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HomeMy WebLinkAbout2019 CON DBX, Inc. - Communications Infrastructure Expansion - Kimball Towers, CIP No. 17-02OWNER - CONTRACTOR AGREEMENT COMMUNICATIONS INFRASTRUCTURE EXPANSION — KIMBALL TOWERS, CIP NO. 17-02 This Owner -Contractor Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and DBX, Inc. ("Contractor"), 42024 Avenida Alvarado, Suite A, Temecula, CA 92590, on the 30th day of May, 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,.) 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) (Ihitial) 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: Brad City ' anager APPROVE AS TO FORM: By: Angi Ci Atto' ey Contractor: (O/ner/Officer signature) James C. Perry, President Pname and title i-b C.- P,_ nd officer signature if a corporation) James C. Perry, Secretary/Treasurer rint name and title 99676 Contractor's City Business License No. 240547 A & C-10 State Contractor's License No. and Class 42024 Avenida Alvarado, Suite A Business street address Temecula, CA 92590 City, State and Zip Code CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 •.. . 5..�,.• ... . . .,.r .. ., Y. � ... .Y... :L.:2 Z•."ff. i. 2. f : 4,4 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 Riverside On May 28, 2019 before me, Date personally appeared James C. Perry } Phyllissa Martz, Notary Public Here Insert Name and Title of the Officer Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. PHYLLISSA MARTZ Notary Public - California Riverside County Commission # 2159844 My Comm. Expires Au p 11, 2020 Place Notary Seal and/or Stamp Above 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 and official seal. Signature OPTIONAL wf)J),. Signature of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages- Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee ❑ Other: Signer is Representing. 0 Guardian of Conservator Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association 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 Sheet Communications Infrastructure Expansion - Kimball Towers, CIP No. 17-02 Item if Item Description (S) Indicates Specialty Item Quantity Unit Unit Price Amount 1 Furnish and Install 2" PVC Conduit with Mule Tape 950 LF $39.00 $37,050.00 2 Furnish and Install 2" EMT Conduit and Fasten to Ceiling 150 LF $41.00 . $6,150.00 3 Furnish and Install 12 Strand SMFOC with Tracer Wire 3000 LF $3.50 $10,500.00 4 Furnish and Install 36 Strand SMFOC with Tracer Wire 2850 LF $4.50 $12,825.00 5 Furnish and Install 36-Strand Fiber Optic Splice Closure 1 EA $1,100.00 $1,100.00 6 Furnish and Install Fiber Optic Splice Box with Extension 1 EA $2,000.00 $2,000.00 7 Furnish and Install Fiber Distribution Unit, 12- Port Splice Cassette, and Fiber Jumpers 1 EA $3,000.00 $3,000.00 8 Furnish and Install #5 Pull Box With Extension 2 EA $1,200.00 $2,400.00 9 Furnish and Install Conduit to Enter Building 2 EA $750.00 $1,500.00 10 Field Splices 20 EA $130.00 $2,600.00 11 Furnish and Install Hardened Switch with Power Supply and Din Rail Mounting 1 EA $4,400.00 $4,400.00 12 Furnish and Install 12-Strand Fiber Optic Fan- Out Kit inside Ex. Metal Enclosure 1 EA $1,800.00 $1,800.00 13 Furnish and Install Street Light Power Tap Adapter 1 EA $350.00 $350.00 14 Fiber Testing and Documentation 1 LS $4,500.00 $4,500.00 15 Mobilization 1 LS $2,000.00 $2,000.00 16 Traffic Control 1 LS $3,500.00 $3,500.00 17 Furnish and Install 2" PVC Conduit with Mule Tape 600 LF $30.00 $18,000.00 Communications Infrastructure Expansion - Kimball Towers Total: $113,675.00 CORPORATE CERTIFICATE James C. Perry certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that James C. Perry , 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. I James C. Perry certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that James C. Perry who signed said contract on behalf of the Contractor, was then Secretary/Treasurer 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: antiku) a e, CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 CO.M1.03CCER1112•19}1RZACtAbt8, 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 Riverside } On May 28, 2019 before me, Phyllissa Martz, Notary Public Date personally appeared James C. Perry Here Insert Name and Title of the Officer Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. PHYLLISSA MARTZ Notary Public - California Riverside County Commission # 2159844 M Comm. Ex . ires Au 11, 2020 z z Place Notary Seal and/or Stamp Above certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature OPTIONAL Signature of Notary Publi Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages. Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator ❑ Other: Signer is Representing• Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee ❑ Other: Signer is Representing: 0 Guardian of Conservator ©2017 National Notary Association PARTNERSHIP CERTIFICATE STATE OF ) COUNTY OF ) On this day of , 20 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: Executed in Three Counterparts Bond #367289P Premium $1,039 PERFORMANCE BOND WHEREAS, the City Manager of the City of National City, on the 30th day of May,, 2019, has awarded DBX. Inc., hereinafter designated as the "Principal', the COMMUNICATIONS INFRASTRUCTURE EXPANSION —KIMBALL TOWERS, CIP NO. 17-02. 