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HomeMy WebLinkAboutACCI Roofing Services - Camacho Gym Roof Replacement, CIP No. 19-51 - 20200 OWNER - CONTRACTOR AGREEMENT CAMACHO GYM ROOF REPLACEMENT PROJECT, CIP NO. 19-51 This Owner -Contractor Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and ACCI Roofing Services ("Contractor"), 11325 Santa Maria Avenue, Lakeside, CA, on the 18th day of February, 2020, for the construction of the above referenced Project. In consideration of the mutual covenants and agreements set forth herein, the Owner and Contractor have mutually agreed as follows: 1. CONSTRUCTION The Contractor agrees to do all the work and furnish all the labor, services, materials and equipment necessary to construct and complete the Project in a turn -key manner in accordance with this Agreement and all documents and plans referenced in Exhibit "A", (hereinafter "Contract Documents"), in compliance with all relevant Federal, State of California, County of San Diego and City of National City codes and regulations, and to the satisfaction of the Owner. 2. CONTRACT PRICE Owner hereby agrees to pay and the Contractor agrees to accept as full compensation for constructing the project in accordance with these Contract Documents in an amount not to exceed the contract price as set forth in Exhibit "B" attached hereto and incorporated herein by reference. Payments to the Contractor shall be made in the manner described in the Special Provisions. 3. TIME FOR PERFORMANCE Time is of the essence for this Agreement and the Contractor shall construct the project in every detail to a complete and turn -key fashion to the satisfaction of the Owner within the specified duration set forth in the Special Provisions. 4. NON-DISCRIMINATION In the performance of this Agreement, the Contractor shall not refuse or fail to hire or employ any qualified person, or bar or discharge from employment any person, or discriminate against any person, with respect to such person's compensation, terms, conditions or privileges of employment because of such person's race, religious status, sex or age. 5. AUTHORIZED OWNER REPRESENTATIVES On behalf of the Owner, the Project Manager designated at the pre -construction meeting shall be the Owner's authorized representative in the interpretation and enforcement of all Work performed in connection with this Agreement. 6. WORKERS' COMPENSATION INSURANCE a) By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for Workers' Compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Agreement. b) The Contractor shall require each subcontractor to comply with the requirements of Section 3700 of the Labor Code. Before commencing any Work, the Contractor shall cause each subcontractor to execute the following certification: "I am aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Agreement." 7. ENTIRE AGREEMENT; CONFLICT The Contract Documents comprise the entire agreement between the Owner and the Contractor with respect to the Work. In the event of conflict between the terms of this Agreement and the bid of the Contractor, then this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the bid conflicting herewith. 8. MAINTENANCE OF AGREEMENT DOCUMENTATION Contractor shall maintain all books, documents, papers, employee time sheets, accounting records and other evidence pertaining to costs incurred and shall make such materials available at its office at all reasonable times during the term of this Agreement and for three (3) years from the date of final payment under this Agreement, for inspection by Owner and copies thereof shall be furnished to Owner if requested. 9. INDEPENDENT CONTRACTOR At all times during the term of this Agreement, Contractor shall be an independent contractor and shall not be an employee, agent, partner or joint venturer of the Owner. Owner shall have the right to control Contractor insofar as the results of Contractor's services rendered pursuant to this Agreement; however, Owner shall not have the right to control the means by which Contractor accomplishes such services. 10. LICENSES AND PERMITS Contractor represents and declares to Owner that it has all licenses, permits, qualifications and approvals of whatever nature which are legally required to practice its profession. Contractor represents and warrants to Owner that Contractor shall, at its sole cost and expense, keep in effect at all times during the term of this Agreement, any licenses, permits, qualifications or approvals which are legally required for Contractor to practice its profession. 11. GOVERNING LAW, VENUE This Agreement and the Contract Documents shall be construed under and in accordance with the laws of the State of California, and the appropriate venue for any action or proceeding arising from this Agreement and/or the Contract Documents shall be had in the Superior Court of San Diego, Central Branch. 12. COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall for all purposes be deemed to be an original. 