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HomeMy WebLinkAboutItem No. 06 Amend No. 03 All American Asphalt Z10002Text File City of Lake Elsinore 130 South Main Street Lake Elsinore, CA 92530 www.lake-elsinore.org File Number: ID# 17-559 Agenda Date: 3/13/2018 Status: Consent AgendaVersion: 1 File Type: ReportIn Control: City Council / Successor Agency Agenda Number: 6) Page 1 City of Lake Elsinore Printed on 3/8/2018 REPORT TO CITY COUNCIL To:Honorable Mayor and Members of the City Council From:Jason Simpson, Assistant City Manager Prepared by: Dave Nichols – General Service Manager Date:March 13, 2018 Subject:Amendment No. 3 – to Increase Compensation for Contract Services (On- Call) with All American Asphalt – Project No. Z10002 Recommendation Approve and authorize the City Manager to execute Amendment No. 3 with All American Asphalt for On-Call Contractor Services in the additional contract amount of $50,000, bringing the total contract amount $105,000 in the form attached and in such final form as approved by the City Attorney. Background The City contracts for street repairs through solicitation of bids. The scope of work consists of furnishing all labor, materials, tools, equipment, and incidentals required to perform street repair work. Locations for crack seal & pothole repairs are developed through staff inspections and resident requests. Work orders are used to complete street repairs. On October 13, 2015, City Council approved the award to All American Asphalt for On-Call Contract Services for the Annual Crack Seal & Pothole Repair Program. Discussion The asphalt maintenance program tracks the repair of streets throughout the City. All work orders specify the type and quantity of work. Because each work order is unique, the billing will vary depending on the individual requests. Contractor will be paid based on the bid schedule and unit prices received. Total payment to contractor will not exceed $105,000 based on budgeted funding. Fiscal Impact Funds in the additional amount of $50,000 have been allocated for the Annual Crack Seal Pothole Repair CIP Project No. Z10002 in FY2017/2018 CIP Budget. Amendment No. 3 Annual Crack Seal & Pothole Repairs Project No. Z10002 March 13, 2018 Page 2 Exhibits All American Asphalt – Exhibit A Amendment No. 3 All American Asphalt – Exhibit B Amendment No. 2 All American Asphalt – Exhibit C Amendment No. 1 All American Asphalt – Exhibit D Original Agreement Exhibit A City of Lake Elsinore Amendment No. 3 All American Asphalt Agreement March 13, 2018 1 AMENDMENT NO. 3 TO AGREEMENT FOR CONTRACTOR SERVICES (ON-CALL) ALL AMERICAN ASPHALT FY17/18 Annual Crack Seal & Pothole Repairs, Project No. Z10002 This Amendment No. 3 to Agreement for Contractor Services (“Amendment No. 3”) is made, and entered into as of March 13, 2018 by and between the City of Lake Elsinore, a municipal corporation (“City), and All American Asphalt, a California corporation (“Contractor”). A.The City and Contractor have entered into that certain Agreement for On-Call Contractor Services dated as of October 13, 2015, (the “Original Agreement”). Except as otherwise defined herein, all capitalized terms used herein shall have the meanings set forth for such terms in the Original Agreement. B.The Original Agreement provided for compensation to Contractor in an amount not to exceed $55,000 per fiscal year. C.Amendment No. 1 dated July 1, 2016 extended the term of the agreement for 12- months. D.Amendment No. 2 dated June 13, 2017 extended the contract an additional 12- months. E.The parties now desire to amend the agreement to increase the compensation for such services as set forth in this Amendment No. 3, in an amount not to exceed $50,000. NOW, THEREFORE, in consideration of the mutual covenants and conditions set forth herein, City and Contractor agree as follows: 1.Section 3, Compensation, is hereby amended and restated in its entirety as follows: Compensation to be paid to Contractor shall be in accordance withthe fees set forth in the Contractor’s Proposal (Exhibit A to the Original Agreement). In no event shall Contractor’s compensation exceed One Hundred and Five Thousand Dollars ($105,000) for Fiscal Year 2017-2018 without additional written authorization from the City. Notwithstanding any provision of Contractor’s Proposal to the contrary, out of pocket expenses shall be reimbursed at cost without an inflator or administrative charge. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment. 2.Except for the changes specifically set forth herein, all other terms and conditions of the Original Agreement shall remain in full force and effect. Exhibit A City of Lake Elsinore Amendment No. 3 All American Asphalt Agreement March 13, 2018 2 IN WITNESS WHEREOF, the parties have caused this Amendment No. 3 to be executed on the respective dates set forth below. “CITY” CITY OF LAKE ELSINORE, a municipal corporation Grant Yates, City Manager Date: ATTEST: City Clerk APPROVED AS TO FORM: City Attorney “CONTRACTOR” ALL AMERICAN ASPHALT, a California corporation Name: Edward J. Carson Its: ___________________________ Date: Exhibit A – Original Agreement Exhibit A City of Lake Elsinore Amendment No. 3 All American Asphalt Agreement 3 March 13, 2018 Original Agreement Exhibit A (Attached) AMENDMENT NO. 2 TO AGREEMENT