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HomeMy WebLinkAbout2019 CON Fordyce Construction - 1430 Hoover Ave. Tenant Improvements, CIP No. 19-07 (2)OWNER - CONTRACTOR AGREEMENT 1430 HOOVER AVENUE TENANT IMPROVEMENTS, CIP NO. 19-07 This Owner -Contractor Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and Fordyce Construction, Inc. ("Contractor"), 9932 Prospect Avenue, Suite 138, Santee, CA 92071, on the 25th day of April, 2019, 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 shad 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) 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: Stehen Manganiell Acting City Manager APPROVED AS TO FORM: By Angil Ci orney rri / -J Contractor: (Owner/Officer signature) Bri . n Ford ce President r' t name and titl- ( econd officer _ha ''t ifaco oration) Krista Fordyce, Secretary Print name and title 100049 Contractor's City Business License No. 608529/Ai 6 State Contractor's License No. and Class 9932 Prospect Avenue, Suite 138 Business street address Santee, CA 92071 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 (NOTE - TO BE COMPLETED TO CONFORM WITH BID SCHEDULE ITEMS) Bid Results for Project 1430 Hoover Avenue Tenant Improvements (CIP No. 19-07) Issued on 04/03/2019 Bid Due on April 18, 2019 1:00 PM (Pacific) Exported on 05/01/2019 Line Totals (Unit Price * Quantity) Fordyce Construction, Inc. Fordyce Construction, Inc. Item Num Section Item Code Description Units Qty. Unit Price Line Total 1 Unnamed Section Mobilization/Demobilization LS 1 $6,560.00 $6,560.00 2 Unnamed Section Fire Sprinkler/Service Design LS 1 $4,140.00 $4,140.00 3 Unnamed Section Fire Sprinkler System Interior LS 1 $38,140.00 $38,140.00 4 Unnamed Section Fire Sprinkler System Exterior LS 1 $58,530.00 $58,530.00 5 Unnamed Section Ventilation System with CO sensor LS 1 $54,210.00 $54,210.00 6 Unnamed Section CMU Infill Wall LS 1 $10,610.00 $10,610.00 7 Unnamed Section Miscellaneous Electrical LS 1 $8,250.00 $8,250.00 Subtotal $180,440.00 Total $180,440.00 I, Krista Fordyce CORPORATE CERTIFICATE certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that Brian Fordyce , who signed said contract on behalf of the Contractor, was then President 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. f, Krista Fordyce certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that Brian Fordyce Contractor, was then who signed said contract on behalf of the President 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. Secretary Signature: Corporate Seal: PERFORMANCE BOND Bond No. LAIFSU0762835 *Premium: 2,468.00 WHEREAS, the City Manager of the City of National City, on the 25th day of April, 2019, has awarded to Fordyce Construction, Inc., hereinafter designated as the "Principal", the 1430 HOOVER AVENUE TENANT IMPROVEMENTS, CIP NO. 19-07. 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 International Fidelity Insurance Company as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of One Hundred Eighty Thousand, Four Hundred Forty ($180,440.00) 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 CON L)IT ION OF-1 HIS 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 6th day of May , 2019 . International Fidelity Insurance Company(SEAL) (SEAL) Bart Stewart, Attorney -in -Fact (SEAL) Surety Fordyce Construction, Inc. (SEAL) (SEAL) Principal (SEAL) PERFORMANCE BOND ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF CALIFORNIA ) ) ss COUNTY OF SAN DIEGO On this 6th day of May , 20 19 , before me, the undersigned, a Notary Public in and for said County and State, personally appeared Bart Stewart known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the International Fidelity Insurance Company , 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. Signature: NOTE: The Attorney -in -fact must attach a certified copy of the Power of Attorney. Name (Type or Print): Erin Elyse Haugh, Notary Public Notary Public in and for said County and State My Commission expires: January 6, 2022 ERIN ELYSE HAUGH Commission No. 2227679 NOTARY PUBLIC - CALIFORNIA .12 SAN DIEGO COUNTY Commission Expires January 6, 2022 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY One Newark