HomeMy WebLinkAboutCalifornia Pavement Maintenance Co, Inc. 2018-08-08Contract 1819096
CITY OF UKIAH
Mendocino County, California
AGREEMENT
FOR
SLURRY SEAL OF LOCAL STREETS
Specification NO. 18-02
THIS AGREEMENT, made this 8th day of August 20 18, by and between the City of
Ukiah, Mendocino County, California, hereinafter called the City and Caiifomia Pavement Maintenance Company, Inchereinafter
called the Contractor,
WITNESSETH:
WHEREAS, the City has caused to be prepared in accordance with law, specifications, drawings and other
contract documents for the work herein described and shown and has approved and adopted these contract
documents, specifications and drawings and has caused to be published in the manner and for the time required
by law a notice to bidders inviting sewed proposals for doing the work in accordance with the terms of this
contract and
WHEREAS, the Contractor, in response to the notice to bidders, has submitted to the City a sealed proposal
accompanied by a proposal guaranty in an amount of not less than 10 percent of the bid price for the construction
of the proposed work in accordance with the terms of this contract and
WHEREAS, the City, in the manner prescribed by law, has publicly opened, examined and canvassed the
proposals submitted and as a result has determined and declared the Contractor to be the lowest and best
regular responsible bidder for the work and for the sums named in the proposal,
NOW, THEREFORE, THIS AGREEMENT WITNESSETH:
Article 1. Work to be Done and Contract s Allow
That the Contractor shall provide all necessary machinery, tools, apparatus and other means of construction;
shall furnish all materials, superintendence, overhead, expenses, all labor and expenses of whatever nature
necessary for completion of the work in conformity with the Special Provisions and other contract documents
hereto attached and according to such instructions as may be given by the Engineer, The Contractor shall
complete the work within thirty (30) calendar days Contract days shall be counted starting with the 10th day
following receipt of notice that the contract has been executed by the City. Contractor, at his or her option, may
begin work prior to start of counting contract days, however, in no event shall the Contractor start work without
giving notification to the Engineer at least 72 hours prior to the start of work, without obtaining an encroachment
permit from the City, or without having submitted certificates of insurance that have been accepted and approved
by the Engineer
SLURRY SEAL OF LOCAL STREETS 47 Spec. NO. 18-02
Article 11. Contract Prices.
That the City shall pay the Contractor the prices stated in the proposal submitted by the Contractor, for complete
performance of the contract by the Contractor. The Contractor hereby agrees to accept the prices as full
compensation for all material and appliances necessary to the work, for all labor and use of tools and other
implements necessary to execute the work contemplated in this contract; for all loss or damage arising out of
the nature of the work or from the action of the elements, or from any unforeseen obstructions or difficulties
which may be encountered in the prosecution of the work; for all risks of every description connected therewith;
for all expenses of the work, as herein specified; for all liability and other insurance, for all overhead and other
expenses incident to the work; all according to the Contract Drawings, the Special Provisions, the Details, the
instructions and the requirements of the City.
Article III. Labor Discrimination.
Attention is directed to Section 1735 of the Labor Code, which reads as follows:
"No discrimination shall be made in the employment of persons upon public works because of the race,
color, national origin or ancestry, or religion of such persons and every contractor for public works
violating this section is subject to all the penalties imposed for a violation of this chapter_"
In connection with the performance of work under this contract, the Contractor agrees as follows:
(a) The Contractor will not willfully discriminate against any employee or an applicant for employment
because of race, color, religion, ancestry, or national origin. The Contractor will take affirmative
action to ensure that applicants are employed and that employees are treated during employment
without regard to their race, color, religion, ancestry, or national origin. Such action shall include,
but not be limited to, the following: employment, upgrading, demotion or transfer; recruitment or
recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and
selection for training, including apprenticeship, The Contractor agrees to post in conspicuous
places, available to employees and applicants for employment, notices to be provided by the
awarding authority setting forth the provisions of this Fair Employment Practice section.
(b) The Contractor will send to each labor union or representative of workers with which he or she has
a collective bargaining agreement or other contract or understanding, a notice, to be provided by
the awarding authority, advising the said labor union or worker's representative of the Contractors
commitments under this section, to employees and applicants for employment.
(c) The Contractor will permit access to his or her records of employment, employment
advertisements, application forms and other pertinent data and records by the Fair Employment
Practices Commission, City of Ukiah or any other appropriate agency of the State of California
designated by the awarding authority, for the purposes of investigation to ascertain compliance
with the Fair Employment Practices section of this contract.
(d) A finding of willful violation of the Fair Employment Practices section of this Contract or of the Fair
Employment Practices Act shall be regarded by the awarding authority as a basis for determining
the Contractor to be not a "responsible bidder' as to future contracts for which such Contractor
may submit bids, for revoking the Contractors pre -qualification rating, if any and for refusing to
establish, reestablish or renew a pre -qualification rating for the Contractor.
The City of Ukiah shall deem a finding of willful receipt of written notice from the Fair Employment
Practices Act to have occurred upon that it has investigated and determined that the Contractor
SLURRY SEAL OF LOCAL STREETS 48 Spec. NO. 18-02
has violated the Fair Employment Practices Act and has issued an order under Labor Code Section
1426 or obtained an injunction under Labor Code Section 1429.
Upon receipt of such written notice from the Fair Employment Practices Commission, the City shall
notify the Contractor that unless he or she demonstrates to the satisfaction of the awarding
authority within a stated period that the violation has been corrected, his or her pre -qualification
rating will be revoked at the expiration of such period.
