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2100 - PTM General Engineering Services, Inc. - Traffic Signal Modification - San Gabriel / Rush (C17802) . A This page is part of your document /� 20200136128 464-'14.im‘ II ill 1I1I1VII 1M ilill IIIIP281.cry\ ftif Recorder"figrifol-ron7a ng \ 02/04/20 aros.azax TAXES: 0.00 PAID: 0.00 A A , LEADSHEET 0 0020 3 10002 001 8 5862 III liii I 11111111 IU I II II II 01049 07 01 UI I IUIIIII I III II 11III liii IIIIIAMIII IIIDIIIIIIIIIIINIIIIIlIII liii IIII� II�IUIIII111 I A A RECORDING REQUESTED BY CITY OF ROSEMEAD. -111-11-11111-11 02/04/2020 ____ AND WHEN RECORDED MAIL TO: 1111111111111111111111111111111111111 Name City of Rosemead *20200136128* Street Address 8838 E.Valley Blvd. City&State Rosemead, CA 91770 ATTN: CITY CLERK SPACE ABOVE THIS LINE FOR RECORDER'S USE Notice of Completion Notice is hereby given that: 1. The undersigned is owner of the interest or estate stated below in the property hereinafter described. 2. The full name of the undersigned is: City of Rosemead 3. The full address of the undersigned is: 8838 E.Valley Blvd., Rosemead, CA 91770 4. The nature of the title of the undersigned is: In fee (If other than fee,strike"In fee"and insert,for example,"purchaser under contract of purchase",or"lessee") 5. The full names and full addresses of all persons, if any,who hold title with the undersigned are: Names Addresses N/A N/A 6. The names of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work of improvement herein referred to: Names Addresses N/A N/A (If no transfer made,insert,"none".) 7. A work of improvement on the property hereinafter described was completed on: August 20, 2018 8. The name of the contractor, if any for such work of improvement was: PTM General Engineering Services, Inc 9. The property on which said work of improvement was completed is in the City of Rosemead County of Los Angeles , State of California, and is described as follows: Traffic Signal Modification Project-San Gabriel Boulevard at Rush Avenue 10. The street address of said property is: as listed in No. 9 (If no street address has been officially assigned,insert"none") Signature of owner named Dated: 2/ /2p 2 a in paragraph 2: Chris aste Director of Public Works By: City of Rosemead I certify (or declare) under penalty of perjury that the foregoing is true and correct. 2 / lil2 02D Date Chris Daste Director of Public Works City of Rosemead, California Rosemead, CA Place of Execution 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 Califor 'a County of J} On ID 4J L0� before me, 1�Qi lMl'u�TV1� ��'cO ��� Ci Dc t . Here Insert Name and Title of tlfe Officer personally appeared VJfV( ' v \t Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person/whose name/is/ewe subscribed to the within instrument and acknowledged to me that he744shreAiley executed the same in his it authorized capacity and that b his/19erftIteirsignature(s) on the instrument the person or the entity upon behalf of which the person acted,'executed the instrument. I certify under PENALTY OF PERJURY under the NAT• Notary uIE Hc-Californiailaws of the State of California that the foregoing Public Cafog g x- Los Angeles County'; paragraph is true and correct. Commission#2272060 • My Comm.Expires Dec 20,2022 WITNESS my hand and official seal. Signature A‘i U"n�. /211,0141/k Place Notary Seal and/or Stamp Above Signatur of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Documn')\-" � (�w�� •i�,.�Title or Type of Document: ��(Q 4 Document Date: 2I*I Number of Pages: 3 Signer(s) Other Than Named Above: NIA Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer—Title(s): 0 Corporate Officer—Title(s): ❑ Partner— 0 Limited 0 General 0 Partner— 0 Limited 0 General ❑ Individual 0 Attorney in Fact 0 Individual 0 Attorney in Fact ❑ Trustee 0 Guardian of Conservator 0 Trustee 0 Guardian of Conservator ❑ Other: 0 Other: Signer is Representing: Signer is Representing: - -g g a e _ a e a x ©2017 National Notary Association Cl 7802 1114 \MaoFn -% CONSTRUCTION CONTRACT TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE (PTM GENERAL ENGINEERING SERVICES, INC.) 1. PARTIES AND DATE This Contract is made and entered into this agi day of 3Un2 , 2017. (Effective Date) by and between the City of Rosemead, a municipal corporation of the State of California, located at 8838 E. Valley Blvd., Rosemead, California 91770, ("City") and PTM General Engineering Services, Inc. with its principal place of business at 5942 Acorn Street, Riverside, CA 92504 (hereinafter referred to as "Contractor"). City and Contractor are sometimes individually referred to as"Party"and collectively as"Parties"in this Contract. 2. RECITALS 2.1 Contractor Contractor desires to perform and assume responsibility for the Traffic Signal Modifications Project—San Gabriel Boulevard at Rush Avenue by the City on the terms and conditions set forth in this Contract. Contractor represents that it is experienced in providing such work services to public clients, that it and its employees or subcontractors have all necessary licenses and permits to perform the Services in the State of California, and that is familiar with the plans of City. 2.2 Project City desires to engage Contractor to render such services described herein as Project ("Project") as set forth in this Contract. 3. TERMS 3.1 Scope of Services and Term 3.1.1 General Scope of Services. Contractor promises and agrees to furnish to the City all labor, materials,tools, equipment, services, and incidental and customary work PTM GENERAL ENGINEERING SERVICES, INC. Page 2 of 10 necessary to fully and adequately supply the professional construction services necessary for the Project ("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 Contract, 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 Contract shall be from Effective Date shown above to December 30, 2017 unless earlier terminated as provided herein. Contractor shall complete the Services within the term of this Contract, and shall meet any other established schedules and deadlines. The Parties may, by mutual, written consent, extend the term of this Contract if necessary to complete the Services. 3.2 Responsibilities of Contractor. 3.2.1 Control and Payment of Subordinates; Independent Contractor. The Services shall be performed by Contractor or under its supervision. Contractor will determine the means, methods and details of performing the Services subject to the requirements of this Contract. City retains Contractor on an independent contractor basis and not as an employee. Contractor retains the right to perform similar or different services for others during the term of this Contract. Any additional personnel performing the Services under this Contract on behalf of Contractor shall also not be employees of City and shall at all times be under Contractor's exclusive direction and control. Contractor shall pay all wages, salaries, and other amounts due such personnel in connection with their performance of Services under this Contract and as required by law. Contractor 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: Contractor shall perform the Services expeditiously, within the term of this Contract, and within the schedules timeline. Contractor represents that it has the professional and technical personnel required to perform the Services in conformance with such conditions. In order to facilitate Contractor's conformance with the Schedule, City shall respond to Contractor's submittals in a timely manner. Upon request of City, Contractor 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 Contractor shall be subject to the approval of City. 3.2.4 City's Representative. The City hereby designates the City Engineer, or his designee, to act as its representative for the performance of this Contract ("City's Representative"). City's Representative shall have the power to act on behalf of the City for all purposes under this Contract. Contractor shall not accept direction or orders from any person other than the City's Representative or his or her designee. 3.2.5 Contractor's Representative. Contractor hereby designates Ms. Elizabeth H. Mendoza de McRae, or his designee, to act as its representative for the performance of this Contract("Contractor's Representative"). Contractor's Representative PTM GENERAL ENGINEERING SERVICES. INC. Page 3 of 10 shall have full authority to represent and act on behalf of the Contractor for all purposes under this Contract. The Contractor's Representative shall supervise and direct the Services, using his/her best 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 Contract. 3.2.6 Coordination of Services. Contractor 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. 3.2.7 Standard of Care; Performance of Employees. Contractor shall perform all Services under this Contract 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. Contractor represents and maintains that it is skilled in the professional calling necessary to perform the Services. Contractor warrants that all employees and subcontractors shall have sufficient skill and experience to perform the Services assigned to them. Finally, Contractor 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 if applicable, and that such licenses and approvals shall be maintained throughout the term of this Contract. As provided for in the indemnification provisions of this Contract, Contractor 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 Contractor's failure to comply with the standard of care provided for herein. Any employee of the Contractor or its sub-contractors who is determined by the City to be uncooperative, incompetent, a threat to the adequate or timely completion of the Project, a threat to the safety of persons or property, or any employee who fails or refuses to perform the Services in a manner acceptable to the City, shall be promptly removed from the Project by the Contractor and shall not be re-employed to perform any of the Services or to work on the Project. 