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2022 CON L.C. Paving & Sealing, Inc. - Sweetwater Road Bikeway Project CIP No. 19-20
OWNER,- CONTRACTOR AGREEMENT SWEETVVATER ROAD BIKEWAY Y PROJECT; IP NO. 19-20 This .nr-ntratr Agreement ("Agreement") is made by and between the City of National City, 1243 National City Boulevard National City, California 91950 and L.C. Paving Sealing, Inc. ("Contractor"), 620 Alpine Way, Escondido, CA 92029 on the 6th day of September, 2022, 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 t_ 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 thse 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 wner 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 persons compensation, terms, conditions or privileges of employment because of such person's race, religious status, sex or age. 5. AUTHORIZED OWI ER REPRESENTATIVES On behalf ofth 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) 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 f 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; EEMENT; 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 thterms f the bid conflicting herewith. 8. MAINTENANCE OF AGREEMENT DOCUMENTATION • 4. 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 years from the date of final payment under this Agreement, for inspection by Owner and copies thereof shall be furnished to Owner if requested. 9. INDEPENDENT CONTRACTOR At all times during the term of this Agreement, Contractor shall be an independent contractor and shall not be an employee, agent, partner or joint venturer of the Owner. Owner shall have the right to control Contractor insofar as the results of Contractor's services rendered pursuant to this Agreement; however, Owner shall not have the right to control the means by which Contractor accomplishes such services. 10. LICENSES AND PERMITS Contractor represents and declares to Owner that it has all licenses, permits, qualifications and approvals of whatever nature which are legally required to practice its profession. Contractor represents and warrants to Owner that Contractor shall, at its sole cost and expense, keep in effect at all times during the term of this Agreement, any licenses, permits, qualifications or approvals which are legally required for Contractor to practice its profession. 11. GOVERNING LAW, VENUE This Agreement and the Contract Documents shall be construed under and in accordance with the laws of the State of California, and the appropriate venue for any action or proceeding arising from this Agreement and/or the Contract Documents shall be had in the Superior Court of San Diego, Central Branch. 12. COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall for all purposes be deemed to be an original. 13. FALSE CLAIMS Contractor acknowledges that if a false claim is submitted to the Owner, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that the False Claims Act, California Government Code sections 12650, et seq., provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include within their scope false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. In the event the Owner seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorneys' fees. Contractor hereby acknowledges that the filing of a false claim may the Contractor to an administrative debarment proceeding wherein Contractor may be prevented from further bidding on public contracts for a period of up to five (5) years. I have read and understood all of the provisions of this Section 15, above: (Initial) 14. AGREEMENT MODIFICATION This Agreement and the Contract Documents may not be modified orally or in any manner other than by an amendment in writing and signed by the Owner and the Contractor. IN WITNESS WHEREOF this Agreement is executed as of the date first written above. Owner: AIejandraSot e'I Mayor, City of National City APPROVED AS TO FORM: By: Barry Schultz Interim City Attorney Contractor: L.C. Paving Sealing, Inc. i f P ( .�ier, Officer signature) /,/ Jose A. Salinas President Print name and title (Second officer signature if a corporation) Print name and title TUD Contractor City Business License No. 621610 AB & C-12 State Contractor's License No. and Class 620 ALPINE WAY Business street address ESCONDIDO, CA 92029 City, State and Zip Code EXHIBIT 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, B ISF, 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 IN1TN BID SCHEDULE ITEMS) Exhibit B Bid Results for Sweetwater Road Bikeway Project (CIP No. 19-20) Item` No. Description Unit Qty. LC Paving & Sealing, Inc. aSweetwater Road Bi eway Pro Mobilization Demobilization LS 1 $92,85073 $92,850.73 Project Schedule LS 1 $l6,16375 $16,163.75 3 Surveying and Construction Staking LS 1 $33,126.44 $33,126.44 4 Traffic Control and Pedestrian Control LS 1 $130,36OE43 $130,360.43 5 Water Pollution Control LS 1 $16,57905 $16,579.05 Unclassified Excavation LS 1 $89,991.31 $89,991.31 Clearing and Grubbing LS 1 $259,858.23 $259,858.23 8 Construct Asphalt Concrete Pavement TON 673 $152.74 $10 , 94. 9 Construct Class II Aggregate Base TON -- -.--1479 $55.98 $82 i 10 Cold Mill SF 3400 $4.16 $14,144.00 11 Slurry Seal SF 545754 $0.39 $212,844.06 12 Construct Curb Ramps (All Types) EA 3 $6,465.05 $19,395.15 18 Construct Type 'B-3' Pin On Curb per SDRSD G-6 LF 1 5103.3.5 $10,335.00 14 Construct Thickened Curb per Plans LF 6 $92.38 A 15 Construct Thickened Curb and Gutter per Plans LF 115 $71.59-. 