(e) The Contractor agrees that should the City determine that the Contractor has not complied with the
Fair Employment Practices section of this Contract, then pursuant to Labor Code Section 1735 and
1775 the Contractor shall, as a penalty to the City, forfeit for each calendar day or portion thereof,
for each person who was denied employment as a result of such non-compliance, the penalties
provided in the Labor Code for violation of prevailing wage rates. Such monies may be recovered
from the Contractor. The City may deduct any such damages from any monies due the Contractor.
(f) Nothing contained in this Fair Employment Practices section shall be construed in any manner of
fashion so as to prevent the City or the State of California from pursuing any other remedies that
may be available at law.
(g) Prior to awarding the Contract, the Contractor shall certify to the awarding authority that he or she
has or will meet the following standards for affirmative compliance, which shall be evaluated in
each case by the awarding authority:
(1) The Contractor shall provide evidence, as required by the City that he or she has notified all
supervisors, foremen and other personnel officers in writing of the content of the anti -discrimination
clause and their responsibilities under it.
(2) The Contractor shall provide evidence, as required by the City, that he or she has notified all
sources of employees' referrals (including unions, employment agencies, advertisements,
Department of Employment) of the content of the anti -discrimination clause.
(3) The Contractor shall file a basic compliance report, as required by the City. Willfully false
statements made in such reports shall be punishable as provided by law. The compliance report
shall also spell out the sources of the work force and who has the responsibility for determining
whom to hire, or whether or not to hire.
(4) Personally, or through his or her representatives, the Contractor shall, through negotiations
with the unions with whom he or she has agreements, attempt to develop an agreement which will:
a. Spell out responsibilities for nondiscrimination in hiring, referral, upgrading and training.
b. Otherwise implement an affirmative anti -discrimination program in terms of the unions'
specific areas of skill and geography to the end that qualified minority workers will be available
and given and equal opportunity for employment.
(5) The Contractor shall notify the City of opposition to the anti -discrimination clause by individuals,
firms or organizations during the period of its pre -qualification.
(h) The Contractor will include the provisions of the foregoing paragraphs 1 through 5 in every first tier
subcontract so that such provisions will be binding upon each such subcontractor.
(i) The "Fair Employment Practices Certification" must be completed and signed prior to the time of
submitting the bid.
SLURRY SEAL OF LOCAL STREETS 49 Spec, NO. 18-02
Article IV. Parts of the Contract.
That the complete contract consists of the following documents, all of which shall be considered a part of this
agreement.
1. Notice to Bidders
2. Wage Rates
3. General Conditions
4. Technical Specifications
5. Proposal
6. Fair Employment Practices Certification
7. Agreement
8. Contract Bonds
9. Contract Drawings and Construction Details
10. Standard Drawings
11. Indemnification Agreement
IN WITNESS WHEREOF, this contract being executed in duplicate and the parties having caused their names
1-1*
to be signed by authority of their duly authorized office this t day of 11 b 1 , 20 I .
CITY OF UKIAH, MENDOCINO COUNTY, CALIFORNIA
By:
CM
Attest:
ITl
By:
Attest:
Title: Tina B.
I -
OF U
CLERK, CITY OF UKIAH
Taylor 1 Vice President
d
The foregoing contract is approved as to form and legality this -28 ^ day of Aw.. .2o t'�
C I T1' MzpeFfN EY, b TY O U iAH
SLURRY SEAL OF LOCAL STREETS 5Q Spec. NO. 18-02
INDEMNIFICATION AGREEMENT
This Indemnification Agreement is made and entered in Ukiah, California, on August 8 , 20 18,
by and between the City of Ukiah (Ukiah) and California Pavement Maintenance Company, Inc. (Contractor).
Contractor is
performing work as specified in Spec. No. 18-02 Slurry Seal of Local Streets
for Ukiah.
As a condition of issuing the work order, attached hereto, Ukiah requires assurance that Contractor will protect
Ukiah from damage or damage claims which arise from its performance of the work.
Accordingly, Contractor agrees as follows:
1. Indemnification. Contractor shall indemnify and hold harmless Ukiah and its officers, agents, and
employees from and against any claim, loss, or damage, including the legal and other costs of defending against
any claim of damage or loss which apses out of the Contractor's negligent or wrongful performance under the
work order attached hereto, except for claims, losses, or damages resulting from the sole and exclusive
negligence or other wrongful conduct of Ukiah or its officers, agents and employees.
CONTRACTOR
BY:
TITLE: Bruce 12y1or 1 Vice President _
SLURRY SEAL OF LOCAL STREETS 51 Spec. NO. 18-02
CONTRACT APPROVAL. & AUTHORIZATIOi TO PROCEED
NOTE. The City Manager will sign contracts once all initials have been signed.
TO: CITY MANAGER CONTRACT #:
SUBMITTED BY:
DATE: J-7 1
�1
PROJECT NAME: JLt�{Z,?� ��j(r�)(j z r )3-02—
S-0ZInitial
Initial Below
CHECKLIST & ROUTING FOR APPROVALS REVIEWED AND
APPROVED BY
1.
Procurement Manager
Sourcing method and justif" tion (attach documentation if necessary):
1-�—
City Council Approval Date: I
Agenda Item No!
Budget No(s).:
Note. Please attach post meeting staff report sho-.ving oppro✓a!, and
any documentation or description sh.;.v'ng fund ng.
2.