13. FALSE CLAIMS Contractor acknowledges that if a false claim is submitted to the Owner, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that the False Claims Act, California Government Code sections 12650, et seq., provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include within their scope false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. In the event the Owner seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorneys' fees. Contractor hereby acknowledges that the filing of a false claim may the Contractor to an administrative debarment proceeding wherein Contractor may be prevented from further bidding on public contracts for a period of up to five (5) years. I have read and understood all of the provisions of this Section 15, above: (Initial) (Initial) 14. AGREEMENT MODIFICATION This Agreement and the Contract Documents may not be modified orally or in any manner other than by an amendment in writing and signed by the Owner and the Contractor. IN WITNESS WHEREOF this Agreement is executed as of the date first written above. Owner: Brady,. on CitKManager APPROVED AS TO FORM: By: Angi P. M City Attor'y Jon-s Contractor: ACCI Roofing Services (Owner/Officer signature) Lt4/[\( ,/1a►-)-►�, 0WY? ec/P41 Print name and title (Second officer signature if a corporation) Print name and title Contractor's City Business License No. . t(c)197 State Contractor's License No. and Class 182,5 404 Ave Business street address Lakes:de, CA /2o14o 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) CORPORATE CERTIFICATE I, certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that , who signed said contract on behalf of the Contractor, was then of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. I, certify that I am the Secretary of the Corporation named as Contractor in the foregoing Contract; that , who signed said contract on behalf of the Contractor, was then of said Corporation; that said contract was duly signed for and in behalf of said Corporation by authority of its governing body and is within the scope of its corporate powers. Corporate Seal: A notary public orother War completing this odic* vefl ss only the identity of the individual who signed the document to wAich this alflictle is attached, and not the Wilfulness, accuracy, a validity of that document. PARTNERSHIP CERTIFICATE STATE OF V tF17e-NI COUNTY OF S D�� ) ss On this 4 day of F - \ , 201P , before me, the undersigned, a Notary Public in and for said County and State, personally appeared: ALMA J. GOCO c,mmiNion No. 2294187 NOTARY MN MOO- FTMORNIII coubn Ogbw July 18, 20Q3 (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) same. Signature: Name (Type or Print): My Commission expires: 10--4l.lo j. 60c0 (Notary Public in and for said County and State) i1 'ice"Z3 Executed in Tnplicate PERFORMANCE BOND Bond No. CAC716117 Premium: $2,940.00 WHEREAS, the City Manager of the City of National City, on the 18a' day of February, 2020, has awarded ACCI Roofing Services, hereinafter designated as the "Principal", the CAMACHO GYM ROOF REPLACEMENT PROJECT, CIP NO. 19-51. 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 Merchants Bonding Company (Mutual) as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of One Hundred Seventeen Thousand Six Hundred ($117,600.00I lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT if the above bounden Principal, his/her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said contract any alteration thereof made as therein provides, on his or their part, to be kept and performed at the time and in the amount therein specified, and in all respects according to their true intent and meaning, and shall indemnify and save harmless the City of National City, its officers, agents, employees, and volunteers as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed herein or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or additions to the terms of the contract or to the work or to the specifications. In the event suit is brought upon this bond by the City and judgment is recovered, the surety shall pay all costs incurred by the City in such suit, including a reasonable attorney's fee to be fixed by the Court. IN WITNESS WHEREOF three identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the 3rd day of February , 20 20 . ants Bonding .o npany (Mutual (SEAL) ACCI Roo Services (SEAL) (SEAL) (SEAL) (SEAL) Tara Bacon Attorney -in -Fact G�fy/ .770C-941/ /H�if (SEAL) Surety Principal PERFORMANCE BOND ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF) ) ss '"SEE ATTACHED ACKNOWLEDGEMENT COUNTY OF ) On this day of , 20 , be . e me, the undersigned, a Notary Public in and for said County nd State, personally appeared known to me to be the person whose name is subscribed to th - ithin instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, an • cknowledged to me that he subscribed the name of said corporation there • as Surety, and his own name as attorney -in -fact. NOTE: ignature of those executing for Surety must be properly acknowledged. NOTE: The Attorney -in -fact must attach a certified copy of the Power of Attorney. Signature: Name (Type or Print): Notary Public in and for said County and State My Commission expires: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verges only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego On February 3, 2020 before me Minna Huovila, Notary Public (insert name and title of the officer) personally appeared Tara Bacon 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. I ' ' i Signature O AA.I _ (Seal) MINNA HUOVILA k COMM. #2313883 n NOTARY PUBLIC-CALIFORNIA V) SAN DIEGO COUNTY t% My Commission Expires .a DECEMBER 6, 2023 l POA 0018 (3/17) STATE OF IOWA MERCHANT BONDING BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC , both being corporations of the State of Iowa (herein collectively called the `Companies') do hereby make, constitute and appoint, individually, Dale Harshaw; Geoffrey Shelton; John R Clualin; Kyle King; Minna Huovila; Tara Bacon their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law_ This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding, Inc, on October 16, 2015_ 'The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other wrings obligatory in the nature thereof.' 