Center, 20'h Floor, Newark, New Jersey 07102-5207 PHONE: (973) 624-7200 Bond # LAIFSU0762835 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint BART STEWART Encinitas, CA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July, 2015 "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December, 2017 STATE OF NEW JERSEY County of Essex George R. James Executive Vice President (International Fidelity Insurance Company) and Vice President (Allegheny Casualty Company) On this 31 st day of December, 2017 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and of ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. ,,,,,,,uun,„,,, •`OtHY CR•., ..;Ssto4• •' i : OP Ito ▪ :o NOTARY A; • :s 11110.•40 m: • s PUBLIC ' : OF NEW 3 ,,,`,�. , ,,,,,,,,,,tio,,, I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the liorne of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. CERTIFICATION IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, May 06, 2019 Cathy a Notary Public of New Jersey My Commission Expires April 16, 2019 A00982 *-444,‘,Abgee Maria H. Branco, Assistant Secretary Bond No. LAIFSU0762835 *Premium Included In Performance Bond PAYMENT BOND WHEREAS, the City Manager of the City of National City, on the 25th day of April, 2019 has awarded Fordyce Construction, Inc., hereinafter designated as the "Principal", the 1430 HOOVER AVENUE TENANT IMPROVEMENTS, CIP NO. 19-07. 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 International Fidelity Insurance Company as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of One Hundred Eighty Thousand, Four Hundred Forty ($180,440.00) 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 6th day of May , 20 19 International Fidelity Insurance Company(SEAL) Fordyce Construction, Inc. (SEAL) (SEAL) SEAL) Bart Stewart, Attorney -in -Fact (SEAL) (SEAL) Surety Principal ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF CALIFORNIA ) ss COUNTY OF SAN DIEGO On this day 6th of May 20 19 , before me, the undersigned, a Notary Public in and for said County and State, personally appeared Bart Stewart known to me to be the person whose name is subscribed to the within instrument as the attorney -in -fact of the International Fidelity Insurance Company , 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 NOTE: The Attorney -in -fact must attach a Surety must be properly certified copy of the Power of acknowledged. Attorney. Signat Name (Type or Print): Erin Elyse Haugh, Notary Public (Notary Public in and for said County and State) My Commission expires: January 6, 2022 ATTACH ALL BONDS ERIN ELYSE HAUGH Commission No. 2227679 z NOTARY PUBLIC - CALIFORNIA v SAN DIEGO COUNTY Commission Expires January 6, 2022 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY One Newark Center, 20th Floor, Newark, New Jersey 07102-5207 PHONE: (973) 624-7200 Bond # LAIFSU0762835 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint BART STEWART Encinitas, CA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July, 2015 "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December, 2017 STATE OF NEW JERSEY County of Essex George R. James Executive Vice President (International Fidelity Insurance Company) and Vice President (Allegheny Casualty Company) On this 31 st day of December, 2017 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and of ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. ,V�� • NOTARY �#. :23 > 1110.•1 m lia It 's PUBLIC CO Op NEW ,�,,. �,I,I,msdI`` IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. fitAkrei,m-ec CERTIFICATION Cathy a Notary Public of New Jersey My Commission Expires April 16, 2019 I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy cr :he Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the orig pals on fiie in the home of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, May 06, 2019 A00982 eykot9f,Aoget9 Maria H. Branco, Assistant Secretary FORDY-1 OP ID: LR ACO/211, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/06/2019 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 Alcott Insurance Agency, Inc. 3945 Idaho Street San Diego, CA 92104-2902 Kirk S. Jorgenson INSURED Fordyce Construction Fordyce Construction