16 Construct Gravity Retaining Wall per SDRSD 9 LF 20 $134.70 • • A 1 17 Construct 4" PCC Sidewalk per G-7, -9, -10 SF 3000 $9.21 $27,630.00 18 Construct Type 'B-2' Curb and Gutter per SDRSD -6 LF 50 $104.67 $5,233.50 19 Construct Type 'B-1' Curb per SDRSD -6 LF 285 $5,8.91 . 6 789,35 20 Construct Type ' ' Curb and Gutter per SDRSD -2 LF 965 . $43.81 $42,276.65 21 Construct OH Curb and Gutter per Plans LF 25 $219.93 $5,498.25 22 Construct 6" Curb per SDRSD --1 LF 165 $52.48 $8,659.20 23 Construct Trench Drain with Grates LF 74 $552.20 $40,862.80 24 Construct Transition Curb and Gutter LF 5 $706.31 3,531.55 25 Construct 4" Integral Colored Concrete Bike Path SF 435 $19.26 8,378.10 26 Construct 4" Integral Colored Concrete Bike Roundabout SF 200 $12.52 2,504.00 27 Construct 4" PCC Bike Ramp EA 1 6 302.52 $6,302.52 28 Construct 4" PCC Bike Path with keyed Joint per -10 SF 16516 8,98 148,313,68 29 Construct 4" Integral Colored Concrete Bike Ramp EA 2 $5,784.15 11 568.30 80 Construct Bus Stop Slab per SDPIlC S-12 SF 900 I 881.00 31 Construct Truncated Domes SF 290 32 Construct Pedestrian Passage Way per Caltrans Standard Plan A88B SF 285 $49.46 . $14,096.10. 38 Traffic Signal Pedestrian Hybrid Beacon Signal System EA 1 $215,403.46 $215,403.46 34 Furnish and Install Flexible Post Delineators EA 914 $174.07 $159,O9998 35 Construct Dispersion Area BMP SF - -- 842 - •— $30.33 . $25,537.86 36 Furnish and Install Mirafi R5380i Woven eo y ntheti , or Approved equal SY 3100 $13.09 . . . $40,579.00 37 Furnish and Install Glaspave 25 or approved equal SY 600 $1814 $1088400. 38 Replace Existing Storm Drain Grate Type 18-9X EA 2 $5,387.92 $10,775.84 39 Construct Structural Storrwater Biofiltratin System EA 1 $38,972.67 $38,972.67 40 Furnish and Install New Sweetwater Authority Approved Back Flow Preventer and Reconnect per SASD 15-B EA 1 $21,649.14 $21,649.14 41 Furnish and Install 18" RCP Storm Drain LF 4 $3,126.93 $12,507.72 42 . Connect Storm Drain with Pipe Collar per D-62 EA 1 $4,333.91 $4,333.91 43 Construct Storm Drain Curb Inlet per SDRSD D-02 Type B EA 1 $19,499.15 $19,499.15 44 Furnish and Install Pipe Guardrail Post Type Protective Railing ' er llll- p LF 31.5 $122.96 $3,873.24 45 Landscaping and Irrigation LS 1 $212,864.32 $212,864.32 46 Removal Disposal, and Replacement of Unsuitable Materia CY 2 $803.18 $16,063.60 47 Signing and Striping LS 1 $211,56319 $211,563.19 48 Traffic Signal Modification - Intersection of Sweetwater Road and Malley Road LS 1 S174,063.40 49 Traffic Signal Modification - Intersection of Sweetwater Road and Plaza Bonita L5 1 $157,744.96$157,744.96 50 Traffic Signal Modification - Intersection of Sweetwater Road and Euclid Avw a LS 1 $431515.85 $43,515.85 51 Traffic Signal Modification Intersection of Sweetwater Road and Interstate 805 B Ramps LS 1 $27,197.41 $27,197.41 :.. :. -.ota t8861799.64 CORPORATE CERTIFICATE JOSE SALINAS certify that I am the Secretary of the Corporationnamed as Contractor in the foregoing Contract; that JOSE SALINAS who signed said contract on behalf of the Contractor, was then All Coi'potate Officers 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: STATE OF PARTNERSHIP CERTIFICATE COUNTY OF ss On this day of , 20 , before me, the undersigned, a Notary Public in and for said County and State, personally appeared: (Notary Seal) known to me to be of the partners of the partnership that executed the within instrument, and acknowledged to me that such partnership executed the same. Signature: Name (Type or Print): (Notary Public in and for said County and State) My Commission expires: Bond No.: CMGP00006049 Premium: $311401.00 Executed in Three (3) Originals PERFORMANCE BOND WHEREAS, the City Council of the City of National City, by Resolution No. o - , on the th_ dav_of September 2022 has awarded LC. Paving & Sealing, inc., hereinafter designated as the "Principal", the SWEETWATER ROAD BIKEWAYP JET, CIP NO. 1- 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 Aronut.Iurpn --- as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of Two Million n Ei ht Hundred Es ! t Six Thousand,L5sven Hundred Ninelyisiline and 64/100 j$2,886,799k641 dollars 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 Aronaut Insurance Company cloCMGIA - 20335 Ventura Blvd., Ste. 426 Woodland Hills, CA 91364 (SEAL) (SEAL) Step nie Hope Shear, Attorney -in -Fact (SEAL) 1st day of September ) 20 22 LC Paving & Sealing, Inc. 690 Alpine Way Esc dido, C 2O Surety Principal (SEAL) (SEAL) (SEAL) 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 San Diego On 'at° .�. tf, Z6I-1- before me Marisa Haas, Notary Public (insert name and title of the officer) personallyeared Jose A. Salinas pp , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscrLbed 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 she 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) MARiSA AIN HAS irr P Notary Public - California San Diego County F , Commission ` 2306519 My Comm, Expires Sep 24, 2023 *** Refer to the attached Notary Acknowledgment *** PERFORMANCE BOND ATTORNEY-1N-FACT ACKNOWLEDGEMENT OF SURETY STATE OF See Atthe COUNTY O �. --- a 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 ibed 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): - -- T Notary Public in and for said County and State My Commission expires: Bond No.: CMGP00006049 Premium: $31,401.00 Argonaut Insurance Company Deliveries Only: 225 W. Washington, 224th Floor Chicago, IL 