3.2.8 Laws and Regulations. Contractor shall keep itself fully informed of and in compliance with all local, state aind federal laws, rules and regulations in any manner affecting the performance of the Project or the Services, including all Cal/OSHA, AQMD requirements, and shall give all notices required by law. Contractor shall be liable for all violations of such laws and regulations in connection with Services. If the Contractor performs any work knowing it to be contrary to such laws, rules and regulations and without giving written notice to the City, Contractor shall be solely responsible for all costs arising therefrom. Contractor shall defend, indemnify and hold City, its officials, directors, officers, employees and agents free and harmless, pursuant to the indemnification provisions of this Contract, from any claim or liability arising out of any failure or alleged failure to comply with such laws, rules or regulations. 3.2.9 Insurance: Contractor shall maintain, prior to the beginning of and for the duration of this Contract, insurance coverage as specified in Exhibit B attached to and part of this Contract. 3.2.10 Safety. Contractor shall execute and maintain its work so as to avoid PTM GENERAL ENGINEERING SERVICES, INC. Page 4 of 10 injury or damage to any person or property. In carrying out its Services,the Contractor 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 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. 3.2.11 Prevailing Wages. Contractor 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" projects. If the Services are being performed as part of an applicable"public works"or"maintenance"project, as defined by the Prevailing Wage Laws, and if the total compensation is$1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. City shall provide Contractor with a copy of the prevailing rates of per diem wages in effect at the commencement of this Contract. Contractor 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 Contractor's principal place of business and at the project site. Contractor shall defend, indemnify 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. 3.2.12 Bonds. 3.2.12.1 Performance Bond: If specifically requested by City, Contractor shall execute and provide to City concurrently with this Contract a Performance Bond in the amount of the total, not-to-exceed compensation indicated in this Contract, and in a form provided or approved by the City. If such bond is required, no payment will be made to Contractor until it has been received and approved by the City. 3.2.12.2 Payment Bond. If required by law or otherwise specifically requested by City, Contractor shall execute and provide to City concurrently with this Contract a Payment Bond in the amount of the total, not-to-exceed compensation indicated in this Contract, and in a form provided or approved by the City. If such bond is required, no payment will be made to Contractor until it has been received and approved by the City. 3.2.12.3 Bond Provisions. Should, in City's sole opinion, any bond become insufficient or any surety be found to be unsatisfactory, Contractor shall renew or replace the affected bond within 10 days of receiving notice from City. In the event the surety or Contractor intends to reduce or cancel any required bond, at least thirty(30) days prior written notice shall be given to the City, and Contractor shall post acceptable replacement bonds at least ten (10)days prior to expiration of the original bonds. No further PTM GENERAL ENGINEERING SERVICES, INC. Page 5 of 10 payments shall be deemed due or will be made under this Contract until any replacement bonds required by this Section are accepted by the City. To the extent, if any, that the total compensation is increased in accordance with the Contract, the Contractor shall, upon request of the City, cause the amount of the bonds to be increased accordingly and shall promptly deliver satisfactory evidence of such increase to the City. To the extent available, the bonds shall further provide that no change or alteration of the Contract (including, without limitation, an increase in the total compensation, as referred to above),extensions of time, or modifications of the time, terms, or conditions of payment to the Contractor, will release the surety. If the Contractor fails to furnish any required bond, the City may terminate this Contract for cause. 3.2.12.4 Surety Qualifications. Only bonds executed by an admitted surety insurer, as defined in Code of Civil Procedure Section 995.120, shall be accepted. The surety must be a California-admitted surety with a current A.M. Best's rating no less than A:Vlll and satisfactory to the City. If a California-admitted surety insurer issuing bonds does not meet these requirements, the insurer will be considered qualified if it is in conformance with Section 995.660 of the California Code of Civil Procedure, and proof of such is provided to the City. 3.3 Fees and Payments. 3.3.1 Compensation. The total compensation shall not exceed Eighty Three Thousands Thirty Eight Dollars ($83,038.00) without advance written approval of City's project manager. Extra Work may be authorized, as described below, and if authorized,will be compensated at the rates and manner set forth in this Contract. 3.3.2 Payment of Compensation. Contractor shall submit to City a monthly itemized statement that indicates work completed and hours of Services rendered by Contractor. 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, as appropriate, through the date of the statement. City shall, within 45 days after receiving such statement, review the statement and pay all approved charges. The payments will be subject to a 5% retention amount,which would be released and paid after all work under the Contract has been satisfactorily completed, and 35 days after a Notice of Completion is filed with the County of Los Angeles. 3.3.3 Reimbursement for Expenses. Contractor 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 Contract, City may request that Contractor perform Extra Work. As used herein, "Extra Work"means any work that 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 Contract. Contractor shall not perform, nor be compensated for, Extra Work without written authorization from City's Representative. 3.4 Accounting Records. PTM GENERAL ENGINEERING SERVICES, INC. Page 6 of 10 3.4.1 Maintenance and Inspection. Contractor shall maintain complete and accurate records with respect to all costs and expenses incurred under this Contract. All such records shall be clearly identifiable. Contractor 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 Contract. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to the Contract for a period of three (3) years from the date of final payment under this Contract. 3.5 General Provisions. 3.5.1 Termination of Contract. 3.5.1.1 Grounds for Termination. City may, by written notice to Contractor, terminate the whole or any part of this Contract at any time and without cause by giving written notice to Contractor of such termination, and specifying the effective date thereof, at least seven (7) days before the effective date of such termination. Upon termination, Contractor shall be compensated only for those services that have been adequately rendered to City, and Contractor shall be entitled to no further compensation. Contractor may not terminate this Contract except for cause. 3.5.1.2 Effect of Termination. If this Contract is terminated as provided herein, City may require Contractor to provide all finished or unfinished Documents and Data and other information of any kind prepared by Contractor in connection with the performance of Services under this Contract. Contractor 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 Contract 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 Contract 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: CONTRACTOR: PTM General Engineering Services, Inc. 5942 Acorn Street Riverside, CA 92504 Attn: Ms. Elizabeth H. Mendoza de McRae (951) 710-1000 CITY: City of Rosemead 8838 E. Valley Boulevard Rosemead, CA 91770 Attn: Rafael M. Fajardo P.E., City Engineer PIM GENERAL ENGINEERING SERVICES, INC. Page 7 of 10 Such notice shall be deemed made when personally delivered or when mailed, forty-eight (48) hours after 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. 3.5.3 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 Contract. 3.5.4 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 Contract, the prevailing party in such litigation shall be entitled to have and recover from the losing party reasonable attorney's fees and all other costs of such action. 3.5.5 Indemnification. Contractor shall defend, indemnify and hold the City, its officials, officers, employees, volunteers and agents free and harmless from any and all claims, demands, causes of action, costs, expenses, liability, loss, damage or injury, in law or equity, to property or persons, including wrongful death, in any manner arising out of or incident to any alleged acts, omissions or willful misconduct of Contractor, its officials, officers, employees, agents, consultants and contractors arising out of or in connection with the performance of the Services, the Project or this Contract, including without limitation the payment of all consequential damages and attorneys fees and other related costs and expenses. Contractor shall defend, at Contractor's own cost, expense and risk, any and all such aforesaid suits, actions or other legal proceedings of every kind that may be brought or instituted against City, its directors, officials, officers, employees, agents or volunteers. Contractor shall pay and satisfy any judgment, award or decree that may be rendered against City or its directors, officials, officers, employees, agents or volunteers, in any such suit, action or other legal proceeding. Contractor shall reimburse City and its directors, officials, officers, employees, agents and/or volunteers, for any and all legal expenses and costs incurred by each of them in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation to indemnify shall not be restricted to insurance proceeds, if any, received by the City, its directors, officials, officers, employees, agents or volunteers. 