Inc 9932 Prospect Ave #138 Santee, CA 92071-4378 NAME: Lori Rubalcaba PHONE 819-293-3800 (MC. No, Ed): E-MAIL ADDRESS: FAX C, No): 619-293-3896 INSURER(S) AFFORDING COVERAGE INSURER A : Ohio Security Insurance Co INSURER B : Contractor's Bonding Ins. INSURER c : California Insurance Company NAIC # 24082 37206 38865 INSURER D : American Fire & Casualty Co 24066 INSURER E : Topa Insurance Company 18031 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR W1/D POUCY NUMBER POUCY EFF (MM/DD/YYYY) POUCY EXP (MMIDO/YYYY) UMITS B GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY X X A31ADG000 03/09/2019 03/09/2020 PREM SES (EaENTED occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X $5,000 BI/PD Ded PERSONAL & ADV INJURY $ 1,000,000 Per Occurrence GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY X PE a LOC $ D AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO X X BAA55980121 02/24/2019 02/24/2020 BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON OS -OWNED AUT PROPERTY DAMAGE (PER ACCIDENT) $ Comp & Coll $ 500 Ded X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 E L EXCESS UAB CLAIMS -MADE XL00200304-02 03/09/2019 03/09/2020 AGGREGATE $ 4,000,000 DED RETENTION $ Following $ Forms WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY X WC STATU- TORY LIMITS OTH- ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N N / A X 881 45601-07 03/01/2019 03/01/2020 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) y E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Inland Marine/Equp RC/Special Form BKS55980121 03/09/2019 03/09/2020 R/L Equip 100,000 Ded 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project No: CIP No. 19-07, 1430 Hoover Avenue Tenant Improvements, 1430 Hoover Avenue, National City CA 91950. The City of National City, its elected officials, officers, agents, employees and volunteers are added as additional insured but only as respects work done by, for, or on behalf of the named insures. This policy shall be considered primary insurance as CERTIFICATE HOLDER CANCELLATION CITYOFN City of National City c/o Rick Manager 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE CITYOFN INSURED'S NAME Fordyce Construction FORDY-1 OP ID: LR PAGE 2 Date 05/06/2019 respects any other valid and collective insurance City of National City may possess, including self -insured retention, City of National City may possess, any other insurance City of National City does possess shall be considered excess insurance only. This insurance shall act for each insured, and additional insured, as though a separate policy had been written for each. This, however, will not act to increase the limit of liability of the insuring company. All and each additional insured shall have the right to select their own defense counsel. Thirty (3) days prior written notice of cancellation shall be given to the Agency in the event of cancellation and/or reduction in coverage of any nature. Per blkt GL forms RGL350, CBGL0072 Primary & Non -Contributory & CBGL0316 Waiver of Subrogation & Per Project Aggregate attached; Auto form CA8810 includes waiver of subrogation and WC waiver of subrogation WC 01 03 03 attached. FORDYCE CONSTRUCTION INC POLICY NUMBER: A31ADG000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WHERE REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. WHO IS AN INSURED (Section II) is amended to include as an insured any person(s) or organ- ization(s) whom you are required to add as an additional insured on this policy pursuant to a written contract or written agreement which is: 1. Valid and legally enforceable; 2. Currently in effect or becoming effective during the term of this policy; and 3. Executed prior to an "occurrence" result- ing in "bodily injury" or "property dam- age." B. When required in the written contract or written agreement, the coverage provided to the addi- tional insured under this policy shall be primary and non-contributory to the additional insured subject to the limitations set forth below. C. The insurance provided to the additional Insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for `bodily injury" or "property