60606 United States Postal Service: P.O. Box 469011, Sari Antonio, TX 78246 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the Argonaut Insurance Company, a Corporation duly organized and existingunder tpe laws of the State of Iilinois and having its principal office in the County of Cook., Illinois does hereby nominate, constitute and appoint: abri lla_Gradv. Shilo Lee Losino, Stephanie Hope Shear, Elizabeth Santos, Stacey Garcia, Matthew Dionisi_oi Christopher Carmel Their true and lawful agent(s) and attorney s -in-fact;, each in their separate capacity if more than one is named above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other undertakings in suretyship provided, however. that the penal sum of any one such instrument executed hereunder shall not exceed the sum 115,000,000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following ( solution adopted by the Board of Drectors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President, Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed by use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the Company, qualifying the attorney or attorneys named in the given power of attorney, to execute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto," IN WITNESSWHEREOF. Argonaut Insurance Company has caused itsofiicia.l seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 19th day of November, 2021. Argonaut Insurance Company ��iii ilia,"1,c g. .. 0 . ):1"V 4,___, s }`•. LSEALii.0- # by .i e, INo� •••' * #? Gary E. Grose l President * STATE OF TEXAS COUNTY OF HARRIS SS: to:\ On this 1 th day of November. 2021 A.D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified, came THE ABOVE OFFICER OF THE COMPANY, to me personally known to be the individual and officer described in. and who executed the preceding instrument. and he acknowledged the execution of same, and being by me duly sworn, deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said corporation, and that Resolution adopted by the Bozu d of Directors ofsaid Company, referred to in the preceding instrument is now in force. k TESTINIONY WHEREOF I have hereunto set my hand, and affixed my Official Seal at the Count of Harris, the day and year first above written. KATHLEEN rvl MEEKS NOTARY F3LliaLIC STATE CIF 3F: X AS V COMM EXP 0711S/2! NO TA RN' ID 5579O2-8 (Notary Public) 1, the undersigned Officer of the Argonaut Insurance Company, Illinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a full, true and correct copy is still in full force and effect and has not been revoked. 1Nl WITNESS ESS WHEREOF, 1 have hereunto set my hand, and affixed the Seal of said Company, on the 1st day of September , 2022 . Austin W. King Secretary IF YOU HAVE QUESTIONS ON AUTHENTICITY ITY F THIS DOCUMENT CALL (') 820 - 9137. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached. and not the truthfulness, accuracy, or validity of that document. State of California County of Los Angeles ) On SAP 012022 before me, Date Lucas Patterson, Notary Public Here Insert Name and Title of the Officer personally appeared Stephanie Hope Shear Name(s) of Sign er0s,) 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. z LUCA p, T ERSON HotaryoP;:b.ic - Cagornya Los Anse;.es County co',m cr- 3 My r,mrr,, mires Mar 19, 2025 Place Notary Seal Above WITNESS my hand and official seal. i nature OPTIONAL Signature of Notary Public Though this section is optional, completing this information can deter alteration of the docum-. or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Documer it ate: Number of Pages: Signer(s) Other Than Named Abov Capacity(ies) Claimed by Signer(s) Signer's Name: J Corporate Officer — Title(s): Partner — Cl Limited El General ri Individual Li Attorne P1 Trustee L n Other: Signer Is E act Ian or Conservator esenting: Signer's Name: L' Corporate Officer -- Title(s): i Partner — 7 Limited CI General El Individual Attorney in Fact 7, Trustee 71 Guardian or Conservator C Other: Signer Is Representing: 02014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY (1-800-87 - 7) Item #5907 Bond No.: CMGP00006049 Premium included In The Performance Bond Executed in Three (3) Originals PAYMENT BOND WHEREAS, S, the City Council of the City of National City, by Resolution No. 0 - , on the 6th day of_Slutenifeer, , has awarded LC. Paving & Sealing, Inc., hereinafter designated as the "Principal', the SWEETWATER ROAD BIKEWAY PROJECT, CIP NO. 1- WHEREAS, said Principal is required by Chapter 5 (commencing at Section3225) 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 r onaut are as surety, are held and firmly bound unto the City of National City, hereinafter called the "City", in the penal sum of Two Millior4 Eight Hundred Eight Six Thousand Seven Hundred Ninety and64 1 $2,886,799.641 dollars 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 10of the Revenue and Taxation Code, with respect to such work and labor the Suretywill 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 oenefit 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, hut 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 deemec are original thereof, have been duly executed by the Principal and Surety above named, on the 1st day of September , 2022 Ar onaut Insurance Company LC Paving & Sealing, Inc. d o CMGA - 20335 Ventura Blvd., Ste. 426 690 Alpine Way _Woodland Hills, CA 91364 (SEAL) E ndido, CA 9 029 (SEAL) (SEAL) Stephanie Rape Shear, Attorney -in -Fact (SEAL) Su rety Principal (SEAL) (SEAL) ACKNOWLEDG 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 I ENT On ((Qi '--1612:2-' before me, Marisa Haas, Notary Public (insert name and title of the officer) personally appeared dose A. Salinas 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) 4 z MARISA ANN HAAS Notary Public - California San Diego County Commission 23 519 My Comm. Expires Sep 24, 2023 STATE OF ATTORNEY -IN -FACT ACKNOWLEDGEMENT OF SURETY See Attached 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 r 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 mast 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: ALL BONDS Bond Premium: 1 401.00 Argonau. Insurance Company Deliveries Dale: 225 W. Washington, hington 24th Floor Chicago, IL 60606 United tat o ta! Serviee: P.O. Box 469011, San Antonio, TX 782 POWER OF ATTORNEY KNOW ALL MEN BY TA 'ESE PRESENTS: That the Argonaut Insurance Company, a Corp ration duly organized and existing under the laws of th State of Illinois and havin tits principal office in the County of Cook, Illinois does hereby nominate, constitute and appoint: Gabriella Grady. Shilo Lee Losino. Stephanie I lope Shear. Elizabeth Santos, Stacey ,Garvin, Matthew Dioni;io. Christopher Coronel Their true and lawful agents) and attorneys) -in -fact, each in their separate capacity if more tf an one is named above, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all bonds, contracts, agreements of indemnity and other undertakings in suretyship provided, however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of $15 ,00 .000.00 This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolution adopted by, the Board of Directors of Argonaut Insurance Company: "RESOLVED, That the President, Senior Vice President. Vice President, Assistant Vice President, Secretary, Treasurer and each of them hereby is authorized to execute powers of attorney, and such authority can be executed h) use of facsimile signature, which may be attested or acknowledged by any officer or attorney, of the Company, qualll ing tine attorney or attorneys named in the given power of attorney, to execute in behalf of, and acknowledge as the act and deed of the Argonaut Insurance Company, all bond undertakings and contracts of suretyship, and to affix the corporate seal thereto." IN WITNESS WHEREOF, Argonaut Insurance Company has caused its official seal to be hereunto affixed and these presents to be signed by its duly authorized officer on the 19tla day of November, 2021. Argonaut Insurance Company *t‘.5LIRAlivet4% !++ 'i,9t ••` [tip � , M0. A + V: >7. it ossli• STATE OF TEXAS COUNTY OF HARRIS SS: by: Gary E. Grose , President On this 19th day of November, 2021 A.D., before me, a Notary Public of the State of Texas, in and for the County of Harris, duly commissioned and qualified, came THE ABOVE OFFICER OF THE COMPANY. to me personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of same, and being by me duly sworn, deposed and said that he is the officer of the said Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said :Corporate Seal and his signature as officer were duly affixed and subscribed to the said nstt-ument by the authority and direction of the said corporation, and that Resolution adopted by the Board of Directors of said Company, referred to in the preceding - instrument is now in force. IN TESTIMONY WHEREOF. I have hereunto set nay hand, and affixed my Official icial Seal at the County of Harris, the day and year first above written. KATHLEEN !M1 M EE KS NOTARY PUBLIC ,TAB OF TEXAS MY COMM_ EX P 07/15/25 NOTA RY 1O 557902-e aMINe.AMI..- -_ 00-kek-hiLudrt 4-n .,-rfrk.,,.u.kiJ (Notary Public) I. the undersigned Officer of the Argonaut Insurance Company, Tllinois Corporation, do hereby certify that the original POWER OF ATTORNEY of which the foregoing is a [tall} true and correct cope, is still in gull force and effect and has not been revoked. TN WITNESS WHEREOF, F, I have hereunto set my hand, and affixed the Seal of said Company, on the 1st day of September Y ;1 .. SEAL a i i3•_ .. I �:!'48 * 4 M ; r *01 crilmoio +� , 2022 Austin W King Secretary, IF YOU iL. VE QUESTIONS ON AUTHENTICITY Of. THIS DOCUMENT CALL (33) 820 - 9137. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL DE § 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 On Los Angeles) SAP 01 zozz Date personally appeared before me, Lucas Patterson, Notary Public Here Insert Name and Title of the Officer Stephanie Hope Shear Name(s) of Signers,) 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. r--4-111-;\ LUCAS PATE SON Notary Pi b11c - Ca'i ornia Los Ar ;ii.e e C ,;rty Corrnisy:�on 23 2Th4 My Corm. Expires Mar 19, 2025 Place Notary Seal Above z 31. WITNESS my hand and official seal. Signature OPTIONAL Signature of Notar Public Though this section is optional, completing this information can deter alteration of the docum fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Other Than Capacity(ies) Claimed by Signer(s) Signer's Name: J Corporate Officer -- Title(s): Partner — 11 Limited i 1 General 0 Individual i] Attorne _ act I Trustee G ian or Conservator E Other: Signer is esenting: 01 Docume■ r ate: Named Abov Signer's Name: Corporate Officer — Title(s): Cl Partner — E. Limited General Individual a Attorney in Fact Trustee Ei Guardian or Conservator Other: Signer Is Representing: ©2014 National Notary Association • www,NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 California Secretary of State Electronic Certified Copy 1, ALEX PADILLA, Secretary of State of the State of California, hereby certify that the attached transcript of 2 pages is a full, true and correct copy of the original record in the custody of the California Secretary of State's office. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California on this day of October 29, 2020 ALEX PADILLA Secretary of State Verification Number: KVVW2 WK Entity (File) Number: C3286410 To verify the issuance f this Certificate, use the Verification Number above with the Secretary of State Electronic Verification Search available at bizfilasos.capgov California Secretary of State Electronic Filing Corporation - Statement of Information FILED Secretary of State State of California Entity Name: L.C. PAVING & SEALING, INC. Entity (File) Number: File Date: Entity Type: Jurisdiction: Document ID: C3 8 410 1o/ / 0 0 Corporation CALIFORNIA GK49303 Detailed Filing Information 1 . Entity Name: . Business Addresses: a. Street Address of Principal Office in California: b. Mailing Address: Street Address of Principal Executive Office: Officers: a. Chief Executive Officer: b. Secretary: L.C. PAVING & SEALING, INC. 620 ALPINE WAY ESCONDIDO, California 92029 United States of America 620 ALPINE WAY ESCONDIDO, California 92029 United States of America 620 ALPINE WAY ESCONDIDO, California 92029 United States of America JOSE A. SALINAS 620 ALPINE WAY ESCONDI'DO, California 92029 United States of America JOSE A. SALINAS 620 ALPINE 'WAY ESCONDIDO, California 92029 United States of America E z 0 0 1) co Li= C.) 3 � f a) co C C) 0) 0 . . Document Use bizfi/e, sos. a. ov to verify the certified copy Use bizfrle sos cagov for onl ne filings, searches, business recordsand resources_ California Secretary of State Electronic Filing Officers (cont'd): c. Chief Financial Officer: 4. Director: Number r of Vacancies on the Board of Directors: , Agent for Service of Process: 6. Type of Business: JOSE A. SA L I I AS 620 ALPINE WAY ESCONDIDO, California 92029 United States of America II 0 E la) 0 -z L% (53 0 q) 0 CONSTRUCTION cz cts By signing this document, I certify that the information is true and correct and that I am authorized by California law to sign. Electronic Signature: Marisa Haas JOSE A. SALTf AS 620 ALPINE WAY ESCONDIDO, California 92029 United States of America JOSE A. SALI f AS 620 ALPINE WAY ESCONDIDO, California 92029 United States of America Use bizfile.sos.cagov for online filin searches, u ine records, and resources. 0) C� 4caRD CERTIFICATE CIF LIABILITYINSURANCE DATE (MM/DDfYYYY) i 0 f 0/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATECERTIFICATE4DOES NOT AFFIRMATIVELY R 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 NAL. INSURED, the poll y(ios) 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 endor ement(s). PRODUCER HARTLEY .Y YLE E l A IFI -#0574 53 INSURANCE SERVICES, INC. 2747 UNIVERSITY AVENUE SAN DIEGO CA 92104-4068 CONTACT JANA CLARK NAME: PHONE .. - (A/C, No, Extt: � } �� FAX 7)91...�..-- 1 291 (A/C, No): -( E-MAIL jana hopacinsuran e.00m ADDRE INSURER(S) AFFORDING COVERAGE NAID # INSURER A : TRAVELERS PROPERTY & CASUALTY CO OF 25674 INSURED L.C. Paving & Sealing, Inc. 20 Alpine Way Escondido CA 92029 INSURER S : � -� �--�------ INSURER D : - - - � - � . INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE ATE NUMBER: CL2221773028 REVISION ION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OFINSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING REQUIREMENT, TERM OR CONDITION N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TFIE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRINSD TYPEINSURANCE ADDL SUBR MD POLICY NUMBER P{ LI Y EFF MM/DD/ YYY PoLi V EXP MMIDD)Y YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 LAIMS-MADE X OCCUR a . 1 ` • 1. . PREMISE1111 Ea occurrence 300,000 MED EXP (Any one person) $ 5, 090 A [ T22C00 1357 ATIL22 02/18/2022 02/18/2023 PERSONAL &ACV INJURY I,000,000 EN'LAGGREGATE LIMIT APPLI EPER: OENERALA OREGATE $ ,000,000 POLICY FX PL O- J EOT Tri LOC PRODUCTS OOI rIP OP AOO , 000, 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED AUTOS ONLY SCHEDULED AUTOS 8100S0955 222 G 02/18/2022 02/18/2023 BODILY INJURY (Per accident) HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE Per accident $ Medical payments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE r ,000,000 EXCESS LIAR CLAIMS -MADE CUPOS1373832226 0 113120 02/18/2023 AGGREGATE ,000 00 DIw D RETENTI O $ $ I RL{ER OMPENSATION A II EMPLOYERS' LIABILITY TH7UTE OTH- ER Y N 1,00(, 000 A ANY PROPF IETC R I PRTC I R EOUTIVE I N IA UI 8S622�101212 09112 2921 09/12/2022 E.L. EACH ACCIDENT OFFI EI IEMBEI EXCLUDED? 