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Bonds - Nor-Cal Pipeline Services, Inc. - 2022-03-28FAITHFUL PERFORMANCE BOND PAGE 1 Bond No. 602-135705-7 Premium: $8,933.00 COSTA MESA SANITARY DISTRICT FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS, COSTA MESA SANITARY DISTRICT (DISTRICT), a California Sanitary District, has on March 16, 2022 awarded to (Name and Address of Contractor) NOR -CAL PIPELINE SERVICES t i ne,�d 983 Reserve Drive Roseville, CA 95678 hereinafter designated as the "PRINCIPAL," an AGREEMENT for the work described as follows: 328 Ductile Iron Pipe Rehabilitation - Phase III fully incorporated herein by reference. Said AGREEMENT is WHEREAS, the said PRINCIPAL is required under the terms of said AGREEMENT to furnish a bond for the faithful performance of said AGREEMENT. NOW, THEREFORE, WE, the undersigned CONTRACTOR, as PRINCIPAL, and (Name and Address of Surety) UNITED STATES FIRE INSURANCE COMPANY 305 Madison Avenue Morristown, NJ 07962 hereinafter designated as the "SURETY," duly authorized to transact business under the laws of the State of California, as SURETY ar held 3nd fi ml boUnun t District, in the penal sum of: Fsl�i}j�No��II l� AND�rwoosta Mesa Sanitaryu►i� less than one hundred percent (100%) of the estimated amount3 a3'oo•• IT, said sum being not payable under the terms of the AGREEMENT for which payment well and truly be made, we bind ourselves and 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 above burdened PRINCIPAL, his/her/its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions, and agreements in the said AGREEMENT 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 true intent and meaning, and shall indemnify and save harmless the Costa Mesa Sanitary District, its officers, and its agents, as therein stipulated, then this obligation shall become null and void, otherwise it shall be and remain in full force and virtue. FAITHFUL PERFORMANCE BOND PAGE 2 Bond No. 602-135705-7 In case suit is brought upon this bond, SURETY further agrees to pay all court costs and reasonable attorney's fees as fixed by the court. And the said SURETY, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the AGREEMENT 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 AGREEMENT or to the work or to the specifications. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 16th day of March 2022 CONTRACTOR Ct 2��)�22- NOR -CAL PIPELINE SERVICES � (j'1 l�.y► (ADDRESS) 983 Reserve Drive Roseville, CA 95678 PRINCIPAL Co any Representative In accordance with the AGREEMENT, all bonds shall have been issued by an admitted surety insurer, and the DISTRICT reserves the right to object to any such surety, in accordance with Code of Civil Procedure Section 995.660. By signing below, SURETY certifies that the bonds are issued by admitted surety. SURETY UNITED STATES FIRE INSURANCE COMPANY By:- Company Representative Karen Amin, Attorney -in -Fact APPROVED AS TO FORM: District Counsel Costa Mesa Sanitary District By /s/ 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 pia( -/r On - Vbvi before me, R►IW VM -Hol -j NtVAwl PL410tt c - (insert name and title of the officer) personally appeared Dam J dlQ 'r who proved to me on the basis of satisfact6ry evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. RILEY 80ATRIC IT COMM. #2285955 z Notary Public CalHanis zY010 County MV Comm. 22.2023 Sig (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Joaquin ) On March 16, 2022 before me, Jennifer Lover, Notary Public (insert name and title of the officer) personally appeared Karen Amin who proved to me on the basis of satisfactory evidence to be the person( whose name(s) ishm subscribed to the within instrument and acknowledged to me that Mt!/she/** executed the same in KWherA#W authorized capacky(04q, and that byMher~ signature(1t) on the instrument the person(tt), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal.°`' ^ JENNIFER LOPER ©,e comm. #2344049 U• o NOTARY PUBUC • CALIFORNIA ca SAN JOAQUIN COUNTY ��. r�rd JAN 27, 2025 Signature (Seal) PAYMENT BOND PAGE 1 Bond No. 602-135705-7 Premium: Included in Conjunction wtih Performance Bond COSTA MESA SANITARY DISTRICT PAYMENT BOND (LABOR AND MATERIAL BOND) KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS, the COSTA MESA SANITARY DISTRICT, a municipal corporation, by minute order of the Board of Directors, adopted on March 16, 2022 , has awarded to CONTRACTOR (NAME AND ADDRESS OF CONTRACTOR) Hereinafter designated as the "Principal", a contract for the work described as follows: 328 Ductile Iron Pipe Rehabilitation - Phase III WHEREAS, said Principal is required by the provisions of said contract and of the Civil Code to furnish a bond in connection with said contract, as hereinafter set forth. NOW, THEREFORE, WE, the undersigned CONTRACTOR, as Principal and UNITED STATES FIRE INSURANCE COMPANY 305 Madison Avenue, Morristown, NJ 07962 (Name and Address of Surety) hhDppu��ly aaa��utthfojjriizmzed to transact business under the laws of the State of California, as Surety, are THREE—r�0II5$NR%&1399414 i Rj� Mesa Sanitary District, in the penal sum of: "FIVE HUNDRED FORTY AND NO/100•' O tars273.00•• J, said sum being set per Civil Code Section 9554 at one hundred (100%) percent of the estimated amount payable under the terms of the contract for which payment well and truly 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 said Principal or his subcontractors, or the heirs, executors, administrators, successors or assigns thereof, shall fail to pay any of the persons named in Section 9100 of the Civil Code of the State of California for any materials, provisions, provender or other supplies used in, upon, for or about the performance of the work contracted to be done, or for any work or labor performed by any such claimant or any amounts required to be deducted, withheld, and paid over to the 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, then said Surety will pay for the same, in an amount not exceeding the sum set forth hereinabove, and in addition, in case suit is brought upon the bond, will pay a reasonable attorney's fee to be fixed by the court. This bond shall inure to the benefit of any and all persons named in the aforesaid Civil Code Section 9100 so as to give a right of action to them or their assigns in any suit brought upon the bond. PAYMENT BOND PAGE 2 Bond NO. 602-135705-7 Further, the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder shall in any way affect its obligation on this bond; and it hereby waives notice of any and all such changes, extensions of time, and alterations or modifications of the contract documents and/or of the work to be performed thereunder. day of IN WITNESS WHEREOF, we have hereunto set our hands and seals this 16th March 2OIR 22 ".. V NOR -CAL PIPELINE SERVICES tlnC Contractor Name 983 Reserve Drive Street Address Roseville, CA 95678 City, State, Zip Code PRINC AL ompany Repre a Ive In accordance with the Contract for 328 Ductile Iron Pipe Rehabilitation - Phase III , all bonds shall be issued by an admitted surety insurer and the DISTRICT reserves the right to object to any such surety, in accordance with Code of Civil Procedure Section 995.660. By signing below, Surety certifies that the bonds are issued by an admitted surety. UNITED STATES FIRE INSURANCE COMPANY Name 305 Madison Avenue Street Address Morristonw, NJ 07962 City, State, Zip Code SURETY ` By: Coma Representative Karen Amin, Attomey-in-Fact APPROVED AS TO FORM.- Alan ORM: Alan R. Burns, District Counsel Costa Mesa Sanitary District By Js/ 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 V a Le -y- ) On3i �J� �?�?'Z before me, P"� iVD" NhUZ (insert name and title of the officer) personally appeared - i 64 - who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. RILEY BOATRIG T COMM. #2285955 z WITNESS my hand and official seal. i ��ryYOio Countyftf my Comm. 2023 Signature (Seal) POWER OF ATTORNEY UNITED STATES FIRE INSURANCE COMPANY PRINCIPAL OFFICE - MORRISTOWN, NEW JERSEY 8914422 KNOW ALL MEN BY THESE PRESENTSThat United States Fire Insurance Company, a corporation duly organized and existing under the laws of the state of Delaware, has made, constituted and appointed, and does hereby make, constitute and appoint: Daniel M. Connolly, Karen Amin, David Schnapp, Jennifer Loper each, its true and lawful Attomey(s)-In-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver: Any and all bonds and undertakings of surety and other documents that the ordinary course of surety business may require, and to bind United States Fire Insurance Company thereby as fully and to the same extent as if such bonds or undertakings had been duly executed and acknowledged by the regularly elected officers of United States Fire Insurance Company at its principal office, in amounts or penalties not exceeding: Seven Million, Five Hundred Thousand Dollars ($7,500,000). This Power of Attorney limits the act of those named therein to the bonds and undertakings specifically named therein, and they have no authority to bind United States Fire Insurance Company except in