Three Peaks Corp/ LQ Park Restrooms 16NX611041MIC11
CONTRACT
THIS CONTRACT, __ by e ee the CITY OF LA QUINTA,
municipal
corporation, rein referred as ity," and ThreeCorp, herein referred o as,
"Contractor."
I
In consideration oftheir mutual covenants, the parties hereto agree as follows:
Contract
1-1
Department of Industrial Relations website at http://www.dir.ca.gov/Public-
Works/PublicWorks.htmi.
Pursuant to Labor Code section 1771 .1, no contractor or subcontractor may be listed on
bid proposal fora public works project submitted on or after March 1, 2015 unless
registered i the Department of Industrial Relations. Furthermore, all bidders and
contractors are hereby notified no contractor or subcontractor may be awarded, on or
after April 1, 2015, a contract for public work on a public works project unless registered
with the Department of Industrial Relations.
Pursuant to Labor Code section 11 all bidders are hereby notified i roject is
- subject o compliance monitoring and enforcement by the Department of Industrial
Relations.
7 Concurrently'with the execution of this Contract, Contractor shall furnish bonds o
surety satisfactory to City, as provided in said Specifications or Invitation to Bid, the
cost of which shall be paidy Contractor.
. Except for the gross negligence or willful misconduct of an -Indemnified Party (as
hereinafter defined), the Contractor hereby assumes liability for and agrees to defend (a
Indemnified Paries' option), indemnify, protect and holdharmless City and its Project
Consultants, and Engineers, officers, agents, and employees ("Indemnified Par ies") from
and against any and all claims, charges, a a s, demands, actions, proceedings, losses,
stop notices, costs, expenses (including counsel fees), judgments, civil fines and penalties,_
liabilities of any kind or nature whatsoever, which may be sustained or suffered by or
secured against the Indemnified Pari s arising out of or encountered in connection with
is Contract or the performance of the Work including, u not limited o, death of or
bodily or personal injury to persons or damage to property, including ro ery owned y or
under the care and custody of City, and for civil fines and penalties, that may arise from or
e caused, in whole or in part, by any negligent or other act or omission of Contractor, its
officers, agents, employees or Subcontractors including, but not limited o, liability arising
from:
1 . _Any dangerous, hazardous, unsafe or defective condition of, in or on the
premises, of any nature whatsoever, which may exist by reason of any act,
omission, neglect, or any use or occupation of the premises by Contractor, its
officers, agents, employees, or subcontractors;
2. Any operation conducted upon or any use or occupation of the premises by
Contractor, its officers, agents, employees, or subcontractors under or pursuant
to the provisions oft is contract or otherwise;
. Any act, omission r negligence of Contractor, its officers, agents, employees,
or Subcontractors;
4. Any failure of Contractor, its officers, agents or employees to comply itany
of the terms or conditions of this Contract or any applicable federal, state,
regional, or municipal law, ordinance, rule or regulation; an
:_ The conditions, operations, uses, occupations, acts, omissions or negligence
referred o in Sub -subsections O, O, (3), and (4), existing or conducted upon
or arising from e use or occupation by Contractor on any other premises in
the care, custody and control of City.
TheContractoralso agrees o indemnify City and pay for all damages or less suffered y
City including u not limited to damage to or loss of City property, tote extent not
insured by City and loss of City revenue from any source, caused by or arising out oft e
conditions, operations, uses, occupations, acts, omissions or negligence referred to in Sub -
subsections (1), (2), (3), () and O.
Contract 1 -2
Contractor's obligations under this Sectionapply regardless of whether or not such claim,
charge, damage, demand, action, proceeding, loss, stop notice, cost expense, judgment,
civil fine or penalty, or liability was caused in part or contributed to by an Indemnified
Party. However, without affecting the rights of City under any provision oft is contract,
Contractor shall not be required to indemnify and holdharmless City for liability
attributable to the active negligence of City, provided such active negligence is determined
y agreement a een the parties or by the findings of a court of competent jurisdiction.
In instances where City is shown to have been actively negligent and where ity's active
negligence accounts for only a percentage of the liability involved, the obligation o
Contractor will be for that entire portion or percentage of liability not attributable to the
active negligence of City.
Contractor agrees to'obtain executed indemnity red tints with provisions identical to
those set forth here in this section from each and every subcontractor or any other person
or entity involved by, for, with or on behalf of Contractor in the performance of this
contract. In the event Contractor fails to obtain such indemnity obligations from others as
required ere, Contractor agrees to be fully responsible accor i tote terms of this
section.
Failure of City to monitor compliance with these requirements imposes no additional
obligations on City and will in no way act as a waiver of any rights hereunder. This
obligation to indemnify and defendCity as set forth here is binding on the successors
assigns or heirs of Contractor and shall survive the termination of this contract or this
section.
is -indemnity shall survive termination of the Contract or Final Payment hereunder. This
Indemnity is in addition to any other rights or remedies that the Indemnified aries may
have under the law or under any other Contract Documents or Agreements. In the event
of any claim or demand made against any party which is entitled to be indemnified
hereunder, City may, in its sole discretion, reserve, retain or apply any monies to the
Contractor under this Contract for the purpose of resolving such claims; provided,
however, City may release such funs if the Contractor provides City with reasonable
assurance of protection of the Indemnified Paries' interests. City shall, in its sole
discretion, determine whether such assurances are reasonable.
Approval of any insurance contracts y the City does not relieve the Contractor or
subcontractors from liability under Section - ,Indemnification of the Specifications.
e City will not be liable for any accident, loss, or a ge tote work prior to its
completion and acceptance.
®retract 13-.3
than a rate of pay provided by law for more -than 8 hours in any one calendar day and 44
ours in any one calendar ee, in violation of the provisions of Sections 1810-1815 o
e Labor Code of the State of California.
11. In acceptinq 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 e religious creed, color,national
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 $1,607.00 liquidated
damaqes for each such breach committed under this contract.
12i Contractor also agrees that for contracts in excess of $30,000 and more than 20
calendar days duration, that apprentices will be employed without discrimination in an
approved program in a ratio established in the apprenticeship standards of the craft
involved(Sectionsr; 1777.6, Labor Code r.. California).Contractors ♦!
willfully fail to comply will be denied the rightR bid on public projectsR period of
monthsaddition tr otherpenalties provided by law.
1. This Contract shall not be assignable y Contractor without the written consent o
City.
1. Contractor shall notify the City Engineer (in writing) forthwith e the Contract is
deemed completed.
15. In accepting is Contract, Contractor certifies that no member or officer of the fir
or corporation is an officer or employee of the City except tot e extent permitted by law.
- _16. Contractor certifies that i _ is the holder of any necessary California State
Contractor's License and authorized to undertake ove work.
17. e 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 II 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.
18. e Contractor shall maintain and preserve all such records for a periodof at least
three years after termination of the contract.
19. The Contractor shall maintain all such records in the City of La Quints. 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 audit at a location other
an at City offices including, u not limited o, such ition I (out of the City) expenses
for personnel, salaries, riv to auditors, travel, lodging, is and overhead.
20. e further terms, conditions, and covenants of the Contract are set forth in the
Contract Documents, each of which is by this reference made a partere.
