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HomeMy WebLinkAboutCALI STATE PAVING INC. (ALLEY IMPROVEMENTS PROGRAM) IfVr jRi`NCF illy FILE �r�ocr_F f; .NJ -:; 03401 CITY OF SANTA ANA 1�Zb FEB 0 6 2026 CONSTRUCTION CONTRACT v: PVJA (2) PROJECT 26-6910 MichsCAe1 (Dz) ALLEY IMPROVEMENTS PROGRAM This CONSTRUCTION CONTRACT is made and entered into this 20" day of January, 2026 by and between the City of Santa Ana, California, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "CITY"), and Cali State Paving, Inc. (hereinafter"CONTRACTOR"). WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, mutually agree as follows: 1. CONTRACTOR agrees to perform all the work and furnish all the materials at its own cost and expense necessary to construct and complete in a good and workmanlike manner and to the satisfaction of the City Engineer of the CITY,Alley Improvements Program(hereinafter referred to as the"WORK OF IMPROVEMENT") identified in and in accordance with the Contract Documents prepared by the City's Public Works Agency and approved by the City Council. 2. The complete Construction Contract consists of the"Contract Documents" as defined by the Standard Specifications for Public Works Construction and which include the following: • Notice Inviting Bids • Information to Bidders • Bid Proposal • Bid Bond • Contract Form • Contract Bonds • General Provisions • Special Provisions • Technical Provisions and Project Plans • Community Workforce Agreement • Appendices In case of conflict between the Contract Documents, the precedence of documents shall be as established in the Standard Specifications for Public Works Construction. 3. CITY agrees to pay and CONTRACTOR agrees to accept in full payment to complete the WORK OF IMPROVEMENT the sum total amount not to exceed Six Hundred Twelve Thousand Five Hundred Dollars and Zero Cents ($612,500.00), as set forth and identified in the itemized BID PROPOSAL uploaded by the Contractor to PlanetBids, which is attached hereto and incorporated herein as Exhibit "A". The BID PROPOSAL contains a schedule of unit price(s) or lump sum(s) based on approximate quantities only, and the City does not expressly or by implication agree that the actual amount of work will correspond therewith, but reserves the right to increase or decrease the amount of any class or portion of the work or to omit portions of the work as may be deemed necessary or advisable. rev.09/01/2017 Pagel of 3 4. CONTRACTOR agrees to complete the WORK OF IMPROVEMENT within the time specified in the Time for Completion of Improvements and Liquidated Damages section of the BID PROPOSAL (Exhibit `B") including commencing construction within the timeframc therein specified after issuance of a Notice to Proceed. 5. The CONTRACTOR will pay, and will require all subcontractors to pay, all employees on the WORK OF IMPROVEMENT a salary or wage at least equal to the prevailing salary or wage established for such work as set forth in the wage determinations for this work in accordance with applicable State and Federal law. 6. If applicable, the CONTRACTOR shall adhere to the CITY'S Community Workforce Agreement (CWA), a pre-hire collective bargaining agreement,which establishes the labor relations policies and procedures for CONTRACTOR to follow in the crafts persons employed to complete the WORK OF IMPROVEMENT as more(ally described in the CWA. The CWA may be found on the City's website at: Santa Ana CWA 7. CONTRACTOR shall, after award of this Contract, furnish two bonds to be approved by the CITY, one in the amount of One Hundred Percent (100%) of the Contract price, to guarantee the faithful performance of the work(Performance Bond),and one in the amount of One Hundred Percent(100%) of the Contract price to guarantee payment of all claims for labor and materials furnished (Payment Bond). This Contract shall not become effective until such bonds are supplied to and approved by the CITY. S. CONTRACTOR shall, prior