2200 - Special Inspection and Materials Testing Services Arterial Street Pavement Rehabilitation Project 43010 MTGLTPO -7 Z�
PROFESSIONAL SERVICES AGREEMENT
SPECIAL INSPECTION AND MATERIALS TESTING SERVICES
ARTERIAL STREET PAVEMENT REHABILITATION PROJECT 43010
MTGL
1. PARTIES AND DATE.
This Agreement is made and entered into this 12th Day of June, 2023 (Effective
Date) by and between the City of Rosemead, a municipal organization organized under
the laws of the State of California with its principal place of business at 8838 E. Valley
Blvd., Rosemead, California 91770 ("City") and MTGL a California corporation with its
principal place of business at 2992 E. La Palma Avenue, Suite A, Anaheim, CA 92806
("Consultant"). City and Consultant are sometimes individually referred to herein as
"Party" and collectively as "Parties."
2. RECITALS.
2.1 Consultant.
Consultant desires to perform and assume responsibility for the provision of certain
professional services required by the City on the terms and conditions set forth in this
Agreement. Consultant represents that it is experienced in providing special inspection
and materials testing for street pavement rehabilitation project to public clients, is licensed
in the State of California and is familiar with the plans of City.
2.2 Project.
City desires to engage Consultant to render such ongoing professional
construction inspection and testing services ("Services") as set forth in this Agreement.
3. TERMS.
3.1 Scope of Services and Term.
3.1.1 General Scope of Services: Consultant promises and agrees to
furnish to the City all labor, materials, tools, equipment, services, and incidental and
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customary work necessary to fully and adequately supply the professional construction
inspection and testing services necessary for the Project, herein referred to a "Services".
The Services are more particularly described in Exhibit A attached hereto and
incorporated herein by reference. All Services shall be subject to, and performed in
accordance with, this Agreement, the exhibits attached hereto and incorporated herein
by reference, and all applicable local, state and federal laws, rules and regulations.
3.1.2 Term. The term of this Agreement shall be for a six (6) month period
from the Effective Date shown above unless earlier terminated as provided herein.
Consultant shall complete the Services within the term of this Agreement and shall meet
any other established schedules and deadlines.
3.2 Responsibilities of Consultant.
3.2.1 Control and Payment of Subordinates; Independent Contractor. The
Services shall be performed by Consultant or under its supervision. Consultant will
determine the means, methods and details of performing the Services subject to the
requirements of this Agreement. City retains Consultant on an independent contractor
basis and not as an employee. Consultant retains the right to perform similar or different
services for others during the term of this Agreement. Any additional personnel
performing the Services under this Agreement on behalf of Consultant shall also not be
employees of City and shall at all times be under Consultant's exclusive direction and
control. Consultant shall pay all wages, salaries, and other amounts due such personnel
in connection with their performance of Services under this Agreement and as required
by law. Consultant shall be responsible for all reports and obligations respecting such
additional personnel, including, but not limited to: social security taxes, income tax
withholding, unemployment insurance, disability insurance, and workers' compensation
insurance.
3.2.2 Schedule of Services: Consultant shall perform the Services
expeditiously, within the term of this Agreement. Consultant represents that it has the
professional and technical personnel required to perform the Services in conformance
with such conditions. In order to facilitate Consultant's conformance with the Schedule,
City shall respond to Consultant's submittals in a timely manner. Upon request of City,
Consultant shall provide a more detailed schedule of anticipated performance to meet the
Schedule of Services.
3.2.3 Conformance to Applicable Requirements: All work prepared by
Consultant shall be subject to the approval of City.
3.2.4 Substitution of Key Personnel: Consultant has represented to City
that certain key personnel will perform and coordinate the Services under this Agreement.
Should one or more of such personnel become unavailable, Consultant may substitute
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other personnel of at least equal competence upon written approval of City. In the event
that City and Consultant cannot agree as to the substitution of key personnel, City shall
be entitled to terminate this Agreement for cause. As discussed below, any personnel
who fail or refuse to perform the Services in a manner acceptable to the City, or who are
determined by the City to be uncooperative, incompetent, a threat to the adequate or
timely completion of the Project or a threat to the safety of persons or property, shall be
promptly removed from the Project by the Consultant at the request of the City.
3.2.5 City's Representative: The City hereby designates the City Manager,
or his or her designee, to act as its representative for the performance of this Agreement
("City's Representative"). City's Representative shall have the power to act on behalf of
the City for all purposes under this Agreement. Consultant shall not accept direction or
orders from any person other than the City's Representative or his or her designee.
3.2.6 Consultant's Representative: Consultant hereby designates Lissette
Montoya, or his/her designee, to act as its representative for the performance of this
Agreement ("Consultant's Representative"). Consultant's Representative shall have full
authority to represent and act on behalf of the Consultant for all purposes under this
Agreement. The Consultant's Representative shall supervise and direct the Services,
using his/her professional skill and attention, and shall be responsible for all means,
methods, techniques, sequences and procedures and for the satisfactory coordination of
all portions of the Services under this Agreement.
3.2.7 Coordination of Services: Consultant agrees to work closely with City
staff in the performance of Services and shall be available to City's staff, consultants and
other staff at all reasonable times.
3.2.8 Standard of Care; Performance of Employees: Consultant shall
perform all Services under this Agreement in a skillful and competent manner, consistent
with the standards generally recognized as being employed by professionals in the same
discipline in the State of California. Consultant represents and maintains that it is skilled
in the professional calling necessary to perform the Services. Consultant represents that
all employees and subcontractors shall have sufficient skill and experience to perform the
Services assigned to them. Finally, Consultant represents that it, its employees and
subcontractors have all licenses, permits, qualifications and approvals of whatever nature
that are legally required to perform the Services, including a City business License, and
that such licenses and approvals shall be maintained throughout the term of this
Agreement. As provided for in the indemnification provisions of this Agreement,
Consultant shall perform, at its own cost and expense and without reimbursement from
the City, any services necessary to correct errors or omissions which are caused by the
Consultant's failure to comply with the standard of care provided for herein.
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3.2.9 Laws and Regulations: Consultant shall keep itself fully informed of
and in compliance with applicable local state and federal laws, rules and regulations in
any manner affecting the performance of the Project or the Services, including all
CaVOSHA requirements, and shall give all notices required by law. Consultant shall be
liable for all violations of such laws and regulations in connection with Services. If the
Consultant performs any work knowing it to be contrary to such laws, rules and
regulations and without giving written notice to the City, Consultant shall be solely
responsible for all costs arising therefrom. Consultant shall indemnify and hold City, its
officials, directors, officers, employees and agents free and harmless, pursuant to the
indemnification provisions of this Agreement, from any liability to the extent found to be
arising out of any failure to comply with such laws, rules or regulations.
3.2.10 Insurance: Consultant shall maintain prior to the beginning of and for
the duration of this Agreement insurance coverage as specified in Exhibit B attached to
and part of this agreement.
3.2.11 Safety: Contractor shall execute and maintain its work so as to avoid
injury or damage to any person or property. In carrying out its Services, the Consultant
shall at all times be in compliance with all applicable local, state and federal laws, rules
and regulations, and shall exercise all necessary precautions for the safety of its
employees appropriate to the nature of the work and the conditions under which the work
is to be performed. Safety precautions as applicable shall include, but shall not be limited
to: (A) adequate life protection and life saving equipment and procedures; (B) instructions
in accident prevention for all employees and subcontractors, such as safe walkways,
scaffolds, fall protection ladders, bridges, gang planks, confined space procedures,
trenching and shoring, equipment and other safety devices, equipment and wearing
apparel as are necessary or lawfully required to prevent accidents or injuries; and (C)
adequate facilities for the proper inspection and maintenance of all safety measures.
3.3 Fees and Payments.
3.3.1 Compensation: Consultant shall receive compensation, including
authorized reimbursements, for all Services rendered under this Agreement and shall not
exceed Nineteen Thousand Eight Hundred Ninety Eight Dollars ($19,898) and in
accordance with consultant's proposal dated June 5, 2023. Consultant's proposal is
hereby incorporated and found in Exhibit A. Extra Work may be authorized in writing, as
described below, and will be compensated at the rates and manner set forth in this
Agreement.
3.3.2 Payment of Compensation: Consultant shall submit to City a monthly
itemized statement which indicates work completed and hours of Services rendered by
Consultant. The statement shall describe the amount of Services and supplies provided
since the initial commencement date, or since the start of the subsequent billing periods,
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as appropriate, through the date of the statement. City shall, within 30 days of receiving
such statement, review the statement and pay all approved charges thereon.
3.3.3 Reimbursement for Expenses: Consultant shall not be reimbursed
for any expenses unless authorized in writing by City.
3.3.4 Extra Work: At any time during the term of this Agreement, City may
request that Consultant perform Extra Work. As used herein, "Extra Work" means any
work which is determined by City to be necessary for the proper completion of the Project,
but which the parties did not reasonably anticipate would be necessary at the execution
of this Agreement. Consultant shall not perform, nor be compensated for, Extra Work
without written authorization from City's Representative.
