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Ortiz Landscaping - 2012-12-01 AGREEMENT FOR MAINTENANCE SERVICES LANDSCAPE MAINTENANCE This Agreement ("AGREEMENT") is made and effective as of December 1, 2012, between the Costa Mesa Sanitary District, a sanitary district ("DISTRICT"), and Ortiz Landscaping, a partnership ("CONSULTANT"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. TERM This AGREEMENT shall commence on January 1, 2013, and shall remain and continue in effect until tasks described herein are completed, unless sooner terminated pursuant to the provisions of this AGREEMENT. 2. SERVICES CONSULTANT shall perform landscape maintenance services described below ("SERVICES") to DISTRICT for DISTRICT's Headquarters and Yard facilities ("PROJECT"). The SERVICES to be provided include the following: all labor, equipment, tools, and services required to provide full professional landscape maintenance on properties located at 628 W. 19th Street (Headquarters) and 174 W. Wilson Street (Yard). The SERVICES to be provided are more particularly described in the Scope of Services attached hereto as Exhibit "A" and incorporated herein by reference. 3. PERFORMANCE CONSULTANT shall perform all SERVICES under this AGREEMENT in a skillful and competent manner, consistent with the standards generally recognized as being employed by consultants in the same discipline in the State of California and consistent with all applicable laws. CONSULTANT shall provide DISTRICT its work product in "turnkey" form. DISTRICT reserves the right to perform reasonable testing of CONSULTANT's work product before accepting the same. CONSULTANT shall warrant that all services provided and equipment installed shall perform in a workmanlike manner and be fit for its particular purpose. 4. COMPENSATION Compensation for the SERVICES shall be based on the actual amount of time spent in adequately performing the SERVICES and shall be billed at the monthly rate(s) of one hundred sixty ($160.00). However, unless expressly agreed in a written change order in advance by DISTRICT, the cost to DISTRICT for the SERVICES shall not 1 . PSA 30U 12 10 exceed one thousand nine hundred twenty ($1,920.00). The written change order requirement cannot be waived. Failure to submit a written change order and receive written approval by the DISTRICT prior to performing extra work shall constitute a waiver of a claim for additional time or compensation. Invoices shall be submitted to DISTRICT monthly as performance of the SERVICES progresses. DISTRICT shall review and pay the approved charges on such invoices in a timely manner. SERVICES on the PROJECT shall begin immediately and be completed by December 31, 2013, unless extended by DISTRICT in writing. If agreed upon by both parties, the DISTRICT has the option to exercise four (4) one-year extensions on this agreement. 5. PREVAILING WAGES CONSULTANT understands that this job, if over Ones Thousand Dollars ($1,000.00) in value and not exempt, requires compliance with the prevailing wage law. (Labor Code §§ 1720 et seq.) As such, DISTRICT will ascertain the prevailing wages to be paid on this job from the Director of Industrial Relations. Said amounts are listed at http://www.dir.ca.gov/dlsr/pwd/index.htm. CONSULTANT agrees to pay prevailing wages and maintain prevailing wage records regarding those payments. CONSULTANT is also required to comply with the apprentice requirements. CONSULTANT shall defend, indemnify, and hold the DISTRICT, its elected officials, officers, employees, and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. CONSULTANT recognizes that state law makes eight (8) hours a day's work, and any worker working in excess of that time must be paid overtime. (Labor Code § 1813.) 6. INSURANCE CONSULTANT shall, at its expense, procure and maintain for the duration of this AGREEMENT insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of this AGREEMENT by the CONSULTANT, its agents, representatives, employees, or subcontractors. CONSULTANT shall also require all of its subcontractors to procure and maintain the same insurance for the duration of this AGREEMENT. If CONSULTANT is an employer or otherwise hires one (1) or more employees during the term of this PROJECT, CONSULTANT shall procure and maintain workers' compensation coverage for such employees which meets all requirements of state law (Labor Code § 1861). At a minimum, CONSULTANT is required to submit proof of insurance in accordance with the following standards: Minimum Scope of Insurance: Coverage shall be at least as broad as the latest version of the following: (1) General Liability: Insurance Services Office Commercial General Liability coverage (occurrence form CG 0001): (2) Automobile Liability: Insurance Services Office Business Auto Coverage form number CA 0001, 2 PSA 30U 12 10 code 1 (any auto); and (3) Workers' Compensation and Employer's Liability: Workers' Compensation insurance as required by the State of California and Employer's Liability Insurance. Minimum Limits of Insurance: CONSULTANT shall maintain limits of no less than: (A)General Liability. One