damage" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; In the performance of your ongoing opera- tions as specified in the written contract. When required in the written contract or written agreement, the coverage provided to the additional insured by this endorsement will apply to "bodily injury" or "property damage" arising out of the `products - completed operations hazard." When cov- erage does apply to "bodily injury" or "prop- erty damage" arising out of the "products - completed operations hazard" such cover- age will cease at the earliest of the follow- ing: a. The period of time specified by the writ- ten contract or written agreement; or b. The expiration date of this policy. RGL 350 06 15 2. The Limits of Insurance applicable to the additional insured are the lesser of the available limits in this policy, or those limits you agreed to provide in the written contract or written agreement. 3. With respect to the coverage provided un- der this endorsement, the following duties are added to Section IV — Commercial General Liability Conditions, paragraph 2. Duties In The Event of Occurrence, Of- fense, Claim or Suit: e. An additional insured under this endorse- ment will as soon as practicable: (1) Give written notice of an "occur- rence" to us which may result in a claim or "suit" under this insurance; (2) Agree to trigger or activate any other insurance which the additional in- sured has for a loss we cover under this Coverage Part by tendering the defense to the insurers of all such other insurance. 4. If required by the written contract or written agreement, we waive the right of recovery we may have against the additional insured to which this endorsement applies for pay- ments we make for "bodily injury" or "prop- erty damage" arising out of "your work' on the written contract or written agreement. However, such waiver does not apply to payments for liability apportioned to the ad- ditional insured. 5. Unless otherwise agreed in the written con- tract or written agreement, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis that is available to the additional in- sured. Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc., with its permission. FORDYCE CONSTRUCTION INC POLICY NUMBER: A31ADG000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- WHERE REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — WHERE REQUIRED BY CONTRACT RGL 350 06 15 Paragraph C. is deleted and replaced with the following: C. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations as specified in the written contract. When required in the written contract or written agreement, the coverage provided to the additional insured by this endorsement will apply to "bodily injury" or "property damage" arising out of the "products -completed operations hazard." FORDYCE CONSTRUCTION INC POLICY NUMBER: A31ADG000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY AMENDMENT OF OTHER INSURANCE — EXCESS PROVISION (Construction Contracts) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section IV, Paragraph 4.b.(1) of the COMMERCIAL GENERAL LIABILITY CONDITIONS is amended by addition of the following: (c) This insurance is excess over any other insurance whether primary, excess, contingent or on any other basis that is available to you as an additional insured or contractual indemnitee under a policy issued to a subcontractor. You are required to give notice of a claim to all "potential insurers" within 30 days of giving notice of claim to us. We have no duty under Coverage A or B to defend any claim or "suit" that any other insurer has a duty to defend. If no other insurer defends, we will undertake to do so, but we will be entitled to our rights against all those other insurers. We will pay only our share of the amount of loss, if any, that exceeds the sum of; (i) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and CBGL00720512 (ii) The total of all deductible and self-insurance amounts under all such insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of the Coverage Part. "Potential insurer" mean all insurance companies who may be obligated to defend the insured as either a named insured or an additional insured. "Potential