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HomeMy WebLinkAboutMARIPOSA LANDSCAPE, INC. (2)A-2018-167-01 INSURANCE NOT ON FILE WORK MAY MI PROCEED CL, CLERK OF COUNCIL MAYOR Miguel A. Pulido DATE: MAYOR PRO TEM Juan Mllegas COUNCILMEMBERS , p� p,j`, Cecilia Iglesias ti 'E � P C% David Penaloza t�V1r. �' ut,t)pf-j Roman Reyna viceole Salmi"AR 1 R ai 2019 Jose Solodc t Mariposa Landscapes, Inc. Attn: Terry Noriega, President 15529 Arrow Highway Irwindale, CA 91706 CITY OF SANTA ANA PARKS, RECREATION AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 . P.O. Box h9fl8 Santa Ana, California 02702 VfM1NV. Santa •ynjla.e„ i g January 28, 2019 CITY MANAGER Raul Godinez II CITY AT70RNEY Sonia R. Carvalho ACTING CLERK Of THE COUNCIL Norma Mitre -Ramirez Re: Extension of Contractor Agreement No. A-2018-167 to provide landscape maintenance services for Pacific Electric Park and Roosevelt Walker Center Dear Mr. Noriega: Pursuant to Section 3 ("Term") of Agreement No. A-2018.167, entered into by Mariposa Landscapes, Inc. ("Contractor"), and the City of Santa Ana, dated June 19, 2018, the time period of the Agreement is hereby extended for an additional one (1) year period, from February 1, 2019 through January 31, 2020. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Stin erely, MARJ OSA LANDSCAPES, INC. J'R,u dloff9yt Terry Norieg ive Director Title: President Parks, Recreation, and Community Services Agency "s CITY OF LANTAANA _ Steven Mendoza Acting City Manager APPROVED AS TO FORM Senior Assistant City Attorney 41 J 4 Norma Mitre Acting Clerk of SANTA ANA CITY COUNCIL 14puMh N�itlo an riuxgai Y.rnnlC bettna�ttv eavlp Perraiata J.S.Svwa Rc R." C.dliaq$..r lAeya Mayor Pro ism Waro 5 Wa�tl 1 W.W 2 Warp 3 ww A Wart: e nwG4a@uni¢;ti;atPia k171 "''al`*G,�ffi "*J '.Si4^�.'t 4W a"NA "-'.:1b 4 ag=il LYP3.RGq awasm ,01'CB 244Yd9A3d."LLV.1m .11i CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDOI18 �^'� 9/10/2018 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 endorsements). PRODUCER NAME: CONTACT Benita Hall, CISR Landscape Contractors (Lic#0755906) _jp{QNNo Ezll: 559)_65D-3555 � AIC,_Not_�559)650-3558 Insurance Services, Inc. E-MAIL bhall@lcisinc.com ADDRESS: 1835 N. Fine Avenue ._.._ INSURERS) AFFORDING COVE_R_AGE _ Fresno CA 93727 .— _..... _N_AICq INSURERA Wesco Insurance Company 25011 INSURED INSURER B Greenwich Ina CO 22322 Mariposa Landscapes Inc _ INSURERC: 6232 Santos Diaz Drive INSURERD: ' INSURER E Irwindale CA 91702 IsuRERF I COVERAGES CERTIFICATE NUMBER-18-19 Pka & Auto & RF\/LClnm MI Illyi 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. —___._.____—.'ADDLSUBp:'_._....._.._ INBR LT. ! TYPE OF INSURANCE - — POLICY NUMBER POLICY EFF M D POLICY EXR MMIDDNYY — LIMITS A X COMMERCIAL GENERAL LIABILITY - i, 1 _ ,CLAIMS MADE X OCCUR I I EACH OCCURRENCE $ 1, 000,000 DAMAGE TO RENTED---- PREMISES_(Eaoccurrence)_ -- '50 $ 500 000 MED EXP (Any one arson person) $ 5,000 WPP1621859 00 4/1/2018 4/1/2019 PERSONAL &ADV INJURY $ 11 000, 000 X, S1,000 PD DED_ _ _ AGGREGATE LIMIT AP POLICY PLIES PER: PRO- I X'JECT �JLOC GENERAL AGGREGATE $ 2,000,000 EN'L 1 ! PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER I Employee Benefits $ 11000,000 AUTOMOBILE LIABILITY 1 COMBINED SINGLE LI T (Ea accident) ;$ 1,000,000 BODILY INJURY (Per person) $ A R ANY AUTO ALL OWNED - -' SCHEDULED 'AUTOS AUTOS HIRED AUTOS NON -OWNED _ AUTOS WPPI621859 00 4/1/2018 4/1/2019 (BODILY INJURY (Per ecmtlent):$ PROPERTY DAMAGE- Per accident -- _ $ Uninsured motorist combined 1$ 1,000,000 X UMBRELLA LAB X I EACH OCCURRENCE $ 5,000,000 r— ...._ _._......_ AGGREGATE _.. $ 5,000,000 B EXCESS LIAB OLAIMS-MADE ... -' OED 1 1 RETENTION $ INEC6005017-00 ! 4/1/2018 -. 