Million Dollars ($1,000,000.00) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with general aggregate limit is used, either the general aggregate limit shall apply separately to this AGREEMENT/location or the general aggregate limit shall be twice the required occurrence limit. (B)Automobile Liability. One Million. Dollars ($1,000,000.00) per accident for bodily injury and property damage. (C)Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the Labor Code of the State of California. Employer's Liability limits of One Million Dollars ($1,000,000.00) per accident for bodily injury or disease. Insurance Endorsements: The insurance policies shall contain the following provisions, and a separate endorsement stating to add the following provisions to the insurance policies shall be submitted and approved by DISTRICT: (A)General Liability. The general liability policy shall be endorsed to state that: (1) DISTRICT, its directors, officials, officers, employees, agents, and volunteers shall be covered as additional insureds with respect to the work or operations performed by or on behalf of the CONSULTANT, including materials, parts, or equipment furnished in connection with such work; and (2) the insurance coverage shall be primary insurance as respects DISTRICT, its directors, officials, officers, employees, agents, and volunteers, or if excess, shall stand in an unbroken chain of coverage excess of the CONSULTANT's scheduled underlying coverage. Any insurance or self-insurance maintained by DISTRICT, its directors, officials, officers, employees, agents, and volunteers shall be excess of the CONSULTANT's insurance and shall not be called upon to contribute with it in any way. (B)Workers' Compensation and Employer's Liability Coverage. The insurer shall agree to waive all rights of subrogation against DISTRICT, its directors, officials, officers, employees, agents, and volunteers for losses paid under the terms of the insurance policy which arise from work performed by the CONSULTANT. (C)AII Coverage. Each insurance policy required by this AGREEMENT shall be endorsed to state that: (A) coverage shall not be suspended, voided, reduced, or canceled except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to DISTRICT, and (B) any failure to comply with reporting or other provisions of the policies, including breaches or warranties, shall not affect 3 PSA 30U 12 10 coverage provided to DISTRICT, its directors, official, officers, employees, agents, and volunteers. Acceptability of Insurers: Insurance is to be placed with insurers with a current A.M. Best's rating of no less than A-:VIII, licensed to do business in California, and satisfactory to DISTRICT. All insurance documents must be submitted and approved by the District's Risk Manager prior to execution of any AGREEMENT with DISTRICT. 7. INDEMNIFICATION (a) Indemnification for Professional Liability. When the law establishes a professional standard of care for CONSULTANT's services, to the fullest extent permitted by law, CONSULTANT shall indemnify, protect, defend, and hold harmless DISTRICT and any and all of its officials, employees, and agents from and against any and all losses, liabilities, damages, costs, and expenses, including attorney's fees and costs to the extent the same arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONSULTANT, its officers, agents, employees, or subconsultants (or any entity or individual that CONSULTANT shall bear the legal liability thereof) in the performance of professional services under this AGREEMENT. (b) Indemnification for Other than Professional Liability. Other than in the performance of professional services and to the fullest extent permitted by law, CONSULTANT shall indemnify, defend, and hold harmless DISTRICT and any and all of its employees, officials, and agents from and against any liability (including liability for claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses, or costs of any kind, whether actual, alleged, or threatened, including attorney's fees and costs, court costs, interest, defense costs, and expert witness fees) where the same arise out of, pertain to, relate to, are a consequence of, or are in any way attributable to, in whole or in part, the performance of this AGREEMENT by CONSULTANT or by any individual or entity for which CONSULTANT is legally liable, including, but not limited to, officers, agents, employees, or subconsultants of CONSULTANT. 