Agreement. b) The Contractor shall require each subcontractor to comply with the requirements of Section 3700 of the Labor Code. Before commencing any Work, the Contractor shall cause each subcontractor to execute the following certification: "I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Agreement." 7. ENTIRE AGREEMENT; CONFLICT The Contract Documents comprise the entire agreement between the Owner and the Contractor with respect to the Work. In the event of conflict between the terms of this Agreement and the bid of the Contractor, then this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the bid conflicting herewith. 8. MAINTENANCE OF AGREEMENT DOCUMENTATION Contractor shall maintain all books, documents, papers, employee time sheets, accounting records and other evidence pertaining to costs incurred and shall make such materials available at its office at all reasonable times during the term of this Agreement and for three (3) years from the date of final payment under this Agreement, for inspection by Owner and copies thereof shall be furnished to Owner if requested. 9. INDEPENDENT CONTRACTOR At all times during the term of this Agreement, Contractor shall be an independent contractor and shall not be an employee, agent, partner or joint venturer of the Owner. Owner shall have the right to control Contractor insofar as the results of Contractor's services rendered pursuant to this Agreement; however, Owner shall not have the right to control the means by which Contractor accomplishes such services. 10. LICENSES AND PERMITS Contractor represents and declares to Owner that it has all licenses, permits, qualifications and approvals of whatever nature which are legally required to practice its profession. Contractor represents and warrants to Owner that Contractor shall, at its sole cost and expense, keep in effect at all times during the term of this Agreement, any licenses, permits, qualifications or approvals which are legally required for Contractor to practice its profession. 11. GOVERNING LAW, VENUE This Agreement and the Contract Documents shall be construed under and in accordance with the laws of the State of California, and the appropriate venue for any action or proceeding arising from this Agreement and/or the Contract Documents shall be had in the Superior Court of San Diego, Central Branch. 12. COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall for all purposes be deemed to be an original. 13. FALSE CLAIMS Contractor acknowledges that if a false claim is submitted to the Owner, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that the False Claims Act, California Government Code sections 12650, et seq., provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include within their scope false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. In the event the Owner seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorneys' fees. Contractor hereby acknowledges that the filing of a false claim may the Contractor to an administrative debarment proceeding wherein Contractor may be prevented from further bidding on public contracts for a period of up to five (5) years. I have read and understood all of the provisions of this Section 15, above: (Initial) (Initial) 14. AGREEMENT MODIFICATION This Agreement and the Contract Documents may not be modified orally or in any manner other than by an amendment in writing and signed by the Owner and the Contractor. IN WITNESS WHEREOF this Agreement is executed as of the date first written above. Owner: LESLIE LEESE, CITY MANAGER Attest: City Clerk, City of N ' ional City Pifltavto AS To Pier- A-ns;l P. M!«,s --runes Cao oep•43 C 3 Ati•n-4) Contractor: AMU (Owner/Officer siature) JAMtS LVMM, pea Print name and title (Second officer signature if a corporation) Zo//A-) VP Print name and title 76 7/1 Contractor's City Business License No. State Contractor's License No. and Class Business street address , SCOXJ_ /DO/ C. E 92 625 City, State and Zip Code EXHIBIT A CONTRACT DOCUMENTS Owner/Contractor Agreement Bid Schedule Addenda Plans Special Provisions (Specifications) San Diego County Regional Standard Drawings City of National City Standard Drawings Standard Specifications for Public Works Construction and Regional Supplements (Greenbook) State Standard Specifications State Standard Plans California Building, Mechanical, Plumbing and Electrical Codes Permits issued by jurisdictional regulatory agencies Electric, gas, and communications companies specifications and standards Sweetwater Authority specifications and standards Specifications, standards and requirements of MTS, BNSF, SANDAG, Port of San Diego and all other agencies that may be adjacent and/or affected by the project. EXHIBIT B CONTRACT PRICE AND SCOPE Forty Five Thousand dollars, ($45,000) lump sum price. Manufacture, construction and install 24th Street Community Gateway Sign, includes site preparation, concrete pedestal and footing, H-beam sign manufacture and installation, provide and install gabion wall, traffic control and site cleanup; excluding demolition and disposal of existing sign and installation/placement of artifacts. CORPORATE CERTIFICATE I, C- oFF /6- certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that -� ,I4S , who signed said contract on behalf of the Contractor, was then f' /D AJT of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. I, certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that who signed said contract on behalf of the Contractor, was then of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. Corporate Seal: PARTNERSHIP CERTIFICATE STATE OF COUNTY OF On this day of , 2017, before me, the undersigned, a Notary Public in and for said County and State, personally appeared: ) ss (Notary Seal) known to me to be of the partners of the partnership that executed the within instrument, and acknowledged to me that such partnership executed the same. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: Bond No. SNN4007719 Premium:$648.00 Premium is for Contract Term and Subject to Adjustment Based on Final Contract Price PERFORMANCE BOND WHEREAS, the City Manager of the City of National City, on the day of 2017, has awarded to LB Civil Construction, Inc. , hereinafter designated as the "Principal", the 24TH STREET COMMUNITY GATEWAY, CIP No. 17-21 WHEREAS, said Principal is required under the terms of said contract to furnish a bond for the faithful performance of said contract. NOW, THEREFORE, we, the Principal and Nationwide Mutual Insurance Company as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of Forty Five Thousand and 00/100 Dollars ($ 45,000.00 lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT if the above bounden Principal, his/her 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 agreements in the said contract any alteration thereof made as therein provides, on his or their part, to be kept and performed at the time and in the amount therein specified, and in all respects according to their true intent and meaning, and shall indemnify and save harmless the City of National City, its officers, agents, employees, and volunteers as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed herein or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or additions to the terms of the contract or to the work or to the specifications. In the event suit is brought upon this bond by the City and judgment is recovered, the surety shall pay all costs incurred by the City in such suit, including a reasonable attorney's fee to be fixed by the Court. IN WITNESS WHEREOF three identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the Isth day of December Nationwide Mut al Insurance Company (SEAL) (SEAL) Lawrence McMahon, Attorney -in -Fact (SEAL) LB Civil Construction. Inc. Surety Principal , 2017. (SEAL) (SEAL) (SEAL) *Please See Attached California All -Purpose Acknowledgment* PERFORMANCE BOND ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF ) COUNTY OF ) On this day of , 2017, before me, the undersigned, a Notary Public in and for said County and State, personally appeared known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, and acknowledged to me that he subscribed the name of said corporation thereto as Surety, and his own name as attorney -in -fact. ) ss NOTE: Signature of those executing for Surety must be properly acknowledged. NOTE: The Attorney -in -fact must attach a certified copy of the Power of Attorney. Signature: Name (Type or Print): Notary Public in and for said County and State My Commission expires: 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 San Diego On DEC 18 2017 Date before me, Rachel A. Mullen personally appeared Lawrence McMahon } Insert Name of Notary exactly as it appears on the official seal Name(s) of Signer(s) , Notary Public, z RACHEL A. MULLEN' Notary Public - California San Diego County Commission # 2181212 My Comm. Expires Jan 23, 2021 Place Notary Seal Above z z who proved to me on the basis of satisfactory evidence to be the person(, whose name( is/tifki subscribed to the within instrument and acknowledged to me that he/t/ /fY/M/ executed the same in his/WO/Alf authorized capacity(104, and that by his/Nit/NW signature(* on the instrument the person(/$/), or the entity upon behalf of which the person 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. Witness my h official seal. Signatur of Notary Public Rachel A. Mullen Signature OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of the form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner ❑ Limited ❑ General Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Surety Company RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer's Name: ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner ❑ Limited El General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here 1n28253 Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company, an Ohio corporation hereinafter referred to as the "Company" and does hereby make, constitute and appoint: Christopher Conte, Lawrence McMahon, Ryan Warnock, Maria Guise each in their individual capacity, its true and lawful attorney -in -fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature, in penalties not exceeding the sum of Unlimited and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: "RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attomeys-in-fact of the Company, and to authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company." "RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document, contract, instrument, or other papers of the Company. IN WITNESS WHEREOF, the Company has caused this instr 4er to q sea and