3.3.5 Prevailing Wages: Consultant is aware of the requirements of
California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code
of Regulations, Title 8, Section 1600, et seq., ("Prevailing Wage Laws"), which require
the payment of prevailing wage rates and the performance of other requirements on
"public works" and "maintenance" project, as defined by the Prevailing Wage Laws, and
if the total compensation is $1,000 or more, Consultant agrees to fully comply with such
Prevailing Wage Laws to the extent they are applicable to Consultant. City shall provide
Consultant with a copy of the prevailing rates of per diem wages in effect at the
commencement of this Agreement. Consultant shall make copies of the prevailing rates
of per diem wages for each craft; classification or type of worker needed to execute the
Services available to interested parties upon request and shall post copies at the
Consultant's principal place of business and at the project site. Consultant shall defend,
indemnity and hold the City, its elected officials, officers, employees and agents free and
harmless from any claim or liability arising out of any failure or alleged failure to comply
with the Prevailing Wage Laws.
3.4 Accounting Records.
3.4.1 Maintenance and Inspection: Consultant shall maintain complete
and accurate records with respect to all costs and expenses incurred under this
Agreement. All such records shall be clearly identifiable. Consultant shall allow a
representative of City during normal business hours to examine, audit, and make
transcripts or copies of such records and any other documents created pursuant to this
Agreement. Consultant shall allow inspection of all work, data, documents, proceedings,
and activities related to the Agreement for a period of three (3) years from the date of final
payment under this Agreement.
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3.5 General Provisions.
3.5.1 Termination of Agreement.
3.5.1.1 Grounds for Termination: City may, by written notice to
Consultant, terminate the whole or any part of this Agreement at any time and without
cause by giving written notice to Consultant of such termination, and specifying the
effective date thereof, at least seven (7) days before the effective date of such termination.
Upon termination, Consultant shall be compensated only for those services which have
been adequately rendered to City, and Consultant shall be entitled to no further
compensation. Consultant may not terminate this Agreement except for cause.
3.5.1.2 Effect of Termination: If this Agreement is terminated
as provided herein, City may require Consultant to provide all finished or unfinished
Documents/ Data and other information of any kind prepared by Consultant in connection
with the performance of Services under this Agreement. Consultant shall be required to
provide such document and other information within fifteen (15) days of the request.
3.5.1.3 Additional Services: In the event this Agreement is
terminated in whole or in part as provided herein, City may procure, upon such terms and
in such manner as it may determine appropriate, services similar to those terminated.
3.5.2 Delivery of Notices: All notices permitted or required under this
Agreement shall be given to the respective parties at the following address, or at such
other address as the respective parties may provide in writing for this purpose:
CONSULTANT
CITY:
MTGL
2992 E. La Palma Ave., Suite A
Anaheim, CA 92806
Attn: Steven Koch
Tel: (714) 632-2999
City of Rosemead
8838 Valley Boulevard
Rosemead, CA 91770
Attn: Ben Kim
Such notice shall be deemed made when personally delivered or when mailed, forty- eight
(48) hours by certified mail or deposit in the U.S. Mail, first-class postage prepaid and
addressed to the party at its applicable address. Actual notice shall be deemed adequate
notice on the date actual notice occurred, regardless of the method of service.
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3.5.3 Ownership of Materials and Confidentiality.
3.5.3.1 Documents & Data; Licensing of Intellectual Property: This
Agreement creates a non-exclusive and perpetual license for City to copy, use, modify,
reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or
works of authorship fixed in any tangible medium of expression, including but not limited
to, physical drawings or data magnetically or otherwise recorded on computer diskettes,
which are prepared or caused to be prepared by Consultant under this Agreement
("Documents & Data"). Consultant shall require all subcontractors to agree in writing that
City is granted a non-exclusive and perpetual license for any Documents & Data the
subcontractor prepares under this Agreement. Consultant represents and warrants that
Consultant has the legal right to license any and all Documents & Data. Consultant makes
no such representation and warranty in regard to Documents & Data which were prepared
by design professionals other than Consultant or provided to Consultant by the City.
The Documents & Data are intended for use solely with respect to the project for which
they were prepared. Any reuse or modification by City shall be at City's sole risk.
3.5.3.2 Confidentiality: All ideas, memoranda, specifications,
plans, procedures, drawings, descriptions, computer program data, input record data,
written information, and other Documents and Data either created by or provided to
Consultant in connection with the performance of this Agreement shall be held
confidential by Consultant. Such materials shall not, without the prior written consent of
City, be used by Consultant for any purposes other than the performance of the Services.
Nor shall such materials be disclosed to any person or entity not connected with the
performance of the Services or the Project. Nothing furnished to Consultant which is
otherwise known to Consultant or is generally known, or has become known, to the
related industry shall be deemed confidential. Consultant shall not use City's name or
insignia, photographs of the Project, or any publicity pertaining to the Services or the
Project in any magazine, trade paper, newspaper, television or radio production or other
similar medium without the prior written consent of City.
3.5.4 Cooperation; Further Acts: The Parties shall fully cooperate
with one another, and shall take any additional acts or sign any additional documents as
may be necessary, appropriate or convenient to attain the purposes of this Agreement.
3.5.5 Attorney's Fees: if either party commences an action against
the other party, either legal, administrative or otherwise, arising out of or in connection
with this Agreement, the prevailing party in such litigation shall be entitled to have and
recover from the losing party reasonable attorney's fees and all costs of such action as
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part of prevailing party's total damages as determined by court of competent jurisdiction
or as agreed upon by the parties in settlement.
3.5.6 Indemnity and Defense.
a. Indemnity and Defense
To the fullest extent permitted by law, Consultant shall indemnify and hold harmless
Agency and any and all of its officials, employees and agents ("Indemnified Parties") from
and against any and all losses, liabilities, damages, costs and expenses, including legal
counsel's fees and costs, to the extent caused by the negligent or wrongful act, error or
omission of Consultant, its officers, agents, employees or subconsultants (or any agency
or individual that Consultant shall bear the legal liability thereof) in the performance of
services under this agreement. Consultant's duty to indemnify and hold harmless Agency
shall not extend to the Agency's sole or active negligence.
b. Duty to Defend
In the event the Agency, its officers, employees, agents and/or volunteers are made a
party to any action, lawsuit, or other adversarial proceeding arising from the performance
of the services encompassed by this agreement, and upon demand by Agency,
Consultant shall defend the Agency at Consultant's cost or at Agency's option, to
reimburse Agency for its costs of defense, including reasonable attorney's fees and costs
incurred in the defense of such matters to the extent the matters arise from, relate to or
are caused by Consultant's negligent acts, errors or omissions. Payment by Agency is
not a condition precedent to enforcement of this provision. In the event of any dispute
between Consultant and Agency, as to whether liability arises from the sole or active
negligence of the Agency or its officers, employees, or agents, Consultant will be
obligated to pay for Agency's defense until such time as a final judgment has been
entered adjudicating the Agency as solely or actively negligent. In no event shall the cost
to defend charged to the design professional exceed the design professional's
proportionate percentage of fault.
3.5.7 Entire Agreement: This Agreement contains the entire Agreement of the
parties with respect to the subject matter hereof, and supersedes all prior negotiations,
understandings or agreements. This Agreement may only be modified by a writing signed
by both parties.
3.5.8 Governing Law: This Agreement shall be governed by the laws of the State
of California. Venue shall be in Los Angeles County.
3.5.9 Time of Essence: Time is of the essence for each and every provision of
this Agreement.
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3.5.10 City's Right to Employ Other Consultants: City reserves right to employ
other consultants in connection with this Project.
3.5.11 Successors and Assigns: This Agreement shall be binding on the
successors and assigns of the parties.
3.5.12 Assignment or Transfer: Consultant shall not assign, hypothecate, or
transfer, either directly or by operation of law, this Agreement or any interest herein
without the prior written consent of the City. Any attempt to do so shall be null and void,
and any assignees, hypothecates or transferees shall acquire no right or interest by
reason of such attempted assignment, hypothecation or transfer.
3.5.13 Construction; References; Captions: Since the Parties or their agents have
participated fully in the preparation of this Agreement, the language of this Agreement
shall be construed simply, according to its fair meaning, and not strictly for or against any
Party. Any term referencing time, days or period for performance shall be deemed
calendar days and not work days. All references to Consultant include all personnel,
employees, agents, and subcontractors of Consultant, except as otherwise specified in
this Agreement. All references to City include its elected officials, officers, employees,
agents, and volunteers except as otherwise specified in this Agreement. The captions of
the various articles and paragraphs are for convenience and ease of reference only, and
do not define, limit, augment, or describe the scope, content, or intent of this Agreement.
3.5.14 Amendment; Modification: No supplement, modification, or amendment of
this Agreement shall be binding unless executed in writing and signed by both Parties.