8. TERMINATION DISTRICT may terminate this AGREEMENT at any time with or without cause. If DISTRICT terminates this AGREEMENT without cause before PROJECT completion, CONSULTANT shall be entitled to be paid for SERVICES adequately completed prior to the notification of termination. CONSULTANT may terminate this AGREEMENT for cause only. 4 PSA 30U 12 10 9. MISCELLANEOUS This AGREEMENT shall be interpreted according to the laws of the State of California and any action arising from this AGREEMENT shall be brought in the superior or federal district court with jurisdiction over DISTRICT. This AGREEMENT and the attachments hereto shall contain the entire agreement between the parties. This AGREEMENT cannot be modified except in a writing signed by both parties. In the event of inconsistency between this AGREEMENT and any attachment hereto, this AGREEMENT shall control in all respects. DISTRICT shall own all work product prepared in the course of providing the SERVICES under this AGREEMENT. In the event of termination of this AGREEMENT, CONSULTANT shall immediately turn all work product over to DISTRICT. If specialized software or computer hardware is required to view or transmit said work product, CONSULTANT shall make that software and hardware available to the DISTRICT at no cost during normal business hours. This AGREEMENT cannot be assigned without the prior written consent of the DISTRICT. CONSULTANT is and shall at all times remain as to DISTRICT an independent contractor. No employee benefits shall be available to CONSULTANT in connection with the performance of this AGREEMENT. Except for the fees paid to CONSULTANT as provided in this AGREEMENT, DISTRICT shall not pay salaries, wages, or other compensation to CONSULTANT for performing any services hereunder for DISTRICT. DISTRICT shall not be liable for compensation or indemnification to CONSULTANT for injury or sickness arising out of performing any services hereunder. All information gained by CONSULTANT in the performance of this AGREEMENT shall be considered confidential and shall not be released by CONSULTANT without DISTRICT's prior written authorization. CONSULTANT shall not, without written authorization from the General Manager or unless requested by the District Counsel, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories, or other information concerning the work . performed under this AGREEMENT. Response to a subpoena or court order shall not be considered "voluntary" provided CONSULTANT gives DISTRICT notice of such court order or subpoena. CONSULTANT warrants that the individual who has signed this AGREEMENT has the legal power, right, and authority to make this AGREEMENT and bind the CONSULTANT hereto. If you agree with the terms of this AGREEMENT, indicate by signing and dating two original agreements where indicated below and return both to the undersigned. Once the documents are fully executed, one original will be returned to you for your records. 5 PSA 30U 12 10 DISTRICT CONSULTANT Approved by: Reviewed and Accepted by: General Manager ignature Michael Ortiz Approved as to Form: Name / General Partner 7 -_' Harper & Burns LLP Title District Counsel /lt. Date Approved as to Content: Anna Sanchez Administrative Service Manager 6 PSA 30U 12 10 EXHIBIT A Exhibit A 44:1E.HoT191-7(' LANDSCAPING www_ortidandsc ainq.com November 20, 2012 RE: Costa Mesa Sanitary District SCOPE OF WORK: Work includes providing all labor, equipment, tools, and services required to provide full professional land- scape maintenance, on properties 628 W. 19th St. & 174 W. Wilson St. in Costa Mesa, CA. In general the work includes: • Maintenance of all landscaping Maintenance and Repair of all Irrigation systems • Parking lot blowing/cleaning • Mulching (Cost of Mulch separate) Debris removal • Weed control 628 W. 19th St. will be visited twice a month while 174 W. Wilson St. will be visited once a month. CODES AND STANDARDS: Ortiz Landscaping is responsible for complying with regulations of all local, state, and federal agencies having jurisdiction over any portion of the work to be performed under this contract. Ortiz Landscaping labor standards provisions will be in accordance with Section 1776 of the California Labor code, not less than the general prevailing rate of per diem wages for each craft of type of worker and mechanic needed to execute the contract. Ortiz Landscaping will have two "Laborer, General Cleanup" which falls under Determination: SC-23-102-2- 2012-1 and will be paid a basic hourly rate of$28.09. Shed. Please let me know if you need anything else. Michael Ortiz Ortiz Landscaping 714-709-6292 Form Vil•9 Request for Taxpayer Give Form to the (Rev.De°ember 2011) . Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service Name(as shown on your income tax return) Michael Ortiz c\i Business name/disregarded entity name,if different from above ;;, Ortiz Landscaping a Check appropriate box for federal tax classification: C o ❑ Individual/sole proprietor ❑ C Corporation ❑ S Corporation 151 Partnership ❑Trust/estate c 0.0 0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Cl Exempt payee o t N a` ❑ Other(see instructions)► U '9-- Address(number,street,and apt.or suite no.) Requester's name and address(optional) U o. 730 W.Aster PI. m City,state,and ZIP code 'a rn Santa Ana,CA 92706 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For individuals,.this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other 6 1 6 — 5 2 - 3 0 9 6 entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign Signature of 12/11/12 Here U.S.person• Date• General Instru ions Note.If a requester gives you a form other than Form W-9 to request Section references are to the Internal Revenue Code unless otherwise your TIN,you must use the requester's form if it is substantially similar