City Attorney
Note: if you have on en70:1 approvo; from the Qty Attorney. thea you may
attach a copy of the email and reference It in lieu of initials
3,
Risk Manager
(Vote: Attach Insurance aocuments.
4.
City Clerk
ADDITIONAL COMMENTS:
http://inet/risk/Contracts/Forms/Allltems.aspx
Bond No 106914819 M
CITY OF UKIAH
Mendocino County, California
DEFECTIVE MATERIAL AND WORKMANSHIP (MAINTENANCE) BOND
KNOW ALL MEN BY THESE PRESENTS.
That we, Californ a Pavement Maintenance Company. Irc dba CPM
as PRINCIPAL
and Travelers Casualty and Surety Company of America
as SURETY,
are held and firmly bound unto the City of Ukiah as Obligee, in the penal sum of
($ 5° f Final Contract Amount
(5 PERCENT OF THE FINAL CONTRACT AMOUNT)
to which payment well and truly to be made, we do bind ourselves, our and each of our heirs, executors.
administrators, successors and assigns jointly and severally, firmly by these presents.
WHEREAS, the said Principal entered into a Contract with the City Of Ukiah
dated August 8. 2018
for Shiag SPai of I nral Strepts Spn6firminn Nn iR-n7
WHEREAS, said Contract has been completed, and was approved on the 8th day of August_
2018
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall guarantee
that the work will be free of any defective materials or workmanship which become apparent during the period
of one (1) year following completion of the Contract, then this obligation shall be void, otherwise to remain in full
force and effect, provided however, any additional warranty or guarantee whether expressed or implied is
extended by the Principal or Manufacturer only, and the surety assumes no liability for such a guarantee.
Signed, sealed, and dated this stn day of August -,20 18
^arfcr,nia Pavement Mainte man , Inc. dba: CPM (Seal)
BY:.A—h A I L (Seal)
r
(Seal)
Principal
r r rx (Seal)
BY: i (Seal)
Stephanie Agapoff. Attorney -in -Fact (Seal)
Surety
SLURRY SEAL OF LOCAL STREETS 57 Spec_ NO. 18-02
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Sacramento )
On August 8 2018 before me, Kelly Marie Ponath, Notary Public
(insert name and title of the officer)
personally appeared Stephanie Agapoff
who proved to me on the basis of satisfactory evidence to be the person(-&) whose name(s) is/a-9
subscribed to the within instrument and acknowledged to me that he/she/" executed the same in
#+ether/04e4 authorized capacity(ies}; and that by 4WI-ierltheif signature(e) on the instrument the
person(s} or the entity upon behalf of which the person(s4 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.
Signature r i (Seal)
V -
17 KE1 L ARIE PONATN
COMM. E 2242541
W03ARY PL)OLIC CALMORNIA u
a COUNTY OF SACRAMENTO
COMM Erp1m K{Y 1512022
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
TRAVELERS J St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company and St.
Paul Fre and Marne Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein col.ectively cal.ed the
'Companies'), and that the Companies do hereby make, constitute and appoint Stephanie Agapoff, of Sacramento, California, their true and lawfu:
Attorney -in -f=act to s gn execute. seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obl gatory in
the nature thereof on beha'f of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts
and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF. the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, lh s 3rd day of February
2017.
`S•LlY .liyp f
Daft
e IUIOOOL VA
State of Connecticut
By.
City of Hartford ss. Robert L Raney. Se or Vice President
On this the 3rd day of February. 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company. and St. Paul Fire and Marine Insurance Company, and
that he. as such, being authorized so to do executed the foregoing instrument for the purposes therein contained by s-gmng on behalf of the corporations
by himself as a du'y authorized officer.
In Witness Whereof. I hereunto set my hand and official seal.
G
My Commission expires the 30th day of June, 2021
0� *gyp 1► Mane C Tetreaull, Notary Pub'ic
Th s Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casua'ty and
Surety Company of America, Travelers Casualty and Surety Company, and SI. Paul Fire and Marine Insurance Company. which resolutions are now ir
full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President. any Vice President any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of author ty may prescribe to s gn with
the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obl gatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company. provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal. if required) by
one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Sen or Vice President any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only
of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to wh.ch it is attached
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America. Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this em day of August , 2018
11R1�f+y ' JµSr ~'p♦
t Y I 101A Ma F MOR 0. 19
CONK
Kevin E Hughes, Assistant Secretary
To verify the authenticity of this Power ofAttorney, please call us at 1 800,421-3880.
Please refer to the above-named Attorney -In -fact and the details of the bond to which the power is attached.
Bond No. 106914819
CITY OF UKIAH
Mendocino County, California
FAITHFUL PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS,
That we the undersigned, California Pavement Maintenance Company,Inc. dba: CPM
AS PRINCIPAL, and
Travelers Casualty and Surety Company of America
AS SURETY,
are held firmly bound unto THE CITY OF UKIAH, hereinafter called the "City", in the penal sum of
One Hundred Ninety Eight Thousand One Hundred Eighteen and 191100 dollars ($9$,118.19 )
for the payment of which sum we bind ourselves, our heirs, executors, administrators, and successors, jointly
and severally.