insurers" includes the insurers of all subcontractors who were contractually obligated to name the insured as an additional insured on their own insurance policy(ies)_ Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc., with its permission. FORDYCE CONSTRUCTION POLICY NUMBER: A31ADG000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY GENERAL LIABILITY ENHANCEMENT SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT This schedule is provided only as a convenience. It should not be assumed to provide a reference to eve- ry provision that can affect a question, claim or coverage. To determine the full scope of coverage and pertinent restrictions and exclusions, the policy, including endorsements, must be read it its entirety. A. Reasonable Force — Bodily Injury Or Property Damage B. Non -Owned Watercraft C. Damage To Premises Rented To You D. Supplementary Payments E. Newly Acquired Or Formed Organizations F. Additional Insured — Owner, Manager or Lessor Of Premises Or Leased Equipment G. Additional Insured — State or Political Subdivisions — Permits Related to Premises or Opera- tions H. Unnamed Partnership Or Joint Venture I. General Aggregate Limit — Per Project or Per Location J. Damage To Premises Rented To You Limit K. Knowledge And Notice Of Occurrence Or Offense L. Unintentional Omission M. Waiver Of Transfer Of Rights Of Recovery Against Others To Us 7� N. Amended Bodily Injury Definition O. Amended Insured Contract Definition CBGL 03 16 05 14 Includes copyrighted material of Page 1 of 6 Insurance Services Office, Inc., with its permission. FORDYCE CONSTRUCTION INC POLICY NUMBER: A31ADG000 the equipment lease ex- pires; or (e) If the equipment is leased with an operator. c. This provision does not apply on any basis to any person or organiza- tion for which coverage as an addi- tional insured specifically is added by another endorsement to this poli- cy. G. Additional Insured — State Or Political Subdivisions — Permits Related To Prem- ises Or Operations The following paragraphs are added: 5. Any state or political subdivision that has issued a permit in connection with premises owned or occupied by, or rented or loaned to, you, but only with respect to "bodily injury", 'property dam- age", "personal and advertising injury' arising out of the existence, ownership, use, maintenance, repair, construction. erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, mar- quees, hoist away openings, sidewalk vaults, elevators, street banners or dec- orations for which that state or political subdivision has issued such permit 6. Any state or political subdivision that has issued a permit, but only with re- spect to "bodily injury", "property dam- age", "personal and advertising injury" arising out of operations performed by you or on your behalf for which that state or political subdivision has issued such permit. However, no such state or political subdivision is an insured for: a. "Bodily injury", "property damage" "personal and advertising injury" arising out of operations performed for that state or political subdivision; or b. "Bodily injury" or "property damage' included within the "products - completed operations hazard'. H. Unnamed Partnership Or Joint Venture 1. The last paragraph of Section II — Who Is An Insured is deleted and replaced by the following: No person or organization is an insured with respect to the conduct of any cur- rent or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Dec- larations. However this limitation does not apply to your liability with respect to your conduct of the business of any cur- rent or past partnership or joint venture: a. That is not shown as a Named In- sured in the Declarations; and b. In which you are a member or part- ner but only if: (1) Each and every member or partner in that joint venture or partnership is not a construction contractor; and (2) The joint venture or partnership is not providing construction contracting services. 2. This provision does not apply to any person or organization for which cover- age is excluded by another endorse- ment to this policy. 