3.5.6 Entire Contract. This Contract contains the entire Contract of the parties with respect to the subject matter hereof, and supersedes all prior negotiations and understandings. This Contract may only be modified by a writing signed by both parties. 3.5.7 Governing Law. This Contract shall be governed by the laws of the State of California. Venue shall be in Los Angeles County. 3.5.8 Time of Essence. Time is of the essence for each and every provision of this Contract. 3.5.9 City's Right to Employ Other Contractors. City reserves right to employ other contractors in connection with this Project. 3.5.10 Successors and Assigns. This Contract shall be binding on the successors and assigns of the parties. PTM GENERAL ENGINEERING SERVICES. INC. Page 8 of 10 3.5.11 Assignment or Transfer. Contractor shall not assign, hypothecate, or transfer, either directly or by operation of law,this Contract 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. 3.5.12 Construction; References; Captions. Since the Parties or their agents have participated fully in the preparation of this Contract,the language of this Contract 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 workdays. All references to Contractor include all personnel, employees, agents, and subcontractors of Contractor, except as otherwise specified in this Contract. All references to City include its elected officials, officers, employees, agents, and volunteers except as otherwise specified in this Contract. 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 Contract. 3.5.13 Amendment; Modification. No supplement, modification, or amendment of this Contract shall be binding unless executed in writing and signed by both Parties. 3.5.14 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, estoppels, or otherwise. 3.5.15 No Third Party Beneficiaries. There are no intended third party beneficiaries of any right or obligation assumed by the Parties. 3.5.16 Invalidity; Severability. If any portion of this Contract is declared invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction,the remaining provisions shall continue in full force and effect. 3.5.17 Prohibited Interests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Contract. Further, Contractor 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 Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Contract. For breach or violation of this warranty, City shall have the right to rescind this Contract without liability. For the term of this Contract, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Contract, or obtain any present or anticipated material benefit arising therefrom. 3.5.18 Equal Opportunity Employment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor,employee PTM GENERAL ENGINEERING SERVICES. INC. Page 9 of 10 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. Contractor 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. 3.5.19 Labor Certification. By its signature hereunder, Contractor certifies that it is aware of the provisions of Section 3700 of the California Labor Code that 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. 3.5.20 Authority to Enter Contract. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Contract. Each Party warrants that the individuals who have signed this Contract have the legal power, right, and authority to make this Contract and bind each respective Party. 3.5.21 Counterparts. This Contract may be signed in counterparts, each of which shall constitute an original. 3.6 Subcontracting. 3.6.1 Prior Approval Required. Contractor shall not subcontract any portion of the work required by this Contract, 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 Contract. [SIGNATURES ON NEXT PAGE] PTM GENERAL ENGINEERING SERVICES, INC. Page 10 of 10 CITY OF ROSEMEAD PTM GEN RAL ENGINEERING SERVICES, INC. By:ooi R '�Y .28 -� By: 6 ��— Bill R. Manis, City Manager Date Date Elizabeth IL Mendoza dr McRac Name: PRESIDENT/CFO Attest: yJ s� 17/ Title: _dee) O City Clerk ate [If Corporation, TWO SIGNATURES, President OR Vice President AND Secretary, AND CORPORATE SEAL OF CONTRACTOR REQUIRED] Approved as to Form: By: _ %1T Brian Mendoza &/J7//7 Name: VICE PRESIDENT/SECRETARY City Attorney Date Title: CITY OF ROSEMEAD TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE PROJECT No. 27004 PERFORMANCE BOND ISSUED IN THREE(3)ORIGINAL COUNTERPARTS BOND NUMBER 0720545 PERFORMANCE BOND WHEREAS the CITY OF ROSEMEAD(also herein"Obligee")has awarded to PTM GENERAL ENGINEERING SERVICES,INC. (hereinafter "Contractor"), a contract for work consisting of but not limited to, furnishing all labor, materials, tools, equipment, services, and incidentals for the TRAFFIC SIGNAL MODIFICATIONS PROJECT—SAN GABRIEL BOULEVARD AND RUSH AVENUE and all other required structures and facilities within the rights-of-way,easements and permits; WHEREAS, the Work to be performed by the Contractor is more particularly set forth in that certain contract for the said Public Work dated (hereinafter the "Public Work Contract"); and WHEREAS, the Contractor is required by said Public Work Contract to perform the terms thereof and to provide a bond both for the performance and guaranty thereof, NOW, THEREFORE, we PTM GENERAL ENGINEERING SERVICES, INC. , the undersigned Contractor, as Principal, and INTERNATIONAL FIDELITY INSURANCE COMPANY a corporation organized and existing under the laws of the State of NEW JERSEY , and duly authorized to transact business under the laws of the State of California,as Surety, are held and firmly bound unto the CITY OF ROSEMEAD in the sum of EIGHTY THREE THOUSAND THIRTY EIGHT NO/100 dollars, (g 83,038 00 ), said sum being not less than 100% of the total amount payable by the said Obligee under the terms of the said Public Work Contract, for which payment well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal, his 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 Public Work Contract and any alteration thereof made as therein provided, on his or their part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill the one-year guarantee of all materials and workmanship; and indemnify and save harmless the Obligee, its officers and agents, as stipulated in the said Public Work Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. In the event legal action is required to enforce the provisions of this agreement,the prevailing party shall be entitled to recover reasonable attorneys' fees in addition to court costs, necessary disbursements, and other damages. In case legal action is required to enforce the provisions of this bond, the prevailing party shall be entitled to recover reasonable attorneys'fees in addition to court costs, necessary disbursements and other consequential damages. • PERFORMANCE BOND- 1 The said Surety, for value received, hereby stipulates and agrees that no change, extensions of time, alteration or addition to the terms of the Public Work Contract or to the Work to be performed thereunder, or the specifications accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract,or to the Work or to Specifications. IN WITNESS WHEREOF,we have hereto set our hands and seals this 2ND day On JUNE 2017 PTM GENERAL ENGINEERING SERVICES, INC. Principaltractor • ) Brian Mendoza VICE PRESIDENT/SECRETARY By: President INTERNATIONAL FIDELITY INSURANCE COMPANY Surety By: Attorney-in-Fact 't111777•a .VEGA The rate of premium on this bond is 14.40 per thousand. • The total amount of premium charged, $ 1,196.00 (The above must be filled in by corporate surety.) PERFORMANCE BOND -2 STATE OF CALIFORNIA ss. COUNTY OF On this_day of , in the year , before me, , a Notary Public in and for said state, personally appeared , known to me (or proved to be on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument as the Attorney-in-Fact of the (surety) and acknowledged to me that he subscribed the name of the (surety) thereto and his own name as Attorney-in-Fact. Notary Public in and for said State (SEAL) My Commission expires PERFORMANCE BOND- 3 CERTIFICATE AS TO CORPORATE PRINCIPAL I, ,certify that I am the Secretary of the corporation named as principal to the within bond: that who signed the said bond on behalf of the principal was then of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed,sealed and attested for and in behalf of said corporation by authority of its governing Board. (Corporate Seal) Signature Date NOTE: A copy of the power of attorney to local representatives of the bonding company may be attached hereto. PERFORMANCE BOND -4 ■ Tel(973)6247200 POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey,having their principal office in the City of Newark,New Jersey,do hereby constitute and appoint KEVIN E. VEGA, BRITTON CHRISTIANSEN, PHILIP E. VEGA, MYRNA SMITH Covina, CA. their true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed,required or permitted by law,statute,rule,regulation,contract or otherwise, and the execufion of such instrument(s) in pursuance of these presents,shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes,as if the same had been duly executed and acknowledged by their ryegularly elected officerand ys at their principal offices. This Power of COMPANY and ALLEGHENY CASUis ALTY COMPANY and ibe s pursuant anted under and bd byy authority of the following resolution adopted of the By-Laws of Nby theAL D Board oELITY f INSURANCE of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July,2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July,2015: "RESOLVED,that (1)the Chief Executive Officer,President,Executive Vice President,Vice President or Secretary of the Corporation shall have the power to appoint,and to revoke the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto,bonds,undertakings, recognizances, contacts of indemnity and other written obligations in the nature thereof or related thereto: and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint-control custodians,agents for acceptance of process,and Attorneys-in-fact with authority to execute waivers and consents on behalf of the Corporation; and (3)the signature of any such Officer of the Corporator and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond,undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December,2016. O- 1TY'krSTATE OFNEW JERSEY {cPSUAL?k G,p 60. County of Essexiti- eta\` Ci SEAL .6 ro 1936 t) » 1 •g�..