®retract 1300-4
WHEREOF,IN WITNESS r this Contractof dates
below.stated
CaliforniaCITY OF LA QUINTA '
i t
4 Digitally signed by Frank J.Spevacek
DN: sera lNumber=g8z17znM0w4d3x,
`'.c=US, st=California, I=La Quinta, o=Frank
7J. Spevacek, cn=Frank J. Spevacek
Date: 2016.04.27 13:09:48-07'00'
Frank J. , t _ Manager
ATTEST: Digitally signed by Susan Maysels
,,..-. DN:serialNumber=j4r7111g1ppsr45f,c=US,st=California,[=La Quinta,o=Susan
:Maysels, cn Susan Maysels
Date: 2016.04.28 09:28:45-07'00'
Dated:
Susan Maysels, City Clerk
APPROVED AS TO FORM:
r
t
City Attorney
corporation, affix
Dated:
m
signature '
i ,—
priest name
Address:__
street address city Mate zip code
signature
i
print name
Address:
street address city state zip cede
Contract 1 -
Bond Number: 390514P
Premium: $4,049.00
Premium is for contract term and subject
to adjustment based on final contract price.
SECTION 1310
IT RI _ ..FO,y w . ..__ rON__
KNOW ALL MEN BY THESE PRESENTS:
THAT the City of La Quinta, a municipal corporation, hereinafter designated the
City, has, on March 1, _216, awarded to Three ks Corp, hereinafter designated as
the Principal, a Contract for Project No. ®1 , La Quinta Parkestro and,
WHEREAS, said Principal is required under the terms of said Contract to furnish a
bond for the faithful performance of said Contracts
THEREFORE, we, the Principal, and Developers Surety and Indemnity Company
Surety, are held and firmlybound unto the City �. t and
l amount
„�, vw,vw._, � a�
Yin the just rtd a#I ar�oiant of Two Hundred
and Three Thousand, Two Hundred and Thirty® ix Dollars and Zero Cents ($ 3, 3 , )
lawful money of the United States, for the payment of which sum well and truly to be
crude, we bind ourselves, our heirs, executors, administrators, and successors, jointly and
severally, firmly by these presents,
THE CONDITION F THIS OBLIGATION IS SUCH, that if said Principals his or its
heirs; executors, administrators, successors, or assigns, shall in all thins stand to and
abide by, and well and truly keep and faithfully perform the covenants, conditions, and
agreements ire the said contract and any alterations crude 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 to 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 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 Contract or to the
work or to the specifications, Said Surety hereby waives the previsions of Sections 2819
and 2845 of the Civil Code of the State of California.
Faithful Performance Boom 1 1 -7
IN WITNESS WHEREOF, the Principal and Surety have executed this instrument
under their seals this 22nd
day of
2016, 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,
Three Peaks Corp.
Principal
(Seal)
S gnature for Prin
I 2j2 pat
Title of S--ig-,n-,a,,-to,—ry---
Developers Surety and Indemnity Company
Surety
(Sea[)
ty
Maria Guise
Attorney -in -Fact
Title of Signatory
500 S. Kraemer Blvd., Suite 300
Brea, CA 92821
(714) 784-5660
Phone f Surety
Debra Bell
Con"i`iic;—tPerson --f o' r- Su —rety
Faithful Performance Bond 7310-2
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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 ro�Orange
On MAR 2 2 2016 before me, i Apodaca, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Maria Guise
Narrie(s) of Signer(s)
......... .. 1-111, 11 1-11, - ... . ......
who proved to me on the basis of satisfactory evidence to be the person(!} whose narrie(is/
subscribed to the within instrument and acknowledged to me that Wshe/ my- executed the same in
lft/her/tM authorized capacity(kx), and that by bWherAbdo- signature( o on the instrument the personW,
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.
JERI AtOADA�CA 0 08
Commission # 2081689
Z Notary Public - California Signature 04 ry Public
orange County�m,e dot
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this forin to an unintended document,
Description of Attached Document
Title or Type of Document: Document Date:
Number of Pages: __ Signerfs) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name. -
Corporate Officer — Title(s):
Partner — F - ', Limited '�. i General
Individual X Attorney in Fact
Trustee Guardian or Conservator
'Other:
Signer Is Representing:
Signer's Narne:
Corporate Officer — Title(s):
Partner — Limited General
Individual Attorney in Fact
Trustee Guardian or Conservator
Other:
Signer Is Representing:
. .. . ......... .... - -----
02014 National Notary Association - www. National Notary org - 1-800- US NOTARY (1 -800-876-6827) ltem#5907
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
INDEMNITY COMPANY OF CALIFORNIA
PO Box 19725, IRVINE, CA 92623 (949) 263-3300
KNOW AIL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETYAND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each
hereby make, constitute and appoint:
***James A. Schaller, Jeri Apodaca, Rhonda C. Abel, Kim Lou, Rachelle Rheault, Nanette Myers, Mike Parizino; Maria Guise, jointly or severally —
as their true and lawful Attorneys) -in -Fact, to make, execute; deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of
suretyship giving and granting unto said Attorneys) -in -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as
each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorneys) -in -Fact, pursuant to these
presents, are hereby ratified and confirmed.
This Power of Attorney is granted and is signed by facsimile udder and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008.
RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the
corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf of the
corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized
to attest the execution of any such Power of Attorney;
RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such
Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking
or contract of suretyship to which it is attached
IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by
their respective officers and attested by their respective Secretary or Assistant Secretary this January 29, 2015.
By _ _ 14 AND Pe: P y
Daniel Young, Senior Vice President f �Zost
F� S
w r OCT. OCT. 5
By: _ -,w 1 9 3 8 1967
Cy
Mark Lansdon, Vice -President /OYV� trFO
A notary public or other officer completing this certificate verifies only the iddntity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy; or validity of that documen#.
Stake of California
County of Orange
On _ ._ Jqr to 2?t15 m..n. before me, .-. ..w.. _- -- Lu _illlle Raymonp i�otaryPublic_ _:. Date _ Here OmssrR dame and Title of the Officer
personally appeared .. - �: _.. �. _ <:_ _ �w BJaniel Yoy2 R ejL Lansdon
Name(s) of 9igner{s)
1
who proved to me on the basis of satisfactory evidence to be the persons) whose names) islare subscribed
to the within instrument and acknowledged to me that helshelthey executed the same in his/her/their authorized j
capacity(ies), and that by hislherttheir signature(s) on the instrument the person(s), or the entity upon behalf of
LUCILLE RAYWND which the person(s) acted, executed the instrument -
Commission issiox
Notary Putiflic - California I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
Orange County true and correct,.
M Coddra.xIr 411
..:WITNESS my hand and official seal.
Place Notary Seal Above Signature __ .._
Lucill y ond, Notary Public
CERTIFICATE
The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby
certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of
said corporations set forth in the Power of Attorney are in force as of the date of this Certificate.
This Certificate is executed in the City of Irvine, California, this 22nd day at March 2016
w
By...._
Cassrr f rrrsictci, Ass+,Crr:t Sc t rr
ID-1380(Rev.01/15)
Bond Number: 390514P
Premium included in Performance Bond
SECTION 1320
MENT� BON_ ...n,
KNOW ALL MEN BY THESE PRESENTS:
THAT the City of La Quinta, a municipal corporation, hereinafter designated the
City, has on March 15, 2016, awarded to Three Peaks Corp, hereinafter designated as the
Principal, a Contract for Project No. ®1 ® La Quinta Parks roo
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 band will pay the same to the extent hereinafter set forth:
NOW, THEREFORE, we, the Principal, and Developers Surety and Indemnity Company a
Surety, are held and firmly bound unto the City in the just and full amount of Two Hundred
and Three Thousand, Two Hundredn Thirty -Six Dollars and Zero Cents 3, )
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 Principals 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 kited 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 onto are amount not exceeding the amount hereinaove set forth, and also
will pay in ease 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 therm or their assigns in any suit brought upon this bond.