WHEREAS, the Principal has entered into a certain Contract with the City, dated August 8 20 18
a copy of which is hereto attached and made a part hereof,
NOW, THEREFORE, the condition of this obligation is such that if the Principal shall in all respects fully perform
the Contract and all duty authorized modifications thereof, during its original term and any extensions thereof
that may be granted and during any guaranty period for which the Contract provides, and if the Principal shall
fully satisfy all claims, arising out of the prosecution of the work under the Contract and shall fully indemnify the
City for all expenses which it may incur by reason of such claims, including its attorney's fees and court costs,
and if the Principal shall make full payment to all persons supplying labor, services, materials, or equipment in
the prosecution of the work underthe Contract, in default of which such persons shall have a direct right of action
hereupon; and if the Principal shall pay or cause to be paid all sales and use taxes payable as a result of the
performance of the Contract as well as payment of gasoline and special motor fuels taxes in the performance of
the Contract and all motor vehicle fees required for commercial motor vehicles used in connection with the
performance of the Contract, then this obligation shall be void; otherwise, it shall remain in full force and effect.
No modification of the Contract or extension of the term thereof, nor any forbearance on the part of the City shall
in any way release the Principal or the Surety from liability hereunder. Notice to the Surety of any such
modification, extension, or forbearance is hereby waived
IN WITNESS WHEREOF, the aforesaid Principal and Surety have executed this instrument and affixed their
seals hereto, this 8th day of August 20 18
In the presence of:
WITNESS:
(SEAL)
(Individual Principal)
(Business Address)
(City/State/Zip Code)
SLURRY SEAL OF LOCAL STREETS 52 Spec NO 18-02
Travelers Casualty and Surety Company of America
. Travelers Casualty and Surety Company
TRAVELERS J St. Paul Fire and Marine insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America -ravelers Casualty and Surety Company, and St,
Pau' Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively caled the
'Compan es") and that the Companies do hereby make, constitute and appoint Stephanie Agapoff, of Sacramento, California, their true and lawful
Attorney in Fact to sign. execute, seal and acknowledge any and all bonds, recognizances, condiliona- undertakings and other writings ob'igatory in
the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guarantee ng the perfcrmance of contracts
and executing or guaranteeing bonds and undertakings required or permitted ;n any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February,
2017.
u'`00I I've#
e
COW 414M0L CONH. �
• �i *�a
State of Connecticut
City of Hartford ss Robert L. Raney, Se or Vice President
On this the 3rd day of February 2017 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casua'ty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such. being author zed so to do. executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized offcer
In Witness Whereof I hereunto set my hand and offiaa seal. at
My Commiss on expires the 30th day of June, 2021 t3uWt. C o
e * �p iY Marie C. Tetreault, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casually and Surety Company, and St. Paul Fire and Marine insurance Company, which resolutions are now in
full force and effect, reading as follows.
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President. the Treasurer, any Assistant Treasurer. the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power g ven h m or her; and it s
FURTHER RESOLVED that the Chairman the President, any Vice Charman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or emp oyees of this Company, provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary: and it is
FURTHER RESOLVED, that any bond, recognizance. contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shat be vaf d and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer any Ass stant Treasurer, the Corporate Secretary or any Assistant
Secretary and du y attested and seated with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by
one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written de;egation of authority, and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President. any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relat ng thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only
of executing and attesting bonds and undertakings and other writings oblgatory in the nature thereof. and any such Power of Attorney or certificate bearing
such facsim le signature or facsimile seal shall be va id and binding upon the Company and any such power so executed and certified by such facsimile
signature and facs'mile seal shall be valid and bind ng on the Company n the future with respect to any bond or understanding to which it is attached.
1, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by sa'd Companies, which remains in full force and effect.
Daled this 8th day of August , 218
u
«�
cow KAt
Kevin E. Hughes, Assi tant Secretary
To verify the authenticity of this Power of Attorney, please call us at 1-800-421-3880.
Please refer to the above-named Attorney -in -Fact and the details of the bond to which the power is attached.
Cal IPAV-Ai 2nnDlrri IG7
- i - - -
,a►coR� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIMY)
0811412018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the Policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CNRNACT
Warren G. Bender Co.
516 Gibson Drive
PHONE FAX
AIC, No. Et): (916) 380-5300 AfC, No :(916) 380-5206
X
Suite 240
Roseville, CA 95678
INSURERS AFFORDING COVERAGE MAIC M
INSURER A: Tokio Marine Specialty Insurance Company 23850
DAMAGE TO RENTED 50,000
INSURED
INSURER B: The Ohio Casualty Insurance Company 24074
INSURER C :AS en American 43460
California Pavement Maintenance Company, Inc. DBA CPM
INSURER D: Arch Insurance Company 11150
9390 Elder Creek Road
Sacramento, CA 95829
INSURER E: Travelers Property Casualty 25674
INSURER F: Admiral Insurance Company 24856
X
COVERAGES CFRTIFICATE NOMRFR- RFVISIAM NIIMRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
ADDL
SUER
-POLICY
POLICY EFF
POLICY EXPLTR
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
X Per job agg
GEN'L AGGREGATE LIMIT APPLIES PER.
POLICY jECT LOC
OTHER.
X
X
-NUMBER
PPK1798129
0313112018
0313112019
EACH OCCURRENCE S 1,000,000
DAMAGE TO RENTED 50,000
MED EXP (Any oneperson) 5,000
PERSONAL & ADV INJURY 1,000,000
GENERAL AGGREGATE 2,000,000
PRODUCTS -GOMPlOPAGG 2,000,000
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUT�OpS ONLY AUTOS p
AUTOS ONLY AUTOS ONLY
X
X
BA057355235
0913012017
0913012018
COMBINED SINGLE LIMIT$ 1,000,000
BODILY INJURY Per arson S
BODILY INJURY Per accident S
Pe�acadenl AMAGE $
C
X
UMBRELLA LIAB
Excess LIAR
X
I OCCUREACH
CLAIMS-MADe
CX005LMIS
0313112018
0313112019
OCCURRENCE S 10,000,000
AGGREGATE 10,000,000
DED RETENTION$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITYSIMUTE
ANY PROPRIETORIPARTNERrEXECUTIVE Y N
FFICERIMEMgER EXCLUDED? N
Mandatory In NH)
I[ Y@S, descrihe under
DESCRIPTION OF OPERATIONS below
N f A
X
WC19405301
1010112017
1010112018
X PER OTH.