to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is'a foreign person, 2.Certify that you are not subject to backup withholding,or • and pay the withholding tax.Therefore,if you are a U.S.person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.12-2011) Form W-9{Rev.12-2011) Page 2 The person who gives Form W-9 to the'partnership for purposes of Certain payees and payments are exempt from backup'withholding. establishing its U.S.status and avoiding withholding on its allocable See the instructions below and the separate Instructions for the share of net income from the partnership conducting a trade or business Requester of Form W-9. in the United States is in the following cases: Also see Special rules for partnerships on page 1. •The U.S.owner of a disregarded entity and not the entity, •The U.S.grantor or other owner of a grantor trust and not the trust, Updating Your Information and You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee •The U.S.trust(other than a grantor trust)and not the beneficiaries of the trust. and anticipate receiving reportable payments in the future from this person.For example,you may need to provide updated information if Foreign person.If you are a foreign person,do not use Form W-9. you are a C corporation that elects to be an S corporation,or it you no Instead,use the appropriate Form W-8(see Publication 515, longer are tax exempt.In addition,you must furnish a new Form W-9 if Withholding of Tax on Nonresident Aliens and Foreign Entities). the name or TIN changes for the account,for example,if the grantor of a Nonresident alien who becomes a resident alien.Generally,only a grantor trust dies. nonresident alien individual may use the terms of a tax treaty to reduce Penalties • or eliminate U.S.tax on certain types of income.However,most tax treaties contain a provision known as a"saving clause."Exceptions Failure to furnish TIN.If you fail to furnish your correct TIN to a specified in the saving clause may permit an exemption from tax to requester,you are subject to a penalty of$50 for each such failure continue for certain types of income even after the payee has otherwise unless your failure is due to reasonable cause and not to willful neglect. become a U.S.resident alien for tax purposes. Civil penalty for false information with respect to withholding.If you If you are a U.S.resident alien who is relying on an exception make a false statement with no reasonable basis that results in no contained in the saving clause of a tax treaty to claim an exemption backup withholding,you are subject to a$500 penalty. from U.S.tax on certain types of income,you must attach a statement to Form W-9 that specifies the following five items: Criminal penalty for falsifying information.Willfully falsifying certifications or affirmations may subject you to criminal penalties 1.The treaty country.Generally,this must be the same treaty under including fines and/or imprisonment. which you claimed exemption from tax as a nonresident alien. Misuse of TINs.If the requester discloses or uses TINs in violation of 2.The treaty article addressing the income. federal law,the.requester may be subject to civil and criminal penalties. 3.The article number(or location)in the tax treaty that contains the saving clause and its exceptions. Specific Instructions 4.The type and amount of income that qualifies for the exemption Name • from tax. 5.Sufficient facts to justify the exemption from tax under the terms of If you are an individual,you must generally enter the name shown on the treaty article. your income tax return.However,if you have changed your last name, for instance,due to marriage without informing the Social Security Example.Article 20 of the U.S.-China income tax treaty allows an Administration of the name change,enter your first name,the last name exemption from tax for scholarship income received by a Chinese shown on your social security card,and your new last name. student temporarily present in the United States.Under U.S.law,this student will become a resident alien for tax purposes if his or her stay in If the account is in joint names,list first,and then circle,the name of the United States exceeds 5 calendar years.However,paragraph 2 of the person or entity whose number you entered in Part I of the form. the first Protocol to the U.S.-China treaty(dated April 30,1984)allows Sole proprietor.Enter your individual name as shown on your income the provisions of Article 20 to continue to apply even after the Chinese tax return on the"Name"line.You may enter your business,trade,or student becomes a resident alien of the United States.A Chinese "doing business as(DBA)"name on the"Business name/disregarded student who qualifies for this exception(under paragraph 2 of the first entity name"line. protocol)and is relying on this exception to claim an exemption from tax Partnership,C Corporation,or S Corporation.Enter the entity's name on his or her scholarship or fellowship income would attach to Form on the"Name"line and any business,trade,or"doing business as W-9 a statement that includes the information described above to (DBA)name"on