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JM Slover/Playground Equipment 10AGREEMENT THIS CONTRACT, by and between the CITY OF LA QUINTA, a municipal corporation, herein referred to as "City," and JM SLOVER INC. herein referred to as, "Contractor." WITNESSETH: In consideration of their mutual covenants, the parties hereto agree as follows 1. Contractor shall furnish all necessary labor, material, equipment, transportation and services for Project No. 2009-06, Playground Equipment at Adams Park in the City of La Quinta, California pursuant to the Request for Proposals and the Contractor's Proposal, dated December 18, 2009, all of which documents shall be considered a part hereof as though fully set herein. Should any provisions of Contractor's Proposal be in conflict with the Request For Proposal or this Contract, then the provisions of said Contract and Request For Proposal shall be controlling; in that order of precedence. 2. Contractor will comply with all Federal, State, County, and La Quinta Municipal Code, which are, as amended from time to time, incorporated herein by reference. 3. All work shall be done in a manner satisfactory to the City Engineer. 4. Contractor shall commence work after the issuance of a written Notice to Proceed and agrees to have all work completed within the specified 25 working days completion time period. 5. In consideration of said work, City agrees to pay Contractor such sums as shall be approved by the City Engineer at lump sums and/or unit prices stated in the Contractor's Bid, the base consideration of one hundred twenty-four thousand four hundred thirty-five dollars ($124,435). All payments shall be subject to approval by the City Engineer and shall be in accordance with the terms, conditions, and procedures provided in the Specifications. 6. Concurrently with the execution of this Contract, Contractor shall furnish bonds of a surety satisfactory to City, as provided in this Agreement, the cost of which shall be paid by Contractor. 7. Contractor shall defend, indemnify and hold harmless the City, its officers, employees, representatives and agents ("Indemnified Parties"), from and against those actions, suits, proceedings, claims, demands, losses, costs, and expenses, including legal costs and attorneys' fees, for injury to or death of person(s), for damage to property (including property owned by City) and for errors and omissions committed by Contractor, its officers, employees and agents, which arise out of Contractor's negligent performance under this Agreement, except to the extent of such loss as may be caused by City's own negligence or that of its officers or employees. In the event the Indemnified Parties are made a party to any action, lawsuit, or other adversarial proceeding in any way involving such claims, Contractor shall provide a defense to the Indemnified Parties, or at the City's 1300-1 Agreement option, reimburse the Indemnified Parties their costs of defense, including reasonable attorney's fees, incurred in defense of such claim. In addition, Contractor shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. 8. Except as otherwise required, Contractor shall concurrently with the execution of this contract, furnish the City satisfactory evidence of insurance of the kinds and in the amounts provided in said Agreement. This insurance shall be kept in full force and effect by Contractor during this entire contract and all premiums thereon shall be promptly paid by it. Each policy shall further state that it cannot be canceled without 30 days unconditional written notice to the City and shall name the City as an additional insured. Contractor shall furnish evidence of having in effect, and shall maintain Workers Compensation Insurance coverage of not less than the statutory amount or otherwise show a certificate of self-insurance, in accordance with the Workers Compensation laws of the State of California. Failure to maintain the required amounts and types of coverage throughout the duration of this Contract shall constitute a material breach of this Contract. 9. In accepting this Contract, Contractor certifies that in the conduct of its business it does not deny the right of any individual to seek, obtain and hold employment without discrimination because of race, religious creed, color, national origin, ancestry, physical handicap, medical condition, marital status, sex or age as provided in the California Fair Employment Practice Act (Government Code Sections 12900, et seq.) Contractor agrees that a finding by the State Fair Employment Practices Commission that Contractor has engaged during the term of this Contract in any unlawful employment practice shall be deemed a breach of this Contract and Contractor shall pay to City $500.00 liquidated damages for each such breach committed under this contract. 