�. ROBERT W MINSTER `\\ i 0 Chief Executive (International Fidelity �H (tee Insurance Company)any))aand President(Allegheny Casualty Company) On this 31st day of December 2018,before me came the individual who executed the preceding instrument,to me personally known,and,being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies;that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark,New Jersey the day and year first above written. v ► ARY m PUBLIC C6: .11: = `^e , A NOTARY PUBLIC OF NEW JERSEY s, en My Commission Expires April 16,2019 . DF NEW d • qpp •r,,.,.,,.n" CERTIFICATION I,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit,and the copy of the Sections of the By-Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof,and of the whole of the said originals,and that the said Power of Attorney has not been revoked and is now In full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand this a..^ day of TUNA a`011 MARIA BRANCO,Assistant Secretary I 1 CALIFORNIA ALL- PURPOSE CERTIFICATE OF 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 tlocument. • State of California } I County of Riverside } 1 On 6 . S f before me, Fli7aberU H \ McRae.Nolan,Public �. cr.,n Mme ��d},mwr personally appeared Brian Mendnvn who proved to me on the basis of satisfactory evidence to be the person(s) whose • names) is/if&subscribed to the within instrument and acknowledged to me that he6kixajfbsor executed the same in histhantlhex authorized capacity(iea), and that by his/Fhegir signature(is) on the instrument the person(6), or the entity upon behalf of • which the personas) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that I the foregoing paragraph is true and correct. _ _ s ELIZABETH H.M.MCRAE3 WIiat y hand and official seal. U orf n.aztoo5zi �T0� ft ILIr-OAIIFORNl4 ) .:,4,2,• ,,y, RIVERSIDE COUNTY . O i" • C0:. 1.EXEIFFS FEE 2029y Notary -ublic Signature (Ninety Public Snit • • ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FORVIciaat ey haTHIS FGand rhra7 red should to ( m call attached the do garetng nmaT warding ane DESCRIPTION OF THE ATTACHED DOCUMENT ✓needed, rstaid he camvlefed and attached to the document Acknowledgments from other solei he completed for documents being aero in that stole o long as the mvtdmg does nor n not requite the Calf rola Profane to viola"(California noon low (rhe or desenpeon o'attached document) • State and County information must be the State and Count,where the document signes)personally appeared before the noun public for acknowledgment r • Date of notarization must be the date t the signet)personally appeared which Mee or Ceschp0on M attached tbWTeet continuedt also be the same date the acknowledgment is completed • The notary public must print his or her nam( a appears within his or her • Number of Pages Doetmenl Date commission followed by a comma and Nen title(notary public) • Print the namelsl of document signer(s) who rermnalh appear at the time of CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crosing off incorrect forms(I e lblshelMey, is lamor circling the correct forms.Failure to correctl,indicate this 0 Individual(s) information may lead to rejection of document recording. 8# Corporate Officer • The notary seal impression must he clear and photograph cau. reproducible Vice President/Secretary Impression must not over text or InesIf seal impression smudges_re-seal if a (Title) sufficient area permits,otherwise omplet a different acknowledgment office form • Signature or thenotary public mustmatch the signature on Ole with the or El Partner(s) the county clerk ❑ Attorney-in-Fad a Additional information at required but could help to ensure this Li Trustee(s) acknowledgment is not misused or attached to a different document Other 4- Indicate title or type or attached document,number or pages and date o e indicate the capacity claimed by the signer If the claimed capacity is a corporate officer,indicate the tale o e CEO.an.Secretary). 2(1 5 vet Son tea Notai yclatsosi min 65.5,07 -qh • Secureh attach thb document to the signed document with a staple CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 w «< .<.,<.r..,. <. - <.... e.. e.....Tn..r e—,..... A notary public o ober officer completing this cedificate verifies only the identity of the individual who signed the doci.ne^.t to which this certificate is attached.and not the truthfulness,accuracy,or validity of that dos—trent. State of California County of ORANCE JUN 0 2 2017 .Monica Blaisdell, Notary Public On before me, Date Here Insert Name and Title of the Officer personally appeared Philip E. Vega Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the personA whose nameN) is/Etarek subscribed to the within instrument and acknowledged to me that he/kDitrrht caycexecuted the same in his/Meat-fear authorized capacity(yat, and that by hisX1Wtht It signature(§)on the instrument the person(L). or the entity upon behalf of which the person* 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. MONICA BLAlsDELt WITNESS my hand and official seal. 6 Commission a 2144666 i'r4grf^.7� Notary Public -Caiuornia n J �'A'17� Orange County ' ¢1V— My Comm.Expires Mar 26.2020 Signature Signature of Notary Public CITY OF ROSEMEAD TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE PROJECT No. 27004 PAYMENT BOND ISSUED IN THREE(3)ORIGINAL COUNTERPARTS BOND NUMBER 0720545 PAYMENT(MATERIAL & LABOR) BOND WHEREAS the CITY OF ROSEMEAD(hereinafter"Obligee") has awarded to PTM GENERAL ENGINEERING SERVICES,INC. (hereinafter "Contractor"), a contract for work consisting of but not limited to, furnishing all labor, materials, tools, equipment, services, and incidentals for the TRAFFIC SIGNAL MODIFICATIONS PROJECT—SAN GABRIEL BOULEVARD AND RUSH AVENUE and all other required structures and facilities within the rights-of-way, easements and permits; WHEREAS, the Work to be performed by the Contractor is more particularly set forth in that certain contract for the said Public Work dated , (hereinafter the "Public Work Contract"); and WHEREAS, said Contractor is required to furnish a bond in connection with said Public Work Contract providing that if said Contractor or any of his or its subcontractors shall fail to pay for any materials, provisions, or other supplies, or terms used in, upon, for or about the performance of the Work contracted to be done, or for any work or labor done thereon of any kind, or for amounts due under the provisions of 3248 of the California Civil Code, with respect to such work or labor, that the Surety on this bond will pay the same together with a reasonable attorney's fee in case suit is brought on the bond. NOW,THEREFORE,we PTM GENERAL ENGINEERING SERVICES,INC. ,the undersigned Contractor,as Principal and INTERNATIONAL FIDELITY INSURANCE COMPANY' , a corporation organized and existing under the laws of the State of NEW JERSEY and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto the CITY OF ROSEMEAD and to any and all material men, persons, companies or corporations furnishing materials, provisions, and other supplies used in, upon,for or about the performance of the said Public Work, and all persons, companies or corporations renting or hiring teams, or implements or machinery, for or contributing to said Public Work to be done, and all persons performing work or labor upon the same and all persons supplying both work and materials as aforesaid excepting the said Contractor, the sum of EIGHTY THREE THOUSAND THIRTY EIGHT NO/100 dollars, ($ 83.038.00 ), said sum being not less than 100%of the total amount payable by said Obligee under the terms of the said Public Work Contract,for which payment well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors and assigns jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that if the Principal, his or its subcontractors, heirs, executors,administrators, successors,or assigns, shall fail to pay for any materials, provisions, or other supplies or machinery used in, upon,for or about the performance of the Work contracted to be done, or for work or labor thereon of any kind, or fail to pay any of the persons named in California Civil Code Section 3181, 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 PAYMENT BOND- 1 Employment Development Department from the wages of employees of the contractor and his subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect to such work and labor, and all other applicable laws of the State of California and rules and regulations of its agencies, then said Surety will pay the same in or to an amount not exceeding the sum specified herein. In case legal action is required to enforce the provisions of this bond, the prevailing party shall be entitled to recover reasonable attorneys'fees in addition to court costs, necessary disbursements and other consequential damages. In addition to the provisions hereinabove, it is agreed that this bond will inure to the benefit of any and all persons, companies and corporations entitled to make claims under Sections 3110, 