'The signature of any authonzed officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed • In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut homy hereby given to the Attomey-in-Fact indudes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation_ It is fully understood that consenting to the State of Flonda Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond_ In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fad cannot be modified or revoked unless pnor written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 7th day of March , 2019 P• � • IO Nq •. Qg C$44: b. 0*. 4 4 :4p';: �O " POq ..19 • MERCHANTS BONDING COMPANY (MUTUAL) :A..: c t; .Z• : • y :co '��.��; MERCHANT) NATIONAL BONDING, INC. v=; 2003 :,.c s ; 1933 • , By .•••,,..a •s,'•••• • •• President COUNTY OF DALLAS ss On this this 7th day of March 2019 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC_; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors z /owp ACACIA K. GRAM Commission Number 767430 My Commission Expires April 1, 2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, Wiliam Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC-, do hereby certify that the above and foregoing is a true and coned copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked_ In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 3rd day of February , 2020 _ • tl0 )V14 NG C • g DE1PO/p . 42 . • 0 ' p A•' 9 . �r� 7 I.'. �c., �' 9�.yc• j• � 2003 : �o; •• y' 1933 • cy�; • dc •.• • .• - ••• Secretary Executed in Triplicate PAYMENT BOND Bond No CAC716117 Premium included in Performance Bond WHEREAS, the City Manager of the City of National City, on the 18th day of February, 2020, has awarded ACCI Roofing Services, hereinafter designated as the "Principal", the CAMCHO GYM ROOF REPLACEMENT PROJECT, CIP NO. 19-51. 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 Merchants Bonding Company (Mutual) as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of One Hundred Seventeen Thousand Six Hundred (S117,600.001 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 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 3rd day of February , 2020 Merc nts Bonding C ny (Mutual) (SEAL) ACCI Rdo 1 • Services (SEAL) A (SEAL) e_/-' `l (SEAL) (SEAL) L 4r✓Y, l6,' 711 C Lv Jr- (SEAL) Principal Tara Bacon, Attorney -in -Fact Surety ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY STATE OF ) ss COUNTY OF ) **SEE ATTACHED ACKNOWLEDGEMENT On this day of , 20 . efore me, the undersigned, a Notary Public in and for said County d State, personally appeared known to me to be the person whose name is subscribed to the withi • instrument as the attorney -in -fact of the , the corporation named as Surety in said instrument, and acknow dged to me that he subscribed the name of said corporation thereto as Suret . nd his own name as attorney -in -fact. NOTE: Signature • ' those executing for Suret must be properly ac owledged. NOTE: The Attorney -in -fact must attach a certified copy of the Power of Attorney. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: ATTACH ALL BONDS CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego On February 3, 2020 before me, Minna Huovila, Notary Public (insert name and title of the officer) personally appeared Tara Bacon 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 (Seal) d,o�v�,r MINNA HUOvI� i COMM. #2313883 N ��: NOTARY PUBLIC CALIFORNIA n '/ SAN DIEGO COUNTY 2 V "' r My Commission Expires DECEMBER 6, 2923 MERCEIANTS�k BONDING COMPANY.. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein colledi ely called the 'Companies') do hereby make, constitute and appoint, individually, Dale Harshaw, Geoffrey Shelton; John R Quake; Kyle King; Minna Huovila; Tara Bacon their true and lawful Attomey(s)-in-Fact, to sign its name as surety(es) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law_ This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding, Inc , on October 16, 2015. 'The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fad, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed • In connection with obligations in favor of the Flonda Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attomey-in-Fad includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation It is fully understood that consenting to the State of Fbnda Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fad cannot be modified or revoked unless pnor written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 7th day of March , 2019 ......qt • �� 0 • •`. • •(tP0►Q'• �0'y • O' ..°e. MERCHANTS BONDING COMPANY (MUTUAL) 1y: c• �Adt Z % • ": OAi•"f' • MERCHANTe$ NATIONAL BONDING, INC. -• •co4 J►:.c• �:? -o- c, 0: .r--:= -o- • �• • - • Z: b: a. 2003 : 0 : t% 1933 • c, By • STATE OF IOWA •••••■.......`•`� •••••••+•• COUNTY OF DALLAS ss. President On this this 7th day of March 2019 before me appeared Larry Taylor, to me personalty known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC ; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors- ALICIA K. GRAM Commission Number 767430 My Commission Expires April 1, 2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, Wiliam Warner, Jr, Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC_, do hereby certify that the above and foregoing is a true and corned copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked_ In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 3rd day of February , 2020 .............. •..