1,000,000 {I~lla�nd Cory in NFI} -- E.L. DISEASE - EA EI PLOYEE $ If fires, describe under DE RIPTION OF OPERA4TION below El. DISEASE - POLICY LIMIT 1000,000 , A INLAND MARINE C T6 00 106923TIL2 02/18/2022 02/18/2023 LEASED/RENTED DEDUCTIBLE 71,000 $100,000 $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *10 day notice of cancellation for non-payment of premium shall apply, 30 day notice of cancellation for all other reasons. *The City of National City, its elected officials, officers, agents, employees and volunteers shall be named Addtional Insured, A Waiver of Subrogation applies as required by written contract. CERTIFICATE HOLDER CANCELLATION City of National City, cfo Risk Manager 1243 National City Boulevard National City j CA 91950-4397 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE E WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 19 - 01 ACORD CORPORATION. All rights reserved. ACORD 2 (01 10) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: trr22C00$12 576ATIL22 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARE FULLY. BLANK T ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contact) This. endorsement ;modifies Osurance prc1ded under the tolioNing: .COMWERCIAL GENERAL L IABI•LITY COVERAGE PART PROVISIONS The following is added to SECTION 11 VVHO IS AN INSURED: Any persco or organizatio.n that you agree in written contract or agreeill elt to ciuJ.05 an addilional insured on this Coverage. Part i5 insured, but on a, With respect to 1brty for 'both! inju ." or "propertytht cccurs or for persona1 injuty'' caused by an ciffen5e that is committed tibsequent to the signing Cit Oat contract cr agreement and while that part cf the contract cr .agreement is in .effect; and b4 If, and only to the extent that si h damage is caused itfy acts or ortitissikms ofyou a your subcontractor in the Iptaifomiance cf 7your work!' to Which the written co -Arad fsr agreement applies Such person or organzatkri doe 5 not quality as an additional i.nsured with respect to the ind ident its or omissions oFsudh person or :.cirganization.. The insurance proVded to such adchtio ect to the fdlowting provisicos: Ft the Limits of Insurance Of this Coverage Part shown in the Declarations exceed the minimum limits required by the written caltract cr agreement the: insurance prwided to the additional insured -will Ebe limited to suclh :minimum required limk% For the purposes Of determining whether this limitation applies3 the minintim Iimt required by the written contract or eement will ,De ronsdereci to include the cf any 'Umbrella cr !Excess .cwerage require:d for the .additional insured by that written contract a agreement ThV r.Mion will nct increa5 e the km it of insurance :liestribed in .Section. III — Limits Of insuraice, b. The: insurance ovide.ci to such additional ft wed doe. not appbr to: '.• insured is (1) Any vtodily 'FflJU3 pope dmge" or rsonal iniury" arising out of the providing, or failure to provid% any professional architecturat engineering cr. surveying services, including: (6) The preparin% apProving or fading to prepare .cr approvei. maps1 shop dawn opinion, reports, surve).es field orders cr change :order . orthe prppaiing approving or fading to prepare or approve drawings ald specilications; and (b) Svpervisory inspectioft arclitecturat engineering activities„ (2) Any 1bod I y injug or "prope rt. damage" caused by yor wok" and included in the products -completed operations haaard" uness the mitten contract or agreement specticI, requfres you to provide such coverage for that additional insured during thepolicy icid c4 The acidttional insured must comply with the .fdlcoAting dufies: (1). Give us written Ind ce as soon aS practicobie of an "occurrence or an cifnse wh-c h n av miutt in a tlaimf To .the extent Iposs Ice should include: (a) HCK When and v4e.ie the ''occtorence" or offense tock 31 ace; k7 such (b) The names and esses of any injured persons and witnesses; and (c) The nature and location of n/ inj damage arisim out cf the 'occutence" or offense6 (2) If a claim is made or "suit' bro lit against the addftional insured: CG 02 46 0419 0 2018 ItIe Travelers indertrity Ctmparry.,AJI kris reserved:, Fe I cf 2 COMMERCIAL, (3ENERAL (a) immecriate!y record the s fics ct the claim or °suit" and the date received; and (b) MAI)/ us a5 soon as pracikable and see to it that we receive written nctice of the claim or '.UV as soon as practicable. ) immediateti send us copies ur ail legal papers received in connection with the claim or "suir% cooperate vititi US the inve5ligOon cr settlement of the ciain defense against the "suirl and otherwise comply with all pokey conditions, (4) Tender the defense and indenin cf a claim or risuir to any prrAdder of other insurance whith would cover such additionci insured for a Ims we cover, However) this condition does not affect whether the insurance proAded to such additional insured :is primary to other insurance avaRable to such additknal insured which covers that person or organization as a named insured as described in Paragraph 44 Other Insurance 41Section IV — Comrnerciai Generiji !Liabty Calditionst Page 4. of 2 0 2016 'The 'Tr6seelers indraTrity CanpanyAll rijis reserved, CG D2 46 04 19 POLICY NUMBER: DT22COOS13576ATIL:22 COMMERCIAL GENERAL. LIABILITY THIS ENDORSEMENT .CHANGES THE POLICY. PLEASE READ IT .CAREFULLY. • XTEND EhDORS M NT FOR. CONTRACTORS This endorsement modifies insurance provided under the foil ing: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL aESCRIPTION OF COVERAGE - This endorsement :broadens coverage, However, coverage for any inury, damage or medical pen ses desaibed in any of the croviskns d this endorsement mpy be excluded or limited by anotber endasement to this Coverage Pert, and these coverage broatleninc provns do rid apply to the extent that coverage is excluded or limited by such an endorserne:nt, The follaving 4 '4 a general coverage description only, Read all the provtions (f this endorsement and the rest of your pdicy carefully to determine rights, duties, and w hat is and is not covered. Who is An insured - •Unnamed Subsidiaries a Blanket Additional insured - Governmental Entities - Permits Or Authotations Relating To tat ons PROVISIONS A. WHO IS AN INSURED UNNAMED SUBSIDIARIES The following is added to SECTION U WHO IS AN INSURED: Arly d ycto sulysidi les, other than a part hip, joint venbie cr limited liability company, that is net shown as a Named Insured in the Declaraiions is a Named insured if, . You are the 5de •ewneraFcr flflfl an ownership interest •of more than 50% in, such suiasidiary on the fitst clay of the polky periot and Such subsidiary not an fl5Urd user slar other insurance, No such subsidia al insured for 'bold or "properly ma' that occurrea or r-sonal and acWe1'sing nju caused by an cffense committed, Before you •maintairgd an ownership interest of more than SO% 'in 5UC1 5the5idiatiy; or b. After the date, if ry during the poligi period that you no long er ,maintain offership inte st of mcee than 50% in such subsidi Pot purposes of Paragraph 1. of Seefion II Who Is An insured, each such subsidry will be deemed to be designated in the Dec rations as: C O. E. F. inkidental M Malpractice Blanket Waiver Of Subrogation Caltractual LObility - Railroads Damage To Premises Rented To You air An 'ttzation other than . eirshigjOi ventv re or laibility company; or: .A trust; as indicated in its name or the documents that govern its strudure, B. BLANKET ADDITIONAL INSURED - GOVERNMENTAL ENTITIES ow PERMITS OR .AU114ORMATIONS RELATING TO OPERATIONS The IdioWin. Sadded to SECTION U— WHO IS AN INSURED: Any governmental entity that has i5sued per :or authcrization lh respect to cperations fQThed I you 'or en Atur behatf and that you are required bya: ordroncel 1.a.w. building code or mitten contract or agreernent include as an . • „ . ..: lona Jmiure, on . is • ove,ge Pt. 15 an insured but only wth repct to146 lity for 1>octiti it*ty", ''orope damage or %'pc nal and adveflFfl fljuVarisi. out siuch operations The insurance provided to •Such :94Nernmental en* does nct oppb1 Any bodily rwy d1T1.rirk or sal and advett ing cut of opratons performed fOE the governmental - entity; or b Any "biodi inju damage" luded fl the iprodixts-con1 eted operations hazard". :a3 D3 16 0219 c 2017 TIE TraMes iridernly Ccuipany„ Al ts reseried, includes mcrighted nariat of insurance Services Oro 'With its petnission4 Page 1 of 3 COMMERCIAL GENERAL LABILITY C. INCIDENTAL MEDICAL IVIALPRA.CTICE 14 The 'following replaces P.argrph b* of he definitkr) of 'tc:currence" in the. DEFINITIONS Section: 1:10 An act: or ;omission committed in pr�vidwtg Of tiling to ITovide "hcidental :medical Ices" z1 first aid or "Gocd Samasitan setvices" to a pew unless you we ki the 'business ,dr occLipatisin orovicli professional health care. service% 24 The .following replaces the last Iparagraiph of ar Pagraph aat(1) :of SECTION WHO IS AN INSURED: Lines5 yal are in the: business or occu goviding trufessional heakh care 5 ervice%.: Paragraphs .(1.Xa), (b),. (d) above. do nct pppber to 'txxi i•rury airg of providing cr fat .provide: "ifled. services'' by any :of your em..byees" who is a nurse:1 nutse assistart emergency Imedical tethnician or paramedic; or .01) First aid cr ''Goicd Samaritan service'by any of your :"empliclyees/i or 'Volunteer worke.rs" other than an empl. cr volunteer doctor .Any 5.uch ". 14 or nvolunteer wake rs!' pw:.dng or fiflng to provide first aid or "Good Samaritan services" durbg their work hours 'V you will te deemed to be acing %tin the $cope af their employment by ylzu fibrming duties related to the ccoduct yeur business, 3 The fcliming replaces the last sentence Cf Paragraph 5* cf .SECTION III umirs OF INSURANCE:: For the pp' ces cif :determining the Ike Each Otcurrence. Limit) all related acts or orntsions corn:tilted in provkling et failing to pnovide medral serviceel first aid or "Goed !Samaritan services" to any cm. perscn will be -deemed to be .one "occu nence at The .folidwing exclusion i5dded to Paragrap.h •:24 Exdusioris d SECTION I COVERAGES - COVERAGE A - BODILY -INJURY AND 'PROPERTY DAMAGE LIABIUTY: SWe Of -Pharmaceuticals odily injulYI or lipropetly dmageati ing out of the vidation a penal statute or ordnance reef to the sale of pharmaceutdcals collimated by or with the knowledge or consent of the insured 5 The following is added to the DEFINMON Section: ncidental iliedical services" means: at Mica surgicall dental laboratory, xi,ray or nursing service or treatnert, advice a instructionl or the related furnishing of ood or beverages; or bi The furnishing or dspensng d drugs Or medical, dentA or urgk JpIIe$ Cr a liancesa 6. The folic:wing !'s added to Paragrvii 44b, Excess Insurancex of SECTION IV COMMERCIAL GENERAL LIABILITY CONMTIONS: This insurance is excess over any valid and collectible other insurancei whether priniaty exces5 contingent or on aly other basis that is available to any II your "eniployees'l for bodi4, injury" tha1 arises out cif providing a .1failing to provide 'incidental medcal services' tz) any per5on to the .extent not subject to 'Paragraph 2sas(1) di -Section .11 - Who Is An nstkell+ EX BLANKET WAIVER OF StalOGATION The .folioNing. is added to Paragraph 11 Transfer CI Right's Of Recovery Against hers To. Us of SECTION IV -. COMMERCIAL GENERAL LIABUTY CONDMONS: the insured ha5 agreed in a contract c agreement to wive tot insured's right of recovey against any persal or organization, we wth our ell of recovely against such person or organizationx but nIy for :payments we make because of: a* 4Bodly Cr prxrty dam "IM occurs; Or