3111, 3112 and 3181 of the California CMI Code, so as to give a right of action to them or their assigns in any suit brought upon this bond. The said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or additions to the terms of the said Public Work Contractor to the Work to be performed thereunder or the specification accompanying the same shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract or to the Work or to the Specifications. IN WITNESS WHEREOF,we have hereto set our hands and seals this 2ND day on JUNE , 2012 . PTM GENERAL ENGINEERING SERVICES.INC. Principal/Contractor Brian Mendoza VICE PRESIDENT/SECRETARY By: / President INTERNATIONAL FIDELITY INSURANCE COMPANY Surety By Attorney-i `til PHILIP E.VEGA PAYMENT BOND - 2 STATE OF CALIFORNIA COUNTY OF ) ss. On this_day of , in the year before me, ,a Notary Public in and for said state, personally appeared known to me (or proved to be on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument as the Attorney-in-Fact of the (surety)and acknowledged to me that he subscribed the name of the (surety)thereto and his own name as Attorney-in-Fact. Notary Public in and for said State (SEAL) My Commission Expires PAYMENT BOND- 3 CERTIFICATE AS TO CORPORATE PRINCIPAL certify that I am the Secretary of the corporation named as principal in the attached bond, that who signed the said bond on behalf of the principal was then of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed and attested for and in behalf of said corporation by authority of its governing Board. (Corporate Seal) Signature Date • NOTE: A copy of the power of attorney to local representatives of the bonding company may be attached hereto. PAYMENT BOND-4 Tel(973)624-7200 POWER OF ATTORNEY - - INTERNATIONAL FIDELITY INSURANCE COMPANY - - ALLEGHENY CASUALTY COMPANY ONE NEWARK CENTER,20TH FLOOR NEWARK, NEW JERSEY 07102-5207 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey,having their principal office in the City of Newark,New Jersey,do hereby constitute and appoint KEVIN E. VEGA, BRITTON CHRISTIANSEN, PHILIP E. VEGA, MYRNA SMITH Covina, CA. their true and lawful attorney(s)-in-fact to execute,seal and deliver for and on its behalf as surety,any and all bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof which are or may be allowed,required or permitted by law,statute.rule,regulation,contract or otherwise, and the execution of such instrument(s) inursuance of these presents,shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes,as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices by following by This Power of is and be revoked, pursuant to and s of INTERNATIONAL ELITY INSURANCE tors of TINCOMT RNATIONANY and AL FIDELITY NSUARANCLTY E COMPANY MPANY at a meeting duly held byranted under and the 20thdayof July,of the 2010 and by the Board of DitheDorsof g_L Gof HENY CASUALTY COMPANY at a meeting duly held on the 10th day of July.2015: "RESOLVED,that (1) the Chief Executive Officer,President,Executive Vice President.Vice President or Secretary of the Corporation shall have the power to. appoint,and to revoke the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto,bonds,undertakings, recognizances, contracts of Indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint-control custodians,agents for acceptance of process,and Attorneys-in-fact with authority to execute waivers and consents on behalf of the Corporation; and (3)the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond,undertaking,recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto. such signature and seals when so used whether heretofore or hereafter. being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation,to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December.2016. �� TY Oft, STATE OF NEW JERSEY {CPSUAf1'Y E OgPOy la County of Essex �_�� \c`aq ' �'.SEA^LWP rim `moi/ 77-//x/ ./�- i \ 19044, re. �Y C a 1936 /Et;`' ROBERT W.MINSTER \:C..""" /{ 31N) s I,� Chief Executive Officer(International Fidelity J* N JER5� Insurance Company)and President(Allegheny. Casualty Company) On this 31st day of December 2016,before me came the individual who executed the preceding instrument,to me personally known,and,being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies;that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, et the City of Newark,New Jersey the day and year first above written. -..oGPZHY CA.'' NOTARY et:.. V t�j/ /Vl :o- Oi APY _ Y•••• %.y'.. y.��n.it, A NOTARY PUBLIC OF NEW JERSEY b, >F'•-1-. . /',s My Commission Expires April 16,2019 . OF NEW d` 'ffg•Oost Blit , CERTIFICATION I,the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that!have compared the foregoing copy of.the Power of Attorney and affidavit,and the copy of the Sections of the By-laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof,and of the whole of the said originals,and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand this ay, day ooff JUHef ?-o/ 2 I I MARIA BRANCO Assistant Secretary 5 • CALIFORNIA ALL- PURPOSE CERTIFICATE OF 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 Riverside On • before me, . a- • „1n•. n.m..e..' personally appeared Brian Mention who proved to me on the basis of satisfactory evidence to be the person(s) whose namefjs) is/ subscribed to the within instrument and acknowledged to me that he teabslk executed the same in his/ authorized capacity(iea), and that by his/I erAtse signature) on the instrument the persons). or the entity upon behalf of which the personks) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregog paragraph is true and correct. U ETH H.It M MCRAE? W my hand and official seal. N eu U ausoawA O �. s4r`,l Ex to ITM , COUNTY Notary -Olio Signature (Notary Pubbc Seal) r'v • • ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Tbshred omplie nFe m Col/or regarding notary wording and DESCRIPTION OF THE ATTACHED DOCUMENT if needed.should be completed and attached to the document Acknowledgments from other states may be completed for documents being sent that stale so long as the wording does not requite the Ca/f rmmnorarr to isolate Ca•f mm?loran (Thor tlesrnpoan of allatlleO Erculmnl) • State and Countyinformationmust be the State and County nowledthe document s,gnerls)personally appeared before the notary public for acknowledgment. QlOe or d cnpton of dttaChed[Sant COnt Oued) • mate of also be the samedation mastbe the ackne owletlthat lbentgnub)peteonell)appearvU which acknowledgment n completed • must notary followed must c m his or her hour it appearsypublic)bu )n nn nr her Number of Pages Document Dale n roes) of dr and men erso moron • Printtheneme(s) of tlocummtnsigner(s) who pelwnalk appear at the lime of CAPACITY CLAIMED BY THE SIGNER • Indtcae the correct singular or plural forms by crossing on incorrect fonts(,e ❑ Individual (s) �hrm�ma,lead to riejec�onthe ofdooccumen rect forms cordingem�m�tyrnmalta this EX Corporate Officer • The noun seal impression must be clear and photograpetcaus reproducible Vice President/Secretary Impre.sion covermust or lines. If seal impression smudges.reseal if a (Title) sufficientarea permitstheise complete a different acknowledgment form • Signature of Nenotary public must match the signature on file with the office or ❑ Partner(s) Ne county rem. ❑ Attorney-in-Fact s Additional information is not required but could help to ensure this o Trustee(s) acknowledgment is not misused or attached to a different document Other O Indicate title or type of attached document.number of pages and date o . Indicate the capacity claimed by the signer If the tamed capacity is a corporate officer.mdmate the role(I e CEO,CEO,Secretar>) 20^5 Version www'tc,arvClessep ern 5e0.ETt-9t'.5 • Securely attach tbbdocument to the signed document with a staple CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 r:..- . -.M.,�..,.,.u:...,K,..,k- .:. ., w- a-.4--.. a,lia.<"a A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to whim this certificate is attached,and not the truthfulness,accuracy,or val dity of that document. State of California County of ORANGE ) On JUN 0 22011 before me,_Monica Blaisdell, Notary Public Dale Hem Insert Name and Title of The Officer personally appeared Philip E. Vega Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(* whose name%) Is/k'es subscribed to the within instrument and acknowledged to me that he/i0(a4aS09(executed the same is his/MMx6hex authorized capacitycka and that by his)4 tMPQ(signature(ffi)on the instrument the person(s), or the entity upon behalf of which the person(y) 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. MONICA BLAISDELL 111.10 y Commission x 2144666 WITNESS my hand and official seal. ET 'ai Notary Public-California z eq...., Orange County ^ MY Comm.Palms Mar 26,2024 Signature 1C Signature Of Notary Public PTM GENERAL ENGINEERING SERVICES, INC. EXHIBIT A SCOPE OF CONTRACT SERVICES SEE ATTACHED BID SCHEDULE/PROPOSAL PTM General Engineering BIDDER: Services,Inc. BID SCHEDULE SCHEDULE OF PRICES FOR TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BOULEVARD AT RUSH AVENUE PROJECT No.27004 BASE BID SCHEDULE UNIT OF EST. UNIT ITEM NO. ITEM DESCRIPTION MEASURE QTY. PRICE COST 1 Clearing&Grubbing per plans LS 1 UO and specifications. 500 `5° ` 2 Disposal of Waste Materials. LS 1 �j00 �46 500. 