4/1/2019 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In Ni If ySCRIP IONCtler DESCRIPTION OF OPERA NS below NIA I; ... (_ PER Ulm - STATUTE j,_ER IIECH ACCIDENT $ E L DISEASE EA EMPLOYE I E. L. DISEASE POLICY LIMIT $ $ Leased/Rented Equipment WPP1621859 00 04-01-2018 4-01-2019 Limit $300,000 j Dad $500 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace is required) RE: All landscape operations performed by or on behalf of the named insured ..` 4.T +✓ (See attached CO2010 & CG20010413) ``11,���� City of Santa Ana, its officers, employees, agents and volunteers and reps� atatives (E� ing Professional Liability) are named as additional insured This revises certificate dated 2018 NO City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Hall, CISR/KSAENZ CORPORATION. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) POLICY NUMBER: WPP162185900 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 Persons) Blanket as required by written contract. to complete this A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or Of Blanket as required by written contract B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 2• 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to - provide for such additional insured. All work, including materials, pads 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 insureds) at the location of the covered operations has been completed; or 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. -0 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number; WPP1621859 00 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 Oc Insurance Services Office, Inc., 2012 Page 1 of 1 ACC>Ra® CERTIFICATE OF LIABILITY INSURANCE -DATE (MMIDD/YYYY) 1., 09/13/2018 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 CONTACT NAME: Global Risk, LLC PHONE NNo Eat). 213-550-2253 _ tFa/c Ner 213-550-2258 800 Wilshire Blvd., Second Floor ADDRESS: certs@globalriskcap.com Las Angeles, CA 90017 INSURERIS)AFFORDING COVERAGE NAIC# License #OL60361 INSURERA: Sentry Casually_ Company _ 28460 INSURED INSURER B _ _ -- Mariposa Landscapes, Inc. 32 Santos Diaz St. INsuRERc: INSURER D; INSURER 5: Irwindale, CA 91702 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR. TYPE OFINSURANCE O POLICY NUMBER MM �D/YYYYY MMIDD YYYY - LIMITS COMMERCIAL GENERAL LIABILITY'. CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGETO RENTED PREMISES Ea occurrence _ --' $ MED EXP (Any one person) $ PERSONAL &ADV INJURY GENE AGGREGATE LIMIT APPLIE POLICY SPER. C JEC LOG _$ _ $ GENERAL AGGREGATE PRODUCTS COMP/OPAGG $ _.- -- $ OTHER: AUTOMOBILE —� LIABILITY COMBINED SINGLE LIMIT (Eaaccident) _.. $ _ $ ANY AUTO, BODILY INJURY person) -- ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTO$ NON -OWNED _ AUTOS BOOT_-_ -RY Peraccident _ ( ) PROPERTY DAMAGE (Per accident) _ _ $ _ $ li-$ UMBRELLA LIAR OCCUR '.. EACH OCCURRENCE $ _ �i, AGGREGATE $ AB EXCESS LI -_ CLAIMS-MADEI DED RETENTION $ - A WORKERS COMPEN A&OY YIN EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? ,N X 90-20720-01 104/011201804/01/20191 X SPER TATUTE. OTH-AND UP _ ELEACH ACCIDENT $ 1,000,000 E.L. DISEASE, EA EMPLOYEE'. $ 1,000,000 - - (Mandatory in NH) f yes, describe undo' -DESCRIPTION OF OPERATIONS beICW - - — E. L. DISEASE -POLICY LIMIT $ 1,000,066 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re. Operations of the Named Insured. ° City of Santa Ana,y.