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 Developers Surety and Indemnity 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 Thirteen Thousand, Six Hundred Seventy Five ($113,675.001 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 15 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 30th day of May , 2019 . Developers Surety and Indemnity (SEAL) Con)arty _(SEAL) D:X Incor•orate • L) By: ./.. (SEAL) Charles L. Flake, Attorney -in -Fact (SEAL) a. (SEAL) Surety Principal 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 Riverside On May 28, 2019 Date personally appeared James C. Perry before me, } Phyllissa Martz, Notary Public Here Insert Name and Title of the Officer Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within Instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. z z PHYLLISSA MARTZ Notary Public - California Riverside County Commission # 2159844 My Comm. Expires Aug 11, 2020 Place Notary Seal and/or Stamp Above 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 and official seal. Signature OPTIONAL WL4"� ignature of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: 0 Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator ❑ Other: Signer is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association PERFORMANCE BOND ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF COUNTY OF ) ss On this day of , 20 , 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: ❑ 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 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT 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 Orange On 5-30-19 Date before me, Lexie Sherwood personally appeared Charles L. Flake } Insert Name of Notary exactly as it appears on the official seal Name(s) of Signer(s) , Notary Public, LEXIE SHERWOOD COMM. # 2203287 3 NOTARY PUBLIC • CAUFORNIA ORANGE COUNTY Comm. Exp. JULY 27, 2021 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 and,official seal Signature OPTIONAL Signatur of Lexie Sherwood 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: 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 POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: ***David L. Culbertson, Charles L. Flake, Lexie Sherwood, Heather Willis, Spencer Flake, jointly or severally*** as their true and lawful Attomey(s)4n-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fad full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attomey(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January lst, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attomey(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and That the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attomey or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this 4th day of October, 2018. By ' By: Gib Daniel Young, Senior Vice -President pick - Mark Lansdon, Vice -President State of California County of Orange 'ao�Sr AND �NO.a cna,c• oPPeRllo.,�t2 1936 :0G7 CgLInoinAt t op ANY Of. 2 OCT.5 ids 1967 a zr Niroik" 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. On October 4, 2018 Date personally appeared before me, LUCILLE RAYMOND Notary Public - California Orange County Commission Y 2258185 My Comm. Expires Oct 13, 2022 ■ Place Notary Seal Above Lucille Raymond, Notary Public Here Insert Name and Title of the Officer Daniel Young and Mark Lansdon Nama(s) of signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 and official seal. Signature l-J Lucillt fj y ond, Notary Public CERTIFICATE v The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of • said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. �` rx'< This Certificate i executed in the City of Irvine, California, this By QQ�{{, Cassie J.,O�nisford, Assistant Se Lary ATS-1002 (10/18) (// 30th day of May , 2019 . OM?ANYOfr OCT, S ° T1 1$67 P p. 2 Executed in Three Counterparts PAYMENT BOND Bond #367289P Premium: Included in Performance Bond WHEREAS, the City Manager of the City of National City, on the 30th day of Mav, 2019 has awarded DBX, Inc., hereinafter designated as the "Principal", the COMMUNICATIONS INFRASTRUCTURE EXPANSION — KIMBALL TOWERS, CIP NO. 17-02. 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 Developers Surety and Indemnity 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 Thirteen Thousand, Six Hundred Seventy Five ($113,675.001 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 15 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 30th day of May , 2019 Developers Surety and Indemnity C9rRp�n� (SEAL) DBX, Incorporated (SEAL) EAL) By: C . (SEAL) Charles L Flake, Attorney -in -Fact (SEAL) (SEAL) Surety Principal 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 Riverside } On May 28, 2019 before me, Phyllissa Martz, Notary Public Date personally appeared James C. Perry Here Insert Name and Title of the Officer Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ..,; PHYLLISSA MARTZ ►� Notary Public - California 'SA Riverside County _ Commission # 2159844 It Exres Aup 11 _2020 C Place Notary Seal and/or Stamp Above 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 and official seal. Signature p OPTIONAL Signature of Notary Pub,' Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer — Title(s): 0 Corporate Officer — Title(s): ❑ Partner — 0 Limited 0 General 0 Partner — 0 Limited 0 General ❑ Individual 0 Attorney in Fact 0 Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator 0 Trustee 0 Guardian of Conservator ❑ Other: 0 Other: Signer is Representing: Signer is Representing: ©2017 National Notary Association ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF ) ss COUNTY OF On this day of , 20 , 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 