00 3 Construct Traffic Signal LS 1 � 9O6 QU. Modifications at San Gabriel D E&031} p Boulevard and Rush Avenue per Plans and Specifications Complete. �pp d38 TOTAL BASE BID PRICE (SCHEDULE BID PRICE':$ U� e/9/>/q 1hr-ems Thousand Thirty [1171 Oo//ars and �� ems. Doll amo t in written form Note:The City of Rosemead reserves the right to reduce or increase the quantifies of any items in the schedule of bid items above, within the limits define in Section 3-2.2.1 of the Standard Specifications, to stay within the budgeted amount of this project. If the Bid Documents specify alternate bid items,the following Alternate Bid amounts shall be added to or deducted from the Total Bid Price entered above.The owner can choose to include one or more of the alternates in the Total Bid Price of the Project If any of the Alternate Bids are utilized by the Owner,the resulting amount shall be considered the Total Bid Price for the Project. The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date,or until a Contract for the Work is fully executed by the Owner and a third party,whichever is earlier. The undersigned also agrees that if there is a discrepancy between the written amount of the Bid Price and the numerical amount of the Bid Price,the written amount shall govern. Attached hereto is a certified check, a cashier's check or a bid bond in the amount of Bid bond 10% Dollars($ )said amount being not less than ten percent(10%)of the Total Bid Price. The undersigned agrees that said amount shall be retained by the Owner if,upon award, we fail or refuse to execute the Contract and furnish the required bonds, certificates and endorsements of insurance and other certifications within the time provided. CBF -2 PTM General Engineering BIDDER: Services Inc If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be prepared by the Owner for execution,within five(5)Calendar Days following the Letter of Award for the Contract, and will deliver to the Owner within that same period the necessary original Certificates of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other documentation and certification required by the Contract. The undersigned offers and agrees that if this bid is accepted,it will assign to the purchasing body all rights, title,and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the Business and Professional Code), arising from purchases of goods,materials or services by the Bidder for sale to the purchasing body pursuant to the bid. Such assignment shall be made and become effective at the time the purchasing body tenders final payment to he Contractor. Bidder understands and agrees that, when requested by Owner, he shall provide: (1) evidence satisfactory to the Owner of Bidders California contractors license(s)in good standing;(2)evidence that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting therefrom; and (3) any other information and documentation, financial or otherwise, needed by Owner to award a Contract to the lowest responsible and responsive bidder. Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts of five.hundred dollars ($500.00) if project is not completed in THIRTY (30) calendar days. The Contract Time will begin to run ten (10)Working Days from the date of the Notice of Proceed and subject to the terms and conditions described in the Contract Form and the Contract Documents. Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data submitted herewith into a contract arising out of this Bid. The undersigned acknowledges receipt, understanding and full consideration of the following addenda to the Contract Documents. Addenda Nos. None per Rafael Fajardo 04.04.2017 2pm The Bidder understands and agrees that the Total E id Price is inclusive of all labor, materials,and equipment or supplies necessary to complete the W irk as described in the Bid Documents. If this bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the necessary bonds and accept the Total Bid Price as compensation in full for all Work under the contract. CBF-3 PTM General Engineering BIDDER: 5942 Acorn St Services, Inc. By: Signature Business Street Address Elizabeth H.Mendoza de McRae Riverside, CA 92504 Type or Print Name City, State and Zip Code President/CFO -951.710.1000 Title Te sphone Number Bidder's/Contractors State of Incorporation: California Partners or Joint Venturers: Bidder's License Number(s): 891265 Department Industrial Relations • Registered No. 1000001433 NOTES: 1) By its signature on this Bid,the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms. 2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address 3) If Bidder is a partnership or joint venture, give full names of all partners or joint venturers. As further discussed in the Instructions to Bidders, Bidder will be required to provide evidence that the person signing on behalf of the corporation, partnership or joint venture has the authority to do so. CBF-4 CERTIFICATE OF CORPORATE RESOLUTION j Brian Mendoza , Secretary of PTM General Engineering Services Inc. , (Corporation) do hereby certify that at a duly constituted meeting of the Stockholders and Directors of the Corporation held at the office of the Corporation on December 30 , 2007(year), it was upon motion duly made and seconded, that it be VOTED: Elizabeth H. Mendoza de, McRae, President/CFO OR. . . . Brian Mendoza, Vice President/Secretary Authorized to sign & execute contracts and submit bids with either one of the corporate officer' s signatures. It was upon further motion made and seconded that it be further VOTED: That Elizabeth B. Mendoza de McRae, President/CFO OR.. ..Brian Mendoza, Vice President/Secretary in the capacity as of the Corporation is empowered, authorized and directed to execute, deliver and accept any and all documents and undertake all acts reasonably required or incidental to accomplish the foregoing vote, all on such terms and conditions as he in his discretion deems to be in the best interests of the Corporation. I further certify that the foregoing votes are in full force this date without rescission, modification or amendment. Signed this 41% qday of //pYe/ , �r� (year). A TRUE RECORD ATTEST Brian Mendoza Sect4tary/Clerk Vice President/secretary (Corporate Seal) 3.3 PTM GENERAL ENGINEERING SERVICES, INC. EXHIBIT B INSURANCE REQUIREMENTS Prior to the beginning of and throughout the duration of the Work, Contractor will maintain insurance in conformance with the requirements set forth below. Contractor will use existing coverage to comply with these requirements. If that existing coverage does not meet the requirements set forth here, Contractor agrees to amend, supplement or endorse the existing coverage to do so. Contractor 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 Contract and which is applicable to a given loss, will be available to City. Contractor shall provide the following types and amounts of insurance: Commercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy form CG 00 01 or the exact equivalent. Defense costs must be paid in addition to limits. There shall be no cross liability exclusion for claims or suits by one insured against another. Limits are subject to review but in no event less than $1,000,000 per occurrence. 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 Contractor owns no vehicles,this requirement may be satisfied by a non-owned auto endorsement to the general liability policy described above. If Contractor or Contractor's employees will use personal autos in any way on this project, Contractor 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 coverage. 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. Coverage shall be applicable to City for injury to employees of Contractor, subcontractors 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. PTM GENERAL ENGINEERING SERVICES, INC. FOR NON-CONSTRUCTION CONTRACTS: 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 Contractor and "Covered Professional Services" as designated in the policy must specifically include work performed under this Contract. 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 policy retroactive date shall be on or before the effective date of this Contract. Insurance procured pursuant to these requirements shall be written by insurers that are admitted carriers in the state of California and with an A.M. Bests rating of A-or better and a minimum financial size VII. General conditions pertaining to provision of insurance coverage by Contractor. Contractor and City agree to the following with respect to insurance provided by Contractor: 1. Contractor agrees to have its insurer endorse the third party general liability coverage required herein to include as additional insured City, its officials, employees and agents, using standard ISO endorsement No. CG 2010 with an edition prior to 1992. Contractor also agrees to require all contractors, and subcontractors to do likewise. 2. No liability insurance coverage provided to comply with this Contract shall prohibit Contractor, or Contractor's employees, or agents, from waiving the right of subrogation prior to a loss. Contractor 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 Contract are intended to apply to the full extent of the policies. Nothing contained in this Contract or any other Contract relating to the City or its operations limits the application of such insurance coverage. 4. None of the coverage 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. Contractor 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. PTM GENERALENGINEERING SERVICES, INC. 7. Proof of compliance with these insurance requirements, consisting of certificates of insurance evidencing all of the coverage required and an additional insured endorsement to Contractor's general liability policy, shall be delivered to City at or prior to the execution of this Contract. 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 Contract and to pay the premium. Any premium so paid by City shall be charged to and promptly paid by Contractor or deducted from sums due Contractor, at City option. 8. Certificate(s) are to reflect that the insurer will provide 30 days notice to City of any cancellation of coverage. Contractor 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 Contract that all insurance coverage required to be provided by Contractor 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.Contractor agrees to ensure that subcontractors, and any other party involved with the project who is brought onto or involved in the project by Contractor, provide the same minimum insurance coverage required of Contractor. Contractor 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. Contractor agrees that upon request, all Contracts with subcontractors and others engaged in the project will be submitted to City for review. 