And the said Surety, for value received, hereby stipulates and agrees that n
change, extension of time, alteration, or addition of the terms of the Contract or to the
work to be performed thereunder or the specifications accompanying the same shall, in
any way, affect its obligations of this band, 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 onto the specifications. Said Surety hereby waives the provisions of Sections 2819
and 2845 of the Civil Code of the State of Californian
Pay am Bond 1320-1
IN WITNESS WHEREOF, the Principal and Surety have executed this instrument
their is
t
ay of
2016, a, name .. corporate
corporate party being hereto ai and these presents duly signed by its undersigned
representative, pursuant to authority of its governing body.
Three Peaks Corp,
Principal
(Seal)
M��
Signature for Prim ipal
Title of Signatory
Developers Surety and Indemnity Company_
ww_._ .w _ ..., .-..�.._�............
Surety � vu w.
teal)
_ignture f®r Surety ro..m
Maria Guise
Attorney -in -Fact
Title �f Slr�atry
500 S. Kraemer Blvd,, Suite 300
Brea, GA 92821
A sil dre es of Surety
(714)784-5660
Phone # of Surety
Debra Bell
b—oh-t—a-at Person for Surety
Payment Bond 1 20-2
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
% isi Sfih as&
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,
_— .............. . .. , ........ ....... 111-11-11-1-- .... . ..... 111111111 _11_____,_ ---- 11-11--_ __,_ , __ I'll, I'll - - 1-1-11-1— ___ __ ___-]
State of California )
County of w._..v uOrange �
n _2016 2 2 before e, of t Apodaca, Notary Public Date Here insert Name and Title of the Officer
personally appeared . Maria Guise
..,.. ,.. . . _.... .. .
Name(s) ofSigner(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(a) isAme
subscribed to the within instrument and acknowledged to me that Wshe/tmy executed the same in
Xft/her/VM authorized capacity( ), and that by hWherAbetr signature(s) on the instrument the peraonW,
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 truce and correct.
CA WITNESS ray hand and official seal.
�, JERI APQDA
Commission 2081689
Notary Public - Galifornla Zz
Orange County >Signature„
comet. ��a6res act 1, 2018
f Nora l bfi
Place Notary Seal Above
OPTIONAL .
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document,
ment,
Description of Attached Document
Title or Type of Document:. _.. ....,,, ,.rc Document Gate;
Number of Pages: _ Signer(s)�.� .,. ,..... b
Other Than Named Above;
apacity(ies) Claimed by Signer(s)
Signer's Name:__,_ nm.,�.
Corporate Officer -
Partner — tJ Limited General
Individuai X Attorney in Fact
Trustee Guardian or Conservator
Other:
Signer Is Representing
Signer's Marne . .... ,, ..w�
Corporate Officer — Titl (s)n ..... �,..�
Partner --- Limited General
Individual Attorney in Fact
Trustee Guardian or Conservator
Other.
Signer Is Representing:
@2014 National Notary Association - www,National Notary .org ®1-600-US NOTARY (1-600-876-6827) Item 5907
POWER OF ATTORNEY FOR
INDEMNITY COMPANY OF CALIFORNIA
PO Box 19725, IRVINE, CA 92623 (949) 263-3300
KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each
hereby make, constitute and appoint:
***James A. Schaller, Jeri Apodaca, Rhonda C, Abel, Kim Luu, Rochelle Rheault, Nanette Myers, Mike Parizino, Maria Guise, jointly or severally —
as their true and lawful Attorneys) -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of
suretyship giving and granting unto said Aterney(s)-in -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as
each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attorneys) -in -Fact, pursuant to these
presents, are hereby ratified and confirmed,
This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY
AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January lot, 2008.
RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice -President, Senior Vice -President or any Vice President of the
corporations be, and that each of them hereby is, authorized to execute this Power of Attorney, qualifying the attorney(s) named in the Power of Attorney to execute, on behalf ofthe
corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized
to attest the execution of any such Power of Attorney;
RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such
Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking
or contract of suretyship to which it is attached,
IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by
their respective officers and attested by their respective Secretary or Assistant Secretary this January 29, 2015,
PO
By: A ND ANyo
'PO So
ent 1
Daniel Young, Senior Vice-Presid10
Z
OCT. CT, 5
OR- 2 0
By: 0 1 936 C) 1967
as
- - ------------ - -- CA
Mark Lanscon, Vice -President Jlow PIF-
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the no t
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document,
State of California
Counts of Orange
On ----------- - ---- --499At!fY,&-ZQ1§ - ---------------- -- before me, ' G
Date fte Insert Name and The or the Officer
personally appeared _..nu Daniel Young andark Lansdan
Name(s) of egrens}
who proved to me on the basis of satisfactory evidence to be the person(s) whose names) 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 shmature(s) on the instrument the percents), or the entity upon behalf of
LUCILLE RAYM01 which the person(s) acted, executed the instrument.
LUCILLE RAY"N' Commission # 20181n,9.45
Public
C� Ilf"(112
Notary Public California I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
Z L ge CCIU
M Comm.Orange County true and correct.
1 0 13 20� 18
M CEx Ires Oct 13, 2018
WV� WITNESS my hand and official seal,
Place Notary Seal Above Signature
Lucill y and, Notary Public
CERTIFICATE
The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby
certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of
said corporations set forth in the Power of Attorney are in force as of the date of this Certificate,
This Certificate is executed in the City of Irvine, California, this 22nd day of March 2016
By:
Lassie J. .rrisfortl, Assistant Se racy
ID-1380(Rev.01/15)
. ....... . . ......
SECTION 1330
WOR TE
In accordance with California Labor Code Section 186 1, prior to commencement of or
on the Contract, the Contractor all sign and file with the it the following certification:
"I am aware of the provisions of Section 3700 of the Labor Code is 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 oft work ofthis contract®"
Signature
Title --
bate
Workers Compensation Insurance CerIffic,
�Ok
LIABILITY
1.0 INDEMNIFICATION
Except r the
grossnegligence or - _if_ I misconduct of _an IndemnifiedParty
(as hereinafter defined), the Contractor hereby assumes liability
agrees to defend (at Indemnified Parties' option), indemnify, r ct and hold
harmless City and its Project Consultants, and Engineers, officers, agents,
and employees ("Indemnified Parties") from and againsty and all claims,
charges, s, demands, actions, proceedings, losses, stop notices,
costs, expenses (including couns s), judgments, civil fines
penalties, liabilities of any kindr nature whatsoever, which may be
sustained r suffered by or secured againstIndemnified Parties arising
out of or encountered in connection ith this Contract or the performance
the Work including, but not li i o, death of or bodily or personal injury
persons or damage to property, including pro r owned by or under the
care and custody i y, and for civil fines and penalties, that may arise
from or be caused, in wholein part, by any negligentr other act or
omission o r c r, its officers, s, employees or Subcontractors
including, t limited , liability arisingfrom:
. Any dangerous, hazardous, unsafef c i condition o, in or o
the premises, f any natures v r, which may exist by reason
any c, omission, I c, or any user occupation of the premises
y Contractor, its officers, s, employees, or subcontractors;
2. y operation conducted or any use or occupation f the
premises y Contractor, its off icrs, agents, employees, or
subcontractors r or pursuant to the provisions oft is contract or
otherwise;
3. y act, omission or _negligence of Contractor, its _ officers, agents,
employees, or Subcontractors;
4. Any failure of Contractor, its officers, agents or employees o comply
with any of the terms or conditions oft is Contract or any applicable
federal, state, regional, r municipal law, ordinance, rule or regulation;
and
. The conditions, operations, uses, occupations, acts,_ omissions or
negligence referred to in Sub -subsections ), (2), (3), and (4),
existing r conducted r arising froms r occupation y
Contractor on any other premises in the care, custody control of
City.