the manner and to the extent therein stated. This Power of Attorney revokes all previous Powers of Attorney issued on behalf of the Attomeys-In-Fact named above and expires on January 31, 2023. This Power of Attorney is granted pursuant to Article IV of the By -Laws of United States Fire Insurance Company as now in full force and effect, and consistent with Article III thereof, which Articles provide, in pertinent part: Article IV, Execution of Instruments - Except as the Board of Directors may authorize by resolution, the Chairman of the Board, President, any Vice -President, any Assistant Vice President, the Secretary, or any Assistant Secretary shall have power on behalf of the Corporation: (a) to execute, affix the corporate seal manually or by facsimile to, acknowledge, verify and deliver any contracts, obligations, instruments and documents whatsoever in connection with its business including, without limiting the foregoing, any bonds, guarantees, undertakings, recognizances, powers of attomey or revocations of any powers of attorney, stipulations, policies of insurance, deeds, leases, mortgages, releases, satisfactions and agency agreements; (b) to appoint, in writing, one or more persons for any or all of the purposes mentioned in the preceding paragraph (a), including affixing the seal of the Corporation. Article 1I1, Officers, Section 3.11, Facsimile Signatures. The signature of any officer authorized by the Corporation to sign any bonds, guarantees, undertakings, recognizances, stipulations, powers of attorney or revocations of any powers of attomey and policies of insurance issued by the Corporation may be printed, facsimile, lithographed or otherwise produced. In addition, if and as authorized by the Board of Directors, dividend warrants or checks, or other numerous instruments similar to one another in form, may be signed by the facsimile signature or signatures, lithographed or otherwise produced, of such officer or officers of the Corporation as from time to time maybe authorized to sign such instruments on behalf of the Corporation. The Corporation may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Corporation, notwithstanding the fact that he may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, United States Fire Insurance Company has caused these presents to be signed and attested by its appropriate officer and its corporate seal hereunto affixed this 28' day of September, 2021. UNITED STATES FIRE INSURANCE COMPANY c" f Matthew E. Lubin, President State of New Jersey } County of Morris } On this 28t1 day of September, 2021, before me, a Notary public of the State of New Jersey, came the above named officer of United States Fire Insurance Company, to me personally known to be the individual and officer described herein, and acknowledged that he executed the foregoing instrument and affixed the seal of United States Fire Insurance Company thereto by the authority of his office. 'IIIfiWY4°t1 a td-h� Melissa H. D'Alessio (Notary Public) I, the undersigned officer of United States Fire Insurance Company, a Delaware corporation, do hereby certify that the original Power of Attomey of which the foregoing is a full, true and correct copy is still in force and effect and has not been revoked. INWITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal of United States Fire Insurance Company on the 16th day of March 20 22 UNITED STATES FIRE INSURANCE COMPANY Alfred N. Wright, Senior Vice President FAITHFUL PERFORMANCE BOND PAGE 2 Bond NO. 602-135705-7 In case suit is brought upon this bond, SURETY further agrees to pay all court costs and reasonable attorney's fees as fixed by the court. And the said SURETY, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the AGREEMENT 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 AGREEMENT or to the work or to the specifications. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 16th day of March 2022 CONTRACTOR Qa NOR -CAL PIPELINE SERVICES , I'nC (ADDRESS) 983 Reserve Drive Roseville, CA 95678 PRINCIP Compa res ntative P In accordance with the AGREEMENT, all bonds shall have been issued by an admitted surety insurer, and the DISTRICT reserves the right to object to any such surety, in accordance with Code of Civil Procedure Section 995.660. By signing below, SURETY certifies that the bonds are issued by admitted surety. SURETY UNITED STATES FIRE INSURANCE COMPANY By: Company Representative Karen Amin, Attomey-in-Fact APPROVED AS TO FORM: District Counsel Costa Mesa Sanitary District By /s/ _ FAITHFUL PERFORMANCE