ER
E.L. EACH ACCIDENT 1,000,000
E.L DISEASE - EA EMPLOYE 1'000'000
1,000,000
E.L DISEASE - POLICY LIMIT
E
F
Installation 1 Build
Pollution
6601790N527
FEI-ECC-10506-05L
0913012017
09/3012017
0913012018
0913012018
50,000
$1,000,000 OccurlAgg 2,000,000
DESCRIPTION OF OPERATIONS !LOCATIONS !VEHICLES {ACORD 101, Additional Remarks Schedule. ma be attached if more space Is required)
Ri_. Slurry Sea] of Local Streets, Specification No. 18.021 Various Streets within the lIty
Additional Insured per attached endorsment(s): The City of Ukiah, its officers, officials, employees and volunteers
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
City of Ukiah �1
all west clay street
ISan Ramon, CA 95482
ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER PPK1798129
COMMERCIAL GENERAL LIABILITY
CG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Project(s):
WHERE REQUIRED BY WRITTEN CONTRACT
Information required to co fete this Schedule if not shown above. will be shown in the Declarations.
A. For all sums which the insured becomes legally
3. Any payments made under Coverage A for
obligated to pay as damages caused by "occur-
damages or under Coverage C for medical
renes" under Section I — Coverage A, and for all
expenses shall reduce the Designated Con -
medical expenses caused by accidents under
struction Project General Aggregate Limit for
Section I — Coverage C, which can be attributed
that designated construction project. Such
only to ongoing operations at a single designated
payments shall not reduce the General Ag -
construction project shown in the Schedule
gregate Limit shown in the Declarations nor
above:
shall they reduce any other Designated Con-
t. A separate Designated Construction Project
struction Project General Aggregate Limit for
General Aggregate Limit applies to each des-
any other designated construction project
ignated construction project, and that limit is
shown in the Schedule above
equal to the amount of the General Aggregate
4. The limits shown in the Declarations for Each
Limit shoavn in the Declarations
Occurrence, Damage To Premises Rented To
2. The Designated Construction Project General
You and Medical Expense continue to apply
Aggregate Limit is the most we will pay for the
However, instead of being subject to the
sum of all damages under Coverage A, ex-
General Aggregate Limit shown in the Decla-
cept damages because of "bodily injury" or
rations, such limits will be subject to the appli-
"property damage" included in the "products-
cable Designated Construction Project Gei-
completed operations hazard', and for medi-
eral Aggregate Limit
cal expenses under Coverage C regardless of
the number af:
a. Insureds:
b. Claims made or "suits!' brought; or
c. Persons or organizations making claims or
bringing "suits"
CG 25 03 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 2 13
13. For all suras which the insured becomes legally
obligated to pay as damages caused by "occur-
rences" under Section I — Coverage A, and for a'I
medical expenses caused by accidents under
Section I - Coverage C, which cannot be attrib-
uted only to ongoing operations at a single des-
ignated construction project shown in the Sched-
ule above:
1. Any payments made under Coverage A for
damages or under Coverage C for medical
expenses sha!I reduce the amount available
under the General Aggregate Limit or the
Products -completed Operations Aggregate
Lim;t, whichever is applicable; and
2. Such payments shall not reduce any Desig-
nated Construction Project General Aggre-
gate Limit
C. When coverage for liability arising out of the
"products -completed operations hazard" is pro-
vided, any payments for damages because of
"bodily injury" or 'property damage" included in
the 'products -completed operations hazard" will
reduce the Products -completed Operations Ag-
gregate Limit and not reduce the General Ag-
gregate Limit nor the Designated Construction
Project General Aggregate Limit.
D. If the applicable designated construction project
has been abandoned, delayed, or abandoned
and then restarted, or if the authorized contract-
ing parties deviate from plans, blueprints, de-
signs, specifications or timetables, the project will
still be deemed to be the same construction pro-
ject
E. The provisions of Section iii — Limits Of Insur-
ance not otherwise modified by this endorsement
shall continue to apply as stipulated
Page 2 of 2 0 Insurance Services Office, Inc.. 2008 CG 26 03 05 09 ❑
POL'CY NUMBER. I PPK1798129
COMMERCIAL GENERAL LIABILITY
CG 20 37 Del 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization s
Location And Description Of Completed Operations
WHERE REQUIRED BY WRITTEN CONTRACT
WHERE REQUIRED BY WRITTEN CONTRACT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
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" at the location designated and
described In the Schedule of this endorsement
performed for that additional insured and
included in the "products -completed operations
hazard'.
However.-
1.
owever:1. The insurance afforded to such additional
Insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
Insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide fbi such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance;
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown in the Declarations.