The Contractor lso agrees to_ indemnify i y for all damages or loss
suffered by Cityincluding but not limited or loss of City
property, to the extentt insured i loss of City revenue r
source, caused by or arisingconditions, operations, s,
occupations, acts, omissions or negligence referred in Sub-subsectio
(1), (2), (3), ) and (5).
Liability and Insurance Requirements 134-1
Contractor's obligations er this Section apply regardless e r or
of such i , caction, roc i , loss, stop notice,
cot expense, judgment, civil fine or penalty, or liability was caused in part o
contributed o by an Indemnified r. However, without affectingthe
rights City under any- r vi i of this Contract, Contractor shall not be
required to indemnify of harmless City for liability attributable to the active
negligenceof City,provided cactive negligence is determined by Contract
between the partiesr by the findings of a court of competent jurisdiction.
In instances r ity is shown to have beenc iv ly negligent and where
i y's active negligenceaccounts for only a percentageof the liability involved,
the obligation of Contractor will- oentire portion or percentage of
liability not attributableactive negligence of City.
Contractor __ agrees to obtain_ executed indemnity are_ ents with provisions
identical to thoseset forth herein thissection rom each and every
subcontractor or any other personentity involved by, for, with or on
behalf of Contractor in rf r c this Contract. In the event-
c fails i indemnity obligations r r required
re, Contractor agrees to be fully responsible acco i r s oft is
section.
Failure of City to _monitor compliance with these _ requirements imposes
additional i t s on Cityill in no way acts a waiver of any rights
hereunder. This obligation to indemnify iy as set forth hereis
binding cc s rs, assigns or heirs of Contractor and shall survive
e termination oft is Contract or this section.
i_ indemnity shall survive termination of the Contractor Final
hereunder.is Indemnity is in additionr rights or remedies that
the Indemnified Parti s may have under the law or under any other tr c
Documents or Agreements._ In the event of any claim
againsty party whichis entitled e indemnified r r, City may, i
its sole discretion, reserve, retain or apply any monies to the Contractor
under this Contract forte purpose of resolving c claims; r vi ,
however, City may release such s if the Contractor providesCity with
reasonable assuranceprotection f the Indemnified Parties' interests.
City shall, in its sole discretion,r i e whether such assurances are
reasonable.
_ Approval of anyinsurance contracts by the City
_ relieve the
Contractor _ or subcontractors r i ili r Section 1340-1.0,
Indemnification. The Cityill not be liable r any accident, loss, or damage
o the workprior to its completion and acce .
Liability and Insurance _Requirements 1340-2
2.0 INSURANCE REQUIREMENTS
2.1 General
Priorto the beginningand throughout r ti of the Work,
Contractor ill maintain insurance in conformance withthe requirements set
forth below.t ct r will use existingcoverage to comply i
requirements. If that existingcoverage does not meet the requirements
forthr, it willo so. Contractor acknowledges that the
insurance coverage and policylimits set forth in thissection constitute the
minimum t ofcvr required. insurance rc s available t
City in excesslimits coverage required in thiso tr c is
is applicableiv loss, ill be availableCity.
_Contractor shall submitcoverage vri is tic for review r l by the
City upon executionof the Contract.
The Notice to Proceedi _ r r this Contract.....ill not be is
and the Contractor shall not commence oruntil such insurance
approved the City. The Contractor shall not allowsubcontractors
commence r its subcontract til all similar insurance it the
subcontractor i verified ct r. Such insurance
shall remain in full force and effectt all times during the prosecutionthe
Work and until the final completion and acc c thereof.
The _tic _ to Proceednot relieve tr _cr of the dutyobtain
such insurance s required by ParagraphINSURANCE
u_
REQUIREMENTS.
_
Contractor ll provide the_ i types
_ amounts_insurance:_ _
2.2 Commercial Generals _ ity Pqliqy
_ Commercial General Liability Insurance usi s r Services f is
"Commercial General Liability" policy form1 or the equivalent.
Defensecosts must be paidin additionlimits. i
Two Million Dollars ($2,000,000) per occurrence for all covered losses and
no less than Four Million , ,general
Contractor's pois shall contain rs is limiting coverage
the sic policy coverage t for any of the following:
. Explosion, Collapse _ r Underground H_ r i
b. Products Completed r ti s.
C.
Pollution i i i
d. Contractual liability.
_ Coverage ll be applicablto Cityr injury to employees. contractors,
subcontractors or others involved in the project. Policy shall ors to
provide separate limit lice to this r ct
2.3 Workers' Corn Insurance
Liability and Insurance Requirements 1 -3
Workers' Compensation on a state -approved_ policy or r _vi i statutory
benefits as required ith employer's liability limits less than
$1,000,000 per accident for all covered ss s®
. BBusiness; f ' olio
Business Auto Coverage Business Auto_ _ Coverage f
92 including symbof 1 (Any ) or the equivalent.Limits shall be no less
than $1,000,000r accident, combined i I limit. If Contractor owns no
vehicles, this it t may be satisfied
endorsement to the generalliability licdescribed above.
2.5 Excess or Umbrella Li flit ° Insurance
Excess or Umbrella iability Insurance (Over Primary) i_used
limit
requirements,s I vi coverage least as broad as specified for the
underlying v c coverage rovi umbrella liability
policy shall include rop down provisionr vi i i r coverage for
liability t covered by primary but covered by the umbrella.Self-insured
retentions are of permitted. Coverageshall be provided
behalf" basis, with defensecosts payablein itipolicy limits. There
shall cross liability xc ion precluding coy r for claims r suits by
one insured i s r. Coverage shall be applicableCity for injury
o employees of Contractor, subcontractors or othersinvolved in the Work.
The scope coverage pr i is subject to approvalifollowing
receipt t insurance as required herein. Limits are subject review
t in no event less than $1,000,000 per occurrenceto
Insurance_ procured pursuant__ to these requirements shall rit _ insurers that
are authorizedcarriers in the state li r ia and'with an A.M. Best rating
r better and a minimumi ci I size of VII.
Contractor and _ City agrees follows:
._Contractor agrees to endorsethird r Commercial r Liability
coverage required r i o include ii insureds i, its officials,
agents,employees and and County, its officials, employees and agents,
using standard rs . CG 2010 withedition
or equivalent._ Contractor also agrees to require ( contractors,
subcontractors, and anyone else involved in any way withproject
contemplated by this agreement to do likewise.
Liability and Insurance a uire ents 13 ®4
2. Any waiver of subrogation _ express _ r implied n the part of City_ to any
partyinvolved in thisContract or related is applieso
extent of insurance proc c y paid. City, having required it be
named s an additionalinsured o all insurance coverage i r i
expressly retains the right to subrogate againstfor sums not paid
y insurance. or its part, Contractor agreesto waivesubrogation rights
againstiy regardless c applicability of any insurance proc s, and t
require contractors, c or others involved in anyy with
the project(s) contemplated by thisContract, to do likewise.
3. All insurance coverage mai_ _ i ed r _procuredContractor or required
others by Contractorr i Contract shall be endorsed
the subrogation condition as to City, or to specifically r t r
others providing insurance herei iye subrogation prior to a loss. This
endorsement shall be obtaineds of existingis r i t
y appear to allowsuch iv rs.
is _agreed by Contractor and City_ that insurance provided
_ to _ these
requirements is not intended ry to be limitedproviding coverage
for the vicarious liability i, or to the supervisory role, if any, of City.