BOND PAGE 1 Bond No. 602-135705-7 Premium: $8,933.00 COSTA MESA SANITARY DISTRICT FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS, COSTA MESA SANITARY DISTRICT (DISTRICT), a California Sanitary District, has on March 16, 2022 awarded to (Name and Address of Contractor)� NOR -CAL PIPELINE SERVICES, 983 Reserve Drive Roseville, CA 95678 hereinafter designated as the "PRINCIPAL," an AGREEMENT for the work described as follows: 328 Ductile Iron Pipe Rehabilitation - Phase III Said AGREEMENT is fully incorporated herein by reference. WHEREAS, the said PRINCIPAL is required under the terms of said AGREEMENT to furnish a bond for the faithful performance of said AGREEMENT. NOW, THEREFORE, WE, the undersigned CONTRACTOR, as PRINCIPAL, and (Name and Address of Surety) UNITED STATES FIRE INSURANCE COMPANY 305 Madison Avenue Morristown, NJ 07962 hereinafter designated as the "SURETY," duly authorized to transact business under the laws of the State of California, as SURETY �aRrEe� held an T �EfiErm) b °��dMOW,n iii Costa Mesa Sanitary District, in the penal sum of: SEVI=NYYTHREE AND N/100• 543.273.00• �, said sum being not less than one hundred percent (100%) of the estimated amount payable under the terms of the AGREEMENT for which payment well and truly be made, we bind ourselves and 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 above burdened PRINCIPAL, his/her/its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions, and agreements in the said AGREEMENT 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 true intent and meaning, and shall indemnify and save harmless the Costa Mesa Sanitary District, its officers, and its agents, as therein stipulated, then this obligation shall become null and void, otherwise it shall be and remain in full force and virtue. 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 P1 aLow- On � 341?,OZZ before me,Rlkt.l,1 I&v%+aMND1�tw�hl� (i sert name and title of the officer) personally appeared D 0'W "j0 -C who proved to me on the basis of satisfactbry evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. RILEY BOATRI6 IT WITNESS my hand and official seal. o COMM. X2285985 Z �► Notary ob C IifornNlitornN O Comm. 2023 Signature (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Joaquin ) On March 16, 2022 before me, Jennifer Loper, Notary Public (insert name and title of the officer) personally appeared Karen Amin who proved to me on the basis of satisfactory evidence to be the person(g) whose name($) ist= subscribed to the within instrument and acknowledged to me that Mi4/she/tt executed the same in Mit /her/ authorized capacky ftt), and that byWher~ signature(#) on the instrument the person(t), or the entity upon behalf of which the person($) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. J�'�'`°`'+�+ JENNIFER LOPER COMM. #2344049 NOTARY PUBLIC -CALIFORNIA m 1 / _ A // /'1 �c _ _ SAN JOAQUIN COUNTY PAYMENT BOND PAGE 1 Bond No. 602-135705-7 Premium: Included in Conjunction wtih Performance Bond COSTA MESA SANITARY DISTRICT PAYMENT BOND (LABOR AND MATERIAL BOND) KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS, the COSTA MESA SANITARY DISTRICT, a municipal corporation, by minute order of the Board of Directors, adopted on March 16, 2022 , has awarded to CONTRACTOR (NAME AND ADDRESS OF CONTRACTOR) Hereinafter designated as the "Principal", a contract for the work described as follows: 328 Ductile Iron Pipe Rehabilitation - Phase III WHEREAS, said Principal is required by the provisions of said contract and of the Civil Code to furnish a bond in connection with said contract, as hereinafter set forth. NOW, THEREFORE, WE, the undersigned CONTRACTOR, as Principal and UNITED STATES FIRE INSURANCE COMPANY 305 Madison Avenue, Morristown, NJ 07962 (Name and Address of Surety) hDpu�lly_gauu�tJhfojrizmed to transact business under the laws of the State of California, as Surety, are THREE TFIOIIS$NRr1WY) HJ9EgW i�j� Mesa Sanitary District, in the penal sum of: "FIVE HUNDRED FORTY AND NO/100" O tars ••543 273.00•• J. said sum being set per Civil Code Section 9554 at one hundred (100%) percent of the estimated amount payable under the terms of the contract for which payment well and truly 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 said Principal or his subcontractors, or the heirs, executors, administrators, successors or assigns thereof, shall fail to pay any of the persons named in Section 9100 of the Civil Code of the State of California for any materials, provisions, provender or other supplies used in, upon, for or