FOR CONTRACTOR SERVICES (ON-CALL) All American Asphalt FY l7118 Annual Crack Seal & Pothole Repairs, Project No. 210002 This Amendment No. 2 to Agreement for Contractor Services (On-Call) ('Amendment No. 2") is made and entered into as of June 13,2017 by and between the City of Lake Elsinore, a municipal corporation ("CiV), and All American Asphalt, a California corporation Contractor"). RECITALS A. The City and Contractor have entered into that certain Agreement for Contractor Services dated as of October 13, 2015 (the "Original Agreement'). Except as otherwise defined herein, all capitalized terms used herein shall have the meanings set forth for such terms in the Original Agreement. B. The Original Agreement provided for compensation to Contractor in an amount not to exceed Fifty-Five Thousand Dollars ($55,000). C. The term of the Original Agreement was for eight (8) months and allows the City to extend the term on an annual basis, for a total of two (2) years. D. Amendment No. 1 dated July 1, 2016, exended the term for 12-months through FY 2016117 . E. The parties now desire to extend the term for such services as set forth in this Amendment No 2. NOW, THEREFORE, in consideration of the mutual covenants and conditions set forth herein, City and Contractor agree as follows: 1. Section 2, Term, is hereby amended to add the following: Unless earlier terminated as provided elsewhere in the Original Agreement, this Amendment No. 2 shall continue in full force and effect for a period of twelve (12) months, commencing on July 1 , 2017 and ending on June 30, 2018. 2. Section 3, Compensation, is hereby amended to add the following: ln no event shall Contractor's compensation exceed Fifty-Five Thousand Dollars ($55,000) for Fiscal Yeat 201712018 without additional written authorization from the City. 3. Except for the changes specifically set forth herein, all other terms and conditions of the Original Agreement shall remain in full force and effect. City of Lake Elsinore Pagg 1 AllAmerican Asphalt June 13,2017 lN WITNESS WHEREOF, the parties have caused this Amendment No. 2 to be executed on the respeciive dates set forth below. clTr CITY OF LAKE ELSINORE, a municipal corporation CONTRACTOR' ALL AMERICAN ASPHALT, lNC., a Califomia corporation Da,*: 6bg/n---r--r-- ATTEST: Tune zL,zotT ItE: Date: APPROVED AS TO FORM: Amendment No. 1 Original Agreement Gty ol tak! EHnoG AlAmilaar A;phalt June 13,2017 Sward J./Carqln Vte, leElD@tt Page 2 GALI FORN IA ALL.PU RPOSE ACKNOWLEDGEM ENT crvrl. coDE s {{89 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. accuracv. or valid'itv of that document. State of California County ot Riverside on June26.20l7 before me, B. Royster" Notary Public , personally appeared Here lnsert name and Title of the Officer 8. ROYSTEB Commlriton ,2083E92 ilohry Publlc . Criltornla Rlvcrrldc Coung Comm. WITNESS my Place Notary Seal Above OPTIONAL Though the information below is not required by law, it may prove valuable to person relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document Amendment No. 2 - City of Elsinore Document Date: June 13,2017 Number of Pages: Signe(s) Other Than Named Above:None Capacity(ies) Claimed by Signer(s) Edward J. CarlsonSignedsName: a lndividual 1 Corporate Officer - Title(s): Vice President who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/a+e subscribed to the within instrument and acknowledged to me that he/sh€lth€y executed the same in his/h€r/th€ir authorized capacity(ires), and that by his/herltheir signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the forgoing paragraph is true and correct. o Partner r o Limited o General o Attorney in Fact r Trustee Top of thumb here n Corporate Officer - o Partner f o Limited o o Attorney in Fact Top of thumb here r Other: 4 Signer is Representing : EXHIBIT A CITY OF LAKE ELSINORE pRoPosAL -scHED.uLE PROJECT NO. Z{0002 FY 15,16 AI.INUAL CRACK SEAL & POTHOLE REPAIRS pROpOSER- AllAmericanAsplgft Contractor Name) PROPOSAL ITEMS AS FOLLOWS: aort Ctu.dl (Words) B!D IIAY BE REJECTE . Paynrent bond required in this arnount - no personal checks will be accepted): rat*r\oA! (t ,t^nJrtXSCur,-,\.u" ITEU NO. DESCRIPTION OF ITEMS ESTIMATED QUANTtrY UNIT FRICE FTGURES) TOTAL cosr FTGURES) 1 Remove and Replace 3 lnches (maximum) sections 5,000 SF Ll.tt rA(, soo 2 I % lnch edge mill 10,000 SF l, to t(,0oo 3 lnstalll inch AG leveling course 335 TON te.??,ct-lo 4 lnstall 11/.inch AC Hot Mix Asphalt Overlay 500 TON s?L1 t,oo o TOTAL FOR ITEMS Based on estimated quantities of items I through 4 I 01, ar? u. SCHEDULE ATotal Bid:lor t) SCHEDULE ATotal Bid: 9 ORIGINAL AGREEIV]ENT IATTACHED] AGREEMENT FOR CONTRACTOR SERVICES (ON-CALL) ALL AMERICAN ASPHALT FY 15/16 Annual Crack Seal & Pothole Repairs, Proiect No.210002 This Agreement for Contractor Services (On-Call) (the "Agreement") is made and entered into as of October 13, 2015, by and between the City of Lake Elsinore, a municipal corporation ("City") and AllAmerican Asphalt, a Califomia corporation ("Contractor"). RECITALS A. The City has determined that it requires the following services: Road repair at various locations Citywide. Services to include but not limited to pothole repair, overlay, and crack seal. B. The City has prepared a notice inviting bids and Contractor has submitted to