II insurance coverage provided pursuant i r Contract
(express or implied) in any way relating o City is intended to o the
-full extentof the policiesivv i referred or contained i
y Contractiyvi it in relation rc()contemplated by this
Contractis intended to be construedlimit the applicationinsurance
coverage in any way.
5. None of the coverages required herei _ _ ill be in compliance _with these
requirements if they include i iiendorsement of any kinds
not been first submitted to Cityy f in writing.
6. i coverage types andlimits required ar subject rov 1, modification
and additional requirements y the City, as the need arises.Contractor shall
not make any reductions in scope coyerage (e.g. elimination of
contractual liability r reduction f discovery period) that may affectiy's
protection it o f ity's prior writtenconsent.
7. Proof of compliance w_i _ these insurance it e t , consisting of b
iti i __
ers
of coverage, or endorsements, or certificates insurance, t the option
City, shall be deliveredCity at or prior to the executioni r c.
In the event suchr insurance is not deliveredas required, r i
the event such insurance is canceled i replacement
coverage is provided, City has the right, but not the duty, to obtain
insurance it deems necessaryto protectits interests under this or any other
agreement and to pay the premium.i so paidy City shall be
chargedo and promptly paid by Contractor or deducted fromsums due
Contractor, ioption.
Uabi/ity and Insurance a it ants 134 -
8. Contractor r s to endorse, and to require _others to endorse, the
insurance provi rs " rat to theserequirements, e itwritten notice
to City and the appropriate tender prior to cancellation of suc liability
coverage and no is rial alteration of non -renewal of any such
coverage, require contractors, subcontr ors, and any other partyi
y way involved wi e project contemplated by this Contract
likewise.
9. It is acknowledged by the parties of is Contract that all insurance coverage
required r i e y Contractor or any subcontractor, is intended to
apply first and on a primary non-contributing basis in relation to any other
insurance or self-insurance av it ity.
10. Contractor re s to ensure subcontractors, and
_any other y
involved i the projectis brought onto or involved in the projecty
contractor, rcvi same minimuminsurance coverage it
Contractor. r cor agrees to monitor and review such coverage
assumes all responsibility for ensuring that such coverage is providedi
conformity with the requirements is section. a r t r agrees
request,upon all agreements with subcontractors others engaged in the
project will be submitted i for review.
11. Contractor agrees not to self -insure_ or to use any self -insured retentions or
deductibles on any portion of the insurance required r i further
agrees that it will not allow any contractor, subcontractor, iea ,
Engineer or other entity or person in any way involved in the performance
work on the projectcontemplated y this Contract to self -insure its
obligations ity. If contractor's existing coverage includes ci
self -insured retention, e deductible or self -insured e timust be
declared tote City. _At that time it' shall review options i the
contractor, is include reduction r elimination of the deduci I or
self -insured retention, substitution other coverage, or other solutions.
12. The City reserves _c right y time_ during r f the "contract to
change the amounts and types of insurance requitgiving the
Contractor i et ( s advance writtenis of suchchange. If such
change results in substantial addiia cost to the Contractor, the City will
negotiate additionalcompensation pro ri to the increased benef
City.
13. For purposes of yi_ _ insurance _ coverage , all contracts pertaining to
the project ill be deemedexecuted i izeactivity
commences in furtheranceof performanceis Contract.
14. Contractor acknowledges and agrees that any actual or allegedfailure
part of City to inform o c r of non-compliancei insurance
requirement in no way imposes y additional obligations on City nor does i
waive any rights hereunder in this or any other regard.
Liability and Insurance _ Requirements 1 40-
15. Contractor will renew the required y rage annually as long as City, or its
employeesr agents face an exposurer r ti type pursuant
to thisContract. This obligationapplies whether or not the Contracti
canceled terminated reason. The insurance shaI include
be limited completed r ticns and disconti
operations, r licable. Termination of thi li i is not effective
untili executes a writtenstatement to that effect.
16. Contractor s_ t_ waive_ its statutory immunity r any workers'
compensation statute r similar statute, in relation to the city, and to require
all subcontractors y other person or entityinvolved in the project
contemplated is Contract to do likewise.
17. Requirementsf specific coverage featur r intended as limitations on
other requirements r as a waiver of anycvr or llprovided
given policy.Specific reference to a givencoverage feature is for purposes
of clarification only as it pertains to a givenissue, is not intended
partyr insured to be all-inclusive.
18. Any provision in any of the construction c is dealing withthe
insurance coverage i s t to these requirements issubordinate
o and superseded by the requirements contained r i. These insurance
requirements ar intended to be separate and distinctr
-
provision in t i tr ct and areintended the partiesto be
interpreted as such.
19. All liability coverage_ provided _ according to _theserequirements t_ be
endorsed provide r limit for -the projectis the
subject of this tr evidencing c completed operations
coverage for not lesst two years after issuance icertificate of
occupancy ri to government agencies or acceptancethe
completed work by City.
20. Contractor agrees to be responsible r ensuring that no contract
y party involved in any way withproject reserves the rightto charge
City or Contractor for the cost of additional insurance coverage it
is Contract. Any such r vi ions are to be deletedi r cCity.
It is not the intent o it reimburse it for the cost of
complying ith these requirements. re shall be no recourse i sCity
r payment of premiumsr amounts with respect thereto.
21. Contractor agrees s t iprovide it copy of Professional
Liability coverage r itec s or Engineers, if any are workingis
project r Contractor. City shall determine the liabilitylimit.
The Contractor r vi immediate rit _ tic _t _ City _f any change i
terms conditions and/or reduction in the coverage r to the
insurance policies. The noticeI t t® Frank J. Spevacek, City
Manager
City i_ t
78-495 Calle Tampico
La Quinta, CA 92253
Liability and Insurance Requirements 1 m7
DATE (MMIDDNYYY)
122/201
CERTIFICATE OF LIABILITY INSURANCE
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, TE D OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE (S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
I PORTA T® If the-cortlflcate holder is an ADDITIONAL INSURED, the olicy(los) must be endorsed. If SUBROGATION IS WAtVED, su f act 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
lrrtificats holder In lieu of such etldoIrsor on A .
PRODUCER _ >n^C'$NTACT Rachel Sliya
WhitneyInsurance Services Inc. rFIsNE w_ PAx
5800 51611 S 13U { 616 41551 g31
Stanford ch Road, Suite 320a•n1AIL
Rocklin, car hlttlyfattkIfTranc®acorn
License 3 INauEAyr1I}11scNNvERAela Nralc
r U
INSURED N FAILI -W, t- _I
ree asks r URINsuRERc
PO X 1 1 tNs�RER e
Callmesa, CA 92320NsuR�O a,
COVERAGES CERTIFICATE R: 00000000-0 REVISION NUMBER: 1
THIS IS TO CERTIFY THAT THE POLICIES OF iN UR NCE LISTED BELOW HAVE SEEN fSSUED TO THE INSURED NAMEDABOVEFOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY RECILPREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT @MITI"{ RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIALD HEREIN IS SUBJECT`TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POUCIE LUDS SHOWN Y HAVE BEEN REDUCED BY PAM Ci AIM&
. mm 1(, m
i SR TYPE OF INSURANCE AOR SUBS Pd3L.ICY EFF POLICY E1(p
IIf �..�.�..r�t�Ltcv NI�Iss� LlMlrs
COMMERCIAL GENERAL LIABILITY000669951 03l10/2016 03/10/2017 EACHoCCURRENCE s 1 I# w
occuR
CLAIMS -BADE ®aK&1Tz F ' ti,
h -�� k _ ro
MED 5EJAy RAp rL.0 1000
PErtiNALAD I N I V RY °00
i
GENL AGORWATF LIMIT APPLIES PER. GENERAL 60 REGATE 1 2 QQ01Q0L
tPLI JPc� ❑ LQCtTTGLIrs r1PIaPuIa $ 2Eiill
En.