+�a' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Purchasing Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE oMW,_-( ,--koltPt CORPORATION. All rinhtc rewPmPd- ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 0000 SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-20720-01 00 181 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payyments from anyone liable -for an injur covered by this policy. We will not enforce our right against �he person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule "ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04.84) Copyright 1983 National Council on Compensation Insurance. V MAR 90-20720-01 00 181 MARIPOSA LANDSCAPES INC 03-30-18 PAGE 001 y� " CERTIFICATE OF LIABILITY INSURANCE DATE 501'9 " THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer Fields to the certificate holder in lieu of such endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY NA ME: CT CLIEN CONTACT CENTER HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 PHONE A/C No 1888-333-4949 FAX Noll 507-446-4664 AL ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(51 AFFORDING COVERAGE NAIL# INSURE2A:FED2ERATED SERVICE INSURANCE COMPANY 28304INSURED �'MARIPOSA LANDSCAPES INC tT'OV/taL171-235-5 INSURE6232 SANTOS DIAZ ST (�INSUREIRWINDALE, CA 91702-3267 p���oZIlV �o� INSURERINSURERINSURER -------' — rtFv-""-' rlV MCC K: I 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. ILTNSR R TYPE OF INSURANCE DL NSR SUBR POLICY NUMBER POLICY EFF MMIDD/ VY PODGY EXP IDD/ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISESEa renw $100,000 CLAIMS -MADE ❑X OCCUR MED EXP (My one person) A Y N 6069499 04/01/2019 04/01/2020 PERSONAL& ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ ECT ❑LOG OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $2,000,000 AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT E accitlen $1,000,000 BODILY INJURY (Per person) A SCHEDULED OWNED AUTOS ONLY AUTOG HIRED AUTOS ONLY NON.OWNED AUTOS ONLY N N 6069499 04/01/2019 04/01/2020 BODILY INJURY (Per accidenp PROPERTY DAMAGE Peracci en A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 6069500 04/01/2019 04/01/2020 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 LIED I I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA PER STATUTE OTN ER E.L. EACH ACCIDENT (ManEalory in NH) If yes, describe under ELDISEASE - EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT e6 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Addifional Remarks Sohedule, may be aldcheC if more spate is required) SEE ATTACHED PAGE 171-235-5 CITY OF SANTA ANA ATTN PURCHASING DEPT 20 CIVIC CENTER PLZ SANTA ANA, CA 927014058 361 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V IeeK-<vu ACONU CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 171-235-5 LOC #: AC RO O® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 FEDERATED MUTUAL INSURANCE COMPANY MARIPOSA LANDSCAPES INC PoLICV NUMBER 6232 SANTOS DIAZ ST SEE CERTIFICATE # 36.1 IRWINDALE, CA 91702-3267 SEE CERTIFICATE # 36.1 I EFFECTIVE DATE: SEE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE IRE: ALL LANDSCAPE OPERATIONS PERFORMED BY OR ON BEHALF OF THE NAMED INSURED CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSURED WITH RESPECT TO THE COMMERCIAL GENERAL LIABILITY POLICY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. Q$G O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. a�� S��yGgP�P� © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 01 04 13 Policy Number: Transaction Effective Date: POLICY NUMBER: 6069499 COMMERCIAL GENERAL LIABILITY CG 2010 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 Organizations: -Y OF SANTA ANA TN PURCHASING DEPT CIVIC CENTER PLZ NTA ANA CA 92701 Location(s) Of Covered Operations COVERAGE PROVIDED BY THIS )RSEMENT APPLIES ONLY TO LANDSCAPING K FOR THE CITY OF SANTA ANA. TIONAL INSUREDS INCLUDE ADDITIONAL RED INCLUDES CITY OF SANTA ANA, ITS :ERS, EMPLOYEES, AGENTS, AND !ESENTATIVES 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. MARIPOSA LANDSCAPES INC 6232 SANTOS DIAZ ST IRWINDALE CA 91702 B. With respect to the insurance afforded to these 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number: 6069499 Transaction Effective Date: 04-01-2019 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 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase applicable Limits