3. The insurance provided by this provision shall be excess over any valid and col- lectible other insurance, whether prima- ry, excess, contingent or on any other basis. SECTION III — LIMITS OF INSURANCE I. General Aggregate Limit — Per Project Or Per Location Paragraph 3. is deleted and replaced by the following: 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages be- cause of "bodily injury' and "property damage" included in the "products - completed operations hazard" and ap- plies separately to each of your "pro- jects" away from premises owned by or occupied by you or to each of your "lo- cations" owned by or occupied by you. "Projects" mean an area away from premises owned by or rented to you at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the appli- CBGL 03 16 05 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 6 FORDYCE CONSTRUCTION INC POLICY NUMBER: A31ADG000 4\--- M. Waiver Of Transfer Of Rights Of Recov- ery Against Others To Us The following is added to paragraph 8. Transfer of Rights of Recovery Against Others to Us: However, we waive any rights of recov- ery we may have against any person or organization because of payments we make for "bodily injury", "property dam- age", "personal injury and advertising in- jury' arising out of: a. Premises owned by you, temporarily occupied by you with permission of the owner, or leased or rented to you; b. Ongoing and completed operations performed by you, or on your behalf, under a contract or agreement with that person or organization; c. Your "work"; or d. ''Your products'. We waive these rights only where you have agreed to do so as part of a con- tract or agreement entered into by you before the "bodily injury" or "property damage" occurs or the "personal and advertising injury" offense is committed. SECTION V - DEFINITIONS N. Amended Bodily Injury Definition Paragraph 3. is deleted and replaced by the following: 3. "Bodily injury" means injury to the body, sickness, disease, or death. "Bodily inju- ry" also means mental injury, mental anguish, emotional distress, pain and suffering, or shock resulting from injury to the body, sickness, disease or death of any person. O. Amended Insured Contract Definition 1. Paragraph 9.a. is deleted and replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemni- fies any person or organization for damage by water, fire, explosion, lightning, or smoke resulting from fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 2. Paragraph 9.c. is deleted and replaced by the following: c. Any easement or license agreement 3. Subsection 9.f.(1) is deleted. 4. The following is added to the end of paragraph 9.: The insurance provided by the above definitions of "Insured Con- tract" shall be excess over any valid and collectible Railroad Protective Liability insurance available to an insured , whether primary, excess, contingent or on any other basis, except for the insurance purchased specifically by you to apply in ex- cess of the Limits of Insurance shown in the declarations for this Coverage Part. CBGL 03 16 05 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 6 FORDYCE CONSTRUCTION INC POLICY NUMBER: BAS55980121 COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 3 ACCIDENTAL AIRBAG DEPLOYMENT 12 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 19 AMENDED FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 13 BROAD FORM INSURED 1 BODILY INJURY REDEFINED 22 EMPLOYEES AS INSUREDS (including employee hired auto) 2 EXTENDED CANCELLATION CONDITION 23 EXTRA EXPENSE -BROADENED COVERAGE 10 GLASS REPAIR- WAIVER OF DEDUCTIBLE 15 HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) 6 HIRED AUTO COVERAGE TERRITORY 20 LOAN / LEASE GAP 14 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 16 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 RENTAL REIMBURSEMENT 9 SUPPLEMENTARY PAYMENTS 4 TOWING AND LABOR 7 TWO OR MORE DEDUCTIBLES 17 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 18 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 20 SECTION 1I - LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self -insured retention plan available to that organization; CA88100113 ® 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and Only for the duration of that contract, agreement or