CO 20 37 04 13 0 Insurance Services Office. Inc., 2012 Page 1 of 1
POLICY NUMBER: PPK1798129
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following -
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Locations Of Covered Operations
WHERE REQUIRED BY WRITTEN CONTRACT
WHERE REQUIRED BY WRITTEN CONTRACT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions, or
2. The acts or omissions of those acting on your
behalf',
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above_
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. 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. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 110 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional Insured is the
amount of insurance -
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less_
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 *Insurance Services Office, Inc., 2012 CG 2010 0413
Policy Number PPK1798129
PRIMARY AND NON-CONTRIBUTORY INSURANCE
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
A. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITION, 4. Other Insurance, and all subparts
thereof, as contained in the policy Is deleted in its entirely and replaced with the following condition:
4. Other Insurance
If all of the other insurance permits contribution by equal shares, we will follow this method unless the
insured is required by written contract signed by both parties, to provide insurance that is primary and
noncontributory, and the "Insured contract" is executed prior to any loss. Where required by a written
contract signed by both parties, this insurance will be primary $ non-contributing only when and to the
extent as required by that contract.
However, under the contributory approach each Insurer contributes equal amounts until it has paid its
applicable limit of Insurance or none of the loss remains, whichever comes first. If any of the other
insurance does not permit contributory by equal shares, we will contribute by limits. Under this method,
each insurer's share is based on the ratio of its applicable limit if insurance to the total applicable limits of
insurance of all insurers.
All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain
unchanged.
COMMON POLICY CONDITIONS
WI Coverage Parts included .n this policy are cubtect to the following conditions.
A. Cancellation
1. The first Named Insured shown in the Declare
bons may cancel this policy by mailing or del!-
vering to us advance written notice of cancella-
tion.
2. We may cancel this policy by mailing or deli-
vering to the first Named Insured written notice
of cancellation at least:
a. 10 days before the effective date of cancel-
lation if we cancel for nonpayment of pre-
mium; or
b. 30 days before the effective dale of cancel-
lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellati:)n. The pullLy period will end
on that date.
5. If this policy is cancelled we will send the first
Named Insured any premium refund due. if we
cancel, the relund will be pro rata. I` the first
Named Insured cancels, the refund may be
less than pro rata. The cancellation will be ef-
fPrtive. PvPn if wP have not made or nffPrnd n
refund.
6. If notice is mailed, proof of mailling will be suffi-
cient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declara-
tions is authorized to make changes in the terms
of this policy with our consent. This policy's terms
can be amended or waived only by endorsement
issued by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and
records as they relate to this policy at any time
during the policy pan!od and up to three years af.
terward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspoctions and eurveys at any time;
IL 0017 1198
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to in-
surability and the premiums to be charged. We
do not make safety inspections. We do not un-
dertake to perform the duty of any person or
organ zation to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and z. of tills condition apply not
only to us, but also to any rating, advisory, rate
service or similar organization which makes In-
surance inspections, surveys, reports or rec-
ommendations.
4. Paragraph 2. of this condition does not apply to
any inspections, surveys, reports or recom-
mendations we may make relative to certifica-
tion, under state or municipal statutes, ordin-
ances or regulations, of boilers, pressure ves-
sels or elevators.
E. Premiums
The first Named Insured shown in the Declara-
tions:
1. Is responsible for the payment of all premiums,
and
2. Will be the payee for any return premiums we
pay.
F. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not
be transferred without our written consent except
in the case of death of an individual named in-
sured.
If you die, your rights and duties will be transferred
to ynrjr IPrdal rP.prPc;PntativP hilt nnly while acting
within the scope of duties as your legal represent-
ative. Until your legal representative is appointed,
anyone having proper temporary custody of your
pruperty will have yuur Hyhts and duties but only
with respect to that property.
IL 001711 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 0
POLICY NUMBER: PPK1798129
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROD U CTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
WHERE Rn:QUZRW BY WRITTEN CONTRACT
Information.- quired to complete this Schedule, if Trot shown.aboyp will be shown in the Declarations...
The following is added to Paragraph S. Transfer Of
Rights Of (Recovery Against Others To Us of
Section IV—Conditions:
We wanre any right of recovery we may nave against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard" This waiver applies
only to the person or organization shown in the
Schedule above
r
i
CG 24 04 05 09 0 Insurance Services Office, inc, 2008 Page 1 of 1 0
POLICY NUMBER PPK1798129 COMMERCIAL GENERAL LIABILITY
CG 21 54 0196
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
EXCLUSION -- DESIGNATED OPERATIONS COVERED BY
A CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Description and Location of Operation(s):
WRAP UP WORK
(if no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement )
The following exclusion is added to paragraph 2 ,
Exclusions of COVERAGE A — BODILY INJURY
AND PROPERTY DAMAGE LIABILITY (Section I —
Coverages):
This insurance does not apply to "bodily injury' or
"property damage" arising out of either your ongoing
operations or operations included within the
"products -completed operations hazard" at the loca-
tion described in the Schedule of this endorsement,
as a consolidated (wrap-up) insurance program has
been provided by the prime contractor/project man-
ager or owner of the construction project in which you
are Involved
This exclusion applies whether or not the consoli-
dated (wrap-up) insurance program:
(1) Provides coverage identical to that provided by
this Coverage Part;
(2) Has limits adequate to cover all claims; or
(3) Remains in effect
CG 21 54 0196 Copyright, insurance Services Office, Inc , 1994 Page 1 of 1 D
WORKERS COMPENSATION AND EMPLOYERS LLA-BILt'rY INSURANCE POLICY VI'C @4 03 OG
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -
CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this polis}. We mill not
enforce our right against the person or organization named in the Schedule. (This alp -Cement applies only to the
extent that you perform work under a udtten contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your eniployees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be 2% of the California workers` compensation premium
otherwise due on such remuneration.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION
NAMED INSURED HAS AGREED 13Y WRITTEN
CONTRACT TO FURNISH THIS WAIVED
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below Is required only when this endorsement is issued subsequent to preparadon of the policy.)