the"Business name/disregarded entity name"line. support that exemption. Disregarded entity.Enter the owner's name on the"Name"line.The If you are a nonresident alien or a foreign entity not subject to backup name of the entity entered on the"Name"line should never be a withholding,give the requester the appropriate completed Form W-8. disregarded entity.The name on the"Name"line must be the name What is backup withholding?Persons making certain payments to you shown on the income tax return on which the income will be reported. must under certain conditions withhold and pay to the IRS a percentage For example,if a foreign LLC that is treated as a disregarded entity for of such payments.This is called"backup withholding." Payments that U.S.federal tax purposes has a domestic owner,the domestic owner's may be subject to backup withholding include interest,tax-exempt name is required to be provided on the"Name"line. If the direct owner interest,dividends,broker and barter exchange transactions,rents, of the entity is also a disregarded entity,enter the first owner that is not royalties,nonemployee pay,and certain payments from fishing boat disregarded for federal tax purposes.Enter the disregarded entity's operators.Real estate transactions are not subject to backup name on the"Business name/disregarded entity name"line.If the owner withholding. of the disregarded entity is a foreign person,you must complete an You will not be subject to backup withholding on payments you appropriate Form W-8. receive if you give the requester your correct TIN,make the proper Note.Check the appropriate box for the federal tax classification of the certifications,and report all your taxable interest and dividends on your person whose name is entered on the"Name"line(IndividuaVsole tax return. proprietor,Partnership,C Corporation,S Corporation,Trust/estate). Payments you receive will be subject to backup Limited Liability Company(LLC).If the person identified on the withholding if: "Name"line is an LLC,check the"Limited liability company"box only 1.You do not furnish your TIN to the requester, and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal 2.You do not certify your TIN when required(see the Part II tax purposes,enter"P"for partnership.If you are an LLC that has filed a instructions on page 3 for details), Form 8832 or a Form 2553 to be taxed as a corporation,enter"C"for 3.The IRS tells the requester that you furnished an incorrect TIN, C corporation or"S"for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation 4.The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax section the LLC box (except for owner the and excise tax), e not return(for reportable interest and dividends only),or check the LLC box line)the is another e the LLC(required nt sr be ( p y identified on the"Name"line)is another LLC that is not disregarded for 5.You do not certify to the requester that you are not subject to federal tax purposes. If the LLC is disregarded as an entity separate backup withholding under 4 above(for reportable interest and dividend from its owner,enter the appropriate tax classification of the owner accounts opened after 1983 only). identified on the"Name"line. Form W-9(Rev.12-2011) Page 3 Other entities.Enter your business name as shown on required federal ' Part I.Taxpayer Identification Number(TIN) tax documents on the"Name"line.This name should match the name shown on the charter or other legal document creating the entity.You Enter your TIN in the appropriate box.If you are a resident alien and may enter any business,trade,or DBA name on the"Business name/ you do not have and are not eligible to get an SSN,your TIN is your IRS disregarded entity name"line. individual taxpayer identification number(ITIN).Enter it in the social security number box.If you do not have an ITIN,see How to get a TIN Exempt Payee below. If you are exempt from backup withholding,enter your name as If you are a sole proprietor and you have an EIN,you may enter either described above and check the appropriate box for your status,then your SSN or EIN.However,the IRS prefers that you use your SSN. check the"Exempt payee"box in the line following the"Business name/ If you are a single-member LLC that is disregarded as an entity disregarded entity name,"sign and date the form. separate from its owner(see Limited Liability Company(LLC)on page 2), Generally,individuals(including sole proprietors)are not exempt from enter the owner's SSN(or EIN,if the owner has one).Do not enter the backup withholding.Corporations are exempt from backup withholding disregarded entity's EIN.If the LLC is classified as a corporation or for certain payments,such as interest and dividends. partnership,enter the entity's EIN. Note.If you are exempt from backup withholding,you should still Note.See the chart on page 4 for further clarification of name and TIN complete this form to avoid possible erroneous backup withholding. combinations. The following payees are exempt from backup withholding: How to get a TIN.If you do not have a TIN,apply for one immediately. To apply for an SSN,get Form SS-5,Application for