of Insurance shown in Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: 6069499 Transaction Effective Date: 04-01-2019 of the the CERTIFICATE OF LIABILITY INSURANCE D 03/27/2019/D0l 03/27 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, 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 CONTACT NAME: Tami Guo Global Risk, LLC PHONE 213-550-2253 Nef, 213-550-2258 A/C No Ext 800 Wilshire Blvd., Second Floor E-MAIL ADDRESS: __ certs@globalriskcap.com Los Angeles, CA 90017 License #01_60361 INSURER(S)AFFORDINGCOVERAGE NAICk INSURERA: Sentry Casualty Company 28460 _ INSURED - Mariposa Landscapes, Inc. INSURER B 6232 Santos Diaz St. INSURER C: - -- NSURER D INSURERE: _ Irwindale, CA 91702 INSURER F: �. �CJK IIrn A,It INUMtttK• REVISION N UMBER. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER THE POLICY PERIOD DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED TO WHICH THIS HEREIN IS SUBJECT EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TO ALL THE TERMS, INSR AODL SUBR. LTR TYPEOFINSURANCE D POLICYNUMBER MNDDYYYFY MMIDDYYYY LIMITS COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE $ CLAIMS -MADE OCCUR D A E T E1 TT ED - — -- - PREMISES(Ea occurred.) $ —. MED EXP (Any one person) $ - _PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ __. POLICYJECTPRO- LOG ' PRO PRODUCTS-COM_P/OPAGG $ OTHER. _ AUTO LIABILITY COMBMED SINGLE LIMIT $ ANY NV AUTO AUTO Via. accident) _ BODILY BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY (Per accident) $ HIRED N _._. AUTOS ONLY J AUTOS ONLY AUTOS O PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 9O-2Q72O-Q1 04/01/19 04/01/20 .PER OTH- X AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYOFFICER/METOR/PARTNER/EXECUTIVE RE%CLUDED? NIA EL. EACH ACCIDENT $ 1,000,000 (Mandatory inN (yes,doryinNH) If yes, describe under - EL. DISEASE -EA EMPLOYEE$ 1,000,000 DESCRIPTION OF OPERATIONS below E-L. DISEASE -POLICY LIMIT $ 1,000,000 < DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Operations of the Named Insured. City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All riahts resarvad. AUUKU ZO (ZUl O/U3) The ACORD name and logo are registered marks of ACORD SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-20720-01 00 191 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payyments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule "ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04-84) Copyright 1983 National Council on Compensation Insurance. MAR 90-20720-01 00 191 MARIPOSA LANDSCAPES INC 03-27-19 PAGE 001 A-aoi-7 1'P - oa, A-D OL&-- l 6o7 - 61 PREMIUM: $3,538.00 Annual HARTFORD FIRE INSURANCE COMPANY One Pointe Drive, Brea, CA 92821 CONTINUATION CERTIFICATE/INCREASED BOND RIDER Mariposa Landscapes Inc as principal, and Hartford Fire Insurance Company a Connecticut corporation authorized to transact surety business in CA, as Surety, hereby notifies the CityCity of Santa Ana, as Obligee, that the above named Principal's Bond No. 72BSBHW5679 is in force effective February 1, 2019 to January 31, 2020 for Second Extension of Contractor ALFreement No. A-2017-216 Landscape Maintenance Services for District 4 and the Bond amount has been amended• FROM: SIX HUNDRED FORTY THREE THOUSAND THREE HUNDRED THIRTY SIX AND NO/100 ($643,336.00) TO: SEVEN HUNDRED SEVEN THOUSAND SIX HUNDRED SIXTY NINE AND 68/100 ($707,669.68) The aggregate liability of the Surety shall not exceed the amount of this certificate. The liability of the Surety shall not cumulate by reason of this certificate, any future continuation certificate, any change rider, endorsement, modification, new bond, reinstatement, reissue, renewal, replacement, substitution, or any other extension of suretyship. IN WITNESS OF THIS CONTRACT, the Principal and the Surety have affixed their hands and seals this 19th day