about the performance of the work contracted to be done, or for any work or labor performed by any such claimant or any amounts required to be deducted, withheld, and paid over to the 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, then said Surety will pay for the same, in an amount not exceeding the sum set forth hereinabove, and in addition, in case suit is brought upon the bond, will pay a reasonable attorney's fee to be fixed by the court. This bond shall inure to the benefit of any and all persons named in the aforesaid Civil Code Section 9100 so as to give a right of action to them or their assigns in any suit brought upon the bond. PAYMENT BOND PAGE 2 Bond No. 602-135705-7 Further, the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or modification of the contract documents or of the work to be performed thereunder shall in any way affect its obligation on this bond; and it hereby waives notice of any and all such changes, extensions of time, and alterations or modifications of the contract documents and/or of the work to be performed thereunder. day of IN WITNESS WHEREOF, we have hereunto set our hands and seals this 16th March _20 22 NOR -CAL PIPELINE SERVICES Contractor Name 983 Reserve Drive Street Address Roseville, CA 95678 City, State, Zip Code PRINCI '000, �Ic WCom an Re res p y p ative In accordance with the Contract for 328 Ductile Iron Pipe Rehabilitation - Phase III all bonds shall be issued by an admitted surety insurer and the DISTRICT reserves the right to object to any such surety, in accordance with Code of Civil Procedure Section 995.660. By signing below, Surety certifies that the bonds are issued by an admitted surety. UNITED STATES FIRE INSURANCE COMPANY Name 305 Madison Avenue Street Address Monistonw, NJ 07962 City, State, Zip Code SURETY By: CO Representative Karen Amin, Attomey-in-Fact APPROVED AS TO FORM.- Alan ORM: Alan R. Burns, District Counsel Costa Mesa Sanitary District By /s/ 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 On S ISD 20-2,z before me, N!LAM 'ev►blrz (insert name and title of the officer) personally appeared 1�jso%vv- \) M who proved to me on the basis of satisfact evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. 1116 BOATRIG T WITNESS my hand and official seal.c COMM. 02285955 A 0 Notary Public • California �X ^ Z Yob County o 1 Comm. Emku A. 22.203 Signature (Seal) NOR -PIP -01 RKRIRMNA CERTIFICATE OF LIABILITY INSURANCE DATE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 3H 6/261202222 11D 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 endorseme a . PRODUCER License 0 OC36861 �' AcT Greg Miller Lodi-Alliant Insurance Services, Inc. 1 PHONE - ------- F_FAX-- — 641 South Ham Ln Ste S u_� NO, Ems: (209) 210-6869 ; (A/C, No):(209) 333-1584 Lodi, CA 95242- - - -- sa; GMlllerlPlliant.com INSURERIS) AFFORDING COVERAGE _ _ NAIC 0 —_ __---------------__-_-- _ , INsuRERA -Travelers Indemnity Company of Connecticut 25682 INSURED 1 INSURER B: Travelers Property Casualty Company of Americs 25674 - _--- Nor -Cal Pipeline Services INSURER C: - — -- 983 Reserve Drive INSURER D___ qo � J POLICY ❑X JEL'T LOC Roseville, CA 95678 INSURER E: 4 - EEBL AGREGATE S 2,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: aptiminm N MBER• 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. - - TYPE OF INSURANCE ASL WVp , POLICY NUMBER POLICY EFF mmilinam —--- - POLICY EXP LIMITS A X 1 COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 1,000,000 CLAIMS -MADE OCCUR X XIDT-CO-3R807248-TCT-21 10/1/2021 10/1/2022 (—PREISES(EaEom �enoeZ_ I� S 3W'� F --f --- --- MED EXP (Am one pawn)___ S 10,000 �: _PERSONAL&ADV ILL ---_ 1,000,000 INJURY Y -- GEN'L AGGREGATE LIMIT APPLIES PER: -� i ! IGENERALAGGREGATE $ 2,000,000 qo � J POLICY ❑X JEL'T LOC ------- (PRODUCTS - COMP/OP AGG = 2,000,000 OTHER; ! EEBL AGREGATE S 2,000,000 B �AUTOMOBILE LIABILITYINd LIMIT ... -- 1,000,000 1€ _ __----- - Xi ANY AUTO 1,810-3R807598-21-26-13 10/112021 _.. 10/1/2022 1 BQOLLv INJURY (Per person) S OWNED !SCHEDULED ,AUTOS ONLY AUTOS ! * , BODILY INJURY (Per accident) S X A�(��� pN yyNEp X UTOS ONLY j AUTO ONCV '', pit PM.7RdBM A__- fis - - UMBRELLA19 6 OCCUR I EACH OCCURRENCE I $ .._ CIS CLAIMS -MADE' i. ! - -- 1 ! _ AGGREGATE ---�5 DED ' RETENTIONS r------- - RKERS TUN AND EMPLOYERS' LIABILITY 'ANY PROPRIETORIPARTNEREXECUTIVE YI B! ANOFFIC XUB 3R809033-21-26-G 10/1/2021 PER OTH- ISTATUTE ER 110/1/2022 1,000,000 ACCIDENT RIM EXCLUDED*? MIA Ialanaam7 E_.E S _ ...... 1 000 000 I yes,describe under ! E. L. DISEASE - EA EMPLOYE i _... 