b4 "Personal and advenng Ohio caned by an offense that is cortnittect stbsequent to the execution of the mitt' agrcnient, E cONTRACTUAL LIABILITY - RAILROADS 10 The following replaces Paragraph ci of the defnitbn of 'iinsured contract" in the DEFINITIONS 'Section: c Any easement or license aoreement Page 2 of 3 0 20'17 Ile Travelers Incieniity CompiTy. Al fights res9Ned. CG 03 16 02 19 Includes copyrighted material oi in5urance Cliteo With its ponlission. COMMERCIAL GENERAL LIABILITY Paragraph fo(1) of the definition of "insured contract° in the DEFINITIONS Section is deleted* DAMAGE TO PREIVIISES RENTED TO YOU The following replaces the definiWn cf "premises damage" in the DEFINMONS Section: "Ptemises damagemeallS '4property damage" ta as Any premises while rented to you C temporarib( occupied by you vah rmisson of the avner or b. The antents of any premises while such premises is rented to you if you rent such premises fix a period cf seven or fewer consecutive days. CG D3 16 02 19 2017 The .travulets indeninty Canpany2 Al I rjs reserved 1nclutz5 cpyrighWd material of Insurance Services Offre with itS ptTnissbn. Page 3 of 3 TRAVELERS]' ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WIC 99 03 7 ( A) - 001 POLICY NUMBER: UB-8S622101-21-26-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2. 00 % of the California workers' compensation pre- mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy,) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 10-13 -21 ST ASSIGN: Page 1 of 1 Receipt 916/22, 1:44 PM 2 e I -a' J• • ! • r4, r — ••,:•5 !! Guest la Home €7) Report a Problem Find Account 3 Submit Payment + Receipt Business License Online Payment PAGE 1"()F1 Y(:)R Thank you for your payment Payment Date: 9/6/2022 1:45:16 PM Confirmation #: 022197 (3835660711) Account Information :•••••••••3 = 4 t Summary Standard %el •?•••• (> Payment Information ••. r • / • 4 5 • • i p . _ fy • 4 ! 09051624 12/31/2022 L.C. PAVING & SEALING, INC. 620 ALPINE WAY ESCONDIDO (760) 752-1743 Input Balance Due 1,00 $4,00 1,00 $75.00 $79.00 $2.29 $81.29 POOM-aby HCV x1052 $81.29 Paying 09051624 L.C. PAVING & SEALING, INC. https://nationalcity.hdlgov.com/Pay/Pay3 Page of 2 Receipt 9/6/22, 1:44 PM https://nationalcity.hdlgov.com/PayfPay3 Page 2 of Receipt • 9/6/22, 1:44 PM : A4' Guest Find Account Submit Payment + Receipt Business License Online Payment Thank you for your payment Payment Date: 9/6/2022 1:45:16 PM Confirmation #: 022197 (3835660711) Account Information „ o Summary Standard C.:/00 in ice op"),‘,.-, I' ti -‘j • Payment Information C a I'd .,•. Arno n 09051624 12/31/2022 L.C. PAVING & SEALING, INC. 620 ALPINE WAY ESCONDIDO (760) 752-1743 Input 1.00 1.00 Balance Due $4.00 $75.00 $79.00 $2.29 $81.29 x1052 $81.29 Home "V Report a Problem Paying 09051624 L.C. PAVING & SEALING, INC. https://nationalcity.hcilgov,com/Pay/Pay3 Page 1 of 2 Receipt 9/6/22, 1:44 PM http : f/naticnaleit .hdl ov.00m/Pair/Pay Page 2 of Form -9 (Rev. October 2018) Department of the Treasury Internal Revenue Service IP. Go to www.irs.gov/FormW9 for instructions and the latest information. Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IFS. 0 ci 0 aw c €I, o 44 470 c +41 C:1:1] C. f 0 1 fame (as shown on your income tax return). Name is required on this line; do not leave this line blank. L.C. PAVING SEALING, INC. 2 Business name/disregarded entity name, if different from above SAME 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. �] individual/sole proprietor or Corporation 1]S Corporation El Partnership ... Trust/estate single -member L.L Limited liability company. Enter the tax classification (Czi-C corporation, µ corporation, P=Partnership) Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check 1_1_ if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of Its owner. Other (see instructions) Ilk LI [1-1 4 Exemptions (codes apply only to certain entities, not individuals; ee instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts mairvained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. 620 ALPINE WAY 6 City, state, and ZIP code ESCONDIDO, CA 92029 Requester's name and address (optional) 7 List account number(s) here (optional) Taxpayer Identification Number r (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. Certification or Employer identification number 2 7 2 3 2 7 7 6 9 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 (IR) 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 . 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 ire'quired to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Here Signature of U.S. person 0. 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 ww.rrs.govForrW9. Purpose of Form An individual or entity (Form W requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TiN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-II T (interest earned or paid) Date Niv- 051291201 9 • Form 1099-DiV (dividends, including those from stocks or mutual funds) • Form 109 -MI (various types of income, prizes, awards, or gross proceeds) • Form 1099- (stock or mutual fund sales and certain other transactions by brokers) • Form 1099- (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (bonne mortgage interest), 109 -{E (student loan interest), 109 --T (tuition) • Form 1099-C (canceled debt) • Form 1099-(acquisition or abandonment of secured property) Use Form if -9 only if you are a J.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018)