AUTOMOBILE LIABILITY^^^
ANY AUTO
BAW56649887 06/17/2015 0611712016 .,SOOfLMAiIlfLI
YIIf`d&INJURY (Pe
NJURY(PerB,Pow)
ow .,..:$
LALLWNED ,SCHEDULEDBODILYINJURY(Pera swl) $S AUTOS
NON -OWNED EPEYOPfA IAUTQS AUTOS Rll,____$$� .,m.. _
UMBRELLA LIAR11XICLAIMIS4AADE
CCUR 27303664 03110/2016 0311012017 .EACH OCCURRENCE
mm m2 #�Ot� OQ
EXCESS LIAS
A GRE AT .,L.._. _ 2 00
DEG -NII N
WORKERS COMPENSATION PER CT
AND EMPLOYERS' LIABILITY YIN LLra1V " ._..,�. ---
ANY PROPRIETOWPAR`l"NFRJEXECUTIVE NIA
A C L Eri#:;H t1.DC.l[SENT $
OF'FICEaMME3dd�ER, EXCk,Uf:EO1
(Mi rklatm IP fil I s L J} rASE . EA r F PLOYI S ;
fiyyaw elascaltraoaxk0r ,M �-�, w,.
0 RIPTI{ N OF OtPE%ATiC7Na sir E,L DISEASE POLICY UM1I ,
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aPtaohod If more space Is required)
City of La Quints is named additional insured.
Project Location: Blackhawk Way & Adams Street, La Quinta, CA 92253.
CERTIFICATE HOLDER CANCELLATION
ATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City LL&i t THE EXPIRATION DATE THEREOF, NOTICE ILL BE DELIVERED IN
y O a ACCORDANCE WITH THE POLICY PROVISIONS,
78-495 Calls Tampico
La Quinta, CA 92263 AUTHORIZED REPRESENTA E
33- 44 AC D CORPORATION, All rights reserved. ;
ACORD 2 (2014/01) The ACORD name and logo are registered marks of ACORD
Printed by RJS on March 22, 2016 at 12:34PM
POLICYNUMBER: 1 000659951
THIS ENDORSEMENT CHANGESTHE POLICY, PLEASE
IT CAREFULLY,
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS -
APARTMENTS AND ALL CONSTRUCTION OTHER
THAN RESIDENTIAL DEVELOPMENT- SCHEDULED
PERSON OR ORGANIZATION
This endorsement modified insurance „provided under the following;
COMMERCIAL GENERAL LIABILITY
SCHEDULE
Name iti n l Insured Per () Covered CompletedOperations
r r a i ti {®
Where required by written contract or written All non-residential construction projects of the
agreement, Named Insured.
Infdrrnatinn re uirdd k a c rnpletd ties Sohedui , if ncl shown above -will be shown in the Declarations,
SECTIONA. N - Who Is An Insured is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property
damage" caused, in whole or In part, by "your work", as described in the schedule of this endorsement
performed for that additional insured and included In the products®completed operations hazard" as
described in the Covered Completed Operations, schedule above,
B. The insurance provided to the additional insured under this endorsement is limited as follows;
Covered Completed Operations shown in the schedule above shah not include "residential
development" of any description,
C. For the purposes of this endorsement, the following is added to the Other Insurance Condition and
supersedes any provision to thecontrary;
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to the
additional Insured designated in the Schedule, provided that,
(1) The additional insured is a Named Insured under such other insurance; and
() You have agreed In writing in a contract or agreement that this insurance would be primary and
would not seek contribution from any other insurance available to the additional insured,
D. The following definitions are added to SECTION V ® DEFINITIONS of this Policy:
"Residential development" means a structure or structures, Including the land upon which It is situated,
designed or intended for occupancy in whole or in part as a residence by any person or persons,
"Residential development' does not include "apartments" or "apartment buildings,"
I
"Apartments" eans one or more rooms of a buildingused as a dwellingunit separate from others i
the building andwhich are rented from others by those dwelling In them.
"Apartments building" means a structure containing two or more separate "apartments,"
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
Includes copyrighted material of Insurance _ Services Office, inc., with its
9
MC2
g
p
I
M
i
s
037U -12 Page 2 of
POLICY _NUMBER: 00065951
i_
THIS T CHANGES THE POLICY. PLEASE READ 1T CAREFULLY.
ADDITIONAL INSURED - I
LESSEES OR
I
OWNERS,
WRITTEN CONTRACT OR AGREEMENT -
APARTMENTS AND ALL CONSTRUCTION OTHER
CONTRACTORS (SCHEDULED) -WHEN REQUIRED IN
THAN RESIDENTIAL DEVELOPMENT
i
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITYj
SCHEDULE
Name Of Additional! r r n(s) Covered Operations
Or r i ati O:
Where required by written contract or written All non-residential construction projects of the
agreement, Named insured.
g
Inforrnatlon re sired to corn 6eto t6his cdulosf rot shown above ;,will'e shown in the Declarations
A. SECTION I o Is An Insured is amended to include any person or organization shown in the
Schedule for which you are required to Include as an additional insured on this policy by written
contract or written agreement in effect during this policy period and executed prior to the "occurrence"
of the bodily injury" or "property damage," Coverage provided such additional insured Is only with
respect to liability for "bodily injury" "property damage" or "personal and advertising injury" caused, in
whole or In part, by:
k
1, Your acts or omissions; or r
_C
2, The acts or omissions of those acting on your behalf, I
k
In the performance of your ongoing operations for the additional,insured(s), providing that; j
your work" or "your product" related to Covered Operations shown in the Schedule above, is other
than "residential development" of any description,
With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply: „
This Insurance does not apply to "bodily injury" or "property damage" occurring after;
1 o 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
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,
i
C.