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 Orange On 5-30-19 before me, Lexie Sherwood Date personally appeared Charles L. Flake Insert Name of Notary exactly as it appears on the official seal Name(s) of Signer(s) , Notary Public, LEXIE SHERWOOD COMM. # 2203287 3 NOTARY PUBLIC • CALIFORNIA n ORANGE COUNTY - Comm. Exp. JULY 27, 2021 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 and official seal. Signature of Note Public Lexie enNood 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: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: 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 ❑ Individual ❑ Corporate Officer —Title(s): ❑ Partner LI Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: RIGHT THUMBPRINT OF SIGNER Top of thumb here POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA92623 (949) 263-3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint ***David L. Culbertson, Charles L. Flake, Lexie Sherwood, Heather Willis, Spencer Flake, jointly or severally*** as (heir true and lawful Attomey(s)-in-Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of suretyship giving and granting unto said Attomey(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorney(s)-in-Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008. RESOLVED, hat a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute his Power of Attorney, qualifying the attomey(s) named in the Power of Attomey to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attomey or to any certificate relating thereto by facsimile, and any such Power of Attomey or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in he future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this 4th day of October, 2018. By CIDatit' -r Daniel Young, Senior Vice -President By. L97-C Mark Lansdon, Vice -President 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 Orange On October4, 2018 before me Date personally appeared LUCILLE RAYMOND Notary Public - California >c Orange County F. Commission / 2258185 My Comm. Expires Oct 13, 2022 ■ Place Notary Seat Above Lucille Raymond, Notary Public Here Insert Name and Tale or the Officer Daniel Young and Mark Lansdon Narnels) of Signori') who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that hefshe/they executed the same in hismer/their authorized capacity(ies), and that by hismer/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) 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 and official seal. Signature CERTIFICATE Lua ond, Notary Public The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA. does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boardsitif Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine, California, this Cassie J1 rrisford, Assistant Se tary ATS-1002 (10/18) ��// -c pu, uad 30th day of May , 2019 . , tcgV AND rN'•.�••• -w'• 1936 ig • a:- gegjt rnns.a, A� b® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/rrYY) 5/23/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 GMGS Risk Management & Insurance Services 6201 Oak Canyon, Suite 100 Irvine, CA 92618 www.gmgs.com 0684519 NAMEACT Charise May PHONENF#7• (949)559-3367 FAX(A/C. No: E-MAIL o IESS: charisem@qmqs.com INSURER(S) AFFORDING COVERAGE NAIC 4 INSURER A: Travelers Indemnity Company of Connecticut 25682 INSURED DBX In Alvarado, Suite A . 42024 AvenidaINSURER Temecula CA 92590 INSURER B: Travelers Property Casualty Co of Amer 25674 C: State Compensation Insurance Fund of CA 35076 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE 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 INSD SUER WVD POLICY NUMBER POLICY EFF IMMIDDIYYYY) POLICY EXP (MM/DDNYTY) LIMITS A / COMMERCIAL GENERAL LIABILITY 4T22-CO-7202P439-TCT-19 3/1/2019 3/1/2020 EACH OCCURRENCE $1,000,000 $300,000 CLAIMS -MADE ✓ OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE ✓ LIMIT APPLIES PEC0. PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG 52000,000 $ B AUTOMOBILE ✓ LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY _ 1 SCHEDULED AUTOS NON -OWNED AUTOS ONLY 4T-810-2K982444-TIL-19 3/1/2019 3/1/2020 COMBINED tSINGLE LIMIT $1000,000 $ BODILY INJURY (Per person) BODILY INJURY accident) (Per) $ PROPERTY DAMAGE (Per accident) S $ B / UMBRELLALIAB EXCESS LIAR V OCCUR CLAIMS -MADE CUP-1J930129-19-2S 3/1/2019 3/1/2020 EACH OCCURRENCE $10,000,000 $ 10 000,000 AGGREGATE DED ✓ RETENT ON$10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOWPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 9218083-2018 10/1/2018 10/1/2019 ,/ STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $1000.000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Communications Infrastructure Expansion; Kimball Towers; CIP No. 17-02 This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto. CERTIFICATE HOLDER CANCELLATION The City of National City c/o Risk Managee 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 Calvin Sistrunk V1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 4009102a 119-20 A/O/U/W-R&L-PP I Charise May 15/23/2019 3:19:03 PM (POT) I Page 1 of 13 ACORD® AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY Risk Management & Insurance Services 9 NAMED INSURED DBGMGS 42024 Inc. Avenida Alvarado, Suite A Temecula Temecula CA 92590 POLICY NUMBER CARRIER NAIL CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: The City of National City c/o Risk Managee ADDRESS- 1243 National City Blvd. National City CA 91950 RE: Communications Infrastructure Expansion; Kimball Towers; CIP No. 17-02 As