permit (3) 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or CA88100113 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V - DEFINITIONS is amended by adding the following: "Total Toss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 CA 88 10 01 13 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: CA88100113 ® 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V - DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. CA88100113 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 15. GLASS REPAIR - WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible; a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. CA88100113 ® 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V - DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V - DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. CA 88 10 01 13 © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 WORKERS COMPENSATION AND r_MPLOYERS LIABILITY INSURANCE POLICY WC 01 03 03 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: (x) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium 1500 The premium charge for this endorsement shall be of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium 5. Advance Premium This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective 03/01/19 Policy No. 46-881456-01-07 Endorsement No. 9 Insured Fordyce Construction, Inc. Premium $ 1,500.00 Insurance Company California Insurance Company Countersigned by Form W-9 (Rev. October2018) Department of the Treasury Internal Revenue Se,v ce 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. I 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 Fordyce Construction, Inc. 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. 4 Exemptions certain entities, instructions Exempt payee Exemption code (if any) Applies re eccwxns (codes apply only to not individuals; see on page 3): code (if any) III Individual/sole proprietor or I9 C Corporation 111 S Corporation il Partnership i1 Trust/estate single member LLC ❑ 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. LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single is disregarded from the owner should check the appropriate box for the tax classification of its owner ■ Other (see instructions) ► ► from FATCA reporting Do not check owner of the LLC is -member LLC that maintained outside The U.S i 5 Address (number, street, and apt. or suite no.) See instructions. 9938 Prospect Avenue, Suite 138 Requester's name and address (optional) 6 City, state, and ZIP code Santee, CA 92071 7 List account number(s) here (optional) w axpayer Ic1en Ica tion Number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid 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 entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TFN, 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. Social security number or Employer identification number 1 9 8 6 2 2 6 Part I1 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 TN. See the instructions for Part II, later. Sign Here Signature of U.S. person ► r`�"✓�i`�--- Date ► 5/3/19 General Instructions 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.irs.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 retums include, but are not limited to, the following. • Form 1099-INT (interest eamed or paid) • 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 11N, you might be subject to backup withholding. See What is backup withholding, later. Cat No. 10231 X Forrn W-9 (Rev. 1 C-20' 8) THIS DOCUMENT HAS A TRUE WATERMARK AND VISIBLE FIBERS DISCERNIBLE FROM BOTH SIDES 100049 BUSINESS LICENSE CERTIFICATE CITY OF NATIONAL CITY PURSUANT TO CITY ORDINANCE THIS LICENSE IS HEREBY GRANTED FOR THE TERM & PURPOSE STATED BUS DESCRIPTION GENERAL CONTRACTOR BUSINESS ADDRESS BUSINESS NAME ATTN: MAILING ADDRESS NON TRANSFERABLE 9932 PROSPECT Alsair 138 INCORPORATED FORDYCE CONSTRUCTION INC 9932 PROSPECT AVE STE 138 SANTEE, CA 92071-4378 POST IN A CONSPICUOUS PLACE Date of Expiration: 12/31/2019 City Manager THIS DOCUMENT IS ALTERATION PROTECTED AND REFLECTS FLUORESCENT FIBERS UNDER UV LIGHT THIS DOCUMENT HAS A TRUE WATERMARK AND VISIBLE FIBERS DISCERNIBLE FROM BOTH SIDES BUSINESS