August of 2019. Mari osaYandsca es, Inc. Ter y Kloriegca,Prosideo Hartford Fire Insurance company M_ f -- MARY S TH Attorney -In -Fact 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 Los Angeles } On August 22, 2019 before me, Patricia Reyes De Martinez, Notary Public ere mse name antl ti e o t e o mer r personally appeared Terry Noriega, President who proved to me on the basis of satisfactory evidence to be the person(.64 whose name(s) is/ere subscribed to the within instrument and acknowledged to me that he/oheilt4ey executed the same in his/heN4 eir authorized capacity(ies), and that by his/hoAheir signature(&) on the instrument the person(e), or the entity upon behalf of which the person(e) 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. PATRICIA REYES DE MARTNEZ S my hand and official seal. Commission No. 2287378 NOTARY PUBLIC-CALIFORNIA LOS ANGELES COUNTY 19my Comm, Expires MAY e. 2023 Votary Public Sig re (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATI DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Tithe or descnphon of attached document continued) Number of Pages _ Document Date CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) / ❑ Corporate Officer ❑ Partner(s) ❑ Attome ❑ Tr e(s) www.NotaryClasses.com 800-873-9865 INSTRUCTIONS FOR COMPLETING THIS FO DN TH jo m complies with current California statutes regarding not ording and, ifneeded, should be completed ¢nd attached to the document. ow(edgments from other states may be campletedfor documents bear t to that state so long as the wording does not require the California not o violate California notary law. • State and County information must a State and County when the document signer(s) personally appeared b e the notary public for acknowledgment. • Date of notarization om the date that the signers) personally appeared which must also be the s ate the acknowledgment is completed. • The notary p c must print his or her name as it appears within his or her commiss ollowed by a comma and then your title (notary public). • Pri a name(s) of document signer(s) who personally appear at the time of otarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/they, is /are) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the once of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. ♦ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document with a staple. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT C: 12.�.H �. ��L.rl2s�LfzsLrv.L.q'.gL �i.a2 aa` a2 a2 2ta2!s�L.a2 1La2 �2.0fCc�2.02rc�t.02(i�•_at aft\•../.�L/a2./�.�L q<ERL aL�i�2/a2;3"'/ivl�t �C A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of Los Angeles ) On 08/19/19 Date personally appeared before me, _ Emily Preciado, Notary Public Smith Here Insert Name and Title of the Officer Name(8f of Signer* who proved to me on the basis of satisfactory evidence to be the personaay whose name(K is/are subscribed to the within Instrument and acknowledged to me that I;W/she/tkey executed the same in WS/her/tWr authorized capacity(Leo, and that by hWher/W81r signatureKon the instrument the personal, or the entity upon behalf of which the person(A acted, executed the instrument. IADO 45802 =it UFCRNIAT =No .. .r. OUNTY�I 11.2WO Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. G Signature ignature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages: Signer(s) Other Than Named Capacity(ies) Claimed by Signer(s) Signer's Name: _ ❑ Corporate Officer — Title(s): L1 Partner — ❑ Limited ❑ Gen ❑ Individual ❑ Atto Fact ❑ Trustee I ardian or Conservator ❑ Other: Signer's Name: I I Corporate Officer — Title(s): 0 Partner — I.l Limited I General CI Individual I I Attorney in Fact Trustee I' I Guardian or Conservator ❑ Other: Signer Is Representing: GG' b•Rt�tt%:'✓ �✓<-°]ti 5v✓Gv vti.4.� "✓S�c`B.GCv --- 4`.GL:GL. .�✓G�K'+�CLv.