11.Contractor 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 Contract to self-insure its obligations to City. If Contractor'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 Contractor, 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 Contractor ninety (90) days advance written notice of such change. If such change results in substantial additional cost to the Contractor, the City will negotiate additional compensation proportional to the increased benefit to City. PTM GENERAL ENGINEERING SERVICES, INC. 13.For purposes of applying insurance coverage only, this Contract 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 Contract. 14.Contractor acknowledges and agrees that any actual or alleged failure on the part of City to inform Contractor 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.Contractor 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 Contract. This obligation applies whether or not the Contract is canceled or terminated for any reason. Termination of this obligation is not effective until City executes a written statement to that effect. 16.Contractor shall provide proof that policies of insurance required herein expiring during the term of this Contract 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 Contractor'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 coverage. 17.The provisions of any workers' compensation or similar act will not limit the obligations of Contractor under this Contract. Contractor 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 Contract 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 Contract to the extent that any other section or provision conflicts with or impairs the provisions of this Section. 21.Contractor 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 Contractor for the cost of additional insurance coverage required by this Contract. 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 PTM GENERAL ENGINEERING SERVICES, INC. shall be no recourse against City for payment of premiums or other amounts with respect thereto. Contractor agrees to provide immediate notice to City of any claim or loss against Contractor arising out of the work performed under this Contract. 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. A ® DATE lMmloon'ryrl CERTIFICATE OF LIABILITY INSURANCE 06/92/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LICENSE NO. 0637431 CONTACT PATRICK MCRAE PATRICK MCRAE INSURANCE SERVICES lta PHONE E (714)779-6999 I PAX 714)779-6903 N: INC.NJ—� 1265 N. MANASSERO SUITE 303 ADDRESS: P.MCRAE@SBCGLOBAL.N ET ANAHEIM HILLS,CA 92807 INSUREIAS)AFFORDING COVERAGE NAICp INSURER A:IRONSHORE SPECIALTY INSURANCE COMP 25445 INSURED INSURER B:CENTURY NATIONAL INSURANCE CO 126905 INSURER C:SCOTTSDALE INSURANCE COMPANY 141297 PTM GENERAL ENGINEERING SERVICES INC. INSURER D:GREAT AMERICAN INSURANCE CO. 16691 5942 ACORN STREETwsuRERE: LIBERTY SURPLUS INSURANCE CORPORAT 10725 RIVERSIDE CA 92504 INSURER F: OBE SPECIALTY INSURANCE COMPANY '.11515 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE IVSD DL WVD PBR OLICY NUMBER IMMNOYIYVYYf EFF IIMMIDDflY 1'I UNITS A X COMMERCIAL GENERAL LIABILITY AGS0106400 05/11/2017.05/11/2018 EACH OCCURRENCE $ 1,000,000 X 1 X DEDUCTIBLE:$5,000/ DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR OCCURRENCE PREMISES(Ea asunenoei $ X XCU/OCP 1I MED EXP(Anyone Person) $ 5,000 _ X EBL:$1,000000 PERSONAL&ADV INJURY '! $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. 1 GENERAL AGGREGATE $ 2,000,000 POLICY f X—I fl JECT LOC PRODUCTS-LOMPIOP AGG ' $ 2.999.900 OTHER B AUTOMOBILE LIABILITY BAP0175004 92/99/201792/99/2018 COMB JED,SINGLELIMIT 1$ 1,000,000 X ANY AUTO X X COMP. DEDUCTIBLE I BODILY INJURY(Per person) is ALL OWNED X SCHEDULED $1,000 : BODILY INJURY(Per acclaent)!S AUTOS ADN-0S_ COLLISION DEDUCTIBLE PROPERTY DAMAGE X HIRED AUTOS X AUTOS $1,900 I (Per accident) $ X HIREDPHY I -15 C UMBRELLA LIAB X_ OCCUR - - XLS0102324 05/11/201705/11/2018 EACH OCCURRENCE s 10,000,000 X EXCESS LIAB CLAIMS-MADE UNDERLYING POLICIES: AGGREGATE $ 10,000,000 X DED rRETENTION$ NIL GL&AL PROD>COMP/OPS $ 10000,000 WORKERS COMPENSATION X STATUTE 1 OTR. AND EMPLOYERS'LIABILITY — - ' -- ANYPROPRIETORJPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT I5 OFFICER/MEMBER EXCLUDED, n N/A Mandato nInn NH EL DISEASE-EA EMPLOYE $ _ If DESCRIPTION OF OPERATIONS below Eo.DISEASE-POLICY LIMIT $$ D PROPERTY&INLAND MARINE MAC0991838-02 '07/10/201607/10/2017 a;.,°ti.,;$07.4.0,=.6:do-°.-.=—"— '"'"°`"'""' F BUILDERS RISK BX10038200 08/01/201608/01/2017 oCLIOr.e,> ee.=n.,ecaomRRE:- E POLLUTION LIABILITY' UBELA611579116 06/13/201606/13/2077 ."„TION LM,a,,mo,o„PER Ox,u-mmxw wxicnoa DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD WI,Additional Remarks Schedule,may be attached if more space&required) THE CITY OF ROSEMEAD ITS OFFICIALS,OFFICERS.EMPLOYEES,VOLUNTEERS AND AGENTS ARE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S).COVERAGE IS PRIMARY&NON-CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT.PER ATTACHED ENDORSEMENT FORMS.WAIVER OF SUBROGATION APPLIES,IF REQUIRED BY WRITTEN CONTRACT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,A 30 DAY WRITTEN NOTICE WILL BE ISSUED. RE.CITY PROJECT NO.:27004 TRAFFIC SIGNAL MODIFICATIONS PROJECT SAN GABRIEL BLVD.AT RUSH AVE.(PTM JOB NO.P17-06) CERTIFICATE HOLDER CANCELLATION CITY OF ROSEMEAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: MR. RAFAEL FAJARDO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 8838 E. VALLEY BLVD. ACCORDANCE%MTH THE POLICY PROVISIONS. ROSEMEAD, CA 91770 AUTHORIZED REPRESENTATIVE /$ `+ o /w/ . I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DormmY) ACORO srazDlr ‘..---- THIS ---- HLCECERTIFICATE ISTI ISSUED AMATTER RMINFORMATION GONLY IAND CONFERS, NO RIGHTS UONER THE CERTIFICATE HOLDER.THIS THE LATE DOES NOT AFFIRMATIVELY NEGATIVELY ADOENN,EXTEND ITR ALTER THE COVERAGE AFFORDED THE POLICIES BELOW.THIS E CERTIFICATEAEOF 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 pollcy(ies)must be endorsed. If SUBROGRATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Willis Towers Watson CONTACT NAME:San Bernardino _,. _.._ 9)_.. 12980 Metcalf Ave Suite 500 PHONE(NC,No Ext):(909)890-3633 FAX(NC,NO):(360)628-0699 Overland Park KS 66213 EMAIL ADDRESS: Rachael.Budrik@bbsihq.com --- - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A'. ACE American Insurance Company 22667 INSURED INSURER B. Barrett Business Services, Inc.LICIF INSURER C: P T M.GENERAL ENGINEERING SERVICES,INC> INSURER D-. DBA R.T.M.GENERAL ENGINEERING SERVICES, INSURER E: INC. INSURER F 5942 ACORN STREET RIVERSIDE,CA 92504 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUES OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AOOL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WD (MMNDNYYY) (MMIBNTYY) GENERAL LIABRITY EACH OCCURRENCE $ 1COMMERCCLA MBNERAL LIAOILITY DADFFMAGE RENTED PREMISES(Ea NDE OCCUR MED EXP(Any one person) PERSONAL BADV INJURY I GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER. POLICY LOC PRODUCTS.COMP/OPAGG ECT I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ZANY AUTO (Ea accident) TALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per Parson) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY/Par accident) PROPERTY DAMAGE UMBRELLA LIAB 1 /COLLIE EACH OCCURRENCE (ex ESS LIAB Cuc AGGREGATE —1 DED I i RETCNTIONS A WORKERS COMPENSATION AND EMPLOYERS' RWC 08/01/16 D810112017 1/ WC STATU- 0TH. LIABILITY Y/N C48819035 TORY LIMITS ER AY PROPRIETOR/PARTNER/EXECUTIVE Y EL EACH ACCIDENT $ 2.000 MX OFFICER/MEMBERW N/A ONFICEMEMBER EXCLUDED? Covered Stales. E.L DISEASE-EA EMPLOYEE S?WODW (Mandatory In NH)If yes,describe under CA EL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below MOO DW DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach AGGRO 101,Additional Remarks schedule,it more spam is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE City of Rosemead Attn: Mr. Rafael Fajardo POLICY PROVISIONS. 8838 E.Valley Blvd. AUTHORIZED REPRESENTATIVE Rosemead CA 91770 Authorized V ^a^—.S— Rep "� is Arrowhead General Insurance Agency c)1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC.//: 4�171® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED: Barrett Business Services, Inc. L/C/F Arrowhead General Insurance Agency P.T.M. GENERAL ENGINEERING SERVICES, INC> DBA P.T.M. POLICY NUMBER GENERAL ENGINEERING SERVICES, INC. 5942 ACORN STREET RWC C48819035 RIVERSIDE, CA 92504 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 08/01/16 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, FORM NUMBER:25 FORM TITLE:Certificate of Liability(01/14) CERTIFICATE HOLDER: City of Rosemead Attn. Mr.Rafael Fajardo ADDRESS: 8838 E.Valley Blvd. Rosemead CA 91770 City Project No. 27004 Traffic Signal Modifications Project San Gabriel Blvd. at Rush Ave. (FTM Job No. P17-06) ACORD 101 (2008/01) c)1988-201D ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD. Workers'Compensation and Employers'Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES, INC. L/C/F P.T.M. GENERAL ENGINEERING SERVICES, INC> DBA P.T M. Policy Number GENERAL ENGINEERING SERVICES. INC. Symbol: RWC Number: C48819035 8100 NE PARKWAY DRIVE, STE.200 VANCOUVER WA 98662 Effective Date of Endorsement 08-01-2016 TO 08-01-2017 08-01-2016 Issued By(Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ASL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2 . 