3.5.15 Waiver: No waiver of any default shall constitute a waiver of any other
default or breach, whether of the same or other covenant or condition. No waiver, benefit,
privilege, or service voluntarily given or performed by a Party shall give the other Party
any contractual rights by custom, estoppel, or otherwise.
3.5.16 No Third Party Beneficiaries: There are no intended third party beneficiaries
of any right or obligation assumed by the Parties.
3.5.17 Invalidity; Severability: If any portion of this Agreement is declared invalid,
illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining
provisions shall continue in full force and effect.
3.5.18 Prohibited Interests: Consultant maintains and warrants that it has not
employed nor retained any company or person, other than a bona fide employee working
solely for Consultant, to solicit or secure this Agreement. Further, Consultant warrants
that it has not paid nor has it agreed to pay any company or person, other than a bona
fide employee working solely for Consultant, any fee, commission, percentage, brokerage
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fee, gift or other consideration contingent upon or resulting from the award or making of
this Agreement. Consultant further agrees to file, or shall cause its employees or
subconsultants to file, a Statement of Economic Interest with the City's Filing Officer as
required under state law in the performance of the Services. For breach or violation of
this warranty, City shall have the right to rescind this Agreement without liability. For the
term of this Agreement, no member, officer or employee of City, during the term of his or
her service with City, shall have any direct interest in this Agreement, or obtain any
present or anticipated material benefit arising therefrom.
3.5.19 Equal Opportunity Employment: Consultant represents that it is an equal
opportunity employer and it shall not discriminate against any subcontractor, employee
or applicant for employment because of race, religion, color, national origin, handicap,
ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all
activities related to initial employment, upgrading, demotion, transfer, recruitment or
recruitment advertising, layoff or termination. Consultant shall also comply with all
relevant provisions of City's Minority Business Enterprise program, Affirmative Action
Plan or other related programs or guidelines currently in effect or hereinafter enacted.
3.5.20 Labor Certification: By its signature hereunder, Consultant certifies that it is
aware of the provisions of Section 3700 of the California Labor Code which require 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 agrees to comply with such
provisions before commencing the performance of the Services.
3.5.21 Authority to Enter Agreement: Consultant has all requisite power and
authority to conduct its business and to execute, deliver, and perform the Agreement.
Each Party warrants that the individuals who have signed this Agreement have the legal
power, right, and authority to make this Agreement and bind each respective Party.
3.5.22 Counterparts: This Agreement may be signed in counterparts, each of
which shall constitute an original.
3.6 Subcontracting.
3.6.1 Prior Approval Required: Consultant shall not subcontract any portion of the
work required by this Agreement, except as expressly stated herein, without prior written
approval of City. Subcontracts, if any, shall contain a provision making them subject to all
provisions stipulated in this Agreement.
[Signatures on next Page]
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CITY OF ROSEMEAD
Ben Kim, b �anager DD tfi e
Attest:
_L�& dd
Ericka Hernandez, City Clerk D to e
Approved as to Form:
3
Rachel Richman Date
City Attorney
MTGL, Inc.
By:
Name: Michelle Elliott
Title: CEO/SECRETARY
[If Corporation, TWO SIGNATURES,
President OR Vice President AND
Secretary, AND CORPORATE SEAL
OF CONTRACTOR REQUIRED]
Name: Isaac Chun
Title: Vice President Engineering
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EXHIBIT A
SCOPE OF SERVICES
Attached
EXHIBIT A - CONSULTANT'S PROPOSAL
"MT
OFFICE LOCATIONS i June 5, 2023
Mr. Ben Kim — City Manager
ORANGE COUNTY City of Rosemead
CORPORATE BRANCH 8838 E Valley Blvd,
2992 E La Palma Avenue Rosemead, CA 91770
Suite A
Anaheim, CA 92806
GEOTECHNICAL ENGINEERING
CONSTRUCTION INSPECTION
MATERIALS TESTING
ENVIRONMENTAL
MTGL Proposal No.: P-23-425.11
Tel: 714.632.2999 Subject: PROPOSAL FOR SPECIAL INSPECTION AND MATERIALS TESTING SERVICES
Fax: 714.632.2974 Arterial Street Pavement Rehabilitation Project 43010 - Revised
Rosemead, CA
SAN DIEGO
IMPERIAL COUNTY Dear Mr. Kim,
6295 Ferris Square
Suite In accordance with your request, MTGL, Inc. (MTGL) is pleased to submit this proposal
San Diego, CA 92121
for professional services at the subject project. We have reviewed the plans,
Tel: 858.537.3999
Fax: 858.537.399D specifications, and 40 day work schedule to address the special inspection and
materials testing requirements. Additionally, a construction schedule was not
available for this proposal. Based on the construction documents available we have
INLAND EMPIRE provided this proposal containing a scope of work, an estimated budget, fee schedule,
14467 Meridian Parkway and terms.
Building 2A
Riverside, CA 92518
Tel: 951.653.4999 When a construction schedule becomes available, please provide it so we may revise
Fax: 951 653.4666 1 this proposal accordingly
SCOPE OF WORK
OCPAND EMPIRE
DISPATCHATCH MTGL's proposed scope of work for special inspection and materials testing will
800,491.2990 consist of the following.
• SOILS COMPACTION TESTING SERVICES - MTGL's proposed scope of work for
providing soils compaction testing on an on-call, as -directed basis will consist
SAN DIEGO DISPATCH of the following.
888.844.5060
o Performing relative compaction testing of utility trench backfills, and
on-site street improvements.
www.mtglinc.com o Performing necessary laboratory tests to evaluate conformance of the
soils and aggregate base materials.
o Preparation of a written report summarizing all test results performed
upon completion of the work. The report will not contain a rendering,
opinion, certificate, or warranty, of the compaction or materials tested.
Page 1
City of Rosemead MTGL Proposal No. P-23-425.11
Arterial Street Pavement Rehabilitation Proiect 43010 lune 5, 2023
• ASPHALT LAVDOWN INSPECTION AND TESTING - MTGL's proposed scope of work for asphalt
laydown inspection and testing will consist of the following. Asphalt inspections and
testing will be performed in general conformance to the latest Standard Specifications
for Public Works Construction (Greenbook).
o Asphaltic Concrete Laydown Inspection - Our services will consist of providing
inspection and quality control during the laydown operation for conformance to
the job specifications. The laydown inspection will consist of monitoring the
temperature and rolling procedure for the in-place density of asphaltic concrete
by nuclear method. The quality control will consist of asphaltic concrete
maximum density testing for conformance to the job specification. A written
report will be provided at the completion of the work.
o Laboratory Testing of Asphaltic Concrete - Our services will consist of materials
testing of asphaltic concrete. Services will include Hveem stabilometer, sieve
analysis and extraction tests of asphaltic pavement. Tests will be performed on
materials sampled at random locations and at frequencies based on the project
specifications. A written report will be provided at the completion of the work.
o A written report summarizing the results of all tests performed will be prepared
upon completion of the work. The report will not contain a rendering, opinion,
certificate, or warranty, of the compaction or the materials tested.
Special inspectors and/or technicians will provide daily field reports describing the work
observed and stating compliance or non-compliance with the project documents. A copy of the
daily report will be left with the on-site client's designated representative.
Laboratory test reports will be prepared by our laboratory manager, reviewed by an engineer
or geologist, and distributed to the designated persons. Failing test results will be reported to
the designated person(s) on the day of the test.
Project supervision will be provided by our experienced Field Supervisor and a Registered Civil
Engineer (RCE) during construction. Duties will include reviewing special inspection reports, test
results, and attendance at site meetings as required.
A final report of special inspections and materials testing will be prepared by an engineer that
consists of a summary of the project special inspections and tests performed by MTGL for the
project.
Page 2
City of Rosemead MTGL Proposal No. P-23-425.11
Arterial Street Pavement Rehabilitation Proiect 43010 June 5, 2023
ESTIMATED BUDGET
We propose to perform the previously described services on an hourly or test rate basis in
accordance with the attached fee schedule. We have provided an estimated budget below.
ITEM
Soils / Asphalt Technician
Qty Unit
130 HR
Estimated
$
Costs
14,950.00
Field Supervisor
10 HR
1,150.00
Laboratory Testing, Equipment, Engineering Review
$
2,850.00
Administrative (5% of Invoice)
$
948.00
TOTAL ESTIMATED COSTS
$
19,898.00
TERMS
Our estimate is based on referenced preliminary information provided by you and our estimate
may vary due to unforeseen circumstances that may develop during construction. If a change in
the scope of work becomes necessary due to unforeseen conditions, which will increase the
charges, we will obtain your written authorization before proceeding.
Our budget estimate is based on understanding that this project is prevailing wage.