Endorsement Effective: 10/01/17 Policy No. ZAWC19405301 Endorsement No.
Insured: California Pavement Maintenance Company Inc. dba CPM
Premium S INCL
Insurance Company: Arch Insurance Co.
Countersigned By:
-1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.
Frank the NVCIRB's Califnrnia Warkers' Compensation Insurance Forms Manual - 1999.
5
Policy Number: BA057355235 COMMERCIAL AUTO
CA 88 10 01 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement.
COVERAGEINDEX
SUBJECT PROVISION NUMBER
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
3
ACCIDENTAL AIRBAG DEPLOYMENT
12
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
19
AMENDED FELLOW EMPLOYEE EXCLUSION
5
AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
13
BROAD FORM INSURED
1
BODILY INJURY REDEFINED
22
EMPLOYEES AS INSUREDS (including employee hired auto)
2
EXTENDED CANCELLATION CONDITION
23
EXTRA EXPENSE — BROADENED COVERAGE
10
GLASS REPAIR — WAIVER OF DEDUCTIBLE
15
HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use)
6
HIRED AUTO COVERAGE TERRITORY
20
LOAN 1 LEASE GAP
14
PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
16
PERSONAL EFFECTS COVERAGE
11
PHYSICAL DAMAGE — ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
8
RENTAL REIMBURSEMENT
9
SUPPLEMENTARY PAYMENTS
4
TOWING AND LABOR
7
TWO OR MORE DEDUCTIBLES
17
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
18
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
20
I+d�L•��[•7►110�I_1.31�ft>rr<d•]�I�:7_[�3��ii�LT.Fi31'•1l • .
1. BROAD FORM INSURED
SECTION II — LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to include the
following as an insured:
d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the
policy period. However, "insured" does not include any organization that:
(1) Is a partnership or joint venture; or
(2) Is an insured under any other automobile policy; or
(3) Has exhausted its Limit of Insurance under any other automobile policy.
Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of
this policy.
e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you
own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days
from the date of acquisition or formation. However, coverage under this provision does not apply:
(1) If there is similar insurance or a self-insured retention plan available to that organization;
0 2013 Liberty Mutual Insurance
CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7
(2) If the Limits of Insurance of any other insurance policy have been exhausted; or
(3) To "bodily injury" or "property damage" that occurred before you acquired or formed the
organization.
2. EMPLOYEES AS INSUREDS
SECTION li — LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to include the
following as an insured:
f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts
within the scope of their employment by you. Insurance provided by this endorsement is excess over
any other insurance available to any "employee".
g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or
agreement in that "employee's" name, with your permission, while performing duties related to the
conduct of your business and within the scope of their employment. Insurance provided by this
endorsement is excess over any other insurance available to the "employee".
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SECTION II — LIABILITY COVERAGE, paragraph A.1. —WHO IS AN INSURED is amended to include the
following as an insured:
h. Any person or organization with respect to the operation, maintenance or use of a covered "auto",
provided that you and such person or organization have agreed in a written contract, agreement, or
permit issued to you by governmental or public authority, to add such person, or organization, or
governmental or public authority to this policy as an "insured".
However, such person or organization is an "insured":
(1) Only with respect to the operation, maintenance or use of a covered "auto';
(2) Only for "bodily injury" or "property damage" caused by an "accident" which takes
place after you executed the written contract or agreement, or the permit has been
issued to you; and
(3) Only for the duration of that contract, agreement or permit
4. SUPPLEMENTARY PAYMENTS
SECTION 11 — LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, paragraphs (2)
and (4) are replaced by the following:
(2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations) required because of
an "accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings up to
$500 a day because of time off from work.
5. AMENDED FELLOW EMPLOYEE EXCLUSION
In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the
employer by the workers compensation exclusivity rule, or similar protection, the following provision is added:
SECTION II -- LIABILITY, exclusion B.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from
the use of a covered "auto" you own or hire.
SECTION III — PHYSICAL DAMAGE COVERAGE is amended as follows:
6. HIRED AUTO PHYSICAL DAMAGE
Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE, is amended by
adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or
Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the
Physical Damage coverages provided are extended to "autos":
a. You hire, rent or borrow; or
02013 Liberty Mutual Insurance
CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7
b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but
only if the damage occurs while the vehicle is being used in the conduct of your business,
subject to the following limit and deductible:
A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of.
(1) $50,000; or
(2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or
(3) The cost of repairing or replacing the damaged or stolen property with other property of like
kind and quality, minus a deductible.
B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage.
C. Subject to the limit, deductible and excess provisions described in this provision, we will provide
coverage equal to the broadest coverage applicable to any covered "auto" you own.
D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired
"auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial
loss.
E. This coverage extension does not apply to:
(1) Any "auto" that is hired, rented or borrowed with a driver; or
(2) Any "auto" that is hired, rented or borrowed from your "employee".
For the purposes of this provision, SECTION V — DEFINITIONS is amended by adding the following:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value.
TOWING AND LABOR
SECTION III — PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the
following:
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto"
classified and rated as a private passenger type, "light truck" or "medium truck" is disabled:
a. For private passenger type vehicles, we will pay up to $50 per disablement.
For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have a gross
vehicle weight (GVW) of 10,000 pounds or less.
C. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a
gross vehicle weight (GVW) of 10,001 — 20,000 pounds.
However, the labor must be performed at the place of disablement.
& PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a., Coverage Extension of SECTION III -- PHYSICAL DAMAGE COVERAGE, is amended to
provide a limit of $50 per day and a maximum limit of $1,500
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9. RENTAL REIMBURSEMENT
SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following:
a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an
"auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under
Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those
expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto."
b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may
be substantially less than $75 per day, and will only be allowed for the period of time it should take to
repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days.
C. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and
replace your tools and equipment from the covered "auto".
d. This coverage does not apply unless you have a business necessity that other "autos" available for
your use and operation cannot fill.
e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under
this coverage only that amount of your rental reimbursement expenses which is not already provided
under Paragraph 4. Coverage Extension.
f. No deductible applies to this coverage.
For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as
defined in provision 11.
10. EXTRA EXPENSE - BROADENED COVERAGE
Under SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of
returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000.
11. PERSONAL EFFECTS COVERAGE
A. SECTION III — PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the
following:
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen,
we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto."
The insurance provided under this provision is excess over any other collectible insurance.
B. SECTION V -- DEFINITIONS is amended by adding the following:
For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an
insured." "Personal effects" does not include tools, equipment, jewelry, money or securities.
12. ACCIDENTAL AIRBAG DEPLOYMENT
SECTION III — PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating
to mechanical breakdown does not apply to the accidental discharge of an airbag.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by
manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or
warranty.
13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III — PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclusions
4.c. and 4.d. is deleted and replaced with the following:
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Exclusion 4.c. and 4.d. do not apply to:
Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed
solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at
the time of the "loss" and such equipment is designed to be solely operated by use of the power from
the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are
provided for the covered "auto"; or
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this
equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced
by a $100 deductible.
14. LOAM / LEASE GAP COVERAGE
A. Paragraph C., LIMIT OF INSURANCE of SECTION III — PHYSICAL DAMAGE COVERAGE is
amended by adding the following:
The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one
"accident" is the greater of the:
Balance due under the terms of the loan or lease to which the damaged covered "auto" is
subject at the time of the "loss" less the amount of:
a. Overdue payments and financial penalties associated with those payments as of the
date of the "loss",
b. Financial penalties imposed under a lease due to high mileage, excessive use or
abnormal wear and tear,
C. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease,
d. Transfer or rollover balances from previous loans or leases,
e. Final payment due under a "Balloon Loan",
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of
a covered "auto",
g. Security deposits not refunded by a lessor,
h. All refunds payable or paid to you as a result of the early termination of a lease
agreement or as a result of the early termination of any warranty or extended service
agreement on a covered "auto",
i. Any amount representing taxes,
j. Loan or lease termination fees; or
2. The actual cash value of the damage or stolen property as of the time of the "loss".
An adjustment for depreciation and physical condition will be made in determining the actual cash
value at the time of the "loss". This adjustment is not applicable in Texas.
B. ADDITIONAL CONDITIONS
This coverage applies only to the original loan for which the covered "auto" that incurred the loss
serves as collateral, or lease written on the covered "auto" that incurred the loss.
C. SECTION V — DEFINTIONS is changed by adding the following:
As used in this endorsement provision, the following definitions apply:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash
value.
A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term
of the loan, thereby requiring a large final payment.
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15. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of
the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE is amended by the addition of
the following:
The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger
type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as
maximum loaded weight the "auto" is designed to carry while it is:
a. In the charge of an "insured";
b. Legally parked; and
C. Unoccupied.
The "loss" must be reported to the police authorities within 24 hours of known damage.
The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations.
This provision does not apply to any "loss" if the covered "auto' is in the charge of any person or organization
engaged in the automobile business.
17. TWO OR MORE DEDUCTIBLES
Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms
apply to the same accident, the following applies to paragraph D. Deductible:
a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or
b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced
by the amount of the smaller (or smallest) deductible; or
C. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest)
deductible will be waived.
For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group.
SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows:
18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph 13.2. is amended by adding the following:
If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date
or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be
prejudiced.
However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and
we have the right to collect additional premium for any such hazard or exposure.
19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following:
a. In the event of "accident', claim, "suit' or "loss", you must promptly notify us when it is known to:
1. You, if you are an individual;
2. A partner, if you are a partnership;
3. Member, if you are a limited liability company;
4. An executive officer or the "employee" designated by the Named Insured to give such notice,
if you are a corporation.
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To the extent possible, notice to us should include:
(1) How, when and where the "accident" or "loss" took place;
(2) The "insureds" name and address; and
(3) The names and addresses of any injured persons and witnesses.
20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against
Others to Us, is amended by the addition of the following:
If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also.
21. HIRED AUTO COVERAGE TERRITORY
SECTION IV — BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is
amended by the addition of the following:
For "autos" mired 30 days or less, the coverage territory is anywhere in the world, provided that the
insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United
States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a
settlement we agree to.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver.
SECTION V — DEFINITIONS is amended as follows:
22. BODILY INJURY REDEFINED
Under SECTION V -- DEFINTIONS, definition C. is replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish,
mental injury, shock, fright or death resulting from any of these at any time.
COMMMON POLICY CONDITIONS
23. EXTENDED CANCELLATION CONDITION
COMMON POLICY CONDITIONS, paragraph A.— CANCELLATION condition applies except as follows:
If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written
notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply
in those states which require more than 60 days prior notice of cancellation.
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