-- •.• .•'�P'1�.Hq<�''•. : •"OG COk. �o,.4o�ipoR' %1:: ; :C> A;•�s•• • ge .• . • ' 2003 o . s 1933 ' t. Secretary t7' •d , 0• :eb. POA 0018 (3/17) ......"' Form W-9 (Rev. October2018) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification ► Go to www.irs.gov/FormW9 for instructions and the latest information. Give Form to the requester. Do not send to the IRS. Print or type. See Specific Instructions on page 3. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. ACCI Roofing Services 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 to accounts (codes apply only to not individuals; see on page 3): code (if any) I• Individual/sole proprietor or • C Corporation • S Corporation '4 Partnership . Trust/estate single -member LLC company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) appropriate box in the line above for the tax classification of the single -member owner. is classified as a single -member LLC that is disregarded from the owner unless the owner is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single from the owner should check the appropriate box for the tax classification of its owner. ► I. II Limited liability Note: Check the LLC if the LLC another LLC that is disregarded • Other (see instructions) from FATCA reporting Do not check of the LLC is -member LLC that maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. 11325 Santa Maria Ave Requester's name and address (optional) 6 City, state, and ZIP code Lakeside CA 92040 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid 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 TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter. Social security number or Employer identification number 2 0 0 7 7 6 7 9 9 Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Signature of Larry R u.s.person► Martin III 1,0101y signed by L., ortn ON• ariarry la Marlin III. •..na.m",mww.mm. Date ► 1/13/2020 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 retum 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 earned 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 Fomi W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not retum Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) ACC)R1) CERTIFICATE OF LIABILITY INSURANCE DATE (AMDDIYYYY) 04/07/2020 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sub)ect 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 endorseme4Y(s). PRODUCER Webster Insurance Agency, Inc. 8315 La Mesa Blvd. La Mesa, CA 91942 License #: 0M08728 INSURED AC C I ROOFING SERVICES LARRY MARTIN 11325 Santa Maria Ave Lakeside, CA 92040-1446 NAME:ACT AKiki Velasquez PHONE C No Fd1 619 433-3801 E-GW L ADDRESS: NSURERA Idkitgwebsteritstr.com INSURER(S) AFFORDING COVERAGE CM Vantage Spec Ins Co FAX (Napa 619 741-1047 WG NSIRERB: Mercury Insurance Group INSURER C: Landmark American Insurance Company RAMERb: CALIFORNIA INSURANCE COMPANY INSURER E NAIC I 15872 38342 33138 38865 INSURER F : COVERAGES CERTIFICATE NUMBER: 00002300-1249692 REVISION NUMBER: 283 THIS IS TO CERTIFY THAT THE POUcIES 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 ADM INSO SUM wvi, POLICY NUMBER POLICY EFF IMMDDNYYY)_ POLICY EXP (MMIDirYWYI LAMS A X COMMERCIAL GRERALU1BILm CMV-PLI-0010019-02 10/0112019 10101/2020 EACH OCCURRENCE s 1,000,000 QLAMSMACE OCCUR ERFAMSEs (Ea occce) $ 300,000 MEDD(P (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,000 $ 2,0-00,000 $ 2,000,000 GENL AGGREGATE -LINT APRJES PER' GENERAL AGGREGATE POLICY oaf LOC PRODUCTS =cor*oPAGG OTHER S $ AUMMOSLEUA Lnr BA040000055919 11/282019 11/282020 ralliBlEa °I'NGLEIIMIT $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED AUTOS ONLY v A SCHEDULEDBODILY AUTOS INJURY (Per °cadent) $ X HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per aadentl S. COMP/COLL DEDC $ 1000 C LAMELLA LAB X Oca1R LHA248990 03/202020 03/20/2021 EACH OCCURRENCE $ 4,000,000 X EXCESS LAB CLAIMS -MADE AGGREGATE s 4,000,000 LED RETENTIONS $ D WORKERS COMPENSATION 46-259560-01-04 12/012019 12/01/202G pg� X 1 STATUTE 1 1 1,000,000 AND EMPLOYERS LIAB&J1Y ANY PROPfAETOPoPARTNEREJ(ECUi1VE Y T N El. EACH / CODl3Ir S. 1,000,000 OFFICER/N'EMBER BrCLUDE - datory In NH) (Mandatory Y N T A EL. DISEASE - EA EMPLOYEE, $ 1,000,000 CESCRI DNOF OPERATIONS beton EL. DSEASE-POLICY UMT $ 1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached if more space is requred) THE CITY OF NATIONAL CITY , ITS ELECTED OFFICIALS, OFFICERS, AGENTS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY AS REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION City of National City c/o Risk Manager 1243 National City Blvd National City, CA 91950-4301 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A REPRESENTATIVE li r 1 S �:�.R. ,:-n," (KMV) ACORD 25 (2016/03) t988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by KMV on April 07, 2020 at 0921AM POUGYNUMBER: CMV-P LI-0010019-02 COMMERCIAL GENERAL LIABIUTY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE City of National City c/o Risk Manager 1243 National City Blvd Naitional city -CA 91950-4301 Designated Construction Project(s): The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camach0 Gym Roof Replacement Project, CIP NO, 19-51 A. For all sums which the insured becomes legally Obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only toongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction 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 "products - completed operations hazard', and for medical expenses under Coverage C regardless of the number of: Insureds; b. Clain* made or "Stilts" brought; or C. persons or organizations making claims or _Winging "suits. 