0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium : $0 Authorized Agent WC 99 03 22 POLICY NUMBER:AGS0106400 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations As required by written contract. If required by your agreement with such Additional Insured. Additional Insureds shown in a written contract, or written agreement that includes primary and non- contributory wording where required. If anyone, other than the Additional Insured, provides similar insurance for the Additional Insured, then this insurance will apply as outlined in SECTION IV — COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to in the performance of your ongoing operations for include as an additional insured the person(s) or the additional insured(s) at the location(s) organization(s) shown in the Schedule, but only designated above. with respect to liability for"bodily injury", "property However damage" or "personal and advertising injury" 1. The insurance afforded to such additional caused, in whole or in part, by: insured only applies to the extent permitted by 1. Your acts or omissions; or law; and 2. The acts or omissions of those acting on your behalf; CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 2. If coverage provided to the additional insured is 2. Available under the applicable Limits of required by a contract or agreement, the Insurance shown in the Declarations; insurance afforded to such additional insured will not be broader than that which you are whichever is less. required by the contract or agreement to This endorsement shall not increase the provide for such additional insured. applicable Limits of Insurance shown in the B. With respect to the insurance afforded to these Declarations. additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III—Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER:AGS0106400 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As required by written contract. If required by your The insurance afforded by this policy for the benefit of written contract or written agreement with such the additional insured does not apply to Additional Insured, this insurance is primary and non- 'property damage'to any building, structure or contributory. appurtenant structure intended to be occupied as a'private residence'. The term"private residence" If anyone, other than the Additional Insured, provides includes single family homes or residences, similar insurance for the Additional Insured, then this multi-family homes or residences. Apartments are not insurance will apply as outlined in SECTION IV — considered "private residences." COMMERICAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II —Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury' or not be broader than that which you are required "property damage"caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". B. With respect to the insurance afforded to these However: additional insureds, the following is added to Section III—Limits Of Insurance: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ©ISO Properties, Inc., 2004 CG 20 37 0413 0 POLICY NUMBER:AGS0106400 COMMERCIAL GENERAL LIABILITY CO 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Whereas Required by Written Contract Information required to complete the Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph B.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the "products-completed operations hazard".This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER:AGS0106400 COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Where as Required by Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A for obligated to pay as damages caused by damages or under COVERAGE C for medical "occurrences" under COVERAGE A (SECTION expenses shall reduce the Designated I), and for all medical expenses caused by Construction Project General Aggregate Limit accidents under COVERAGE C (SECTION I), for that designated construction project Such which can be attributed only to ongoing payments shall not reduce the General operations at a single designated construction Aggregate Limit shown in the Declarations project shown in the Schedule above: nor shall they reduce any other Designated Designated Construction Project Construction Project General Aggregate Limit 1. A separate 9 1 for any other designated construction project General Aggregate Limit applies to each shown in the Schedule above. designated construction project, and that limit is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Fire Damage and Medical Expense continue to apply. However, instead 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the of being subject to the General Aggregate Limit shown in the Declarations, such limits sum of all damages under COVERAGE A, except damages because of"bodily injury" or will be subject to the applicable Designated Construction Project General Aggregate Limit. "property damage" included in the "products-completed operations hazard", and B. For all sums which the insured becomes legally for medical expenses under COVERAGE C obligated to pay as damages caused by regardless of the number of: "occurrences" under COVERAGE A (SECTION a. Insureds; I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), b. Claims made or"suits" brought; or which cannot be attributed only to ongoing c. Persons or organizations making claims or operations at a single designated construction bringing "suits". project shown in the Schedule above: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 1 of 2 0 C. When coverage for liability arising out of the E. The provisions of Limits Of Insurance(SECTION "products-completed operations hazard" is III) not otherwise modified by this endorsement provided, any payments for damages because of shall continue to apply as stipulated. "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97 0 05/11/2016 IL SCOTTSDALE INSURANCE COMPANY® COMMERCIAL EXCESS LIABILITY SCHEDULE OF CONTROLLING UNDERLYING INSURANCE Policy No.: XLS0099545 Effective Date: 05/1112016 12:01 A.M.Standard Time Named Insured: RTM GENERAL ENGINEERING INC. Agent No.: 04787 INSURER, POLICY NUMBER TYPE OF COVERAGE APPLICABLE LIMITS AND POLICY PERIOD General Liability Applicable Limits $1,000,000 Each Occurrence Insurer's Name $1,000,000 Personal and IRONSHORE INSURANCE CO. Advertising Injury Policy Number $2,000,000 General Aggregate AGS106400 (other than products/ completed operations) Policy Period 'PER PROS 05/11/2017 T005/11/2018 $2,000.000 Products/Completed Operations Aggregate *General Aggregate Applies n Occurrence Clams Made Commercial Auto Liability (Bodily Injury and Property Damage Limit Insurer's Name $-:,ono, ciao Each Accident CENTURY NATPONAL Policy Number SAP0175004 Policy Period 02/09/2017 TO 02/09/2016 Employer's Liability Bodily Injury Limit Insurer's Narre $ Each Accident NOT APPLICABLE (by accident) $ Policy Limit Policy Number (by disease) $ Each Employee Policy Period (by disease) to XLS SP-1 01-081 ipso ed copy CENTURY-NATIONAL INSURANCE COMPAN1 P.C. Box 3999 •North Hollywood, CA 91609-0599 For Service Cell Your Broker. For Claims Call:800-733-1980 CHAIX&ASSOC INS BROKERS INC FREEWAY ELECTRIC INC 3200 EL CAMINO REAL STE 290 PTM GENERAL ENGINEERING SVCS IRVINE CA 92602-1382 P O BOX 7745 RIVERSIDE CA 92503 (949) 722-4177 Name of Insured: Endorsement Effective Date and Time: FREEWAY ELECTRIC INC/PIM GENERAL ENG.SVCS 02/09/2017 at 12:01 AM Policy Number: Policy Perm Covers from: Endorsement Number: BAP0175004 _ 12:01 AM on 02/09/2017 to 02/09/2018 at 12:01AM 000 Name of Agency: CHAIR&ASSOC INS BROKERS INC 122800 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured Endorsement IT IS AGREED THAT INSURANCE AFFORDED BY THE ABOVE POLICY SHALL APPLY TO THE PARTY(S) NAMED BELOW,AS THEIR INTEREST MAY APPEAR BUT SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE COMPANY'S LIABILITY.ANY ADDITIONAL INSURED LANGUAGE ON A CERTIFICATE OF INSURANCE IS VOID. The additional insured named below is only an insured for liability which is the result of an actor omission of the 'NAMED INSURED"of the policy and shall have no coverage under this endorsement or the policy for its own acts or omissions, those of its agents or employees, or those of any other person or entity for which it is vicariously liable, save for acts of omissions of the"NAMED INSURED"of the policy. Further, any insurance provided by this endorsement shall be excess to all other insurance available to any person or entity who becomes an insured by reason of this endorsement whether the other insurance is primary or excess and whether or not the other insurance is collectible. In the event the other insurer has a duty to defend any person or entity added to our policy by reason of this endorsement,we will have no duty to defend that person or entity however,we may elect to do so, and, if we do,we will be entitled to the rights of any person or entity we do defend against the other insurer. ADDITIONAL INSURED The insurance is Primary and Non-Contributory with respect to any insurance carried by the Additional Insured ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 02/09/2017 RENE FAJARDO Page 1 !13 (07/11PN 613 CCENTURY-NATiONAL INSURANCE COM PA NS P.O. Box 3999 •North Hollywood, CA 91609-0599 For Service Cell Your Broker For Claims Call:800-733-1980 Name of Insured: Endorsement Effective Date and Time: FREEWAY ELECTRIC INC/PTM GENERAL ENG.S. 02/09/2017 at 12:01 AM Policy Number: Policy Term Covers from: Endorsement Number: RAP0175004 12:01 AM on 02/09/2017 to 02/09/2018 at 12:01 AM 000 Name of Agency: CHAIX&ASSOC INS BROKERS INC 122800 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Waiver of Subrogation "THE RIGHT TO SUBROGATE AGAINST THE ADDITIONAL INSURED NAMED BELOW IS WAIVED FOR LOSSES PAID WHICH ARISE OUT OF THE OPERATIONS OF THE NAMED INSURED", FOR WHICH THE NAMED ADDITIONAL INSURED HAS NO INDEPENDENT NEGLIGENCE. CERTIFICATE HOLDER ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Date Printed: 02/09/2017 RENE FAJARDO GN 613A (07/11) Page t • O ]\{ « ai w ,ar t2 � § g) 0 \ ) A � e= ; in x! ; _ o » ] - � a; \16 3 ) , � b! ; . � o @! 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