1,000,000 DESCRIPTION OF OPERATIONS below Ii E. L. DISEASE -POLICY LIMIT ' i ! I ) DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Addldonal Rem rice Schedule, may be attached N more apace Is required) Re: Projectt328 Ductile Iron Pipe Rehab - Phase 111. Costa Masa Sanitary District and Its ofNcers, officials, employees, and agents are additional Insureds as respects General Liability per attached endorsements. Coverage Is primary. GL 3 WC waiver of subrogation appy per attached endorsements. Costa Mesa Sanitary District 628 W. 19th Street Costa Mesa, CA 92627 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 AI.UKU LO (LUIO/UJ) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: DT -CO -3R807248 -TCT -21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury' caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section 111 — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 C 2018 The Travelers indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: DT -CO -3R807248 -TCT -21 c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. — d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury' for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V – DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: C. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication: and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 m 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 0219' Includes copyrighted material of Insurance Services Office. Inc. with its permission. Policy Number: DT -CO -3R807248 -TCT -21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any I". damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what Is and Is not covered. A. Who Is An Insured — Unnamed Subsidiaries C. Irxidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability — Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership, joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION ii — WHO IS as indicated in its name or the documents that AN INSURED: govern its stricture. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED pint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured If: a. You are the sole owner of, or maintain an ownership interest of more than 50% In, such subsidiary on the first day of the policy period; and b. Such subsidiary Is not an Insured under similar other insurance. No such subsidiary Is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense conurdtted: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, If any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section 11— Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: The following is added to SECTION 11— WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to Include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury', "properly damage" or "personal and advertising injury arising out of operations performed for the governmental entity, or b. Any "bodily injury" or "property damage" Included in the "products -completed operations hazard". CO 0316 0219 02017 The Travebm We" Company, All rWft recurved. Page 1 of 3 lm*Aa WWW M*ftl of Inewwce Semmes Ofte, Ino., wflh ib penniaebn. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1Ka), (b), (c) and (d) above do not apply to "bodily Injury arising out of providing or failing to provide: (a) "incidental medical services" by any of your "employees" who Is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your 'employees" or "volunteer workers". other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hoUs for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION 111 — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related ads or omissions committed in providing or falling to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". pharrnaceu it als committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgicai supplies or appliances. 6. The follaMng is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that Is available to any of your "employees" for "bodily Injury" that arises out of providing or falling to provide "Incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section 11 — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of. a. "Bodily Injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION 1 — agreement. COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE E. CONTRACTUAL LIABILITY —RAILROADS LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 12D17 The Travelers Irdemnity company. AN rights reserved. CG D316 0219 Inclixtes copyrighted material of insurance Servioes Oboe. Inc., with Its permksfon.