10. This Contract shall not be assignable by Contractor without the written consent of City. 11. Contractor shall notify the City Engineer (in writing) forthwith when the Contract is deemed completed. 12. In accepting this Contract, Contractor certifies that no member or officer of the firm or corporation is an officer or employee of the City except to the extent permitted by law. 13. Contractor certifies that it is the holder of any necessary California State Contractor's License and authorized to undertake the above work. 14. The City, or its authorized auditors or representatives, shall have access to and the right to audit and reproduce any of the Contractor records to the extent the City deems necessary to insure it is receiving all money to which it is entitled under the contract and/or is paying only the amounts to which Contractor is properly entitled under the Contract or for other purposes relating to the Contract. 15. The Contractor shall maintain and preserve all such records for a period of at least three years after termination of the contract. 16. The Contractor shall maintain all such records in the City of La Quinta. If not, the Contractor shall, upon request, promptly deliver the records to the City or reimburse the City for all reasonable and extra costs incurred in conducting the audit at a location other 1300-2 Agreement than at City offices including, but not limited to, such additional (out of the City) expenses for personnel, salaries, private auditors, travel, lodging, meals and overhead. 17. The further terms, conditions, and covenants of the Contract are set forth in the Contract Documents, each of which is by this reference made a part hereof. IN WITNESS WHEREOF, the parties have executed this Agreement as of the dates stated below. Dated: ATTES . Veronica Monte noy Clerk APPROVED AS TO FORM: Katherine enson, City Attorney "CITY" CITY OF LA QUINTA, a California municipal corporation By-.Z Thomas P. Genovese, City Manager Dated:A r / / Dated: M44441 c �Q10 "CONTRACTOR" JM SLOVER, INC. Dated: 2 , Terresa Slover 1630 Lotus Road Placerville, CA 95667 (530)621-4815 Phone (530) 621-4869 Fax "CONTRACTOR" (If corporation, affix seal) Agreement 1300-3 Bond # CA1614091 Premium: $2,867.00 FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: THAT the City of La Quinta, a municipal corporation, hereinafter designated the City, has, on . awarded to JM Slover Inc. hereinafter designated as the Principal, a Contract for Project No. 2009-06, Playground Equipment at Adams Park and; WHEREAS, said Principal is required under the terms of said Contract to furnish a bond for the faithful performance of said Contract: NOW, THEREFORE, we, the Principal, and Great American Insurance Company as Surety, are held and firmly bound unto the City in the just and full amount of one hundred twenty-four thousand four hundred thirty-five dollars ($124,435) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if said Principal, his or its heirs, executors, administrators, successors, or assigns, shall in all things stand to and abide by, and well and truly keep and faithfully perform the covenants, conditions, and agreements in the said contract and any alterations 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 City, its officers and agents as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. It is acknowledged that the Contract provides for one-year guarantee period, during which time this bond remains in full force and effort. 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 Contract or to the work to be performed there under or the specifications accompanying the same shall, in any way, affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California. 1310-1 Faithful Performance Bond IN WITNESS WHEREOF, the Principal and Surety have executed this instrument under their seals this 16th day of February 2010, the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. JM Slover Inc. Principal icon Signature Tor rrincipai - /c�� Title of Signatory Great American Insurance Company Surety (Seal) AlYA-ZI; — Signature for Surety Attorney —in —Fact Title of Signatory 1350 Treat Blvd. Suite 300 walnut Creek, CA 94597 925-988-2214 Address of Surety Phone # of Surety Shirley Paiva Contact Person For Surety 1310-2 Faithful Performance Bond CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sacramento Onbefore me, J. Swalley Notary Public personally appeared 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 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. N.,,u J. ovJALLEY � rpratl,JJ i"IU2437 I certify under PENALTY OF PURJURY under the laws of the state of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. e of Notary the data below is not requiredlaw, Oe'IIO�AL ' q' n q b y la wit may prove valuable to persons relying on the document and could prevent at reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ MEMBER of LLC ❑ ATTORNEY -IN -FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR OTHER: Title or Type of Document Number of Pages Date of Document SIGNER IS REPRESENTING: Signer(s) other than named above NAME OF PERSON(S) OR ENTITY(IES) Bond # CA1614091 premium included in performance bond PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: THAT the City of La Quinta, a municipal corporation, hereinafter designated the City, has, on , 2010 awarded to JM Slover Inc., hereinafter designated as the Principal, a Contract for Project No. 2009-06, Playground Equipment at Adams Park, and WHEREAS, said Principal is required to furnish a bond in connection and with said Contract, providing that if said Principal, or any of it or its subcontractors shall fail to pay for any materials, provisions, or other supplies used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor done thereon of any kind, the Surety of this bond will pay the same to the extent hereinafter set forth: NOW, THEREFORE, we, the Principal, and Great American Insurance as Surety, are held and firmly bound unto the City in the just and full amount of one n d twenty-four thousand four hundred thirty-five dollars ($124,435) lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, that if said Principal, it or its heirs, executors, administrators, successors, or assigns, shall fail to pay for any materials, provisions, or other supplies used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor thereon of any kind or for amount due under the Unemployment Insurance Act with respect to such work or labor, or for any amounts due, or to be withheld pursuant to Sections 18806 of the Revenue and Taxation Code of the State of California with respect to such work or labor, then said surety will pay the same in or to an amount not exceeding the amount hereinabove set forth, and also will pay in case suit is brought upon this bond, such reasonable attorney's fees to the City as shall be fixed by the court. This bond shall insure to the benefit of any and all persons, companies, and corporations named in Section 3181 of the Civil Code of the State of California so as to give a right of action to them or their assigns in any suit brought upon this bond. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, or addition of the terms of the Contract or to the work to be performed there under or the specifications accompanying the same shall, in any way, affect its obligations of this bond, and it does hereby waive notice of any change, extension of time, alteration, or addition to the terms of the contract or to the work or to the specifications. Said Surety hereby waives the provisions of Sections 2819 and 2845 of the Civil Code of the State of California. 1320-1 Payment Bond IN WITNESS WHEREOF, the Principal and Surety have executed this instrument under their seals this 16th day of February , 2010, the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. .1M Slover Inc. Principal n (Seal) Signature for Principal �C Title of Signatory Great American Insurance Company Surety (Seal) Signature for Surety Attorney —in —Fact Title of Signatory 1350 Treat Blvd. Suite 300 Walnut Creek, CA 94597 Address of Surety 925-988-2214 Phone # of Surety Sbirley Faiva Contact Person For Surety 1320-2 Payment Bond CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sacramento OnQ before me, J. Swalley Notary Public personally appeared 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 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. NLe. �1( •: Co!aA1.lt ii�2437 1 v� i ate \ NOW, 1 on uN 0.Nln �.� MV co" P. 11c;t 10. .010 Though the data below is not required by law, it may prove fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER ❑ PARTNER(S) ❑ MEMBER of LLC ❑ ATTORNEY -IN -FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR OTHER: I certify under PENALTY OF PURJURY under the laws of the state of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Si e of Not To persons relying on the document and could prevent DESCRIPTION OF ATTACHED DOCUMENT Title or Type of Document Number of Pages Date of Document SIGNER IS REPRESENTING: Signer(s) other than named above NAME OF PERSON(S) OR ENTITY(IES) . GREAT AMERICAN INSURANCE COMPANYO Administrative Office: 580 WALNUT STREET • CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740 lice number of persons authorized by this power of attorney is not more than ONE No. 014466 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than one is named, its true and lawful attorney -in -fact, for it and in its time, place and stead to execute on behalf of the said Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond, undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below. Name Address Limit of Power SHIRLEY PAIVA SACRAMENTO, CALIFORNIA $75,000,000.00 This Power of Attorney revokes all