to the release of the performance and payment bonds or the retention payment, furnish a warranty performance and payment bond (Warranty Bond). Said Warranty Bond shall also be required as a condition of project acceptance. For projects up to Five Hundred Thousand Dollars($500,000),the Warranty Bond amount shall be the greater of Ten Thousand Dollars($10,000) or Twenty Percent (20%) of the final contract price. For projects above Five Hundred Thousand Dollars ($500,000),the Warranty Bond amount shall be the greater of One Hundred Thousand Dollars ($100,000) or Ten Percent(10%) of the final contract price. 9. CONTRACTOR shall, after award of this Contract, furnish Certificates of Liability Insurance and Worker's Compensation Insurance as outlined in the General Provisions,to be approved by the CITY. 10. INDEMNIFICATION. To the fullest extent allowed by law, CONTRACTOR and its Subcontractors hereby agree to defend, indemnify, and hold harmless CITY, its City Council, boards and commissions, officers, agents, employees, representatives and volunteers (hereinafter collectively referred to as "Indemnitees"), through legal counsel acceptable to CITY, from and against any liability, claims, actions, costs, damages or losses, including reasonable costs and attorney's fees, for injury, including death to any person or damage to any property, arising directly or indirectly from, or in any manner relating to, any of the following: (i) Performance or nonperformance of the Work of Improvement by CONTRACTOR or its Subcontractors of any lower tier; (ii) Performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of any of the obligations under the Contract Documents; Page 2 of 3 (iii) The construction activities of CONTRACTOR or its Subcontractors of any lower tier, either on the project site or on other properties; (iv) The payment or nonpayment by CONTRACTOR of any of its Subcontractors of any lower tier, for Work of Improvement performed on or off the project site; and (v) Any personal injury, property damage or economic loss to third persons related to and arising from the performance or nonperformance by CONTRACTOR or its Subcontractors of any lower tier, of the Work of Improvement. (vi) The indemnity obligations of Subcontractors provided by this Section shall be included in all subcontract documents issued by CONTRACTOR. Nothing in the Contract Documents shall be construed to give rise to any implied right of indemnity in favor of CONTRACTOR against CITY or any other Indemnitee. IN WITNESS WHEREOF, the parties hereto have executed this Construction Contract on the day and year first above written. ATTEST: CITY O SANTA A t� IFE HA L ALVARO'VNUNEZ City Cler City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONTRACTOR: City Attorney Cali State Paving, Inc. By: jo'LE NELLESEN BY: Jesus Gutierrez Assistant City Attorney TITLE: President RECOMMENDED FOR APPROVAL: Oil t1h,signed 1,RodIIPn flows Rodolf o Ro sa s dN.cn—Hodoifo Rosas,email=rrosas@santa- rwa,org.=us l.202&0LOS 19;4132-M'00' RODOLFO ROSAS, P.E. Acting Executive Director Public Works Agency Page 3 of 3 qCCOR"® GATE{MM1DDlYYYY) L,,,^� CER a IFICATE OF LIABILITY INSUF�ANCE 12/15/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER Steven Luu NAME: SJL Insurance Services Inc (A/C ONE 626 387-6688 -M No Ext: (AlC.No): AIL 539 E Garvey Ave ADDRESS: SteYen@sjlins.com INSURERS)AFFORDING COVERAGE NAIC# Monterey Park CA 91755 INSURER A: JAMES RIVER CASUALTY COMPANY 13685 INSURED INSURER B: REDWOOD FIRE AND CASUALTY INSURANCE CO 11673 CALI STATE PAVING INC. INSURER c: CLEAR SPRING PROPERTY&CASUALTY COMPA-6 15563 6699 CHADBOURNE AVE INSURER D: INSURER E: RIVERSIDE CA 92505-2007 INSURER F: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY) (MMIDDNYYY) LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 7 OCCUR PREMISES(Ea aocun•ence) $ 50,004 MED EXP(Any one person) $ 1,000 A Y Y 1 00152824-1 03/01/2025 03/01/2026 PERSONAL&ADVINJURY $ 1,000,000 GFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 �C POLICY jE O LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accdent) $ 1,000)000 ANY AUTO BODILY INJURY(Par person) $ B OWNED SCHEDULED Y Y OIAPM057253-01 04104/2025 04/04/2026 BODILY INJURY(Peraccident $ X.AUTOS ONLY � AUTOS ) HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY Per accident) UMBRELLA LIAR K OCCUR EACH OCCURRENCE $ 2,000,000 A 4XEXCESS LIAR CLAIMS-MADE 00162180-0 03/12/2025 03/01/2026 AGGREGATE $ 2,000,000 IED RETENTION$ $ ORKERS COMPENSATION XC STATUTE EOTH R 4.ND EMPLOYERS'LIABILITY Y 1 N kNY C FFICEWMEMBER EXCLUDEDPROPRIETORIPARTNERIEX?ECUTIVE NIA A �, CSWC05049600 06/25/2025 06/25/2026 E.L.EACH ACCIDENT $ 1,000,000 Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,400,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE TO BE COVERED AS ADDITIONAL INSUREDS ON CONTRACTOR'S AL POLICIES WITH RESPECT TO LIABILITY ARISING OUT OV WORK OPERATIONS PERFORMED BY OR ON BEHALF OF CONTRACTOR INCLUDING MATERIALS,PARTS,AND EQUIPMENT FURNISHED IN CONNECTION WITH SUCH WORK OR OPERATIONS AND AUTOMOBILES OWNED,LEASED,HIRED,OR BORROWED BY OR ON BEHALF OF CONTRACTOR,ADDITIONAL INSURED STATUS CAN BE PROVIDED IN THE FORM OF AN ENDORSEMENT TO CONTRACTOR'S INSURANCE.TEN(10)DAYS PRIOR WRITTEN NOTICE FOR NON-PAYMENT AND THIRTY(30)DAYS PRIOR WRITTEN NOTICE FOR POLICY CANCELLATION SHALL BE PROVIDED TO THE CITY. DIgltallysigned TU TYan byTuTran `Nguyen Nguyen o8438200' I APPROVED.. :. ,_.....I CERTIFICATE HOLDER CANCELLATION ®y ru Tran Nguyen of 8:41 am,Jan 07,202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Public Works Agency 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE CITY HALL-ROSS ANNEX Ste-,-- L-K SANTA ANA CA 92701 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD POLICY NUM13LK: 00152824-1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) Or Or anization s : As agreed to by written contract or agreement If no entry appears above, this endorsement applies to all Additional Insureds covered under this 2olicy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE.POLICY REMAIN UNCHANGED, AP5031 US O4-10 Page 1 of 1 POLICY NUMBER: 00152824-1 COMMERCIAL GENERAL LIABILITY CG20100704 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 Or anization s : Locations Of Covered Operations As agreed to by written contract or agreement All locations as agreed to by written contract or agreement 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 B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following additional exclu- organization(s)shown in the Schedule, but only with sions apply: respect to liability for"bodily injury", "property This insurance does not apply to "bodily injury" or damage" or"personal and advertising injury" , „ pp y y caused, in whole or in part, by: property damage occurring after: 1. All work, including materials, parts or equip- 1. Your acts or omissions; ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: 00152824-1 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations As agreed to by written contract or agreement All locations as agreed to by written contract or agreement Information required to complete this Schedule if not shown above,will be shown in the Declarations. 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" or"property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 ❑ 5 POLICY NUMBER: 00152824-1 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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: As agreed to by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section 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 O Insurance Services Office, Inc., 2008 Page 1 of 1 13 POLICY NUMBER: 01APM057253-01 COMMERCIAL AUTO CA 04 44 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CALI STATE PAVING INC Endorsement Effective Date: 04/04/2025 SCHEDULE Name(s) Of Person(s) Or Organization(s): CITY OF SANTA ANA, ITS CITY COUNCIL, OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the 