respects General Liability coverage, City of National City and its elected officials, officers, employees, agents, employees and volunteers added as Additional Insured and this insurance is primary, per CGD2460805 attached. As respects General Liability CGD3161111 attached. As respects General Liability CGD2110104 attached. As respects General Liability Occurrence. coverage, coverage, coverage, a Waiver of Subrogation is hereby included per a General Aggregate Limit applies Per Project, per a $5,000 Property Damage Deductible applies per As respects Automobile Liability coverage, City of National City and its elected officials, officers, employees, agents, employees and volunteers added as Additional Insured, per CAT3530215 attached. As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, CAT3530215 attached. per As respects Automobile Liability coverage, No Liability Deductible applies. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per 2572 attached. As respects Workers' Compensation coverage, No Deductible applies. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 48891024 119-20 A/G/U/W-R&L-PP I Char -Lee May 15/23/2019 3:19;03 PM (PDT) I Page 2 of 13 DBX Inc. 4T22-CO-7202P439-TCT-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury, "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection,architectural or engineering activities. The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 48891024 119-20 A/G/U/W-R&L-PP I Charise May 15/23/2019 3:19:03 PM (POT) 1 Page 3 of 13 COMMERCIAL GENERAL LIABILITY i. How, when and where the '!occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. 48891024 119-20 A/O/U/W-R&L-PP 1 Chartse May 15/23/2019 3:19:03 PM (PDT) I Page 4 of 13 CG D2 46 08 05 DBX Inc. 4T22-CO-7202 P439-TCT-19 by any ordinance, law or building code to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal in- jury" or "advertising injury" arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to: a. Any "bodily injury," "property damage," "per- sonal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision; or b. Any "bodily injury" or "property damage" in- cluded in the "products -completed operations hazard". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence or offense is known by you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture or limited liability company, and none of your partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur- rence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture; CG D316 1111 (3) COMMERCIAL GENERAL LIABILITY (ii) A manager of any limited liability company; or (iii) An executive officer or director of any other organization; that is your partner, joint venture member or manager; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. Notice to us of such "occurrence" or of an offense will be deemed to be given as soon as practicable If it 'is given in good faith as soon as practicable to your work- ers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge, release or escape of "pollut- ants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional error in,, any information provided by you which we relied upon in issuing this policy will not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: O 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 48891024 1 19-20 A/G/U/W-R&L-PP 1 Char se May 1 5/23/2019 3:19:03 PM (PDT) I Page 5 of 13 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion, but only for payments we make because of: a. "Bodily injury" or "property damage" that oc- curs; or b. 'Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement. M. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: 3. "Bodily injury" means bodily injury, mental anguish, mental injury, shock, fright, disability, humiliation, sickness or disease sustained by a person, including death resulting from any of these at any time. N. CONTRACTUAL LIABILITY— RAILROADS 1. The .following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Page 6 of 6 O 2011 The Travelers Indemnity Company. All rights reserved. CG D316 11 11 48891024 119-20 A/G/0/N-RaL-PP I Cha0ise May 15/23/2019 3:19:03 PM (PDT) I Page 6 of 13 DBX Inc. COMMERCIAL GENERAL POLICY NUMBER. 4T22-CO-7202P439-TCT-19 ISSUE DATE: 3/1/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies Insurance provided underthe following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED. IN A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT; PROVIDE➢ THAT, THE CONTRACT IS SIGNED AND EXECUTED PRIOR TO ANY LOSS FOR WHICH COVERAGE IS SOUGHT. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to operations at a single designated "project' shown in the Schedule above' 1 A separate Designated Protect General Ag gregate Limit applies to each designated "project', and that limit is equal to the amount of the General Aggregate Limit shown In the Declarations, unless separate Designated Project General Aggregate(s) are scheduled above 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury' or "property damage" included in the "productscompleted operations hazard", and for medical expenses under COVERAGE C, regardless of the number of: a. Insureds, b Claims made or "suits" brought, or c Persons or organizations making claims or bnnging "suits". CG D211 01 04 Designated Protect General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS LIABILITY 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Designated Project General Aggregate Limit for that designated "project' Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Project General Aggregate Limit for any other designated "protect" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C. (SECTION I), which cannot be attributed only to operations at a single designated "project' shown in the Schedule above. Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 40891024 1 19-20 A/a/u/W-RSL-PP 1 Charise May 1 5/23/2019 3:19:03 PM (PDT) 1 Page 7 Of 13 COMMERCIAL GENERAL LIABILITY 1 Any payments made under COVERAGE A for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products - Completed Operations Aggregate Limit, 'whichever is applicable, and 2 Such payments shall not reduce any Desig nated Project General Aggregate Limit C Part 2 of SECTION 111- LIMITS OF INSURANCE is deleted and replaced by the following. 2. The General Aggregate Limit is the most we will pay for the sum of. a. Damages under Coverage B; and b. Damages Prom "occurrences" under COVERAGE A (SECTION I) and for all medical expenses caused by accidents under COVERAGE C (SECTION I) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard' is pro vided, any payments for damages because of "bodily injury" or "property damage" Included in the "products - completed operations hazard" will reduce the Products - Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Project General Aggregate Limit. E For the purposes of this endorsement the Definitions Section is amended by the addition of the following definition. "Project" means 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 applicable aggregate limit of insurance, each "project' that Includes premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project'. F. The provisions of SECTION III - LIMITS of INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 48891024 119-20 A/0/D/N-R&L-PP I Charlee May 15/23/2019 3:19:03 PM (PDT) I Page 8 of 13 DBX Inc. 4T-810-2 K982444-T I L-19 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described In any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, end these coverage broadening provisions do not apply to the extent that coverage Is excluded or limited by such an endorsement, The following listing Is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine fights, dutles, and what Is and Is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE— INCREASED LIMIT C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E, SUPPLEMENTARY PAYMENTS —INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A, BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- fng tho pollcy period over which you maintain 50% or more ownership Interest and that Is not separately insured for Business Auto Coverage. Coverage under this provision Es afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following Is added to Paragraph c. In A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who Is required under a written contract or agreement between you and that person or organization, that Is signed and executed by you before the "bodily injury" or "property damage" occurs and that Is In effect during the policy period, to be named as an addl- tionei Insured Is an "Insured" for Covered Autos Liability Coverage, but only for damages to which CA T3 63 0215 I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L, NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this Insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained In Section II, C. EMPLOYEE HIRED AUTO 1, The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours Is an "insured" while operating an "auto" hired or rented under a contract or agreement In an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2, The following replaces Paragraph b, in B.6„ Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow-, and (2) Any covered "auto" hired or rented by your "employee" under a contract In an "employee's" name, with your ®2015 The Travelers Indemnity Company. Alt rtghle reserved, Page 1 0(4 Inoiudes copydghled material of Insurance Services Office, Inc. with Ito permisslon. 48891024 119-20 A/G/U/W-RLL-PP I Charlse May l 5/23/2019 3:19:0 (PDT) 1 Page 9 of 13 COMMERCIAL AUTO permission, while performing duties rotated to the conduct of your busi- ness. However, any "auto" that Is leased, hired, rented or borrowed- with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following Is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE; Any "employee" of yours is an "Insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS 1. The following replaces Paragraph A,2,a,(2), of SECTION 11— COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3;000 for cost of ball bonds (In- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, Including actual loss of earnings up to $500 a day be- cause of time off from work, F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS The following replaces Subparagraph (6) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION IV — BUSINESS AUTO CONDI- TIONS: (5) Anywhere In the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation Imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that Is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (If you are a limited liability company) or members of their households. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "In- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (II) Neither you nor any other Involved "Insured" will make any settlement without our consent, (Ili) We may, at our discretion, participate in defending the "Insured" against, or In the settlement of, any claim or "suit", (iv) We will reimburse the "Insured° for sums that the "Insured" legally must pay as damages because of "bodily Injury" or "property damage" to which this Insurance applies, that the "In- sured" pays with our consent, but only up to the limit described In Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses Incurred with our consent for your investlga• tlon of such claims and your defense of the "Insured' against any such "suit", but only up to and Included within the limit described In Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of Insurance in payments for damages, settlements or defense expenses. (b) This Insurance Is excess over any valid and collectible other insurance available to the "Insured" whether primary, excess, contingent or on any other basis. (c) This Insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Page 2 of 4 ®2016 The Travelers Indemnify Company, All rights reserved. Includes copyrighted material of insurance Services Office, Iria. With as permission. CAT3530215 40891024 1 19-20 A/G/U/W-R&L-PP I Chariee May 1 5/23/2019 3:19:03 PM (PDT) I Page 10 of 13 You agree to maintain all required or compulsory Insurance In any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not Invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory In- surance requirements. (d) It Is understood that we are not an admit- ted or authorized Insurer outside the United States of America, Its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the famishing of certificates of Insurance, or for compliance in any way with the laws of other countries relating to Insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: ' No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. . H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE —INCREASED LIMIT The following replaces the last sentence of Para- graph A.4,b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE; However, the most we will pay for any expenses for loss of use Is $85 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence In Para- graph A.4,a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL. PROPERTY The following Is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE; Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personalproperty which Is: (1) Owned by an "Insured"; and CA T3 63 0215 COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto", No deductibles apply to this Personal Property coverage. K. AIRBAGS The following Is added to Paragraph B,3„ Exclu- slons, of SECTION III — PHYSICAL DAMAGE COVERAGE; Exclusion 3,a, does not apply to 'loss" to one or more airbags In a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth In Paragraphs A,1,b, and A.1.c., but only; a. If that "auto" Is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally Inflated, We will pay up to a maximum of $1,000 for any one 'loss", L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following Is added to Paragraph A.2.a„ of SECTION IV- BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or 'loss" Is known to: (a) You (If you are an Individual); (b) A partner (If you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or Insurance manager (If you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". -M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESs AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract. signed and executed prior to any "accident" or "loss', provided that the "accident" or "loss" arises out of operations contemplated by 02015 The Travelers Indemnity Company, All rights rose rood. Page 3 of 4 Includes copydghted material of Insurance ear/Ices 011oe, Inc. wfth Its permission. 40091024 I. 19-20 A/G/U/W-RUL-PP I Charise May 15/23/2019 3:19:03 PM (PDT) I Page 11 of 13 COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated In such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following Is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional orror In, any information given by you shall not prejudice your rights under this Insurance, How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 o 2015 The Travelers Indemnity Company, All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with Ito permission.. CA T3 53 0215 48891024 119-20 A/a/U/W-R&L-PP I Charise May 15/23/2019 3:19:03 PM (POT) l Page L2 of 13 ENDORSEMENT AGREEMENT STATE COMPENSATION INSURANCE FUND WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 1, 2018 AT 12.01 A.M. AND EXPIRING OCTOBER 1, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME DBX, INC. 42024 AVENIDA ALVARADO STE A TEMECULA, CA 92590 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP 02 9218083-18 RENEWAL SP 1-29-45-17 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: SEPTEMBER 26, 2018 ee 98091029 119-20 A/G/U/W-R&tAUTHQR{ZED EEPRESENTiPI 1VT3 PM (PDT) I Page 13 of 13 PRESIDENT AND CEO 2572 SCIF FORM 10217 IREV.4.20181 OLD DP 217 CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950-4397 619-336-4228 Michael R. Dalla, CMC - City Clerk DBX, INC. Communications Infrastructure Expansion —Kimball Towers, CIP No.17-02 Kathy Masters (Engineering/Public Works) forwarded a duplicate original Agreement to DBX, Inc. CONTRACT TRANSMITTAL FORM (Attach to Documents dropped off to City Clerk's Office) Date: 049 From (Dept.): flAgil Mart vl&t ?ii Submitted by (First Initial, Last Name): Vendor: 1)13)( 1 l\C Resolution: YES 0 Masters 2 3 4 Originals Provided to City Clerk (circle quantity) X Department has copy Vendor has copy