previous powers issued in behalf of the atmmey(s}in-fact named above. IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereurto affixed this 7& day of, MAY , 2009. Attest STATE OF OHIO, COUNTY OF HAMILTON - ss: GREAT AMERICAN INSURANCE COMPANY KITCHIN (513412-4602) On this 71h day of MAY , 2009, before me personally appeared DAVID C. KITCHIN, to me known, being duly mom, deposes and says that he resides in Cincinnati, Ohio, that he is the Divisional Senior Vice President of the Bond Division of Great American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his time thereto by like authority. This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated March 1, 1993. RESOLVED: That the Division President, the Division Senior Vice President, the several Divisional Vice Presidents and Dtvisiomd Assistant Vice Presidents, or any one of them, be and hereby is authorized, from time to time, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof; to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment at any time. RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary our Assistant Secretary of the Company may be affixed by facsimile to arty power of attorney or certificate of either given for the execution of airy bond, undertaking, contract or suretyship or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed CERTIFICATION 1, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect. Signed and sealed this 16th day of, February , 2010 S1029Y(10/08) WORKERS' COMPENSATION INSURANCE CERTIFICATE In accordance with California Labor Code Section 1861, prior to commencement of work on the Contract, the Contractor shall sign and file with the City the following certification: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." � . I C FO Title Date Workers Compensation 1330-1 1 ® A6 v CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDM/YY) 2/24/2010 PRODUCER (916) 932-2355 FAX: (916) 932-2356 Innovative Broker Services 101 Parkshore Dr, Suite 100 Folsom CA 95630 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND, EXTEND OR BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED J M Slover Inc 1630 Lotus Road Placerville CA 95667 INSURERA:United Specialty Ins CO 12537 INSURER B. Nationwide Mutual Ins Co 23787 INSURERC:Mt Hawley Insurance Company 37974 INSURER 0: 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 OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I IDD' POLICYNUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 1XI OCCUR C61000337 EA CH OCCURRENCE $ 1,000,000 A 5/11/2009 5/11/2010 DAMAGE TO RENTED PREMISE Ea.unnce $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2, 00,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aoaden ) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED AUTOS CP7813083175 10/13/2009 10/13/2010 SCH EDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) S NON -OWNED AUTOS PROPERTY DAMAGE (Per amidenU $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO $ EXCESS I UMBRELLA LIABILITY X OCCUR 0 CLAIMS MADE EACH OCCURRENCE $ 1 000,000 AGGREGATE $ 1 000 000 8 $ C DEDUCTIBLE M4K0312083 9/14/2009 5/11/2010 WC STATU- OTH- $ RETENTION $ O WORKERSCOMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYERTLIABILITY YIN ANY PROPRIETOWPARTNERIEXECUTIVE E.L. DISEASE - EA EMPLOYE $ OFFICEREMBER EXCLUDED? MI ❑ (Mandatory in NH) If yes, descbbe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Adams Park / Project No. 2009-06, Is Quinta, CA. will endeavor to provide 10 day notice of cancellation for nonpayment of premium. GENERAL LIABILITY: When required by written contract, certificate holder is additional insured per forms attached. Limits of liability are at policy inception. BUSINESS AUTO: When required by written contract, certificate holder is additional insured per form CA2048 attached. (760)777-1231 aguereque@la-quinta.org City of La Quinta Angela Guereque 78-495 Calls Tampico La Quints, CA 92253 ACORD25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 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 AUTHORIZED REPRESENTATIVE Anitra Koski/AK (D1988-2009 ACORD INS025 (20090I) - The ACORD name ana togo are regisrereu rnwaa er .,....— All rights reserved. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement 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 This Certificate of Insurance 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. 21 120091011 INS025(200WI) POLICY NUMBER: FEC61000337 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, 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, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. 