For the purposes of this endorsement, the following Is added to the Other Insurance Condition and
supersedes any provision to the contrary:
Primaryand NoncontributoryInsurance
This insurance ss pri ary o n rii not seek contnuMon from any other Insurance available c the
additional insured designated in the Schedule, provided that:
) The additional insured is a NamedInsured under such other insurance; and
You have agreed in writing in a contract or agreement t this insurance would be primary and i
would not seek contribution from any other insurance available to the additional insured, {
The following definitions are added to SECTION V — DEFINITIONS of this policy"
"Residential development" means a structure or structures, including the land upon which it is situated,
designed or intended for occupancy in whole or in part as a residence by any person or persons, I
"Residential development" does not include "apartments" or "apartment buildings,"
"Apartments" eans one or more rooms of a building used as a dwelling unit separate from others in the
building and which are rented from others by those dwelling in thern,
"Apartments building" means a structure containing two or more separate "apartments,"
a
ALL OTHER
TERMS _ CONDITIONS I LI_REMAIN
I
Includes copyrighted material of Insurance Services Office, Inc., with its
permission,
i
i
I
t
}
4
1OU 09-12 Page 2 of
I
POLICY ®_ 000691
THIS ENDORSEMENT CHANGES THE POLICY._ _ iT
ADDITIONAL INSURED - SPECIFIED
RESIDENTIAL HOUSING
Name f Additional Insured Rerson(siDescriptionLocation----
Or
I i
residential si "l i ( )
Where required by written contract or written All "residential housing" projects of the Named
agreement, insured,
j_
SECTION t s An Insuredis amended to include any person or organization you are
required to include as an additional insured on this policy by written contract or written agreement
in effect during this policy period and executed prior to the "occurrence" of the "bodily injury" or
®"property damage,®,
The insurance provided to the additional insured under this endorsement is limited as follows:
1. The parson or organization scheduled above' is only an additional insured with respect to
liability which is imputed to such additional insured arising solely out of ;
a. "your work" or "your product", and
, with respect to "residential housing,"
2. In the event that the Limits of Insurance provided by this policy exceed the Limits of
insurance required by the written contract or written agreement, the insurance provided by
this endorsement shall be limited to the Limits of Insurance required by the written contract or
written agreement, This endorsement shall not increase the Limits of insurance stated in the E
Declarations, I
3. This insurance does net apply to "bodily injury" or "property damage" arising out of "your
work" or "your product" included in the "products —completed operations hazard" unfess you �
are required to provide such coverage by written contract or written agreement but only for k
the period of time required by the written contract or written agreement and only for "bodily
injury" or "property damage" that occurs during the policy period arising out of "your work" or
"your product"
4, Any coverage provided by this endorsement to an additional insured shall be excess over
any other valid and collectible insurance available to the additional insured whether primary,
excess" contingent or on any other basis,
& Where no coverage under this policy shall apply for the Named Insured, no coverage or
defense shall be afforded to the additional insured, „
, This Insurance does not apply to "bodily injury" or "property damage" arising out of the sole
negligence of the additional insured, ;
it
4
y
AP2209US 04-10 Page I of 2
ENDORSEMENTTHIS CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
The following definitions are added to SECTIONDEFINITIONS f this policy:
"'Residential housing" means a structure or structures,
Including the land upon which it is situated,
designed or intended for occupancy in whole or In part as a reWdence, by any person or persons,
'Residential housing", does not Include "apartments"or'apartment buildings,'
"Apartments" means one or more roams of a building used as a dwelling unit separate from
ethers in the building and which are rented from others by those dwelling in there. i
I
"Apartments building" means a structure containing o or more separate "apartments,"
L OTHER
i
f'
,
k
E
1
22 9US 04-10 Page 2 of
LICY m 0006991
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFEULLY,
WAIVER OF SUBROGATION AS REQUIRED. BY
P"
CONTRACT
This n rs nt modifies insurance provided under the following;
r
ALL COVERAGE PARTS
n Company agrees to waiveany right orecovery against any person or organizaWn, as
required by written contract, because at payments make for injury or damage which is limited
to liability directly caused b 'your work" which 16 imputed to such person ®r organization,
ALL OTHER TERMS AND "CONDITIONS OF THE POLICY REMAIN
UNCHANGED.
a
i`
k
F
a
9
i
n
{
04U 11-06 Page 1 of 1
DATE (MM/DD/YYYY)
4/13/2016
f' i . .. , f. .-fir:: , ! •' , f, i
not • .. rightsto the certificate holderof ♦•
-*RCIDUCER OnPointd •
8390 E Crescent Pkwy, Suite 200
Greenwood Village, CO 80111
INSURED
Barrett Business Services, Inc. L/C/F
THREE PEAKS CORP.
13046 BURNS LANE
REDLANDS, CA 92376
COVERAGES CERTIFICATE NUMBER:
CONTACT NAME: Steven McComb
PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699
EMAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIL #
INSURER A: ACE American Insurance Company 22667
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
ISSUES OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iNSR
TYPE OF INSURANCE
ADDL SUBR
POLICY NUMBER POLICY EFF POLICY EXP
LIMITS
LTR
INSR WVD
(MM/DD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
OCCUR
CLAIMS -MADE 1=1
DAMAGE TO RENTED PREMISES (Ea
occurence)
$
$
MED EXP (Any one person)
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
$
POLICY PROD- LLOC
PRODUCTS - COMP/OP AGG
%
ECT
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
ALL OWNED AUTOS AUTOS
BODILY INJURY (Per person)
$
[]SCHEDULED
HIRED AUTOS NON -OWNED AUTOS
BODILY INJURY (Per accident)
$
$
PROPERTY DAMAGE
$
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
$
EXCESS LIAB .:.00CUR
AGGREGATE
$
DED RETENTION $
$
A
WORKERS COMPENSATION AND EMPLOYERS'
RWC 09/01/15 09/01/2016
`/ WC STATU- I JOTH-
LIABILITY Y/N
C48550113
TORY LIMITS ER
ANY PROPRIETOR/PARTNER/ EXECUTIVE
OFFICER/MEMBER EXCLUDED? Y
(Mandatory in NH) If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A Y
Covered states:
CA
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$2,000,000
$2,000,000
$2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to
the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of La Quinta
EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
POLICY PROVISIONS_
WITH THE
78495 Calle Tampico
AUTHORIZED REPRESENTATIVE
La Quinta CA 92253
Richard Poling
c) 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD.
AGENCY CUSTOMER ID:
LOC: #:
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMEDINSURED
Barrett Business Services, Inc.
OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200
Vancouver WA 98662
POLICY NUMBER
RWC C48550113
CARRIER
ACE American Insurance Company
NAIC CODE
22E EFFECTIVE DATE: 09/01/15
ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved,
The ACORD name and logo are registered marks of ACORD.
Named Insured
Endorsement Number
BARRETT BUSINESS SERVICES, INC. L/C/F
THREE PEAKS CORP.
Policy Number
8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662
Symbol: RWC Number: C48550113
Policy Period
Effective Date of Endorsement
09-01-2015 TO 09-01-2016
09-01-2015
Issued By (Name of Insurance Company)
ACE AMERICAN INSURANCE COMPANY
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of
the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect
to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract
to obtain this waiver from us.
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
1. Specificr-,T"aiver
Name of person or organization:
X ) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this
waiver.
411111111111150-TOW-01115 M11
The premium charge for this endorsement shall be 2.0 percent of the California premium developed
on payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium: $0
��-
Authorized Agent
to
MEMORANDUM
TO: Frank J. Spevacek, City Manager
Leonard r, Construction Manager/inspection Supervi r
Am Jon i Development Director/City Enins
Ed i r, Engineering isPrincipal i r
Susan Maysels, CityDATE: March 28, 2016
RE: La i t Park Restroorn
Project
TO: Susan Maysels, City Clerk
FROM: Leonard R. St. Sauver, Public Works Construction Manager
Via: Tim Jonasson, Design and Development Director/City En lneer"-
Ed Wimmer, Engineering Services Principal Engineer
DATE: August 5, 2016
RE: Contract Change Order No. 1
La Quinto Park Restroom
Project No. 2013-12
Attached for your signatures is one (1) original Contract Change Order No. I between Thr
Peaks Corp. and the City of La Quinta for the project referenced above. I
This Contract Change Order allows for the installation of an electrical transformer required to
power the bathroom.
.',,lease sigh and return both originals to the City Clerk for final distribution.
REQUESTING DEPARTMENT TO CHECK THE ITEMS BELOW AS APPROPRIATE:
Authority to execute this agreement is based upon:
—X— Department Director's signature authority provided under Contract Change Order Policy Contracts
under $5,000.00
The following Budget Summary is provided:
Project Budget $ 273,224
Testing, Survey, Inspection & Plan Costs ($ 51,075)
Original Contract Amount ($203,236)
Contract Change Order No. 1 ($ 3,900)
Balance Remaining $ 15,013
FIX AUT 1M
I
Sheet 1 of 2
CONTRACT: Lo Quinta Park Restroorn
PROJECT NO. 213-12
CONTRACTOR:
1025 .,
Calimeso, Co. 92320
CONTRACT CHANGE ORDER NO.1
Pursuant to the terms of the original Contract Agreement, you are hereby directed to make the herein described changes or
do the following described work not included in the plans and specifications for this Contract. Unless otherwise stated all
work shall conform to the terms, general conditions, and special provisions of the original Contract.