a Social Security 1.An organization exempt from tax under section 501(a),any IRA,or a Card,from your local Social Security Administration office or get this custodial account under section 403(b)(7)if the account satisfies the form online at www.ssa.gov.You may also get this form by calling requirements of section 401(f)(2), 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer 2.The United States or any of its agencies or instrumentalities, Identification Number,to apply for an ITIN,or Form SS-4,Application for 3.A state,the District of Columbia,a possession of the United States, • Employer Identification Number,to apply for an EIN.You can apply for or any of their political subdivisions or instrumentalities, an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number(EIN)under Starting a 4.A foreign government or any of its political subdivisions,agencies, Business.You can get Forms W-7 and SS-4 from the IRS by visiting or instrumentalities,or IRS.gov or by calling 1-800-TAX-FORM(1-800-829-3676). 5.An international organization or any of its agencies or If you are asked to complete Form W-9 but do not have a TIN,write instrumentalities. "Applied For"in the space for the TIN,sign and date the form,and give Other payees that may be exempt from backup withholding include: it to the requester.For interest and dividend payments,and certain 6.A corporation, payments made with respect to readily tradable instruments,generally you will have 60 days to get a TIN and give it to the requester before you 7.A foreign central bank of issue, are subject to backup withholding on payments.The 60-day rule does 8.A dealer in securities or commodities required to register in the not apply to other types of payments.You will be subject to backup United States,the District of Columbia,or a possession of the United withholding on all such payments until you provide your TIN to the States, requester. 9.A futures commission merchant registered with the Commodity Note.Entering"Applied For"means that you have already applied for a Futures Trading Commission, TIN or that you intend to apply for one soon. 10.A real estate investment trust, Caution:A disregarded domestic entity that has a foreign owner must 11.An entity registered at all times during the tax year under the use the appropriate Form W-8. Investment Company Act of 1940, Part II.Certification 12.A common trust fund operated by a bank under section 584(a), To establish to the withholding agent that you are a U.S.person,or 13.A financial institution, resident alien,sign Form W-9.You may be requested to sign by the 14.A middleman known in the investment community as a nominee or withholding agent even if item 1,below,and items 4 and 5 on page 4 custodian,or indicate otherwise. 15.A trust exempt from tax under section 664 or described in section For a joint account,only the person whose TIN is shown in Part I 4947. should sign(when required). In the case of a disregarded entity,the The following chart shows types of payments that may be exempt person identified on the"Name"line must sign.Exempt payees,see from backup withholding.The chart applies to the exempt payees listed Exempt Payee on page 3. above,1 through 15. Signature requirements.Complete the certification as indicated in items 1 through 3,below,and items 4 and 5 on page 4. IF the payment is for... THEN the payment is exempt 1.Interest,dividend,and barter exchange accounts opened for... before 1984 and broker accounts considered active during 1983. Interest and dividend payments All exempt payees except You must give your correct TIN,but you do not have to sign the certification. for 9 2.Interest,dividend,broker,and barter exchange accounts Broker transactions Exempt payees 1 through 5 and 7 opened after 1983 and broker accounts considered inactive during through 13.Also,C corporations. 1983.You must sign the certification or backup withholding will apply.If Barter exchange transactions and Exempt payees 1 through 5 you are subject to backup withholding and you are merely providing patronage dividends your correct TIN to the requester,you must cross out item 2 in the certification before signing the form. Payments over$600 required to be Generally,exempt payees 3.Real estate transactions.You must sign the certification.You may reported and direct sales over 1 through 72 cross out item 2 of the certification. $5,000 'See Form 1099-MISC,Miscellaneous Income,and its instructions. 'However,the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding:medical and health care payments,attorneys'fees,gross proceeds paid to an attorney,and payments for services paid by a federal executive agency. Form W-9(Rev.12-2011) Page 4 4.Other payments.You must give your correct TIN,but you do not Note.If no name is circled when more than one name is listed,the have to sign the certification unless you have been notified that you number will be considered to be that of the first name listed. have previously given an incorrect TIN."Other payments"include payments made in the course of the requester's trade or business for Secure Your Tax Records from Identity Theft rents,royalties,goods(other than bills for merchandise),medical and Identity theft occurs when someone uses your personal information health care services(including payments to corporations),payments to such as your name,social security number(SSN),or other identifying a nonemployee for services,payments to certain fishing boat crew information,without your permission,to commit fraud or other crimes. members and fishermen,and gross proceeds paid to attorneys An identity thief may use your SSN to get a job or may file a tax retum (including payments to corporations). using your SSN to receive a refund. 