Invoices for our services will be rendered at the completion of the work and upon completion
of the report. Invoices are due and payable upon presentation. Should the duration of the job
exceed one-month, monthly invoices will be presented for services performed. Any amount not
paid within 30 days of the date due will bear interest at a rate of 18% per annum. In the event
legal action is instituted to enforce this agreement, the prevailing party will be entitled to
reasonable attorney fees.
Recognizing that our services are directly dependent upon the performance of others, we will
invoice for services rendered at the specified unit rates for the quantities shown on our budget
estimate. It should be recognized that unforeseen conditions, unfavorable weather and other
unanticipated conditions may affect the actual duration of the work. Services in addition to
those described in this budget estimate may be requested by or on behalf of the client and will
be invoiced on a time and materials basis at the unit rates outlined in this proposal.
The unit costs shown are based upon work taking place between the normal business hours
(7:00 a.m. to 5:00 p.m.) Monday through Friday, excluding nationally recognized holidays. Work
performed on a Saturday or more than 8 hours on a given day will be invoiced at 1.5 times the
standard rate. Work performed on Sunday or nationally recognized holidays will be invoiced at
2 times the standard rate. All unscheduled cancellations will be invoiced a minimum of 2 hours.
All other terms and conditions shall be per our standard Schedule of Fees.
Our services will consist of inspection and materials testing only on an on-call and as -directed
basis. The presence of our field representative will be for the purpose of observing the
construction and reporting its general compliance with the approved plans and the applicable
Page 3
City of Rosemead MTGL Proposal No. P-23-425.R
Arterial Street Pavement Rehabilitation Project 43010 June 5, 2023
building codes. Our work does not include the supervision or direction of the contractor's work,
it's employees or agents. The contractor is responsible for their services, and neither the
presence of our field personnel nor the observation and testing by this firm should excuse the
contractor in any way for defects in his work. It should further be understood that we are not
responsible for site safety. No warranty of any kind whatsoever, express or implied, is made or
intended by MTGL, its employees or agents, in connection with the services provided under this
Agreement.
CLOSURE
MTGL does not guarantee the performance of the contractor(s) by performing these services.
MTGL's performance of these services shall not relieve the contractor(s) of his obligation to
perform the work in conformity with the drawings and specifications and in a workmanlike
manner; shall not make MTGL an insurer of the contractor's performance; and shall not impose
on MTGL any obligation to see that the work is performed in a safe manner.
Thank you for the opportunity to submit this proposal. This proposal will be valid for 90
calendar days. We look forward to working with you on this project and can begin our work
upon receipt of your notice to proceed and receipt of a signed copy of this proposal authorizing
us to perform these professional services. If you have any questions regarding this proposal,
please contact the undersigned Project Manager.
Respectfully Submitted, Authorized by:
MTGL, Inc. City of Rosemead
Steven Koch Signature
Senior Vice President
Attachments: Schedule of Fees
Basis of Charges
Page 4
Print Name
Title
Date
MTGL Fee Schedule
PROFESSIONAL SERVICES
UNIT
$ 145.00
RATE
Staff Engineer/ Geologist
HR
5
115.00
Project Manager/Engineer/Geologist
HR
$
135.00
Principal Engineer/Geologist
HR
$
175.00
Draftsperson
HR
$
70.00
Administrative (Per Monthly Invoice)
Prestressed/Post Tensioned Inspector
HR
5%
Project Setup Fee
EACH
$
200.00
Certified Payroll (Per Pay Period)
Tech Rate
$
95.00
$ 0.58
EACH
$
110.00
FIELD INSPECTION PERSONNEL
UNIT
RATE
RATE
ICC Special Inspector
HR
$
115.00
Soils/Asphalt Technician
HR
$
115.00
AWS/CWI Welding Inspector
HR
$
115.00
NDT Technician / Fabrication Inspector
HR
$
145.00
Field/Lab Supervisor
HR
$
135.00
DSA Masonry/Shotcrete Inspector
HR
$
125.00
L.A. Deputy Grading Inspector
HR
$ 145.00
L.A. City Special Inspector
HR
$ 145.00
Multi -Certified Inspector
HR
$ 135.00
Pull I Torque Testing Technician
HR
$ 115.00
Batch Plant (Concrete or Asphalt) Technician
HR
$ 115.00
Firestopping Inspection
HR
$ 180.00
Floor Flatness / Levelness (Inc. Equipment)
DAY
$ 1,500.00
Prestressed/Post Tensioned Inspector
HR
$ 115.00
Concrete, Masonry, Asphalt Coring or Sawing
EACH
QUOTE
Travel Time
HR
Tech Rate
Mileage
MILE
$ 0.58
EACH
$
110.00
LAB TESTING - SOIL
UNIT
RATE
D422 Hydrometer Analysis
EACH
$ 175.00
D422 Sieve Analysis of Soil
EACH
$ 200.00
D558 Soil Cement - Maximum Density
EACH
$ 300.00
D559 Soil Cement- Sample Preparation
EACH
$ 100.00
D854 Specific Gravity of Soils
EACH
$ 125.00
D1140 Materials Finer than #200 (Sieve)
EACH
$ 60.00
D1557 Maximum Density
EACH
$ 290.00
D1883 California Bearing Ratio (CBR)
EACH
QUOTE
D2216 Soil Moisture Content by Mass
EACH
$ 25.00
D2419 Sand Equivalent
EACH
$ 110.00
D2434 Permeability
EACH
QUOTE
D2435 Consolidation
EACH
$ 225.00
D2435 Consolidation with Time Rate
EACH
$ 275.00
02844 R -Value & Expansive Pressures
3 Points
$ 250.00
D2937 Moisture& Density(Ring Samples)
EACH
$ 30.00
D3080 Direct Shear
EACH
$ 200.00
D4318 Plasticity Index of Soils EACH $ 145.00
D4829 Expansion Index of Soils EACH $ 135.00
CT 216 CA Impact Max Density EACH $ 225.00
CT 216 CA Impact Rock Correction EACH $ 95.00
LAB TESTING - AGGREGATES
UNR
$
RATE
C40 Organic Impurities in Fine Agg
EACH
$
95.00
C88 Soundness by Sodium Sulfate
EACH
$
315.00
C123 Percent Lightweight particles
EACH
$
215.00
C127 Specific Gravity(Coame Agg)
EACH
$
130.00
C128 Specific Gravity (Fine Agg)
EACH
$
150.00
C131 Abrasion- Los Angeles Rattler
EACH
$
235.00
C136 Sieve Analysis (Combined Agg)
EACH
$
130.00
C136 Sieve Analysis (Fine or Coarse Agg)
EACH
$
110.00
C142 Clay Lumps & Friable Particles
EACH
$
135.00
C535 Abrasion (Large Agg)- Los Angeles Rattler
EACH
$
235.00
C566 Moisture Content by Drying
EACH
$
2500
CT 227 Cleanness Value
EACH
$
230.00
D3744 Durability Index
EACH
$
180.00
D5821 Flat & Elongated Particles
EACH
$
200.00
T335 Crushed Particles
EACH
$
170.00
LAB TESTING - Misr.