SCRIPTION OF CHANGE
Contract Change Order allows for the furnishing and installation of an electrical transformer $
Ori final Contract Amount $ 203,236.00
.Add This Chan a Order No. i S 3.900.00
Revised Contract Total L 207,136.00
By reason of this contract change order the time of completion is adjusted as follows: -0- days added/deleted to contract time.
The revised contract completion date shall be: 11/ 08/16
Submitted'y:
Approved 03r.
overhead exp®ncoc fnr nnv rlalnwt
Accepted BY` Title. r
•
Contractor. ate,
THREE PEAKS C
THREE PEAKS CORP.
Po Box I ol
CALIMESA, CA 9232o
909.522.2219
erik ala)jtthfreggggg�♦ !
TO CITY OF LA QUINTA
LEONARD ST. SAUVER, CM/INSPECTION SUPERVISOR
78495 CALLE TAMPICO
LA QUINTA, CA 92253
QUOTE
LA QUINTA PARK DUE UPON RECEIPT
QUANTITY DESCRIPTION UNIT PRICE LINE TOTAL
1.00 ACME TRANSFORMER, MODEL: T-2-53518-3S $ 1,503.00 $ 1,503.00
1.00 ,BREAKER $ 469.00 $ 469.00
INSTALLATION LABOR $ 1,278.00 $ 1,278M
SUBTOTAL $ 3,250.00
PO 650.00,
TOTAL $ 3,900.00
QUOTATION PREPARED BY: ERIK SIMMONS
THIS IS A QUOTATION ON THE GOODS NAMED, SUBJECTTO THE CONDITIONS NOTED ABOVE. THE PERSON ACCEPTING
THIS QUOTATION ON BEHALF OF AN ENTITY REPRESENTS AND WARRANTS THAT HE/SHE HAS BEEN DULY AUTHORIZED TO
ACCEPTTHIS QUOTATION ON BEHALF OF SUCH ENTITY, AND THAT SUCH ENTITY IS FULLY BOUND.
TO ACCEPTTHIS QUOTATION, SIGN HERE AND RETURN:
® CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
8/8/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGRATION IS WAIVED,
subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does
not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER OnPoint Underwriting Inc.
8390 E Crescent Pkwy, Suite 200
Greenwood Village, CO 80111
CONTACT NAME: Steven McComb
PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C, NO): (360) 828-0699
EMAIL ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A:
ACE American Insurance Company
22667
INSURED
Barrett Business Services, Inc. L/C/F
THREE PEAKS CORP.
13046 BURNS LANE
REDLANDS, CA 92376
INSURER B:
INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
ISSUES OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
DAMAGE TO RENTED PREMISES (Ea
occurence)
$
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE E7 OCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PROJ- LOC
$
ECT
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
ALL OWNED AUTOS SCHEDULED AUTOS
BODILY INJURY (Per accident)
$
HIRED AUTOS NON -OWNED AUTOS
PROPERTY DAMAGE
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
OCCUR
AGGREGATE
$
DIED
RETENTION $
$
A
WORKERS COMPENSATION AND EMPLOYERS'
LIABILITY Y/N
RWC
C48821145
09/01/16
09/01/2017
V
WC STATU-
TORY LIMITS
OTH-
ER
E.L. EACH ACCIDENT
$2,000,000
ANY PROPRIETORIPARTNER/ EXECUTIVE Y
OFFICEWMEMBER EXCLUDED?
N / A
Y
Covered states:
E.L. DISEASE- EA EMPLOYEE
$2,000,000
(Mandatory in NH) If yes, describe under
DESCRIPTION OF OPERATIONS below
CA
E.L. DISEASE - POLICY LIMIT
$2,000,000
DESCRIPTION`OF OPERATIONS / LOCATIONS /:VEHICLES(Attach ACORD 101, Additional Remarks Schedule, if more space is required) - -
In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to
the Loss, insurer hereby agrees to also waive our right of recovery but only respect to such Loss.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of La Quinta
EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
78495 Calle Tampico
AUTHORIZED REPRESENTATIVE
La Quinta CA 92253
—�
Richard Poling
c) 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD.
AGENCY CUSTOMER ID:
LOC: #:
O AC�
ADDITIONAL REMARKS SCHEDULE Page 2 of 2
AGENCY NAMEDINSURED
Barrett Business Services, Inc.
OnPoint Underwriting Inc. 8100 NE Parkway, Suite 200
POLICY NUMBER Vancouver WA 98662
RWC C48821145
CARRIER NAIC CODE
ACE American Insurance Company 22667 EFFECTIVE DATE: 09/01/16
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14)
CERTIFICATE HOLDER: City of La Quinta
ADDRESS: 78495 Calle Tampico La Quinta CA 92253
WOS in favor of the City of La Quinta, its officials, officers, agents, employees and
volunteers. Re: La Quinta Park Restroom Project 2013-12
ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD.
Workers' Comoensation and Emnlovers' Liabilitv Policv
Named Insured
Endorsement Number
BARRETT BUSINESS SERVICES, INC. UC/F
THREE PEAKS CORP.
Policy Number
8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662
Symbol: RWC Number: C48821145
Policy Period
Effective Date of Endorsement
09-01-2016 TO 09-01-2017
09-01-2016
Issued By (Name of Insurance Company)
ACE AMERICAN INSURANCE COMPANY
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of
the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect
to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract
to obtain this waiver from us.
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
-- - --- - work -described in -the -Schedule.-
Schedule
Specific Waiver
Name of person or organization:
( X ) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this
waiver.
2. Operations:
ALL CALIFORNIA OPERATIONS
3. Premium:
The premium charge for this endorsement shall be 2 . 0 percent of the California premium developed
on payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described.
4. Minimum Premium: $ 0
Authorized Agent
99 03 22
Document-193151 1 -Page-1
Page 1 of 1
PLEASE COMPLETE THIS INFORMATION
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
CITY OF LA QUINTA
Attn: City Clerk
78-495 Calle Tampico
La Quinta, CA 92253
DOC # 2016-0414293
09/22/2016 03:07 PM Fees: $0.00
Page 1 of 2
Recorded in Official Records
County of Riverside
Peter Aldana '
Assessor -County Clerk -Recorder
**This document was electronically submitted
to the County of Riverside for recording**
Receipted by: MARIA#309
SPACE ABOVE FOR RE(
NOTICE OF COMPLETION
LA QUINTA PARK RESTROOM
CITY OF LA QUINTA PROJECT 2013-12
CONTRACTOR: Three Peaks Corporation
Title of Document
THIS PAGE ADDED TO PROVIDE ADEQUATE SPACE FOR RECORDING INFORMATION
Exempt Recording Fees per Government Code Sections 6103 and 27383
about:blank 9/23/2016
NOTICE OF COMPLETION
FILED BY THE CITY OF LA QUINTA, CALIFORNIA
NOTICE IS HEREBY GIVEN:
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 W" day of August 20,16, a work of improvement on the real property herein
described was completed.
5. The public work improvement is described as follows: La Quinta Park Restroom. City
Project No. 2013-12.
6. The name of the contractor for said work of improvement was: Three Peaks
Corporation.
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: Corner
of Blackhawk Way and Adams Street.
DATED: September 20, 2016 CITY OF LA O.UINTA, CALIFORNIA 11
BY: e - t�
TLE: Susan Maysels, City Clerk
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. -»
SUSAN MAYSELS, City Clerk
City of La Quinta, California