'loss" under a contract with that person or organization. CA 04 44 03 10 0 Insurance Services Office, Inc., 2009 Page 1 of 1 i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION Any Person or Organization for which the insured has agreed by written contract executed prior to loss to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 06-25-25 Policy No. CSWC05049600 Endorsement No. lnsured CALI STATE PAVING INC. Premium $ Incl . Insurance Company Clear Spring Property and Casualty Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual©'1999. ASURED CITY 7SANTA ANA a.. c � Risk Management a divisiori of Human Resources +' Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR PROFESSIONAL LIABILITY INSURANCE I Jesus Gutierrez/President ("Representative"), attest that I am an authorized (Name and Title of Vendor Representative) representative of Cali State Paving, Inc. p ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number PROJECT 26-691 a ("Agreement")to provide ALLEY IMPROVEMENTS ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company will not use the services of an expert necessitating professional liability/errors & omissions liability insurance coverage in the performance of Services to, for, or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 1/7/2026 Signature hate Jesus Gutierrez Print Name President Title (714)757-8019/Jesus@calistatepaving.com Contact Information,i.e.,Telephone Number and/or Email Address Affidavit of Exemption for Professional Liability Insurance 11.12.2024 ® DATE(MM/DD/YYYY) ACC OR" � CERTIFICATE OF LIABILITY INSURANCE 6/23/2026 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 INSURERS),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: Steven Lau SJL Insurance Services Inc PHONE FAX 626 387-6688 A/C,No,Ext: ( ) (A/C,No): 539 E GARVEY AVE ADDRESS: steven@sjlins.com INSURER(S)AFFORDING COVERAGE NAIC# MONTEREY PARK CA 91755 INSURER A: JAMES RIVER INS CO 12203 INSURED INSURER B: National Fire&Marine Insurance Co CALI STATE PAVING INC. INSURER C: Berkley Net 6699 CHADBOURNE AVE INSURER D: INSURER E: RIVERSIDE CA 92505-2007 INSURER F: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 1,000 A Y P0000013738 03/01/2026 03/01/2027 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ECT ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED AUTOS ONLY X AUTOSULED Y 72APS132411 04/04/2026 04/04/2027 BODILY INJURY(Per accident) $ HIRED NON-OWNED HF<UHEK I Y DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA LAB M OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LAB CLAIMS-MADE Y P0000013758 03/01/2026 03/01/2027 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? Fy] N/A Y 4160238711-1 06/25/2026 06/25/2027 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICIALS,EMPLOYEES,AGENTS,AND VOLUNTEERS ARE TO BE COVERED AS ADDITIONAL INSUREDS ON CONTRACTOR'S AL POLICIES WITH RESPECT TO LIABILITY ARISING OUT OF WORK OPERATIONS PERFORMED BY OR ON BEHALF OF CONTRACTOR INCLUDING MATERIALS,PARTS,AND EQUIPMENT FURNISHED IN CONNECTION WITH SUCH WORK OR OPERATIONS AND AUTOMOBILES OWNED, LEASED,HIRED,OR BORROWED BY OR ON BEHALF OF CONTRACTOR.ADDITIONAL INSURED STATUS CAN BE PROVIDED IN THE FORM OF AN ENDORSEMENT TO CONTRACTOR'S INSURANCE.TEN(10)DAYS PRIOR WRITTEN NOTICE FOR NON-PAYMENT AND THIRTY(30)DAYS PRIOR WRITTEN NOTICE FOR POLICY CANCELLATION SHALL BE PROVIDED TO THE CITY. CERTIFICATE HOLDER APPROVED CANCELLATION By Tu Tran Nguyen at 7.27 am,Jun 25,202'6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. Attention:Public Works Agency AUTHORIZED REPRESENTATIVE 20 CIVIC CENTER PLAZA siv-v' ...kUU SANTA ANA CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR LOSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Cali State Paving Inc Effective Policy No. Endorsement No. Insured 4160238711-1 Premium Insurance Company Countersigned by StarNet Insurance Company WC 00 03 13 (Ed. 4-84) 0 1983 National Council on Compensation Insurance.