UNR
$
RATE
C67 Roofing Tile Absorption
EACH
$
65.00
C67 Roofing Tile Strength Test
EACH
$
60.00
C78 Flexural Strength - Beams (6" x 6")
EACH
$
60.00
Sample Pickup Charges
UNIT
$
RATE
Pick up Sample Trip Charge(2hr Minimum)
HR
$
65.00
Weekend Sample Pick Up Charge (21fir Minimum)
HR
$
80.00
LAB TESTING - CONCRETE
UNIT
$
RATE
C39 Compressive Strength - Concrete Cylinders (6" x 12")
EACH
$
35.00
C39 Compressive Strength- Cores (6" Max. Diameter)
EACH
$
55.00
C78 Flexural Strength - Beams (6" x 6")
EACH
$
60.00
C157 Concrete Shrinkage (Set of 3)
SET
$
350.00
Core Trimming (in Laboratory)
EACH
$
55.00
C192 Concrete Trial Batch w/ Lab Testing
EACH
$
1,100.00
Ca69 Modulus of Elasticity
EACH
$
150.00
C495 Comp. Strength - Ughtweight Concrete Fill
EACH
$
45.00
Handling Charge - Beams Not Broken/Hold
EACH
$
50.00
C496 Tensile Strength, Splitting
EACH
$
75.00
C567 Unit Weight (Hardened Lightweight Concrete)
EACH
$
50.00
C1140 Shotcrete Panel Test
EACH
$
300.00
D1188 Core Density Parafilm Coated
EACH
$
85.00
D1560 Stabilometer -HVEEM
EACH
$
290.00
D1561 Max Density- HVEEM
EACH
$
195.00
D2172 Asphalt Content by Solvents
EACH
$
250.00
D3910 Wet Track Abrasion
EACH
$
195.00
D5444 Gradation of Extracted Agg
EACH
$
275.00
D6307 Asphalt Content by lRnition
EACH
$
245.00
D6926 Max Density -Marshall
EACH
$ 295.00
D6927 Stability and Flow - Marshall
EACH
$ 375.00
T209/DZD41 Theoretical Maximum Density
EACH
$ 150.00
T324 Hamburg Wheel
EACH
$ 1,000.00
CT 370 Moisture Content
EACH
$ 70.00
UAB TESTING - MASONRY
UNIT
RATE
RATE
C109 Mortar- 2" Cube Compressive Strength
EACH
$
40.00
C140 Block- Compressive Strength
EACH
$
75.00
0340 Block - Moisture & Absorption
EACH
$
80.00
C140 Block- Unit Weight & Measurements
EACH
$
275.00
C426 Block - Linear Shrinkage
EACH
$
180.00
C780 Mortar- (2" x 4") Cylinders Comp. Strength
EACH
$
35.00
C1019 Grout Prisms- Compressive Strength
EACH
$
35.00
Handling Charge (Cylinders/Cubes/Prisms) Not Broken/Holds
EACH
$
75.00
C1314 CMU Grouted Prisms -Comp. Strength (� B" x B" x 16")
EACH
$
180.00
C1314 CMU Grouted Prisms - Comp. Strength (> 8" x 8" x 16")
EACH
$
245.00
C67 Brick - Boil
EACH
$
90.00
C67 Brick- Compressive Strength
EACH
$
50.00
C67 Brick- Moisture & Absorption
EACH
$
85.00
LAB TESTING - STEEL
UNIT
RATE
Steel Chemical Analysis/AWS Weld: Macroetch/Fracture/Bend Test
EACH
QUOTE
A325 High Strength Bolt, Nut & Washer Conformance (Per Assembly)
EACH
$ 180.00
A370 Brinell & Rockwell Hardness Test
EACH
$ 80.00
A370 Nelson Stud Tensile
EACH
$ 195.00
A370 Rebar Bend & Tensile Test No. 11 Bar & Smaller
EACH
$ 45.00
A615/706 Bend Test No. 11 Bar and Smaller
EACH
$ 60.00
A615/706 Tensile No. 11 Bar and Smaller
EACH
$ 65.00
A615/706 Tensile No. 14 Bar and Larger
EACH
QUOTE
A416 Prestressing Wire, Tension
EACH
$ 170.00
Sample Preparation (Cutting)
EACH
$ 80.00
A416 Prestressing Cable(? Wire) -Yield&Tensile
EACH
$ 170.00
E605 Fireproofing Unit Weight
EACH
$ 60.00
EQUIPMENT CHARGES
UNIT
RATE
Air Meter
DAY
$ 30.00
Dye Penetrant Equipment
DAY
$ 50.00
Emissivity Test Kit
EACH
$ 50.00
Ground Rod Equipment
DAY
$ 50.00
Jacking Assembly
DAY
$ 65.00
Magnetic Particle Equipment
DAY
$ 50.00
Nuclear Density Gauge
DAY
$ 70.00
Pachometer
DAY
$ 55.00
Sand Cone Kit DAY $ 50.00
Schmidt Hammer
DAY
$ 45.00
Skidmore -Wilhelm Bolt Cell
DAY
$ 65.00
Torque Wrench
DAY
$ 50.00
Ultrasonic Equipment
DAY
$ 45.00
Outside Services
Cost +20%
Basis of Charges and Contract Terms
The charges for services and General Terms and Conditions set forth below will govern the provision of services and will constitute the contract terms between the Owner or Owners
Representative (Client) and MTGL, Inc unless the Client and MTGL, Inc. have executed a written contract with respect to such services, in which case the terms and provisions of the written contract
shall supersede.
Minimum Field Hourly Charges
For Field Technicians, Special Inspectors or any on-site (field) materials testing services
4 hours: 4 -hour minimum charge up to the first four hours of work.
8 hours: 8 -hour minimum charge for over four hours of work, up to eight hours.
Project time accrued includes portal to portal travel time.
Scheduling & Cancellations
• A 24-hour notice is required when scheduling an inspection or technician.
• A two-hour show -up charge will be applied to any service canceled the same day of service.
• Verbal request will be considered authorization to perform billable work. Client shall designate
member(s) of staff who have authority to request services and notify MTGL in writing of their
authorized representative. Otherwise all service requests are billable.
Travel Charges & Mileage
• For projects outside a 50 -mile radius from the nearest MTGL facility, $0.63 per excess mile to and
from the project will be charged for inspectors and technicians.
• When project related equipment is required to be transported to and from the project site, time
and mileage for inspectors and field technicians will be billed on a portal to portal basis.
• For all projects, $0.63 per mile rate and applicable travel time will be charged portal to portal for
engineers, consultants, and supervisors from the laboratory to the project site and return.
Overtime Rates Laboratory Testing
• Work performed in excess of 8 hours per day and / or up to eight (8) hours on Saturdays will be • A 2 -hour minimum material sample pick-up charge with an hourly rate of $65 will be billed in
billed at 1.5 times the unit rate. addition to the prices quoted for testing.
• Work performed on Sunday, recognized holidays, or in excess of eight (8) hours on Saturdays will • Quoted laboratory test rates assume samples are free of hazardous materials. Handling and
be billed M 2.0 times the unit rate. testing of samples containing hazardous materials may include additional costs.
• A 20% surcharge will be applied for laboratory tests performed on a Saturday or Sunday.
• Work performed by field or laboratory staff outside of normal business hours ( 5:00 AM - 5:00
PMI will be subiect to the above overtime rates.
Administrative Charges
• All admintstrative costs including report distribution are billed at 5% of the monthly invoice
total.
• Certified payroll requests will have a processing fee applied for each project, billed at $95 per
payroll week.
Anticipated Costs
• MTGL estimates a budget to assist the client with code required inspections and testing based
upon information provided by the client. MTGL's ability to perform within the estimated budget
relies heavily on the accuracy of the information provided, as well as the cooperation of clienCs
management staff.
• Project actual budget totals may vary. Estimated budget hours are based upon 40 hours a
week, 8 hours a day, Monday -Friday. Client shall monitor the percentage of work remaining to
assure inspections and testing is not greater than the estimated budget and adjusts the
contractors labor and scheduling to maintain the work completion schedule.
• Client recognizes and agrees that any "anticipated costs," "budget estimates," or the like
that may be prepared by MTGL are NOT "guaranteed maximums," "lump sums;" or "not -to -
exceed totals". Client will be invoiced for all work performed and only for work performed
based on MTGL's working conditions and hours as an attachment to their contract.
• Additionally, any weekly overtime hours, Saturday or Sunday, double shift, and/or night shift
differential for shop steel inspection are NOT included in MTGUs proposal.
Reimbursable Expenses & Outside Services
• Heavy equipment, subcontractor fees and expenses, supplemental insurance, travel,
shipping, outside reproduction, and other reimbursable expenses will be invoiced at cost plus
20%.
• Outside services will be billed at cost plus 20% unless billed directly to and paid for by Client.
Weekend Sample Pick -Ups
In order to be in strict conformance with testing standards, it may be required that weekend pick-
ups be performed (e.g. concrete specimens cast on Friday must be picked up during weekend to
be in conformance with ASTM C31 requiring specimens to be moved to their final curing location
within 48 hours of casting.) Applicable charges for weekend work will apply when this is required.
Should these charges not be authorized then MTGL will not be held responsible for any negative
consequences for non-conformance.
Terms of Payment
• Invoices for all services willl be submitted monthly. These invoices are due in full upon
presentation to client. Invoices outstanding over 45 days are considered past due and will be
subject to a finance charge of 1.5% of the unpaid balance each month.
• All invoice errors or necessary corrections shall be brought to the attention of MTGL within 30
days of receipt of invoice. Thereafter, customer, acknowledges invoices are correct and valid.
• MTGL reserves the right to terminate its services to a customer without notice if all invoices are
not current. Upon such termination of services, the entire amount accrued for all services
performed shall immediately become due and payable. Customer waives any and all claims
against MTGL, its subsidiaries, affiliates. servants and agents for termination of work on account of
these terms.
• In the event of any litigation arising from or related to any agreement to provide services
whether verbal or written, the prevailing parry shall be entitled to recover from the non -prevailing
parry all reasonable costs incurred, including staff time. court costs, attorney fees and all other
related expenses in such litigation. Additionally, in the event of a non -adjudicative settlement of
litigation between the parties or a resolution of dispute by arbitration, that same process shall
determine the prevailing parry.
Please note that field service rates will increase at 6%July 1st ofeach year for cost of living
increases.
Our professional engineering, geology, and inspection services are performed in accordance with the current standards of practice in the industry. No other warranty or representation,
express or implied, is made or intended.