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project Such payments shall not reduce the General Aggregate Limit shown iri the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project 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 Construction Project General Aggregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 CI B. For ail sums which the insured becomes legally obligated to pay as damages caused try "occurrences" under Section I -Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attributed only .to. ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made: under Coverage A for damages or under Coverage C for medical expenses shall reduce the mount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of 'bodily injury" or "property darnage" 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 Construction Project General Aggregate Limit D. If the applicable designated construction Project has been abandoned,: delayed, or abandoned and then restarted, or if the .authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will Still be deemed to be the same construction project. E. The provisions of Section III — Limits Of Insurance not otherwise modified by this endorsement shall continueto apply as stipulated Page 2 of 2 © Insurance Services Office, Inc.; 2008 CG 25 03 05.09 ❑ POLICY NUMBER: CMV-PLI-0010019-02 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS Thls endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) _ Or Oraanizaton(s) City of National City c/o Risk Manager 1243 National City Blvd National city CA 91950-4301 Location And Description Of Completed Operations The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camacho Gym Roof Replacement Project, CtP NO. 19-51 Information required to complete this Schedule, if not shown above, will be shown in the Declarations_ A. Section 11 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property damage" caused, in whole or in part, t►y "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed Operations hazard". However' 1. The insurance afforded to such additional insured only applies to the .extent permitted by law; and 2. If coverage :provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be- broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract of agreement, the mast we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is Tess. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © ISO Properties, Inc., 2004 CG 20 37 07 04 D POLICY NUMBER: CM114:11_141010019-02 COMMERCIAL GENERAL Luksiurr ce-zolo ois 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE .READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: QOM MERCIAL:QENERAL LIABILrly COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Mr Ornan0711i011(S) City of National City cto Risk Manager 1243 National City Blvd National city CA 91950-4301 The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "CamachoGym Roof Replacement Project, CIP NO. 19-51 Location(s) Of Covered Operations A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Sohecfule, but only with respect to liability for "bodily injury", "property damage Of 'personal and advertising injury" caused, in whole or in part, by: 14 Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations fOr the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies_ to the extent permitted by law; and Z if cOVerage providecito theadditional insured: it required by a contrapti or agreement, the insurance afforded to sUOti additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. VVith respect to the insurance afforded to these additional insiireCIS, the following additional exclusions apply: • Thi.s insurance does ncit :aPPIY tO "bodily injuiy.":or "-property -damage" occurring. after: All work, includirg Materials, parts :or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations .has been completed; or 2. That portion of 'your wcirk" out of vithiCt the injury or damage arises has been pUt .to its intended use by any person or organization other than another contractor or subcontractor engaged in -performing :operations for a principatas-a part of the same project CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Pagel. iit2 G. With respect to the insurance afforded to these additional insureds, the following is added to Section Limits Of Insurance: If coverage provided to the additional insured is required lay a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ® Insurance Services Office, Inc., 2012 CO 201004IS CMV-PLI-001001 9-02 IHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT - ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION City of National City c/o Risk Manager 1243 National City Blvd National city CA 91950-4301 Additional Insured: SCHEDULE The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camacho Gym Roof Replacement Project, CI P NO. 19-51 A. Information to complete the Schedule, if not shown above, will be shown in the Declarations. The following is added tOttle Other Insurance Condition eraSuperSedesitly provision to:the cOntrary: Primary and Noncontributory Insurance As respects the Additional Insured Shown in the Schedule -above, this insurance is primary to and will not seek Contribution from any other insurances available to the Additional Insured, provided that: B. TheAdditional Insured is a Named Insured under such other insurance and C.