City a proposal, dated September 24, 2015, both of which are attached hereto as Exhibit A collectively, the "Contractor's Proposal") and incorporated herein, to provide services and related work to the City pursuant to the terms of this Agreement. C. Contractor possesses the skill, experience, ability, background, certification and knowledge to perform the services and related work described in this Agreement on the terms and conditions described herein. D. City desires to retain Contractor to perform the services and related work as provided herein and Contractor desires to provide such services and related work as set forth in this Agreement. AGREEMENT 1. Scope of Services. Contractor shall perform the services and related work described in Contractor's Proposal (Exhibit A). Contractor shall provide such services and related work at the time, place, and in the manner specified in Contractor's Proposal (Exhibit A), subject to the direction of the City through its staff that it may provide from time to time. Contractor acknowledges that the Scope of Services provides for 24 hour-a-day, 7 day-a-week, on-callsupport on an as needed basis. 2. Time of Performance. a. Time of Essencg. Time is of the essence in the performance of this Agreement. The time for completion of the services and related work to be performed by Contractor is an essential condition of this Agreement. Contractor shall prosecute regularly and diligently the services and related work contemplated pursuant to this Agreement consistent with Contractor's Proposal (Exhibit A) and shall provide, furnish and pay all labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required to perform such the services and related work. b. Performance Sg.hedule" Contractor shall commence the services and related work pursuant to this Agreement upon receipt of a written notice to proceed and shall Ofl-Call Contract AllAmerican Asphalt Proiect 2'10002 Page 1 perform all services and related work within the time period(s) established in the Contractor's Proposal (Exhibit A). When requested by Contractor, extensions to the time period(s) specified may be approved in writing by the City Manager. c. Term_md CompliALge with TaskAffork Order Svstem. Unless earlier terminated as provided elsewhere in this Agreement, this Agreement shall continue in full force and effect for a period of eight (8) months, commencing on October 13, 2015 and ending on June 30, 2016. The City may, at its sole discretion, extend the term of this Agreement on a 12-month basis not to exceed two (2) additional twelve (12) month renewal terms by giving written notice thereof to Contractor not less than thirty (30) days before the end of the contract term, such notice lo be exercised by the City Manager. Contractor hereby agrees and acknowledges that any and all work or services performed pursuant to this Agreement shall be based upon the issuance of a TaskAtr{ork Order by the City. Contractor acknoadedges that it is not guaranteed any minimum or specific amount of work or services as all work or services shall be authorized through a TaskMork Order issued by the City. 3. Comoensation and Cost of Livino Adiustment. Compensation to be paid to Contractor shall be in accordance with the fees set forth in Contractor's Proposal (Exhibit A), which is attached hereto and incorporated herein by reference. ln no event shall Contractor's compensation exceed FIFTY FIVE THOUSAND DOLLARS ($55,000) without additionalwritten authorization from the City. Notwithstanding any provision of Contractor's Proposal to the contrary, out of pocket expenses set forth in Exhibit A shall be reimbursed at cost without an inflator or administrative charge. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment. The compensation paid to Contractor may be adjusted on each July 1 following the first anniversary of the commencement of the term of this Agreement, provided that The request for cost of living adjustment shall be presented to the City no later than June 1st of a particular year and, if approved by the City, will become effective on July 1st of that year. Any adjustment will be based on the Los Angeles-Riverside-Orange County Consumer Price lndex (CPl) but in no eyent shallthe price adjustment exceed five percent (5%). 4. Method of Pavment. Contractor shall promptly submit billings to the City describing the services and related work performed during the preceding month to the extent that such services and related work were performed. Contractor's bills shall be segregated by project task, if applicable, such that the City receives a separate accounting for work done on each individual task for which Contractor provides services. Contractor's bills shall include a brief description of the services performed, the date the services were performed, the number of hours spenl and by whom, and a description of any reimbursable expenditures. City shall pay Contractor no later than forty-five (45) days after receipt of the monthly invoice by City staff. 