5.Mortgage interest paid by you,acquisition or abandonment of To reduce your risk: secured property,cancellation of debt,qualified tuition program .protect your SSN, payments(under section 529),IRA,Coverdell ESA,Archer MSA or HSA contributions or distributions,and pension distributions.You •Ensure your employer is protecting your SSN,and must give your correct TIN,but you do not have to sign the certification. •Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a What Name and Number To Give the Requester notice from the IRS,respond right away to the name and phone number For this type of account: Give name and SSN of: printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you 1.Individual The individual think you are at risk due to a lost or stolen purse or wallet,questionable 2.Two or more individuals(joint The actual owner of the account or, credit card activity or credit report,contact the IRS Identity Theft Hotline account) if combined funds,the first at 1-800-908-4490 or submit Form 14039. individual on the account' For more information,see Publication 4535,Identity Theft Prevention 3.Custodian account of a minor The minor and Victim Assistance. (Uniform Gift to Minors Act) 4.a.The usual revocable savings The grantor-trustee Victims of identity theft who are experiencing economic harm or a trust(grantor is also trustee) system problem,or are seeking help in resolving tax problems that have b.So-called trust account that is The actual owner' not been resolved through normal channels,may be eligible for not a legal or valid trust under Taxpayer Advocate Service(TAS)assistance.You can reach TAS by state law calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 5.Sole proprietorship or disregarded The owner' 1-800-829-4059. entity owned by an individual Protect yourself from suspicious emails or phishing schemes. 6.Grantor trust filing under Optional The grantor Phishing is the creation and use of email and websites designed to Form 1099 Filing Method 1(see mimic legitimate business emails and websites.The most common act Regulation section 1.671-4(b)(2)(i)(A)) • IS sending an email to a user falsely claiming to be an established For this type of account: Give name and EIN of: legitimate enterprise in an attempt to scam the user into surrendering 7.Disregarded entity not owned by an The owner private information that will be used for identity theft. individual 8.A valid trust,estate,or pension trust Legal entity' The IRS does not initiate contacts with taxpayers via emails.Also,the LLC electing The corporation IRS does not request personal detailed information through email or ask 9.Corporation or LL corporate status C term 8832 or taxpayers for the PIN numbers,passwords,or similar secret access Form 2553 information for their credit card,bank,or other financial accounts. 10.Association,club,religious, The organization If you receive an unsolicited email claiming to be from the IRS, charitable,educational,or other forward this message to phishing@irs.gov.You may also report misuse tax-exempt organization of the IRS name,logo,or other IRS property to the Treasury Inspector 11.Partnership or multi-member LLC The partnership General for Tax Administration at 1-800-366-4484.You can forward 12.A broker or registered nominee The broker or nominee suspicious emails to the Federal Trade Commission at:spam®uce.gov 13.Account with the Department of The public entity or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT Agriculture in the name of a public (1-877-438-4338). entity(such as a state or local Visit IRS.gov to learn more about identity theft and how to reduce govemment,school district,or your risk. prison)that receives agricultural program payments 14.Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2(see Regulation section 1.671-4(b)(2)(i)(B)) 'List first and circle the name of the person whose number you furnish.It only one person on a joint account has an SSN.that person's number must be furnished. Circle the minor's name and furnish the minor's SSN. 'You must show your individual name and you may also enter your business or"DBA"name on the"Business name/disregarded entity"name line.You may use either your SSN or EIN(if you have one),but the IRS encourages you to use your SSN. 'List first and circle the name of the trust,estate,or pension trust.(Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.)Also see Special rules for partnerships on page 1. *Note.Grantor also must provide a Form W-9 to trustee of trust. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons(including federal agencies)who are required to file information returns with the IRS to report interest,dividends,or certain other income paid to you;mortgage interest you paid;the acquisition or abandonment of secured property;the cancellation of debt;or contributions you made to an IRA,Archer MSA,or HSA.The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information.Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities,states,the District of Columbia,and U.S.possessions for use in administering their laws.The information also may be disclosed to other countries under a treaty,to federal and state agencies to enforce civil and criminal laws,or to federal law enforcement and intelligence agencies to combat terrorism.You must provide your TIN whether or not you are required to file a tax return.Under section 3406,payers must generally withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer.Certain penalties may also apply for providing false or fraudulent information. • AWR®® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) L------ -/ 12/14/2012 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION FREXINY LAZO INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 280 E LINCOLN AVE 200 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR NAHEIM,CA 92805 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. • • PH(714)535-1854 INSURERS AFFORDING COVERAGE NAIC# INSURED I INSURER A: PREFERRED CONTRACTORS INSURANCE ORTIZ LANDSCAPING INSURER B: j 730 W ASTER PLACE INSURER C: SANTA ANA CA 92706 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRI INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) I POLICY DATE(MM/DD/YY)NI LIMITS GENERAL LIABILITY PCI005017-PCA-96711 12/12/12 12/12/13 I EACH OCCURRENCE $ 1,000,000 '4 X. COMMERCIAL GENERAL LIABILITY I PREMISES O(Ea occurence) $ 50,000 DAMAGE • CLAIMS MADE I X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 • GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO I I LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ • (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG I $ EXCESS/UMBRELLA LIABILITY i EACH OCCURRENCE $ OCCUR (CLAIMS MADE AGGREGATE $ $ _ DEDUCTIBLE - $ RETENTION $ I $ • WORKERS COMPENSATION AND I TORY LIMITS I ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I E.L.DISEASE-EA EMPLOYED $ If yes,describe under . SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT I $ OTHER • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS DISTRICT, ITS DIRECTORS,OFFICIALS,OFFICERS, EMPLOYEES,AGENTS,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECT TO WORK OR OPERATIONS PERFORMED PER CONTRACT. CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION COSTA MESA SANITARY DIS,TRI-, DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 628 VV COSTA 19TH ST I 4�\\� COSTA MESA CA 92627 / \V\1 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1 '� REPRESENTATIVES. AUTHORIZED REPRESENTATIVE O,glally signed by HANADI NA5RI HANADI NASRI emad-HA D'®AO'tOM.e=U5 I Dale:2(112.12.141001:27-0B'W' ACORD 25(2001/08) ©ACORD CORPORATION 1988 • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statment on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) Pt- . r ; - , a n .51 IF r c Preferred Coniraelors Irt ur:,nce Company. RRG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION INCLUDING PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person(s) or Organization(s); Location(s) of covered operations; Additional Insured(s) Address: Certificate Holder—DISTRICT, ITS DIRECTORS , OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECT TO WORK OR OPERATIONS PERFORMED PER CONTRACT. (If no entry appears above,the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 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. B. With respect to the insurance afforded to these additional insureds, the following exclusions apply: This insurance does not apply to"bodily injury" or"property damage" occurring after: (I) 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 engaged in performing operations for a principal as part of the same project. C. The insurance afforded by the policy to the Additional Insured's) listed in the Schedule for the described location(s) is primary insurance. Any other insurance or self-insurance maintained by the Additional Insured(s) is excess of this insurance and shall not contribute to it. Policy No.: PCIC5017-PCA96711 Date: 12/12/12 Time: 12:01 a.m. Preferred Contractors Insurance Company Risk Retention Group, LLC 27 North 27th Street, Suite 1900 Billings, Montana 59103 By: ...pjulttoo• . Authorized Ilepresentative PCIC 24 7 10 07 • POLICY NUMBER: PCIC5017-PCA96711 COMMERCIAL GENERAL LIABILITY PCIC 24 10 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person(s) or Organization(s); Location(s) of covered operations; Additional Insured(s)Address: Certificate Holder—DISTRICT, ITS DIRECTORS, OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECT TO WORK OR OPERATIONS PERFORMED PER CONTRACT. (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 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. PCIC 24 10 07