<L-•:' ✓2`!i�%GV15GL:G"✓G[n�G�GL.<'+� ✓GG:•S6 :tiGL:GV Direct Inquiries/Claims to: THE HARTFORD BOND, T-12 POWER OF ATTORNEY HartfOne ord, Connecticut6155 Bond.Claims(althehartford corn call: 888-266-3488 or fax: 860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: BOLTON & COMPANY Agency Code: 72-183250 0 Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut 0 Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana 0 Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Mchnnn Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida ---; 'a .� — —I U —]J�U rr1 ncruviu, wnnucucur, tnerematter collectively referred to as the "Companies") do hereby make, Up to theamountof Unlimited : Steven L. Brookmeyer, Barbara Doerning, Emily Preciado, Mary Smith, Ronald C. Wanglin of PASADENA, California their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. .... ss 9 ^e By .• -e;or"°'oi M1[;a;'m�� '6� �_.r "ra.°o S97% 6x ID70` •A�S 'ho:��F.s 4�+w..�'+A ria-fix+. +* 1� �t- ��...JF`.�'k>i.1�9�. e John Gray, Assistant Secretary STATE OF CON N ECTICU T ss. Hartford COUNTY OF HARTFORD jjj M. Ross Fisher, Senior Vice President On this 5th day of January, 2018, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. fSNtµ9t Kathleen T. Maynard Notary Public CERTIFICATE My Commission Expires July 31, 2021 I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of August 19, 2019 Signed and sealed at the City of Hartford. pi" 78789)0 s 7 3974 Heckman, Assistant Vice President MAmrs Hartford Fire Insurance Company One Pointe Drive, 6" Floor Brea, CA 92822-2333 RIDER This Rider is to be attached to and form part of Performance and Payment Bonds Bond No. 72BSBHW5679 executed by Hartford Fire Insurance Company as Surety, on behalf of Mariposa Landscapes, Inc. in favor of the City of Santa An for Contractor Agreement No. A-2017-216 Landscape Maintenance Services for District 4 IT IS HEREBY UNDERSTOOD AND AGREED THAT, effective July 1, 2018 to June 30, 2019 the said Bond Effective Dates Amended: FROM: July 1, 2018 to June 30, 2019 TO: February 1, 2018 to January 31, 2019 IT BEING FURTHER UNDERSTOOD AND AGREED THAT: 1. In no event will the total aggregate liability of the Surety during the entire period of said Bond is in force exceed $643,336.00 2. All terms and conditions of said Bond shall remain unchanged except as herein expressly modified. Signed, sealed, and dated this 19th of August 2019. Mariposa Landscapes, Inc. lJ� � rry Nori�9 �resic �n-F Hartford Fire Insurance Company MARY SMIT ttorney-In-Fac 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 Los Angeles } On August 22, 2019 before me, Patricia Reyes De Martinez, Notary Public ere insert name 9ht e o the o cer ' personally appeared Terry Nonage, President who proved to me on the basis of satisfactory evidence to be the person(&) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/sheHhey executed the same in his/heM ieir authorized capacity(ies), and that by his/h9W4keir signature(e) on the instrument the person(e), 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. PATRICIA REYES OE MYtTINEZ SS my hand and official seal. Commission No. 2287378 NOTARY PUBLIC-CALIFORNIA L. E ANUEIEE COUNTY MYCarNnEgtns Nov 1, 2021 Notary Public Sig t re (Notary Public Seal) DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) of Pages Document Date CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) / ❑ Corporate Officer ❑ Partner(s) ❑ Attorneyw ❑ Tr e(s) 800-873-9865 INSTRUCTIONS FOR COMPLETING THIS FO Thisform complies with current California statutesregardingnot ordmg and, ifneeded, should be completed and attached to the document. owledgmems from other states may be completedfor documents bein t to that state so long as the wording does not require the California not o violate California notary law. • State and County