5. Suspension or Termination. a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Contractor at least ten 10) days prior written notice. Upon receipt of such notice, the Contractor shall immediately cease all work under this Agreement, unless the notice provides othenrise. lf the City suspends Page 2 or terrninates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. ln the event this Agreement is terminated pursuant to this Section, the City shall pay to Contractor the actual value of the work performed up to lhe time of terrnination, provided that the work performed is of value to the City. Upon ternrinalion cf the Agreement pursuant to this Section, the Contractor wilt submit an invoice to the City, pursuant to Section entitled "Method of Payment' herein. 6. Ownership of Documents. All plans, studies, documents and other writings prepared by and for Contractor, its officers, employees and agents and subcontractors in lhe course of implementing this Agreement, except working notepad internal documents, shall become the property of the City upon payment to Contractor for such work, and the City shall have the sole right to use such materials in its discretion without further compensation to Contractor or to any other party. Contraclor shall, at Contractor's expense, provide such reports, plans, studies, dccuments and other writings to City upon written request. City acknowledges that any use of such materials in a manner beyond the intended purpose as set forth herein shall be at the sole risk of the City. City further agrees to defend, indemniff and hold harmless Contractor, its officers, officials, agents, employees and volunteers from any claims, demands, actions, losses, damages, injuries, and liabitity, direct or indirect (including any and all costs and expenses in connection therein), arising out of the City's use of $uch materials in a manner beyond the intended purpose as set forth herein. a. Licensino of lntellectual... Property.This Agreement creates a nonexclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and allcopyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or othenruise recorded on computer diskettes, wtrich are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require that all subcontractors agree in uniting that City is granted a nonexc,lusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and wanant$ that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data wtrich were p{epared by design professionals other than Contractor or provided to Contractor hy the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at Ci$'s sole risk. h. Confidential8. All ideas, memoranda, specifications, plans, procedures, drawings, descriptions, cornputer program data, input reeord data, written information, and other Docurnents & Data either created by or provided to Contractor in connection with the performance of this Agreement shall be held confidential by Contractor. Such materials shall not, wtthout the prior written consent of City, be used by Contractor for any purpose$ other than the performance of the services under this Agreement. Nor shall such materials be disclosed to any person or entity not connected with the performanec of the services under this Agreement. Nothing furnished to Contractor wfiich is otherwise known to Contractor or is generally known, or has become known, to the related industry shall be deemed confidential. Contractor shall not use City's name or insignia, photographs relating to project for which Contractot's services are rendered, or any publicity pertaining to the Contractor's services under this Agreement in any magazine, trade paper, newspaper, television'or radio production or other similar mediurn without the prior written consent of City. Page 3 7. Contractot's Book.s and Records. a. Contractor shall maintain any and atf ledgers, books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for services, or expenditures and disbursements charged to City for a minimum period of three 3) years, or for any longer period required by law, from the date of final payment to Contractor to this Agreement. b. Contractor shall maintain all documents and records which demonstrate performance under this Agreement for a minimum period of three (3) years, or for any longer period required by law, from the date of termination or completion of this Agreement. c. Any records or documents required to be maintained pursuant to this Agreement shall be made available for inspection or audit, at any time during regular business hour$, upon written request by the City Manager, City Attorney, City Auditor or a designated representative of these officers. Copies of such documents shall be provided to the City fcr inspection at City Hall when it is practical to da so. Otherwise, unless an alternative is mutually agreed upon, the records shall be available at Contractor's address indicated for receipt of notices in this Agreement. d. Where City has reason to believe that such records or documents may be lost or discarded due to dissolution, dishandment or termination of Contractor's business, City may, by written request by any of the above-named officers, require that custody of the records be given to the City and that the records and documents be maintained in City Hall. Access to such records and documents shall be granted to any party authorized by Contractor, Contractor's representatives, or Contractor's successor-in-interest. L lndependent Contractor. lt is understood that Contractor, in the performance of the work and services agreed to be perfonned, shall act as and be an independent