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 b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 From: Sharon Harris At: Armstrong & Assoc. FaxID: To: Angela Guereque Date: 322010 01:48 PM Page: 2 of 3 JMSLOVE-01 HASH ACORDIM CERTIFICATE OF LIABILITY INSURANCE °A sit/ oio ) PRODUCER (530) 668-2777 Armstrong & Associates Insurance Services License # OB50501 P.O. Box 1270 Woodland. CA 95776-1270 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED JM Slover Inc. 1630 Lotus Road Placerville, CA 95667- INSURERA Southern Insurance Company INSURER B. INSURER C INSURER D. INSURER E' GIES 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. INSR LTRDATE DD'L l TYPE OF INSURANCEPOLICY NUMBER POLICY EFFECTNE 4MMIDDLYYI POLICY EXPIRATION DATE (MWDDWL LIMBS GENERAL LIABILITY COMMERCIAL GENERAL. LIABILITY CLAIMS MADE1-1 OCCUR EACH OCCURRENCE $ PREMISES(Ee cccurence $ MED EXP (Any one person) $ PERSONAL & PLO INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER POLICY PROT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED ALTOS COMBINED SINGLE LIMIT (Ea eccidanU $ BODILY INJURY (Per person) $ BODILY INJURY (Per ecsdenl) $ PROPERTY DAMAGE (Per acudenp $ GARAGE LIABILITY MY AUTO AUTOONLY- EAACCIDENT $ OTHER THAN EA ACC AUTO ONLY AGO $ $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILrrY ANY PROPRIETOR/PARTNERIEXECLTIVE OFFICER/MEMBER EXCLUDED? It yes, deecdbe under SPECIAL PROVISIONS bpOWL WS1001010302 3/1/2010 3/1/2011 WC STATU- OTI+ X TORY LIMITS ER L L. EACI IACCIDCIT ry 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS `10 Day Notice of Cancellation for Premium Non Payment Applies Re: Adams Park/Project No 2009-06 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of LaQUinta DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Attn: Angela Guereque NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO $O SHALL 78-495 Calle Tampico La Qu l nta, CA 92253- IMPOSE NO OBLIGATION OR UABILFTY OF ANY KIND UPON THE INSURER. RS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / ✓ 1 ACORD 25 (2001/08) U ACORD CORPORA I iO N 1988 From: Sharon Harris At: Armstrong & Assoc. FaxlD: To: Angela Guereque Date: 3/2/2010 01:48 PM Page: 3 of 3 JMSLOVE-01 HASH IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement 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 (2001108) PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: VERONICA J. MONTECINO, City Clerk AND WHEN RECORDED MAIL TO: CITY OF LA QUINTA Attn: Veronica J. Montecino P O Box 1504 La Quinta, CA 92247 DOC # 2010-0390071 08/17/2010 08:00R Fee:NC Page 1 of 2 Recorded in Official Records County of Riverside Larry W. Ward Assessor, County Clerk & Recorder 111111111111111111111111111111111111111III111111111II II S R U PAGE SIZE DA I MISC LONG I RFD I COPY a M A L 465 426 PCOR NCOR SMP NC EXAM UNI �v f6 T: CTY SPACE ......... . .... CORRECTED - NOTICE OF COMPLETION M FOR PLAYGROUND EQUIPMENT AT ADAMS PARK, PROJECT NO. 2009-06 1030 (THIS DOCUMENT IS BEING SUBMITTED FOR RE-RECORDING DUE TO INCORRECT VERBIAGE - ON PAGE 2 CHANGING "DAVE BANG ASSOCIATES" TO "JM SLOVER, INC") Title of Document THIS AREA FOR RECORDERS USE ONLY THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION 03.00 Additional Recording Fee Applies) PLEASE COMPLETE THIS INFORMATION RECORDING REQUESTED BY: VERONICA J. MONTECINO, CMC, City Clerk AND WHEN RECORDED MAIL TO: CITY OF LA QUINTA Attn: Veronica J. Montecino P. 0. Box 1504 La Quinta, CA 92247-1504 NOTICE IS HEREBY GIVEN: SPACE ABOVE FOR RECORDER'S USE ONLY NOTICE OF COMPLETION 1. That the interest or estate stated in paragraph 3 herein in the real property herein described is owned by: The City of La Quinta, California, a Municipal Corporation, organized and incorporated pursuant to the laws of the State of California. 2. The City Clerk of the City of La Quinta is authorized and directed to execute, on behalf of said City, any and all Notices of Completion. 3. That the nature _of the life. of the stated owner, or if more than one owner, then of the stated owner and co -owners is: In Fee. 4. That on the 20tb day of July 2010, a work of improvement on the real property herein described was completed. 5. The public work improvement is described as follows: Playground Equipment at Adams Park, Project No. 2009-06. 6. The name of the contractor for said work of improvement was: JM Slover, Inc. 7. The property on which said public work of improvement was completed is in the City of La Quinta, County of Riverside, State of California, and is described as follows: 44-425 Adams Street. DATED: July 21, 2010 CITY OF LA/dUINTA, CALIFORNIA , TITLE: STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ► I hereby certify that I am the City Clerk of the governing board of the City Council of the City of La Quinta, the political subdivision which executed the foregoing notice and on whose behalf I make this verification: that I have read said notice, know its contents, and that the same is true. I certify under penalty of perjury that the foregoing is true and correct. Executed at La Quinta, California. VERONICA J�NTECINO, City Clerk City of La Q nta, California