MTGL
Page 13 of 18
EXHIBIT B
INSURANCE REQUIREMENTS
Prior to the beginning of and throughout the duration of the Work, Consultant will
maintain insurance in conformance with the requirements set forth below. Consultant will
use existing coverage to comply with these requirements. If that existing coverage does
not meet the requirements set forth here, Consultant agrees to amend, supplement or
endorse the existing coverage to do so. Consultant acknowledges that the insurance
coverage and policy limits set forth in this section constitute the minimum amount of
coverage required. Any insurance proceeds available to City in excess of the limits and
coverage required in this agreement and which is applicable to a given loss, will be
available to City.
Consultant shall provide the following types and amounts of insurance:
Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance with coverage at least as broad as Insurance Services Office
form CG 00 01, in an amount not less than $1,000,000 per occurrence, $2,000,000
general aggregate, for bodily injury, personal injury, and property damage. The policy
must include contractual liability that has not been amended. Any endorsement restricting
standard ISO "insured contract" language will not be accepted.
Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including
symbol 1 (Any Auto) or the exact equivalent. Limits are subject to review, but in no event
to be less that $1,000,000 per accident. If Consultant owns no vehicles, this requirement
may be satisfied by a non -owned auto endorsement to the general liability policy
described above. If Consultant or Consultant's employees will use personal autos in any
way on this project, Consultant shall provide evidence of personal auto liability coverage
for each such person.
Workers Compensation on a state -approved policy form providing statutory
benefits as required by law with employer's liability limits no less than $1,000,000 per
accident or disease.
Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit
requirements, shall provide coverage at least as broad as specified for the underlying
coverages. Any such coverage provided under an umbrella liability policy shall include a
drop down provision providing primary coverage above a maximum $25,000 self-insured
retention for liability not covered by primary but covered by the umbrella. Coverage shall
be provided on a "pay on behalf' basis, with defense costs payable in addition to policy
limits. Policy shall contain a provision obligating insurer at the time insured's liability is
determined, not requiring actual payment by the insured first. There shall be no cross -
liability exclusion precluding coverage for claims or suits by one insured against another.
MTGL
Page 14 of 18
Coverage shall be applicable to City for injury to employees of Consultant, subconsultants
or others involved in the Work. The scope of coverage provided is subject to approval of
City following receipt of proof of insurance as required herein. Limits are subject to review
but in no event less than $1 Million per occurrence.
Professional Liability or Errors and Omissions Insurance as appropriate shall be
written on a policy form coverage specifically designed to protect against acts, errors or
omissions of the consultant and "Covered Professional Services" as designated in the
policy must include work performed under this agreement. The policy limit shall be no
less than $1,000,000 per claim and in the aggregate. The policy must "pay on behalf of
the insured and must include a provision establishing the insurer's duty to defend the
Named Insured. The policy retroactive date shall be on or before the effective date of this
agreement.
Acceptable insurers: All insurance policies shall be issued by an insurance
company currently authorized by the Insurance Commissioner to transact business of
insurance or is on the List of Approved Surplus Line Insurers in the State of California,
with an assigned policyholders' Rating of A- (orhigher) and Financial Size Category Class
Vll (or larger) in accordance with the latest edition of Best's Key Rating Guide, unless
otherwise approved by the Agency's Risk Manager.
General conditions pertaining to provision of insurance coverage by Consultant.
Consultant and City agree to the following with respect to insurance provided by
Consultant:
1. Consultant agrees to have its insurer endorse the third -party general liability
coverage required herein to include as additional insureds City, its officials,
employees and agents, using standard ISO endorsement No. CG 2010 (or
otherwise consistent with the insurer's endorsement). Consultant also
agrees to require all contractors, and subcontractors to do likewise.
2. No liability insurance coverage provided to comply with this Agreement shall
prohibit Consultant, or Consultant's employees, or agents, from waiving the
right of subrogation prior to a loss. Consultant agrees to waive subrogation
rights against City regardless of the applicability of any insurance proceeds,
and to require all contractors and subcontractors to do likewise.
3. All insurance coverage and limits provided by Contractor and available or
applicable to this agreement are intended to apply to the full extent of the
policies. Nothing contained in this Agreement or any other agreement
relating to the City or its operations limits the application of such insurance
coverage.
MTGL
Page 15 of 18
4. None of the coverages required herein will be in compliance with these
requirements if they include any limiting endorsement of any kind that has
not been first submitted to City and approved of in writing.
5. No liability policy shall contain any provision or definition that would serve
to eliminate so-called "third party action over" claims, including any
exclusion for bodily injury to an employee of the insured or of any contractor
or subcontractor.
6. All coverage types and limits required are subject to approval, modification
and additional requirements by the City, as the need arises. Consultant shall
not make any reductions in scope of coverage (e.g. elimination of
contractual liability or reduction of discovery period) that may affect City's
protection without City's prior written consent.
7. Proof of compliance with these insurance requirements, consisting of
certificates of insurance evidencing all of the coverages required and an
additional insured endorsement to Consultant's general liability policy, shall
be delivered to City at or prior to the execution of this Agreement. In the
event such proof of any insurance is not delivered as required, or in the
event such insurance is canceled at any time and no replacement coverage
is provided, City has the right, but not the duty, to obtain any insurance it
deems necessary to protect its interests under this or any other agreement
and to pay the premium. Any premium so paid by City shall be charged to
and promptly paid by Consultant or deducted from sums due Consultant, at
City option.
8. Certificate(s) are to reflect that the insurer will provide 30 days notice to City
of any cancellation of coverage. A ten (10) day notice to City shall apply to
nonpayment of premiums. Consultant agrees to require its insurer to modify
such certificates to delete any exculpatory wording stating that failure of the
insurer to mail written notice of cancellation imposes no obligation, or that
any party will "endeavor" (as opposed to being required) to comply with the
requirements of the certificate.
9. It is acknowledged by the parties of this agreement that all insurance
coverage (except Professional Liability and Workers' Compensation)
required to be provided by Consultant or any subcontractor, is intended to
apply first and on a primary, noncontributing basis in relation to any other
insurance or self-insurance available to City.
10. Consultant agrees to ensure that subcontractors, and any other party
involved with the project who is brought onto or involved in the project by
Page 16 of 18
Consultant, provide the same minimum insurance coverage required of
Consultant. Consultant agrees to monitor and review all such coverage and
assumes all responsibility for ensuring that such coverage is provided in
conformity with the requirements of this section. Consultant agrees that
upon request, all agreements with subcontractors and others engaged in
the project will be submitted to City for review.
11. Consultant agrees not to self -insure or to use any self-insured retentions or
deductibles on any portion of the insurance required herein and further
agrees that it will not allow any contractor, subcontractor, Architect,
Engineer or other entity or person in any way involved in the performance
of work on the project contemplated by this agreement to self -insure its
obligations to City. If Consultant's existing coverage includes a deductible
or self-insured retention, the deductible or self-insured retention must be
declared to the City. At that time the City shall review options with the
Consultant, which may include reduction or elimination of the deductible or
self-insured retention, substitution of other coverage, or other solutions.
12. The City reserves the right at any time during the term of the contract to
change the amounts and types of insurance required by giving the
Consultant ninety (90) days advance written notice of such change. If such
change results in substantial additional cost to the Consultant, the City will
negotiate additional compensation proportional to the increased benefit to
City.
13. For purposes of applying insurance coverage only, this Agreement will be
deemed to have been executed immediately upon any party hereto taking
any steps that can be deemed to be in furtherance of or towards
performance of this Agreement.
14. Consultant acknowledges and agrees that any actual or alleged failure on
the part of City to inform Consultant of non-compliance with any insurance
requirement in no way imposes any additional obligations on City nor does
it waive any rights hereunder in this or any other regard.
15. Consultant will renew the required coverage annually as long as City, or its
employees or agents face an exposure from operations of any type
pursuant to this agreement. This obligation applies whether or not the
agreement is canceled or terminated for any reason. Termination of this
obligation is not effective until City executes a written statement to that
effect.
MTGL
Page 17 of 18
16. Consultant shall provide proof that policies of insurance required herein
expiring during the term of this Agreement have been renewed or replaced
with other policies providing at least the same coverage. Proof that such
coverage has been ordered shall be submitted prior to expiration. A
coverage binder or letter from Consultant's insurance agent to this effect is
acceptable. A certificate of insurance and/or additional insured
endorsement as required in these specifications applicable to the renewing
or new coverage must be provided to City within five days of the expiration
of the coverages.
17. The provisions of any workers' compensation or similar act will not limit the
obligations of Consultant under this agreement. Consultant expressly
agrees not to use any statutory immunity defenses under such laws with
respect to City, its employees, officials and agents.
18. Requirements of specific coverage features, or limits contained in this
section are not intended as limitations on coverage, limits or other
requirements nor as a waiver of any coverage normally provided by any
given policy. Specific reference to a given coverage feature is for purposes
of clarification only as it pertains to a given issue, and is not intended by any
party or insured to be limiting or all inclusive.
19. These insurance requirements are intended to be separate and distinct from
any other provision in this agreement and are intended by the parties here
to be interpreted as such.