contracto'r and shall not act as an agent or employee of the City. g. PEB_S EliEibititv lndemnification. ln the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Contractor shalt indemnify, defend, and hold harmless City for the payment of any employee andlor employer contributions fsr PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of Ci$. Notwithstanding any other federal, state and local laws, codes, ordinances and regulations to the contrary, Contractor and any of its employees, agents, and subcontractors providing service under this Agreement shatl not qualify for or become entitled to. and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City. including but not limited to eligibility to enroll in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits. 10. lnterests of Contractor. Contractor (including principals, associates and management employees) covenants and represents that it does not nsw have any investment or interest in real property and shall not acquire any interest, direct or indirect- in the area Page 4 covered by this Agreement or any other source of income, interest in real property or investment which would be affected in any manner or degree by the performance of Contractor's services hereunder. Contractor further covenants and represents that in the performance of its duties hereunder no person having any such interest shall perform any services under this Agreemeni. Contractor is not a designated employee within the meaning of the Political Reform Act because Contractor: a. will conduct researeh and anive at conclusions with respect to his/her rendition of information, advice, recommendation or counsel independent of the control and direction of the City or of any City official, other than normal agreemenl monitoring; and b. possesses no authority with respect to any City decision beyond rendition of information, advice, recommendation or counsel. (FPPC Reg. '18700(aX2).) 11. Abilitv of Contractor. City has relied upon the training and abili$ of Contractor to perform the services hereunder as a material indueement to enter into this Agreement. Contractor shatl therefore provide properly skilled personnel to perform all services under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily to be expected of competent contractors in Contractor's field of expertise. 12. Compliance with Laws. Contractor shafl use the standard of care in its profession to comply with all applicable federal, state and local laws, codes, ordinances and regulations. 13. Licenses. Contractor represents and warrants to City that it has the licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor to practice its profession. Contractor represents and wanants to City that Contractor shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractor to practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 14. l$e_mnLty. Contractor shall indemnify, defend, and hold harmtess the City and its officials, officers, employees, agents, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodity injury, loss of life, or damage to propefi, or any violation of any federal, state, or municipallaw or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the qualtty or character of their work. The foregoing obligation of Contractor shall not appty when (1) the injury, loss of life, damage to propedy, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to property, or violation of law. lt is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by Ci$ of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indernnification and hold harmless.clause shall apply to any damages or clairns for damages whether or not such insurance policies shall have been determined to apply. By Page 5 execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a malerial element of consideration. 15. lnsuranceRequirements. a. lnsurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the contract, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' C.gmpensation 9overage. Contractor shall maintain Workers' Compensation lnsurance and Employer's Liability lnsurance for his/her employees in accordance with the laws of the State of California. ln addition, Contractor shall require each subcontractor to similarly maintain Workers'Compensation lnsurance and Employe/s Liability lnsurance in accordance with the laws of the State of Califomia for all of the subcontractor's employees. Any notice of cancellation or non-renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. ln the event that Contractor is exempt from Worker's Compensation lnsurance and Employer's Liability lnsurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation lnsurance in a form approved by the City Attorney. ii. General Liabilitv Coveraqe" Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. lf a eommercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as lnsurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11/BB) or lnsurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and lnsurance Services Office form number GL M04 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liahjlitv Q-o"_vSf"qgg. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as lnsurance Services Office Automobile Liability form CA 0001 (ed. 12190) Code 1 ("any auto'). No endorsement may be attached limiting the coverage. b. Endorsements. Each general liability and automobile liability insurance policy shall be with insurers possessing a Best's rating of no less than A:Vll and shall be endorsed with the following specific language: Page 6 i. The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. v. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elecled or appointed officers, officials, employees, agents or volunteers. vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. c. Qeductibles and Self-lnsured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City. At the City's option, Contractor shall demonstrate financial capability for payment of such deductibles or setf-insured retentions. d. Certificates of lnsurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 16. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, flrst class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. lf to City:City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 With a copy to: Page 7 lf to Contractor: All American Asphalt Attn: Edward J. Carson 400 East Sixth Street Corona, CA 92879 17. Entire Aqreement. This Agreement constitutes the complete and exclusive statement of Agreement between the City and Contractor. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. 18. Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 19. Assionment and Subcontractinq. The parties recognize that a substantial inducement to City for entering into this Agreement is the reputation, experience and competence of Contractor. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Contractor under this Agreement wilt be permitted only with the express consent of the City. Contractor shall not subcontract any portion of the work to be performed under this Agreement without the written authorization of the City. lf City consents to such subcontract, Contractor shall be fully responsible to City for all acts or omissions of those subcontractors. Nothing in this Agreement shall create any conhactual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 20^ Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. 21. Severabilitv. lf any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in fullforce and effect. 22. Controllinq Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of Califomia and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 23. Litioation Expenses and Attornevs' Fees. lf either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys' fees. 24. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. lf the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interest. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. lf the dispute remains unresolved after mediation, either party may commence litigation Page 8 25. Authoritv to Enter Aoreement. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and pedorm the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. The City Manager is authorized to enter into an amendment or othenvise take action on behalf of the City to make the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non- monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. 26. Prohibited lnterests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this wananty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material beneftt arising therefrom. 27. Eoual Onoortunitv Emnlovment. Contractor represents that it is an equal opportuni$ employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 28. Prevailinq Waqes. Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Seetion 16000, et seq., ('Prevailing Wage Laws"), wfiich require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation, if applicable, the Prevailing Wage Laws). lt is agreed by the parties that, in connec{ion with the work or services provided pursuant to this Agreement, Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, and its officials, officers, employees, agents, and volunteers, free and harmless from any claim or liabili$ arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The foregoing indemnity shall survive termination of this Agreement. 29. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. ln approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. Signatures on next page] Page 9 lN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above. clTY" CITY OF LAKE ELSINORE, a municipal corporation Attachments: Exhibit A * Contractor's Proposal CONTRACTOR" All American Asphalt, a California corporation Edward J. Page 10 By: Its: AelS fopi>'.ACOR CERTIFICATE OF LIABILITY INSURANCE oAIE (HUTDO/YrYY) o7/L2/20L6 THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY ANo coNFERs No RIGHTS uPoN THE ceanrlcArr xol.osn. rxs CERTIFICATE DOES NOT AFFIRMATIVETY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THEPOLICIESBELow. THls GERTIFICATE OF INSURANCE DoEs NOT CONSTTTUTE A COITITRACT BETWEEN THE tssUtNG tt{sURER(s), AUTHORTZED REPRESEMATNE OR PRODUCER, ANO THE CERTIFICATE HOLDER. lMPoRTANT:l'lhec!rtificateholderi3anAoDlTloNAtlNsURED'thepolicy(ies)mustbeendors th. lrrms and condlllons of the Pollcy' ceiain pollclos may require an endorsemenl, A statomont on this cerlificate does not confar rights tothccefificatrholdorinlicuofruchcndorscrileni(!). PROoUCER CA LIC 0829370 1-925-2ll-'r700 Bdgcrood PaEtncrr InruraDco ColterB (EPIC) Inland hlr1r. - Eruch ID la5{2] P.O. Eor 5003 San RrDon, CA 9{583 Uf; i' 1 _ _c=.t$_]c-a,tr.al_6-p_"_' *91! EE!t9Utt_or9u9go-!!! 