duly attested by the signature of its officer the 1st day of May, 2017. Antonio C/Albanese, Vice President of Nationwide Mutual Insurance Company ACKNOWLEDGMENT STATE OF NEW YORK, COUNTY OF NEW YORK: ss On this 1st day of May , 2017, before me came the above -named officer for the Company aforesaid, to me personally known to be the officer described in and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn, deposes and says, that he is the officer of the Company aforesaid, that the seal affixed hereto is the corporate seal of said Company, and the said corporate seal and his signature were duly affixed and subscribed to said instrument by the authority and direction of said Company. BARRY T. BASSIS Notary Public, State of New York No. 02BA4656400 Qualified in New York County Commission Expires April 30, 2019 Notary Public My Commission Expires April 30, 2019 CERTIFICATE I, Laura B. Guy, Assistant Secretary of the Company, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner; that said Antonio C. Albanese was on the date of the execution of the foregoing power of attorney the duly elected officer of the Company, and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of attorney is still in full force and effect. IN WITNESS WHEREOF, I have hereunto subscribed my name as Assistant Secretary, and affixed he corporate seal of said Company this day of , 20 1' DEC 18 2017 Assistant Secretary This document is void if VOID appears in the BLUE line on the right, the Nationwide watermark is missing from the center of the page and/or the red consecutive number is missing from the upper right-hand corner. Contact us at 212-329-6900 if this document is void or if you have any questions. Bond No. SNN4007719 Premium Included in Performance Bond PAYMENT BOND WHEREAS, the City Manager of the City of National City, on the day of 2017 has awarded LB Civil Construction, Inc. , hereinafter designated as the "Principal", the 24TH STREET COMMUNITY GATEWAY, CIP No. 17-21. WHEREAS, said Principal is required by Chapter 5 (commencing at Section 3225) and Chapter 7 (commencing at Section 3247), Title 15, Part 4, Division 3 of the California Civil Code to furnish a bond in connection with said contract; NOW, THEREFORE, we, the Principal and Nationwide Mutual Insurance Company as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of Forty Five Thousand and 00/100 Dollars ($45,000.00) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if said Principal, his/her or its subcontractors, heirs, executors, administrators, successors, or assigns, shall fail to pay any of the persons named in Section 3181 of the California Civil Code, or amounts due under the Unemployment Insurance Code with respect to work or labor performed by any such claimant, or for any amounts required to be deducted, withheld, and paid over to the Franchise Tax Board from the wages of employees of the Contractor and his subcontractors pursuant to Section 18806 of the Revenue and Taxation Code, with respect to such work and labor the Surety will pay for the same in an amount not exceeding the sum hereinafter specified, and also, in case suit is brought upon this bond, a reasonable attorney's fee, to be fixed by the Court. This Bond shall inure to the benefit of any of the persons named in Section 3181 of the California Civil Code, so as to give a right of action to such persons or their assigns in any suit brought upon this bond. It is further stipulated and agreed that the Surety on this bond shall not be exonerated or released from the obligation of this bond by any change, extension of time for performance, addition, alteration or modification in, to, or of any contract, plans, specifications, or agreement pertaining or relating to any scheme or work of improvement hereinabove described or pertaining or relating to the furnishing of labor, materials, or equipment therefore, not by any change or modification of any terms of payment or extension of the time for any payment pertaining or relating to any scheme or work of improvement hereinabove described, nor by any rescission or attempted rescission of the contract, agreement or bond, nor by any conditions precedent or subsequent in the bond attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or agreement or under the bond, nor by any fraud practiced by any person other than the claimant seeking to recover on the bond and that this bond be construed most strongly against the Surety and in favor of all persons for whose benefit such bond is given, and under no circumstances shall Surety be released from liability to those for whose benefit such bond has been given, by reason of any breach of contract between the owner of Public Entity and original contractor or on the part of any obliges named in such bond, but the sole conditions of recovery shall be that claimant is a person described in Section 3110 or 3112 of the California Civil Code, and has not been paid the full amount of his claim and that Surety does hereby waive notice of any such change, extension of time, addition, alteration or modification herein mentioned. IN WITNESS WHEREOF three identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the tsth day of December 2017. Nationwide Mutual Insurance Company (SEAL) LB /Civil Construction, Inc. (SEAL) Al (SEAL) (SEAL) Lawrence McMahon, Attorney -in -Fact (SEAL) (Cr. .61J/V l ` Q (SEAL) Surety Principal STATE OF *Please See Attached California All -Purpose Acknowledgment* ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY COUNTY OF ) ss ) On this day of , 2017, before me, the undersigned, a Notary Public in and for said County and State, personally appeared known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, and acknowledged to me that he subscribed the name of said corporation thereto as Surety, and his own name as attorney -in -fact. NOTE: Signature of those executing for Surety must be properly acknowledged. NOTE: The Attorney -in -fact must attach a certified copy of the Power of Attorney. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: ATTACH ALL BONDS 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 San Diego On DEC 1 8 2017 before me, Rachel A. Mullen Date personally appeared Lawrence McMahon } Insert Name of Notary exactly as it appears on the official seal Name(s) of Signer(s) , Notary Public, RACHEL A. MULLEN Notary Public - California Can Diego County Commission # 2181212 D My Comm. Expires Jan 23, 2021 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person* whose name* is/tifil subscribed to the within instrument and acknowledged to me that he/ff '/f'ft executed the same in his/M//,t/Alt authorized capacity(/,A), and that by his!! fFMj/ signature* on the instrument the person*, or the entity upon behalf of which the person(/¢/) 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. Witness my hand a Signature OPTIONAL seal. Signature of Notary Public Rachel A. Mullen 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 the form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Number of Pages: ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner ❑ Limited ❑ General Attorney in Fact LI Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: Surety Company RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer's Name: ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here 1028254 Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company, an Ohio corporation hereinafter referred to as the "Company" and does hereby make, constitute and appoint: Christopher Conte, Lawrence McMahon, Ryan Warnock, Maria Guise each in their individual capacity, its true and lawful attorney -in -fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings, and other obligatory instruments of similar nature, in penalties not exceeding the sum of Unlimited and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: "RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys -in -fact of the Company, and to authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company." "RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document, contract, instrument, or other papers of the Company. IN WITNESS WHEREOF, the Company has caused this instrj,4erji tot seal;. and duly attested by the signature of its officer the 1st day of May, 2017. Antonio C/Albanese, Vice President of Nationwide Mutual Insurance Company ACKNOWLEDGMENT STATE OF NEW YORK, COUNTY OF NEW YORK: ss On this 1st day of May , 2017, before me came the above -named officer for the Company aforesaid, to me personally known to be the officer described in and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn, deposes and says, that he is the officer of the Company aforesaid, that the seal affixed hereto is the corporate seal of said Company, and the said corporate seal and his signature were duly affixed and subscribed to said instrument by the authority and direction of said Company. BARRY T. BASSIS Notary Public, State of New York No. 02BA4656400 Qualified in New York County Commission Expires April 30, 2019 Notary Public My Commission Expires April 30, 2019 CERTIFICATE I, Laura B. Guy, Assistant Secretary of the Company, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner; that said Antonio C. Albanese was on the date of the execution of the foregoing power of attorney the duly elected officer of the Company, and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of attorney is still in full force and effect. IN WITNESS WHEREOF, I have hereunto subscribed my name as Assistant Secretary, and affixed he corporate seal of said Company this day of 20 DEC 18 2017 Assistant Secretary This document is void if VOID appears in the BLUE line on the right, the Nationwide watermark is missing from the center of the page and/or the red consecutive number is missing from the upper right-hand corner. Contact us at 212-329-6900 if this document is void or if you have any questions. 24TH STREET COMMUNITY GATEWAY, CIP No. 17-21 BID DOCUMENT NON -COLLUSION AFFIDAVIT The undersigned declares: The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or a sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose. Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder and has full knowledge of whether any acts of collusion occurred or did not occur. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on: DcG:: /8 2o/ 7 Date By: Signature of Corporate Officer or Owner Eva/0- � v p Print name and title ,L 3 G(),(./S % r2 v 67"704✓ Name of Company Non -Collusion Affidavit Page 1 of 1 24TH STREET COMMUNITY GATEWAY, CIP No. 17-21 BID DOCUMENT VERIFICATION AND EXECUTION By signing and submitting this Verification and Execution form, the bidder certifies and declares under penalty of perjury under the laws of the State of California that all the information contained in all bid documents is true and correct and that any deviations, errors and omissions may subject the bid to a determination as non -responsive, that Bidder agrees to be bound by their bid prices to complete the work and that the Bid prices as a whole and in the ultimate quantities used represent all costs associated with constructing the project as a complete and functioning project as intended and represented in all plans, specification and referenced materials. Further, the bidder agrees to defend by legal counsel of the Agency's choosing, and to indemnify and hold harmless the City of National City against all legal challenges to this bidder's bid. L c� C/ I//7 )C Y7 L) Official Company Name DBA, if a y atu OMM Sign of CorFJg►rate Officer, or Partner, or Owner JMS LtMM PREs. Print name and title Signature of second Corporate Officer (required for corporations) � �� �30 ✓�, vp Print name and title DEG /i5i 20/7 Date Failure to fully execute this document will render the bid non -responsive. Verification and Execution Page 1 of 1 24TH STREET COMMUNITY GATEWAY, CIP No. 17-21 BID DOCUMENT IRAN CONTRACTING ACT CERTIFICATION (Public Contract Code section 2200 et seq.) As required by California Public Contract Code section 2204, under penalty of perjury the Contractor hereby certifies upon execution of this document that the following statements as to the Contractor's status in regard to the Iran Contracting Act of 2010 (Public Contract Code section 2200 et seq.) is true and correct: The Contractor is not: 1. identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code section 2203; or 2. provides goods or services of twenty million dollars ($20,000,000) or more in the energy sector of Iran, including a person that provides oil or liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas, for the energy sector of Iran; or 3. a financial institution that extends, for 45 days or more, credit in the amount of $20,000,000 or more to any other person or entity identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code section 2203, if that person or entity uses or will use the credit to provide goods or services in the energy sector in Iran. In accordance with Public Contract Code section 2205, false certification of this form will be reported to the California Attorney General and may result in civil penalties equal to the greater of $250,000 or twice the Contract Price, termination of the Contract and/or ineligibility to bid on contracts for three years. 6/ ►//L Go,(S-r-r2 Uc rio cJ Company Name Signature of Corporate Officer or Owner - 6 6 /4J ) e Print Name and Title Dec / 20/7 Date This Certification applies to Contracts over $1,000,000 Iran Contracting Act Certification Page 1 of 1 ACO OR CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/18/2018 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 Wood Gutmann & Bogart 15901 Red Hill Ave., Suite 100 Lic. #0679263 Tustin CA 92780 INSURED L.B. Civil Construction, Inc. 324 East Valley Pkwy Escondido CA 92025 LBCIV-1 CONTACT NAME: PHONE 714-824-8393 (A/C No E#): E-MAIL ADDRESS: Michele@wgbib.com FAX No): 714-573-1770 INSURER(S) AFFORDING COVERAGE INSURER A : Zurich American Insurance NAIC 8 16535 INSURER B : Scottsdale Insurance Company INSURER C : 41297 INSURER D : Associated Industries Ins Co 23140 INSURER E : INSURER F : CATE NUMBER: 1396699811 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUER VJVD POLICY NUMBER POLICY EFF (MM/DD/YYYYIJMM/DD/YYYY1, POLICY EXP LIMITS D X COMMERCIAL GENERAL LIABILITY AES104811000 5/1/2017 5/1/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE a LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BAP450354805 10/1/2017 10/12018 COMBINED SINGLE LIMIT (Ea accident) $1.000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON OWNED AUTO-S PROPERTY DAMAGE (Per accident) $ B UMBRELLA LIAB X OCCUR XLS0102269 5/1/2017 5/1/2018 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DED RETENTION $ $ A WORKERS COMPENSATION WC450354705 10/1/2017 10/12018 X STATUTE ERH- AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is named as additional insured on the General Liability per attached forms as required by written contract subject to the terms and conditions of the policy: GL Additional Insured - Completed Ops Form #CG 20 37 04 13 GL Additional Insured - Ongoing Ops Form #CG 20 33 04 13 GL Waiver of Subrogation Form #24 04 05 09 GL Per Project Aggregate Form #GLS-332s (1-12) GL Primary Form #GLS-152s (4-14) See Attached... CERTIFICATE HOLDER CANCELLATION National City 1243 National City Blvd National City CA 91950 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZE REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LBCIV-1 -�1 ACORO® LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Wood Gutmann & Bogart POLICY NUMBER CARRIER NAIC CODE NAMED INSURED L.B. Civil Construction, Inc. 324 East Valley Pkwy Escondido CA 92025 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE• CERTIFICATE OF LIABILITY INSURANCE GL Wrap Up Exclusion Form #GLS-454s (5-14) Workers' Compensation Waiver of Subrogation Form #WC040306 RE: Main Street Community Gateway, CIP No. 17-21, Loc - 24th and Wilson Ave Division St. Project, CIP NO. 17-22, Loc- Division St and Roosevelt Ave. CERTIFICATE HOLDER VESTING: City of National City and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers Certificate holder is named as additional insured on the Auto per attached CA 20 48 10 13, as required by written contract subject to the terms and conditions of the policy. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY CG 21 54 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Description and Location of Operation(s): All operations at locations at which the insured was at any time: 1. Covered, offered Coverage, or denied coverage; or 2. Enrolled, offered enrollment, or not allowed to enroll under a wrap-up program (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following exclusion is added to paragraph 2., Exclusions of COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Cove- rages): This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing operations or operations included within the "products - completed operations hazard" at the location de- scribed in the Schedule of this endorsement, as a consolidated (wrap-up) insurance program has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) insurance program: (1) Provides coverage identical to that provided by this Coverage Part; (2) Has limits adequate to cover all claims; or (3) Remains in effect. CG 21 54 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect 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 for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. CG20330704 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying servic- es, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY NX GL 093 08 09 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 FORM Schedule Overall Policy Aggregate Limit: $5,000,000 (Information required to complete this Schedule, if not shown above, will be shown in Declarations.) A. Paragraphs 2. and 3. of SECTION III — LIMITS OF INSURANCE are replaced by the following: 2. The Overall Policy Aggregate Limit is the most we will pay for the sum of a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and c. Damages under Coverage B. 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard" to each of your projects away from premises owned by or rented to you. B. The following is added to SECTION III — LIMITS OF INSURANCE: 8. Subject to Paragraph 2. and 3. above, the General Aggregate Limit is the most we will pay under for the sum Coverage A, Coverage B, or Coverage C to each of your projects away from premises owned by or rented to you. NX GL 093 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY NX GL 009 08 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE (THIRD -PARTY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Third Party: As required by written contract (Absence of a specifically named Third Party above means that the provisions of this endorsement apply as required by written contractual agreement with any Third Party for whom you are performing work.) Paragraph 4. of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance: With respect to the Third Party shown above, this insurance is primary and non-contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co-insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. NX GL 009 08 09 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations where required by written contract with the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY CG20370704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations National City 1243 National City Blvd. National City, CA 91950 Division St. & Roosevelt Ave. National City, CA 91950 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property darn - age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products - completed operations hazard". CG 20 37 07 04 ©1S0 Properties, Inc., 2004 Page 1 of 1 O POLICY NUMBER: AES1046110 00 COMMERCIAL GENERAL LIABILITY CG20370704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations National City 1243 National City Blvd. National City, CA 91950 24th St & Wilson Avenue National City, CA 91950 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sche- dule of this endorsement performed for that addi- tional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: BAP450354805 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: L.B. Civil Construction, Inc. Endorsement Effective Date: 12/19/2017 SCHEDULE Name Of Person(s) Or Organization(s): National City 1243 National City Blvd National City, CA 91950 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Wolters Kluwer Financial Services i Uniform FormsTM POLICY #: WC450354705 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA We have the right to recover our payments from 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 0 % of the California workers' compensation pre- mium otherwise due on such remuneration. Person or Organization ALL PERSONS OR ORGANIZATIONS WHEN REQUIRED BY WRITTEN CONTRACT Schedule Job Description WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Page 1 of 1 CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950 619-336-4228 Michael R. Dalla, CMC - City Clerk LB CIVIL CONSTRUCTION, INC. 24TH Street Community Gateway Project CIP No. 17-21 Judy Hernandez (Engineering/Public Works) forwarded a copy of the Agreement to LB Civil Construction, Inc.