20. The requirements in this Section supersede all other sections and
provisions of this Agreement to the extent that any other section or provision
conflicts with or impairs the provisions of this Section.
21. Consultant agrees to be responsible for ensuring that no contract used by
any party involved in any way with the project reserves the right to charge
City or Consultant for the cost of additional insurance coverage required by
this agreement. Any such provisions are to be deleted with reference to City.
It is not the intent of City to reimburse any third party for the cost of
complying with these requirements. There shall be no recourse against City
for payment of premiums or other amounts with respect thereto.
Consultant agrees to provide immediate notice to City of any claim or loss against
Consultant arising out of the work performed under this agreement. City assumes no
obligation or liability by such notice but has the right (but not the duty) to monitor the
handling of any such claim or claims if they are likely to involve City.
MTGLINC-01 MURPHE
A�oRo CERTIFICATE OF LIABILITY INSURANCE DnT6/6/2OD32YY)
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(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). -
License # OE67768 CONTACT Mandy Murphey
PRODUCER NAME:
ian Diego, CA 92122
INSURED
MTGL, Inc.
2992 E. La Palma Ave., Ste. A
Anaheim, CA 92806
(AC,ii, Er. (619) 400-1990 50200 HOFAX c, No): (619) 574-6288
ADDRESS, Mandy.Murphey@ioausa.com
INSURER(S)AFFORDING COVERAGE — __. NAIC M.
INSURER A: Travelers Property Casualty Company of America 25674
INSURER B: State Compensation Insurance Fund of CA 35076
INSURER C: Continental Casualty Company 20443
INSURER D:
INSURER E:
mwnee renrrelr Are HUMBER RFVLCIr1N rdIrMRFR-
v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
City of Rosemead
AUTHORIZED REPRESENTATIVE
INSR TYPE OF INSUMNLE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP
LIMITS
8838 E Valley Blvd.
Rosemead. CA 91770
A X COMMERCIAL GENERAL LMBILIW
EACH OCCURRENCE $
1'000'000
CLAIMS -MADE X OCCUR X X 6802HO20984 9/1/2022 9/1/2023
DAMAGE TO RENTED
PREMISE$(Ea occurrence) $
1,000,000
-_.
X Cont Llab/Sev of Int
MED EXP JAny one person) $
5'000
1'000'000
PERSONAL B ADV INJURY_ $
2'000'000
GEN'L AGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE _.$__.
-
POLICY X JEC'T LOC
PRODUCTS-COMPIOP AGG . $
2,000,000
Deductible
0
OTHER'.
$
A
COMBINED SINGLE LIMIT
1,000,000
AUTOMOBILE LIABILITY
(Ee accident) __ __B
X ANY AUTO X X BA2S139998 9/1/2022 9/1/2023
BODILY INJURYJPer person) _S_.
OWNED -- SCHEDULED
A AUTNr1OpSSyw�N.�
_BODILY INJURYSPer ecddent) $
pp
ONLY
MRS ONLY AUTOSO V
nt)AMAGE- $-
Leri PROPERTY
—_
_.AUTOS _-
X Comp- $1,000 X Coll.: $1,000
$
A X UMBRELLA LIAB X OCCUR
EACH OCCURRENCE $
9'000'000
EXCESS LIAB CLAIMS -MADE CUP4161T475 9/1/2022 9/112023
AGGREGATE $
9'000'000
DED X RETENTION $ 0
B WORKERS COMPENSATION
X STATUTE ETH
ANO EMPLOYERS' LIABILITY 9278739-22 711/2022 7/1/2023
YIN
X
1,000,000
ANY PROPRIETORIPARTNERIEXECUTIVE
NIA
E.L-EACH ACCIDENT $
J�pF11/M�MBER EXCLUDED?
1,000,000
IMandatory n N j
E_. L. DISEASE- EA EMPLOYEE 8
If Year describe under
_
1,000,000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
C Prof Liab/Clms Made MCH591879084 9/1/2022 9/1/2023
Per Claim
5,000,000
C Ded.: $60K Per Claim MCH591879084 9/1/2022 9/1/2023
Aggregate
5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Addi lonal Remarks Schedule, may be aeached N more space is required)
Re: Arterial Street Pavement Rehabilitation Project 43010
City of Rosemead is Additional Insured with respect to General and Auto Liability per the attached endorsements as required by written contract Insurance is
Primary and Non -Contributory. Waiver of Subrogation applies to General Liability, Auto Liability and Workers' Compensation.
30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
CANCEI 1 ATIAM
ACORD 25 (2016/03) cV 1588-ZOTb AL.LKu tUKrUKAI IUn. AN ngnrs reserveu.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Rosemead
AUTHORIZED REPRESENTATIVE
Attn: Okan Demirci
8838 E Valley Blvd.
Rosemead. CA 91770
ACORD 25 (2016/03) cV 1588-ZOTb AL.LKu tUKrUKAI IUn. AN ngnrs reserveu.
The ACORD name and logo are registered marks of ACORD
Policy No.: 6802HO20984
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
(ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that you agree in a
"written contract requiring insurance" to include as
an additional insured on this Coverage Part, but:
a. Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and
b. If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work' to which the "written contract
requiring insurance" applies, or in connection
with premises owned by or rented to you.
The person or organization does not qualify as an
additional insured:
c. With respect to the independent acts or
omissions of such person or organization; or
d. For "bodily injury", 'property damage" or
"personal injury" for which such person or
organization has assumed liability in a
contract or agreement.
The insurance provided to such additional insured
is limited as follows:
e. This insurance does not apply on any basis to
any person or organization for which
coverage as an additional insured specifically
is added by another endorsement to this
Coverage Part.
f. This insurance does not apply to the
rendering of or failure to render any
"professional services".
g. In the event that the Limits of Insurance of the
Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the
insurance provided to the additional insured
shall be limited to the limits of liability required
by that "written contract requiring insurance".
This endorsement does not increase the
limits of insurance described in Section III —
Limits Of Insurance.
h. This insurance does not apply to "bodily
injury" or "property damage" caused by "your
work' and included in the "products -
completed operations hazard" unless the
"written contract requiring insurance"
specifically requires you to provide such
coverage for that additional insured, and then
the insurance provided to the additional
insured applies only to such "bodily injury" or
"property damage" that occurs before the end
of the period of time for which the "written
contract requiring insurance" requires you to
provide such coverage or the end of the
policy period, whichever is earlier.
2. The following is added to Paragraph 4.a. of
SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS:
The insurance provided to the additional insured
is excess over any valid and collectible other
insurance, whether primary, excess, contingent or
on any other basis, that is available to the
additional insured for a loss we cover. However, if
you specifically agree in the "written contract
requiring insurance" that this insurance provided
to the additional insured under this Coverage Part
must apply on a primary basis or a primary and
non-contributory basis, this insurance is primary
to other insurance available to the additional
insured which covers that person or organizations
as a named insured for such loss, and we will not
share with the other insurance, provided that:
(1) The 'bodily injury" or 'property damage" for
which coverage is sought occurs; and
(2) The 'personal injury" for which coverage is
sought arises out of an offense committed;
after you have signed that "written contract
requiring insurance". But this insurance provided
to the additional insured still is excess over valid
and collectible other insurance, whether primary,
excess, contingent or on any other basis, that is
available to the additional insured when that
person or organization is an additional insured
under any other insurance.
CG D3 8109 15 ® 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2
Includes the copyrighted material of Insurance Services Office, Inc., with its permission
COMMERCIAL GENERAL LIABILITY
3. The following is added to Paragraph 8., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS:
We waive any right of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal injury" arising out of "your
work" performed by you, or on your behalf, done
under a "written contract requiring insurance" with
that person or organization. We waive this right
only where you have agreed to do so as part of
the "written contract requiring insurance" with
such person or organization signed by you
before, and in effect when, the "bodily injury" or
"property damage" occurs, or the "personal injury"
offense is committed.
4. The following definition is added to the
DEFINITIONS Section:
"Written contract requiring insurance" means that
part of any written contract under which you are
required to include a person or organization as an
additional insured on this Coverage Part,
provided that the "bodily injury" and "property
damage" occurs and the "personal injury" is
caused by an offense committed:
a. After you have signed that written contract;
b. While that part of the written contract is in
effect; and
c. Before the end of the policy period.
Page 2 of 2 ® 2015 The Travelers Indemnity Company. All rights reserved. CG D3 8109 1$
Includes the copyrighted material of Insurance services Office, Inc., with its permission
Named Insured: MTGL, Inc.
Policy Number: BA2S139998
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BLANKET ADDITIONAL INSURED
B. EMPLOYEE HIRED AUTO
C. EMPLOYEES AS INSURED
D. SUPPLEMENTARY PAYMENTS —INCREASED
LIMITS
E. TRAILERS —INCREASED LOAD CAPACITY
F. HIRED AUTO PHYSICAL DAMAGE
G. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES —INCREASED LIMIT
A. BLANKET ADDITIONAL INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION 11 — LIABILITY COV-
ERAGE:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that is signed and
executed by you before the "bodily injury" or
"property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional insured is an "insured" for Liability Cover-
age, but only for damages to which this insurance
applies and only to the extent that person or or-
ganization qualifles as an "insured" under the
Who Is An Insured provision contained in Section
I.