information must a State and County where the document signers) personally appeared b the notary public for acknowledgment. • Date of notarization must he date that the signer(s) personally appeared which must also be the s ate the acknowledgment is completed. • The notary p c must print his or her name as it appears within his or her commiss' ollowed by a comma and then your title (notary public). • Pri a names) of document signers) who personally appear at the time of • Indicate the correct singular or plural forms by crossing off incorrect fortes (i.e. he/she/Urey, is /are ) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). r Securely attach this document to the signed document with a staple. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL ./ A notary public or other officer completing this certificate verifies only the identify of the individual who signed the document to which this certificate Is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of Los Angeles ) On 08/19/19 Date before me, Emily Preciado, Notary Public personally appeared Mary Smith Here Insert Name and Title of the Officer Name((aj of Signer(of who proved to me on the basis of satisfactory evidence to be the person(O whose name(a') is/are subscribed to the within instrument and acknowledged to me that be9she/Wey executed the same in fWWherltlaelP authorized capacity(iaSj, and that by W97her/bo e* signature(ey on the instrument the personW,, or the entity upon behalf of which the persona) acted, executed the instrument. PRECIADO t't �� COMM. #2145802 � 2 NOTANVPUBLIC•CALIFOflNIA� LOS ANOELE3 COUNTY i MyCanm.E�ires Mer.71,2020 Place Notary Seal Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature IVA I AIZj ignature of Notary Public OPTIONAL Though this section is optional, completing this information can deter alteration of the docurn r fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Number of Pages; Signer(s) Other Than Named Capacity(ies) Claimed by Signer(s) Signer's Name: _ ❑ Corporate Officer — Title(s): Partner — ❑ Limited ❑ Gen ❑ Individual ❑ Attor n Fact ❑ Trustee I ardian or Conservator ❑ Other: Ling: Signer's Name: f 1 Corporate Officer — Title(s): ❑ Partner — 1.1 Limited Ll General CI Individual C.I Attorney in Fact Fl Trustee I Guardian or Conservator Cl Other: Signer Is Representing: LS'✓GC✓«✓ ✓<'e>'b �✓<�<'✓ "ei6�/.1"✓.G' titi:G'+iq✓" •/6'e�g`/,«vti.' O 1 � . • . . . . .. . r :11 • v :11 � 1 Direct Inquiries/Claims to: THE HARTFORD POWER OF ATTORNEY BOND, T-12 HartfOne od�Connetcut 06155 Bon d.Claim s(&.thehar[ford.com call: 888-266-3488 or fax: 860-757.5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: BOLTON & COMPANY Agency Code: 72-183250 0 Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut 0 Hartford casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana 0 Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida Connecticut, as uptotheamountof Unlimited : Steven L. Brookmeyer, Barbara Doerning, Emily Preciado, Mary Smith, Ronald C. Wanglin of PASADENA, California and appoint, their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. @AGOr �,r..,„fev ..ervJ`SB 1D 1 191 ;a:vt J ','`•�,,.ii.ms' r.�.,Ll/��-�"1//�J` V John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President STATE OF CONNECTICUT 1 Hartford COUNTY OF HARTFORD On this 5th day of January, 2018, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. x'gtro /J/y/xr. aT�d W I/ �n�an.cQ K2GIt,c.e . rye Kedileen T. Maynazd Nc. ycard Notary Public CERTIFICATE My Commission Expires July 31, 2021 I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is still in full force effective as of August 19, 2019 Signed and sealed at the City of Hartford. r I w 5�k\ 1459 * �;'_ � �+v....v' ',>': x:•r •'`'"; � ..o s r�. '"fir., .,C.a,. �si ---- Kevinu�an, Assistant Vice President MA 2018