ADDRESS 9520 PATHWAY ST BUSINESS NAME ATTN: MAILING ADDRESS 22174 BUSINESS LICENSE CERTIFICATE CITY OF NATIONAL CITY PURSUANT TO CITY ORDINANCE THIS LICENSE IS HEREBY GRANTED FOR THE TERM & PURPOSE STATED BUS DESCRIPTION FIRE PROTECTION SVCS 4 CALf���I�� Date of Expiration INATIOs CIf /- 'LI()J ARROW AUTOMATIC FIRE SPRII�/peep 9520 PATHWAY ST SANTEE, CA 92071-4169 NON TRANSFERABLE POST IN A CONSPICUOUS PLACE 12/31 /2019 City Manager THIS DOCUMENT IS ALTERATION PROTECTED AND REFLECTS FLUORESCENT FIBERS UNDER UV LIGHT KEEP FOR YOUR RECORDS BUSINESS TAX RECEIPT License No. 22174 A $50 00 SB1186 $4.00 TOTAL $54.00 CITY OF NATIONAL CITY BUSINESS LICENSE APPLICATION 1243 NATIONAL CITY BLVD, NATIONAL CITY, CA 91950 LICENSE WILL NOT BE ISSUED IF REQUIRED INFORMATION IS INCOMPLETE. ENCLOSE PAYMENT WITH APPLICATION. MAKE CHECKS PAYABLE TO THE CITY OF NATIONAL CITY. PLEASE TYPE OR PRINT A. GENERAL INFORMATION BUSINESS NAME (D.B.A. OR INDIVIDUAL NAME) tvCJ CORPORATE NAME (IF DIFFERENT FROM D.B A.) LOCAL BUSINESS PHONE TION IN NATIONAL CITY NUMBER DIR STREET NAME ROOM/SUITE NO. NUMBER DIR MAILINGADDRESSAND/OR P.O. BOX STREET NAME ROOM/SUITE NO. P.O. BOX NO. CITY \ o \'n (oykt STATg ZIP CODE 7 PHONE NUMBER AT MAILING ADDRESS. INCLUDE AREA CODE APPLICANT COPY EMAIL ADDRESS: kYue hIPSOY li `k(61,OD' ((WA Rev. 6/2015 Bt I R' National City 1243 National City Blvd. 618-336 4330 / 76516 05/07/2019 09:38:29.000 Validation Receipt Reg CHW( IN 27 CHARGES - 001-00000 3040 BL truline masonry $ 50.00 001--00000-3043 S81186 truline masonry $ 4.00 Sub -total 3*********54.00 PAYMENT - Check - 5183 $ 54.00 truline masonry Change $sssss*ss*s0.00 City of National City FBUSINESS LICENSE DIVISION (619) 336-4330 TAXES $ 7) MISC $ SB1186 $ TOTAL $ 4.00 S 4.00 CITY OF NATIONAL CITY BUSINESS LICENSE APPLICATION 1243 NATIONAL CITY BLVD, NATIONAL CITY, CA 91950 LICENSE WILL NOT BE ISSUED IF REQUIRED INFORMATION IS INCOMPLETE. ENCLOSE PAYMENT WITH APPLICATION. MAKE CHECKS PAYABLE TO THE CITY OF NATIONAL CITY. PLEASE TYPE OR PRINT A. GENERAL INFORMATION BUSINESS NAME (D.B.A. OR INDIVIDUAL NAME) WG Construction, Inc CORPORATE NAME (IF DIFFERENT FROM D.B.A.) NUMBER DIR LOCAL BUSINESS PHONE 619-401-8000 LOCATION IN NATIONAL CITY STREET NAME ROOM/SUITE NO. 101�7R DIR MAILING A DRESS AND/OR P.O. BOX STREET NAME El Cajon Blvd P.O. BOX NO. ROOM/SUITE M/SUITE NO. CITY EL Cajon PHONE NUMBER AT MAILING ADDRESS. INCLUDE AREA CODE 619-401-8000 STATE CA ZIP CODE 92019 APPLICANT COPY EMAIL ADDRESS: bill@wgcontructioninc.com Rev. 6/2015 BUS # Lic # ALL LICENSES EXPIRE DECEMBER 31 RENEWALS ARE DUE BY FEBRUARY 28 THIS STUB, WHEN VALIDATED, 1S YOUR OFFICIAL RECEIPT FROM THE: City of National City BUSINESS LICENSE DIVISION (619) 336-4330 TAXES $ MISC $ SB1186 $ 4.00 TOTAL $ 4.00 CITY OF NATIONAL CITY BUSINESS LICENSE APPLICATION 1243 NATIONAL CITY BLVD, NATIONAL CITY, CA 91950 LICENSE WILL NOT BE ISSUED IF REQUIRED INFORMATION IS INCOMPLETE. ENCLOSE PAYMENT WITH APPLICATION. MAKE CHECKS PAYABLE TO THE CITY OF NATIONAL CITY. PLEASE TYPE OR PRINT A. I,1:NtRAL INFORMATION BUSINESS NAME (D.B.A. OR INDIVIDUAL NAME) P.A.C. Heating and Air Conditioning, Inc. CORPORATE NAME (IF DIFFERENT FROM D.B.A.) NUMBER DIR ,,OCATION IN NATIONAL CITY STREET NAME LOCAL BUSINESS PHONE 619-561-9163 ROOM/SUITE NO. NUMBER MAILING ADDRESS AND/OR P.O. BOX DIR I 5E36 Po.Box ROOM/SUITE NO. 3E] F�(J.t3 P.O. NO. crr Lakeside STATE CA ZIP CODE 92040 PHONE NUMBER AT MAILING ADDRESS. INCLUDE AREA CODE 619-561-9163 APPLICANT COPY EMAIL ADDRESS: kristina©(Iacheatingandair corn Rev. 612015 BUS # LIC # ALL LICENSES EXPIRE DECEMBER 31 RENEWALS ARE DUE BY FEBRUARY 28 THIS STUB, WHEN VALIDATED, IS YOUR OFFICIAL RECEIPT FROM THE: City of National City BUSINESS LICENSE DMSION (619) 336-4330 TAXES $ MISC $ SB1186 $ 4.00 TOTAL $ 4.00 ed-D14?-f.7__ Date: From (Dept.): CONTRACT TRANSMITTAL FORM (Attach to Documents dropped off to City Clerk's Office) 6/4/2019 Engineering Submitted by (First & Last Name): Tirza Gonzales Vendor: Fordyce Construction, Inc. — 1430 Hoover Ave Tenant Improvements CIP 19-07 Resolution: YES / 11111 I 2 3 4 Originals Provided to City Clerk (circle quantity) x Department has copy x Vendor has copy