B. EMPLOYEE HIRED AUTO
The following is added to Paragraph A.1.,
Who Is An Insured, of SECTION 11 — LI-
ABILITY COVERAGE:
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT — INCREASED LIMIT
1. WAIVER OF DEDUCTIBLE — GLASS
J. PERSONAL EFFECTS
K. AIRBAGS
L. AUTO LOAN LEASE GAP
M. BLANKET WAIVER OF SUBROGATION
performing duties related to the conduct of
your business.
2. The following replaces Paragraph b. in 6.5.,
Other Insurance, of SECTION IV — BUSI-
NESS AUTO CONDITIONS:
b, For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's" name,
with your permission, while perform-
ing 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".
An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED
operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is
under a contract or agreement in that "em- An Insured, of SECTION 11 — LIABILITY COV-
ployee's" name, with your permission, while ERAGE:
CA T4 20 07 10 0 2010 The Travelers Indemnfty Company. All rights raserved. Page 1 of 9
Includes copyrighted material of Insurance services Office, Inc. with its permission.
COMMERCIAL AUTO
Any "employee" of yours is an "insured" while us -
Ing a covered "auto" you don't own, hire or borrow
in your business or your personal affairs.
D. SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2) of
SECTION II— LIABILITY COVERAGE:
(2) Up to $3.000 for cost of bail bonds (in-
cluding bonds for related traffic law viola-
tions) required because of an "accident"
we cover. We do not have to furnish
these bonds.
2. The following replaces Paragraph A.2.a.(4) of
SECTION 11—LIABILITY COVERAGE:
(3) If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of betterment.
(4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
covered "auto".
(5) This Coverage Extension does not apply to:
(a) Any "auto" that is hired, rented or bor-
rowed with a driver, or
(b) Any "auto" that is hired, rented or bor-
rowed from your "employee".
G. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES—INCREASED LIMIT
(4) All reasonable expenses incurred by the The following replaces the first sentence in Para-
graph AA.a., Transportation Expenses, of
"insured" at our request, including actual SECTION III — PHYSICAL DAMAGE COVER -
loss of earnings up to $500 a day be- AGE:
cause of time off from work.
E. TRAILERS —INCREASED LOAD CAPACITY
The following replaces Paragraph C.I. of SEC-
TION I—COVERED AUTOS:
1. "Trailers" with a load capacity of 3,000
pounds or less designed primarily for travel
on public roads.
F. HIRED AUTO PHYSICAL DAMAGE
The following is added to Paragraph AA., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Hired Auto Physical Damage Coverage
If hired "autos" are covered "autos" for Liability
Coverage but not covered "autos" for Physical
Damage Coverage, and this policy also provides
Physical Damage Coverage for an owned "auto",
then the Physical Damage Coverage is extended
to "autos" that you hire, rent or borrow subject to
the following:
(1) The most we will pay for "loss" in any one
"accident" to a hired, rented or borrowed
"auto" is the lesser of:
(a) $50,000;
(b) The actual cash value of the damaged or
stolen property as of the time of the
"loss"; or
(c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
ered "auto" of the private passenger type.
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT — INCREASED LIMIT
Paragraph C.2.. Limit Of Insurance, of SEC-
TION IN — PHYSICAL DAMAGE COVERAGE is
deleted.
I. WAIVER OF DEDUCTIBLE—GLASS
The following is added to Paragraph D., Deducti-
ble, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered "auto" will apply to
glass damage if the glass is repaired rather than
replaced.
J. PERSONAL EFFECTS
The following is added to Paragraph A.4„ Cover-
age Extensions, of SECTION 111 — PHYSICAL
DAMAGE COVERAGE:
Personal Effects Coverage
We will pay up to $400 for "loss" to wearing ap-
parel and other personal effects which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto".
This coverage only applies in the event of a total
theft of your covered "auto".
No deductibles apply to Personal Effects cover -
(2) An adjustment for depreciation and physical age.
condition will be made in determining actual
cash value in the event of a total "loss".
Page 2 of 3 0 2010 The Travelers Indemnity company. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
CA T4 20 07 10
K. AIRBAGS
The following is added to Paragraph B.3., Exclu-
sions, of SECTION 111 — PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to "loss" to one or
more airbags in a covered "auto" you own that In-
flate due to a cause other than a cause of "loss"
set forth in Paragraphs A.1.b, and AA.c., but
only:
a. If that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one "loss".
L. AUTO LOAN LEASE GAP
The following is added to Paragraph AA., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private
Passenger Type Vehicles
In the event of a total "loss" to a covered "auto" of
the private passenger type shown in the Schedule
or Declarations for which Physical Damage Cov-
erage is provided, we will pay any unpaid amount
due on the lease or loan for such covered "auto"
less the following:
(1) The amount paid under the Physical Damage
Coverage Section of the policy for that "auto";
and
COMMERCIAL AUTO
(2) Any:
(a) Overdue lease or loan payments at the
time of the "loss";
(b) Financial penalties imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
(c) Security deposits not returned by the les-
sor;
(d) Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or
lease; and
(e) Carry-over balances from previous loans
orleases.
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.S., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — BUSINESS AUTO CONDI-
TIONS:
S. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract exe-
cuted prior to any "accident" or "loss", pro-
vided that the "accident" or "loss" arises out of
the operations contemplated by such con-
tract. The waiver applies only to the person or
organization designated in such contract.
CA T4 20 07 10 0 2010 The Travelers Indemnity Company. All rights reserved. Page 3 of 3
Includes copyrighted malarial of Insurance Services Office. Inc. with its permission.
HOME OFFICE
SAN FRANCISCO
ALL EFFECTIVE DATES
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
MTGL, INC.
2992 E LA PALMA AVE
STE A
ANAHEIM, CA 92806
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION
BLANKET BASIS Pagel
9278739-22
RENEWAL
EFFECTIVE July 1, 2022 AT 12:01 AM. Southern
AND EXPIRING July 1, 2023 AT 12:01 AM 1374747
WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN
INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST
THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE.
THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER
A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US.
THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE
TOTAL POLICY PREMIUM.
PERSON OR ORGANIZATION
ANY PERSON OR ORGANIZATION
FOR WHOM THE NAMED INSURED
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
SCHEDULE
JOB DESCRIPTION
BLANKET WAIVER OF SUBROGATION
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS,
AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL
BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: June 20, 2022
f�.�
AUTHORIZED REPRESENTATIVE
2572
SCIF FORM 10217 (REV. 4.2018)
PRESIDENT AND CEO
OLD OF 217
germ W-9
Request for Taxpayer
Give Form to the
Identification Number and Certification
requester. Do not
;Rev. October 20181
Me Treasury
Depaittemal
send to the IRS.
Rev n ioe
�ntertnel Revenue Service
► GO UD www.fra9ov/FamW9 /or Ir15U1rGi1D118 and 11M latlat lrrlditrtad0rl.
1 Name (as shown on your income tax ream). Name is required on this line; do not leave this line blank.
MTGL, Inc.
2 Business name/disregarded entity name, if different from above
m
3 Check appropriate box for federal tax classification of the person whose name is entered on lire 1. Check only one of the
4 Exemptions (codes apply only to
individuals;
following seven boxes.
certain entities, not see
a
ketructions on page 3):
p
❑ Individualfsole propnetor or Elc corporation ElS Corporation ElPartnership ElTruwarstate
ori
single -member LLC
Exempt payee code (f any) 5
0
❑Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
p
Note: Chock the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
LLC if the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
code lit any) 5
.0
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
Il Y
.E
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
8
❑ Other (see instructions) ►
ppwsroern dmsnb edw bd oust
&
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address loptional)
N
2992 E. La Palma Ave., Suite A
8 City. state, and ZIP code
Anaheim, CA 92809
7 List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Sock security number
u
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 Pan I, later. For other
entities it is your employer identification number (EIN). t you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer Identification nunhber
Number To Give the Requester for guidelines on whose number to enter.
3 3 — 0 1 5 1 8 1 0 1 7 1 6 1 8
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. 1 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. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form ('rf any) in that 1 em exempt from FATCA reporting is cones.
Certification instructions You must cross out i - 2 above if u have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and yield on yo ax 4tum. For real estate transactions, item 2 does not appy. For mortgage interest paid,
acquisition or abandonment of secured pro, can tion of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends,. you are n requi , to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sin L4
9 Signature of 1
Here U.S.parson ► Date / 204L _
General Instructions/
Section references are to the Internal Revenue a unl 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.ks.gov/F`ormK'9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns 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 10995 (proceeds from mal estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan Interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.