9E. . ____ ANCE SDECIALTY INS CO 91.:9111 IIISURED All laerican Aaphal,t P.O. Box 2229 ColoD!, CA 92E78-2229 rNsuRERq. zlll-Ill_llc.x rNs co I 15535 TNSURERS. AMERICIN GUAR & LIAB INS Wr* INSURER O ITSURER E : COVERAGES TE NUMBER: 47x7'to43 REVISION NUMBER: THls ls ro cERTIFY THAT THE PoLIctES oF INSURANcE LtsrED BELow HAVE BEEN tssuEo ro rHE TNSURED ruauto eaove ron-ine por-rc.rTEFioo INOICATEO NOTWITHSTANDING ANY REOUIREMENT. IERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POTICIES DESCRIEEO HEREIN IS SUEJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN i/lAY I'JAVE BEEN REDUCEO BY PAID CLAIMSHT *'.*,**^-* -- n?S..F,.Fl-"- ;;;,*.,.u iffi*+E;l;fi$ffi, - -- ,,r,,.' A I x i coumrncrer.GExEnALLrAElLny I -: i.LA,M'.MADE El o..r*f-- DPCl00585500 08 / 0r/16 08/oL/L7 eacxoccunietcE lS 1,o0o,oo0 DAIr-AGE-i6R-ENIEI I I'REMISES lEa acu([gl ;t-ltt.|tog - MEp_ExP (-{ly mepcrson) 3 TERSoNAL &Aov rN;r Ts 1, ooo, ooo GENT AGGREGATE LIMIT APPLIES PER'l tl t[.o; I I lo"' '] r."o GENERALAGGREGATE 1 g 2,000,000 PRooucls. coMP/oP AGG I s 2,000, 000llBIern lxF- -" t-...- I IOXOBILE LIABILTTY i nur^rro . i lt"r owtrto f- scxeoureolAuros | .AurosII .NoN-owNED i I HIREDAUTOS I : AJTosItt--: Blt5 57 10 8 I O{o8/al/L6 O8 / Ot I L', C-oMBINEOSINGLE LIMIT' ltsa a@oeno AOO[Y INJURY (Per gcrson) 80D|LY tNJtJRY (Per acodont) I peoprnw oevrcE' JP-er!9S!q9!!L_ __ s 2,000,000 s s c l- I UHBRELL LTaB I x loccrn f--tttt::t'::.---.1 . - 1 lgrrus'uaoe sxso19797000 08 / ot /1,6 o8 / or / L1 . e,lc[ cggu_qlqcE i f9G,.EEG4IE--rpoIlryl.ng-trorrn I s 10, ooo, ooo j s 10,000, ooo o.o I x I pp1sa716g3 1o,ooo s a woRxEns coxPEilsaYroil AI|DEUPLOYERS'LTAB|UTY Y' it ANY PROPRIETOR/PAR-NERJtXECIJTIVE T::--..] oFFIcER/MEMBaR ExcLUoEo, tI_J(I.ndrtory ln NX) ll E. descnbeundtrnFsaPrgTloNaFopFpATro{s hr& 1{/A wc593205?o3 .ogloL/a5 i oo/o'.tLl. xlSilrrr. i l8l'_ r.'lt9ll_A99.1.?!Nr __. E L OISEASE.EAEMPLOYEE I - '--- E L OISEASE. POLICY LIMIT S 1,000 000 s 1,000,000 g 1,000,000 DESCRIPTIOIOfOPEnAnOIS/LOCATIOXS/VEXICL€S {ACORDl0l,Addiion!lRcmrrkrSchadulG,htybrrli.chldilmor.!p.c.l!r.quir.d) Projoct lz1o002 / RE: fi l5/L5 .lnnual Crack sea] & ,othol6 R€paira Cortlfi,c.te HoLder It Aaldltional Insured j.f R€quired by Writtsn Contract Excludj,ng lrorkerB Conpenaatloa [21 TION Clty of Lake Bulaore 130 south l,taLD stroet Lal(o Elaiuor€, CI 92531 SHOULD ANY OF THE ABOVE OESCRIEEO POLICIES BE CANCELLEO BEFORE THE EXPIRATION OATE THEREOF, NOTICE WILL EE DELIVEREO It{ ACCOROANCE WITH THE POLICY PROVISIONS. AUIHORIZED REPRESEX'ATIVE O 19E6-2014 ACORD CORPORATION. All rlghts rcservod. The ACORD name and logo ar€ reglstared rnarks ofACORDACORO2512014101'l. Dcamon - r,e t73770{3 IIISURER F : iIIli trEItrEI MEMO Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Karh, LopW Account Manager To:Whom it may concern From:Edgewood Partners lnsurance Centers (tPlC) Named lnsured:AllAmerican Asphalt et al Policy Number{s):Dpc100585500, 8Ap557108804, WCs93205703, SXS019797000 RE:Notice of Cancellation 1e1t925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license 0829370 epicbrokers,com THIS ENDORSEMENT CHA}IGES THE POLICY. PLEASE READ IT CAREFULLY. BLA}.IKET ADDMONAL INSURED ENDORSE]$ENT Thl3 Grdolstmtnl rnodncs lngltancc prwldod urder ltp follot{rg: COMMERCIAL GENERA LIABILITY COVERAGE FORM COMMERCIAL GENEML LIAEILIIY SELF-INSURED REIENTION COVERAGE FORM EECnOI [ - VUHO lE At{ IIISURED b anrandod !o induda c il addiliorxrl inrurud ihc6G Portonl or orggnlzfiiom $tu aie rcqulred undet a u'fltten coilrsd $'lth )'ou to ba mmed a3 en dt[ion8l lmtred' br.i orfy wfth tBspecl b llabltlty br'bdlly lnJqf, Tloperty damogs', or ]elsond 8nd adv€rtslrE tnllr:a carced. ln wioh'or ln parl, by yuur ads r onlsslom or tlr ects or omlsslons of lor submntr*1rs: A ln $r pcrlornancc of lour mgplng e.utlom or fpur worl(. irrludlqg YoJr ttut'lhat ha ban omPlc6( or B. In cqtnsdbn wilh yutr premiss swr'.d by or reriod b you' As utd m hb andararnont llro wprdrlrou' and lrcrlr rulbr b thr Namad lnottrud' All otltr tcrmr end condltlort of lhb Polby trlmeln unclrsngnd. Schedule Project City of Lake Elsinore, its elected or appoinled officers, officials, Prolect #ZIOOOZ / RE: FY 15/'16 Annual Crack Seal employees, agents and volunteer5 & Pothole Repairs EndorulrEnt Ntmbr: Tlis e ndorromanl iE stfodivo m tha incsplion dala ol thie pdicy unle es otftswieo rEtad heoin' fhs momrilon belG, b reqrlred only wten thlB erdors€mont ls lssuad subsoqusnt to praparallon ol the polloy.) PollcY Nun6er )PC1C05B5 600 NeDxd l,l3utd: AllArEilcan AsPlr[ er al EndoGarEnl Etrectlw Dab: August l" , 2016 00 cGL0000 m 05 07 Paga 1 cf 1 TI{IS E}IDORSETE]{T CHANGES T}IE POLICY. PI.EASE READ IT CAREFULLY. OTHER INSURAHCE. EROAD FORH, CGL POLICY ENDORSEilIEilT Tlls Grldolsamcnt modtrlcr lnsuranor plo rklad urdcr lhc bllonlrg: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Undcr SEGTK)I{ lV' COtf,ERCTAt OEIIERAL LIABIUTY CfiDmOXE. tho bllorirp pangraph is adcbdlo Oon<Ilbn i Otlt r llrunncr: Wlrerc the l,lanEd lniurEd b rEqulGd by e srltlen coilr6.1 ta Fovlde lnsurance that ls prllllry and noncorlrib[ory, ard the writon cqtracl so rsquirirE is cpcutod by ths Narrd lnor,rred bsbrg ny'oocurErr'or offrrxe. thb lnsurane wlll be