- Youv.haVe agreddin writing in a contractor agreement that this insurance would be primary and would not seekcontri6ution from any other insurance available to the additional insured. All other terms and conditions of the policy remain unchanged_ PLI 52 40 06:16 Page 1 of 1 Copyright 2016, CM Vantage Specialty Insurance Company IjOLIG'iC.NUMBER: CM V-P L I-0010019-02 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF -RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILIP COVERAGEPART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Person Or Organizatii� ** SCHEDULE City of National City c/o Risk Manager 1243 Nationality Blvd National city CA 91950-4301 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The: following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IH--Conditions: We waive any :right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work" done under a canted With that :person or organization and included in the "products- completed operations hazard'. This waiver applies only to the person or organization shown in the Schedule above. The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camacho:Gym Roof Replacement Project, CIP NO. 19-51 CG 24 04 05 09 © Insurance Services Office, inc., 2008 Page 1 of 1 Q Palicy plumber: BA040000055919 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Business Auto Broadening Endorsement This endorsement modifies insurance provided under -the following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) IL EMPLOYEES AS: INSUREDS III. AUTOMATIC ADDITIONAL INSURED IV. EMPLOYEE HIRED AUTO LIABILITY V. SUPPLEMENTARY PAYMENTS VI. FELLOW EMPLOYEE COVERAGE VII. ADDITIONAL TRANSPORTATION EXPENSE VIII. HIRED: AUTO PHYSICAL DAMAGE COVERAGE IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE X. LOAN/LEASE GAP COVERAGE XI. GLASS: REPAIR — DEDUCTIBLE WAIVER XII. TWO OR MORE DEDUCTIBLES XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS: XIV. WAIVER OF SUBROGATION XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE XVIL PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT XVIII. HIRED AUTO —COVERAGE TERRITORY XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH Copyright 2,017 Mercury Insurance Services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance-Seri/tees Office, Inc., with its Permission Page 1 of 6 Policy Number: BA040000055919 BUSINESS. AUTO COVERAGE FORM NEWLY ACQUIRED OR FORMED ENTITY (Broad Form Named Insured) SECTION II - LIABILITY COVERAGE, A. Coverage, I. Who-1s An Insured; the following is added: d. Any business entity newly acquired or famed by you during the policy period provided you own SO% or more of the business entity and the business entity, is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formationof the business entity. Coverage under this provision is afforded only until the end of the policy period, Coverage does not apply to an "accident" which occurred before you acquired or formed the organization. 11. EMPLOYEES AS INSUREDS SECTION II - LIABIUTY COVERAGE, A. Coverage, 1. Who is An Insured, the following is added: e. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. III. AUTOMATIC ADDITIONAL INSURED SECTION 11- LIABIUTY COVERAGE, A. Coverage, 1. Who:Is An Insured, the following is added: f. Any person or organization thatyou•are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or 'property damage" occurs and: that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" underthe Who Is An Insured provision contained in Section II. IV. EMPLOYEE HIRED AUTO LIABILITY SECTION II - LIABILITY COVERAGE, A. Coverage,1. Who Is An Insured, the following is added: g. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's"name, with your permission, while performing duties related to the conductofiyOur business. V. SUPPLEMENTARY PAYMENTS SECTION II — LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions,. a.: Supplementary Payments, Subparagraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for -related traffic law violations) required because of an "accident" we cover. Wearenot obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a_day because of time off from work. MCA85100817-CA Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 2 of 6 Policy Number: BA040000055919 VI. FELLOW EMPLOYEE COVERAGE: SECTION 11— LIABILTfY COVERAGE, B. Exclusions,;5. Fellow Employee This exclusion does not apply if youhave workers' compensation insurancein-forte covering all of your 'employees". Coverage is excess over anyother collectible insurance. VII. ADDITIONAL TRANSPORTATION EXPENSE SECTION III -•PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation Expenses, is replaced with the following: We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered. "autos" forwhich you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending; regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". If your business shown in the Declarations is other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered auto from the place where it is recovered to its usual garaging location. VIII. HIRED AUTO PHYSICAL DAMAGE COVERAGE SECTION III —PHYSICAL .D MAG E COVERAGE, A. Coverage, 4. Coverage Extensions, the following is added: If Liability Coverage is provided in this policy oit a Symbol 1 or a Symbol 8 basis and Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this coverage form for any"auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire, subject tothe following limit: (1) The most we will pay for "loss" to any hired"auto" is $50,000 or Actual Cash Value or Cost of Repair, whichever is Tess (2) $500 deductible. will: apply to any Toss under this coverage extension, except that no deductible shall apply to "loss caused by fire or lightning Subject to- the limit and deductible we will provide coverage equal to the broadest coverage applicable to any covered 'auto" you own of similar size and type. Thiscoverage extension is excess coverage over any other collectible insurance. IX. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. MCA85100817-CA Includes copyrighted material of Insurance SerAces:Office, Ihc., With its Permission Page of 6 Policy Number: BA040000055919 X. LOAN/LEASE GAP COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE C. Limit of Insurance,: the following is added: 4. In the event of a "total loss" to a covered "auto" shown in the schedule or declaratiions for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. (3) Security deposits not returned by the lessor; (4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased: with the loan or lease; and (5) Carry-over balances from previous bans or leases. The most we will pay under Auto Loan/Lease Gap Coverage for an insured auto is 25% of the actual cash value of that insuredauto at the time of the bss. XI. GLASS REPAIR — DEDUCTIBLE WAIVER SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. XII. TWO OR MORE DEDUCTIBLES SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: If two or more "company" policies or coverage forms apply to the same accident 1. If the applicable Business Auto deductible is the smallest, it will be waived; or 2. If the applicable Business Auto deductible is not the smallest, it will be reduced by the amount of the smallest deductible; or 3. If the loss involves two or more Business Auto coverage forms or policies the smallest deductible will be waived. For the purpose of this endorsement "company" means the company providing this insurance and any of the affiliated members of the Mercury insurance Group of companies.: XIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUITOR LOSS The requirement in SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit, Or Loss, a, In the event of "accident", you must notify usof a_ n "accident" applies only when the "accident" is known to: (1) You, if you are an individual (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. MCA85100817-CA Copyright 2017 Mercury Insurance Services, LLC, All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 4 of 6 Policy Number: BA040000055919 Xlif, WAIVER Ot SUBROGATION. SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, section is replaced by the.. following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive anyright of recovery we: may have against any person ororganization to the extent required of you bya written contractexecuted prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. XV. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS SECTION IV - BUSINESS AUTOCONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, or Fraud, the following is added: Any unintentional omission of or error in information given by you, or unintentional failure to disclose all exposures or hazards existing as of the effective date or at any time during the policy period: shall not invalidate or adversely affect thecoverage:for :such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right. of cancellation or non -renewal. XVI. EMPLOYEE HIRED AUTO PHYSICAL DAMAGE SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, b. For Hired Auto. Physical Damage Coverage, is replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: 1. Any covered "auto" you lease, hire, rentor:borrow; and. 2. Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, withyour permission, while performing duties related to the conduct of your business;. However, any"auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". XVII. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT SECTION IV— BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, the following is added and supersedesany provision to the Contrary: e. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under yourpolicyprovided that: (1) The additional Insured is a Named Insured: under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. tvICA85100817-CA Copyright 2017 Mercury insurance Services, LLC. All rights reserved. Include3 copyrighted material of Insurance Services Office, Inc., with its Permission Page 5 of 6 Policy Number: BA040000055919 XVIII. HIRED AUTO -COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 7. Policy Period, Coverage Territory, e. Anywhere in the world if:, is replaced by the following: e. Anywhere in the world if: (1) A covered "auto" is leased, hired, rented or borrowed without a driver for a period of 30 days or less; and (2) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico, or Canada or in a settlement we agree to. XIX. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH SECTION V — DEFINITIONS, C. "Bodily Injury" is amended by adding the following: "Bodily injury" also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness, or disease. MCA85100817-CA Copyright 2017 Mercury Insurance Services, LLC. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its Permission Page 6 of 6 c CERTIFICATE_ OF LIABILITY ,T;0�";°" INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U.PON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICES 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,aubject to the terms and conditions of the policy, certain poticies may require an endorsement A statement on this certificate does not.Onfer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AU insurance Services 1`0825 Old Mill Rd Omaha, NE 68154 (877) 234-44420: CONTACT NAME- PHONEJ No, Extk (877) 244-4420 FAX µik (-977) 234-4421 ADDRESS: PRODUCER CUSTOMER IDS INSUR ER(S) AFFORDING COVERAGE' MAC • INSURED Martin, Larry Rex II and Jones, Helen Elaine dba A C C I Roofing Services 11325 Santa Maria Ave Lakeside, CA 92040-1446 CTL 1273 1595227 INSURERA. California Insurance Co. '39865 INSURE:RB: INSURER C: INSURER II INSURER E INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEP.TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSIIEDTOTHE INSURED NAMED ABOVE. FOR THE POLICY PERIOD INDICATED. NOIWFTHSTANDING ANY REGUIREMENT,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. MR LTR TYPE OFiNSUP.ANCE ADDgSUB F INSR:WVD POLICYNUEa9ER POLICY EFF 1 POUCY EXP CIIMIDD/YYYY)IEkBI'DDiYYYY) LOTS GENERAL LIABILITY COMAE Ran. GENERAL UABILITY I EACH OCCURRENCE DAMAGE TO RENTED. _PFENSt_SIF..assomatelr ALD EXP Ears 063 osrson) S — - - . L ❑❑ I j--- (� 10.AIMS MADE pi i IR PEPS()NN_ &ADV INJURY. ! GENERAL AG( EGAIE S — — . : AGGREGATE. Tiff APPIJE3.1713: PRODUCTS -CONIvOr AGG x I POLICY nJ I LOD 1* T0f109ILE LJABIUT( NIYAUTO Li - ---1 I -I ! COMBINED MGT i.rr axidenl) BODILY INAhiYker song I ALL IAVNEUAUTOS -- _ DAUTOS FARED A:. . DP1JiQR BODILY INJURYEtixacadnt) .-t> i PROPERTY DAMAGE i (PBramides° i t I S - 1 I RRELLA LIAR OC(XIR �...y L JL J ' EACH '�- :S EXCESSLJAB HCLAIMSMADE AGGREGATE ��D£DLICT:RLI N > $ • iRETENII[ - — A WORKERSCOMPENSATIONI AND EMPLOYERS' LIABILITY ANYfiPFmFRLETOR1PARINERT:X .CU T I E (Manda ory inafBERIXGLUCfE[ (Ma:Ida:oryinKH) 'wit d9Pn[Ysabe unILSder IC1iSbelow NIA 4 6-2 5 4 5 6 0- 01 - 0 4 12/01/21119 12/01/202Q LWCCSTATU- I jciiH-. 1 31 ---1- -�-- EL EACH ACCDEN7 L 1,060,060 I ELDISEASE --EAEMPLGYfE -s 1,-000.,.000 E.L. DISEASE -POLLCYEMIT $ 1;.000.,.000 DESCRIPTION OFOPttRATIONSILOCATIONS%VEHICLES (Attach Acord 1G1,AdditiDna: Remarks Schedrle,I RI: Camacho Gym Roof Replacement Project, CIP 3D. 19-51 - Waiver of subrogation officials, officers, agents, and employees relative to cork performed more spate ismaimed; in favor of The.City-of rational C tr, its slsctS4 under contact. CERTIFICATE HOLDER CANCELLATION City of National City cats 1243 National City Blvd National City, CA 91950-4301 Attn: Project Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED INACCORDANCE WrTH THE POLICY PROVISIONS. AUTHORZED REPRESENTATIVE _ �. -- _ j / /0D78336 ACORD 25 (2009/09) *1988.2009ACORD CORPORATION. All rights reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 01 03 03 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the nght to recover our payments from anyone liable for an inury covered by this Fo>licy_ 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 i. (,) Specific Waiver Name of person or organization: The City of National City, its elected officials, officers, agents, and employees 1243 National City Blvd National City, CA 91950-4301 () Blanket Waiver Any person or organization for ,,vhom the Named Insured has agreed by written contract to furnish this waiver. Operations: Camacho Gym Roof Replacement Project CIP NO. 19-51 3. Premium 150 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 organizat on(s) arising out of the operations described. Minimum Premium Advance Premium This endorsement changes the policy to which it is attached and is effective on the date issued urdess otherwise stated. Endorsement Etfectve 12/01/19 Policy No. 46-259560-01-04 Insured ACCI Roofing Services Insurance Company California Insurance Company Countersigned by Endorsement No. 11 Premium $ 150. 00 POLICY NUMBER. BA040000055919 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not after coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named insured: ACCI ROOFING SERVICES Endorsement Effective Date: 11/28/2019 SCHEDULE Name Of Person(s) Or Organization(s): ** City of National City c/o Risk Manager 1243 National City Blvd National city CA 91950-4301 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. ** The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camacho Gym Roof Replacement Project, CIP NO. 19-51 CA 20 48 1013 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA 04 441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) BA040000055919 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policyunless another date is indicated below. Named Insured: ACCI ROOFING SERVICES Endorsement Effective Date: 11/28/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): ** City of National City c/o Risk Manager 1243 National City Blvd National city CA 91950-4301 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. ** The City of National City, it's elected officials, officers, agents, and employees" and identify the Location as "Camacho Gym Roof Replacement Project, CIP NO. 19-51 CA 04 44 1013 © Insurance Services Office, Inc., 2011 Page 1 of 1 CONTRACT TRANSMITTAL FORM (Attach as Cover Sheet to Documents dropped off to City Clerk's Office) Date: From (Dept.): /P-7/2-0 Submitted by (First & Last Name): Vendor: ' I Cam/ /- O? 1 jh, 5 e v /(-. L---5 Resolution: YES / NO 0 Resolution No. (if applicable): 1 2 3 4 Originals Provided to City Clerk (Select Quantity) 0000 Department has Copy / Duplicate Original Vendor has Copy / Duplicate Original