pnmry. but orfy I ard lo the exlerl r€qulred by Itutnadtcn q,ntrect All ollpr terms and mndltlorE of thb Polk? lEmaln uncharEpd. Schedule Project City of Lake Elsrnore, its elected or appointed officers, officials, Project #Z1OO02 / RE: FY 15i 1 6 Annual Crack Seal employees, agents and volunteers & Pothole Reparrs Endorccnrnt Nunbr' Tlie ordorromant is €rf€dive m lha incsption &a olthis pdicy unless oh€rwisa &tad horein. fhe lllomatlon bs]or b reqrlred only u,hen lhls erdolsamant ls l8eued mbsoquent lo pr€parallon orthB poilcy.) PoUcf Nutr5cr: DPC10058 5 600 Narrd lnrursd: All Ametuan tuphall ea al Endo6emeni Effedlve Deb August 1, 2016 00 cGL0130 00 09 0€Pap1 ol'l coas THIS ENDORSEMENT CIIANGES THE POUCY. PLEASE READ IT CAREFULLY' WANER OF SUBROGATION ENDORSEHENT Tl{s trt'olE6mcnt modtfl's insrrarrcc prwldcd urdcr thc bllo,Yirg: COMMERCIAL GENERA LIABILITY COVERAGE FORM -- - ^. co MMERc tfr ;EiaEHAL r-i esr[ rw sdui- rr.rsune D RE TENTto N covERaGE F oR M SCHEDULE rnrofPrrsanorOngtnlredm:Whererequlredbywrlnencdtlrect' UndcrSEGTlol{lv-ool,itERclAloEllERALLlABlLlTYcoNDmoilS,Corrditm&TrlnlfeIof Rlg;! Of n#ty ^ c.fi odtor" ro U. ie arpndsd by tha ddrtion cf llr following prcvrsion: wc unive eny fioH of rec'very llt mdy hs''e lgryrE [t" ' f * or orgeniz€llon s]u'^'n ln the g.HEDULE abo' bacauso of paymants * .rnke (oi lniury or dannge arierp oul ol yorr opcraliors or lpur trorf'dnl-,J"i " wrtieii c6ntrect wllh thet pelson a orgnnlzatim' AllotlE'termrandcondltlolBdfutBPollcyemalnunchanged' Schedule Project cityofLakeElsinore'[selectedorappointedofficers'officials'Project#z1ooo2lRE:FY15/16Annualcrackseal ftby*r, agents and volunteers & Pothole Repairs Endorscnrnt Nunbg: Tlisgrdomomonlisefledivarrtheirrcap(ion&olthirpdicyunlassottlgwitadatodherain' rrh6f,ormsilonbgloflbreqrlredonlywtlenthlserdoB€mentlslEstEdsubg€qumltopreparellonofthBpollcy.) Pollcy NunDcr DPC100 58 5 60C N.m€d ln uEd: All AnErlcan AspMn er al En(hre[rent E fedlt'e p56' Au$ust 1' 20L6 o0 cct0121 oo 0eo0 lrdudesoqvnn'* ltlfl ilffi5tr scMe oiica' rnc'' P4e 1 of 1 pofrcyNunER BApss7108804 *airttE II{IS EI{DORSflEIT CHAilGES IIIE PqJCY. H.EISIE READ IT CIREFI'IIY. DESIGNATED INSURED f r cdoalarrant flEdIb hallaE€ fo'rlrd uflrer lrE totoli[: Busf€ss At To co/EnAGE ront{ GAnAGE COr/ER GE FOFI I/PIOR CARRIER @IERAGE FOflI/i TNrcIGRS @\/ERAGE FOR'I tJlh ,Bp.cl to covr{p trolilrtd ty thb taors'rrf. lho rcvldon8 dUECoYr{o Foan eoly unB modlH by lllts sldqsfllll. Tnt rdas'lsl lhn6 pstor{s} or ol!riz.aio({6) x,lE eB h6u1dr' undfr th. }ilD ,t An hqmd Prolhbn 0( lhs corr{c Fodn. Thb ernoltsrfl doe d .la coruQa Fot ldd h lha covt{o turlll. IHi dorrrEl ctlr|oE $o poEy €lldtf, ofl tha ltdlon dac d tho Fby url6t trther dae-L hdbtd b*w. endw: B/i/\6 Coud€rd0nd $,: ln$rd: A1I ADerlcaD ADpbalE SCHEU-E rr ol F..Dn(r] a OrE!tI!&{9: ANY PERSON OR ORGAIIIZATION TO IITOM OR HEICH YOU ANE NEQUIRED To PNOVIDE N)DITIONAI, INSURED STATUS ON ADDITION}I INSURED STATUS ON A PRIII4ARY, }ioN-COIITRIBUIORY BAsIs, IN A flnlTlEl{ Col{I?Aer oR IIRITEN ACREEI{EITI EXACUTED PNIOR TO LOSS, EXCEPT HHERE SUCH CONTNACI ON, AGREEIIIENT IS PROf,IBITED BY I,AW. Schedule Project City of Lake Elsinore, its elected orappointed officers, Project #Zl OO02 / RE: FY15/16Annual Crack Seal officials, employees, agenls and volunteers & Pothole Repairs ll no dlry ppsr rDori€. t ffirtlon l4lld to cqnpldo thb andslfirdt !.rl be Elloxn h lhe Dadtdbor B eplcibb to the rx,oalefisl.] EEh psloar o. agEurtbn tllo5l h tlE Schdule b m tsutd'lot UdIy cqvs{o. hl all, !s trla tdsL tM rg'[,i q qcrl&.abn qr& 6 'l rrsurd' undr lho UrD lr An ln3lrd PtoYltbn conlaH h s.cftn I oa iha Co\l'{oFbltll cA20/l8tlE Copyrhtl, lnsrrEE sclrtB Olfbo. lrr.. lS PIltoat O roo: BAP557108804FoucrNuEn "-lul...ffi IHIS ET{reXE'IT C}I,^IIGES TIIE FOTrcY. E.EAI9E READ ]T ANNCR'IY. WAVER OF IRANSFER OF RIGHTS OF RECOVERY AGATNSTOTHERS TO US (WAIVER OF SUBROGATTON) ltla-da:rd lrdab hrllrBFot lad mdr llrlblorh0: BJETTCS' Alrro OOVEnT FOtgJSI\ESS AI'IO PlIYSrcAL UTffGE CO\ERAGE rc ' GANGECOIERAGE FMI TftIIOR Cr*R @I,ERACE FOna rntxERS @\iEm6E FORu ff,n r?d io orr{r p.Dt fr- by th5.darffif, Or pmt/ftns d l,ra Co,!{r fun lpay unbrdtlEbrttida!]rt Iltl ilddlrsl dlfir ttr Foty dleti,i al llEirslloo dC. of 0r ,ot, unbt rdt: da. bhftsrldb. lrt lU .Amrlcell .[5pha]-t r. 8/L/1-6 G{gI'E In(r| ot rr(t) ct orlrrrar{r* AI.I PERSONS AIID/OR ORGAITIZATIONS THAT ANE REQUINED BY ITRITMN coNrRtrct on tGnEEuElrT rtrB IgE rNsunED, EXEC-ITTED PRIOR rO IIIE ACCIDE}IT OR I'SS, rlIA? XAII'ER OF SI'BROGAI IO}f BE PROVIDED IJNDER IBIS POI,ICI nrll arotHaotE., lgtrr d r lo lrr Coralbo (b. r|ot eCy b tr pau{s) aoo.t!ab.{r) dlm h trr Sc!sd., Dll only b Or f,m ha_anloeabn b rdvd ,br lo lh. b Pro.iect sffi * f I cctdtliu0E pstor Proiecr *z t0o02 / RE: Fy 15/16 Annuat Crack seal City ot Lake Elsinore, its elecled or appointed officers, oll-c'ab, & Pdhole Repairs etnployees, agenB and volunteers cA 0a aa t3 to g lnarrrr€s(lh- dlb!, |rc,. &Frgr l rt O IrcEGRS C*EilSANON lI{D EFLOIIERS'LNBLTTY INSLNT{CE FOUCY lrc oa 03G WAIVER OF OI..R RIGHT TO RECOVER FROM OMERS ENDORSEMENT- CAUFORNIA yh hsE tDrbff to rEoFr oui FynBnlE from rnycr hDb tor m l*rycotsd by Otb poly. \l€ wll not nforcE qlr dgn T*rC ttE fEil or ollstClon ntrEd h tlE Sclndub. (Ihb ttwmnl *plas mU to tts drl lH lon psEm wI undr a wrtren contrt t}* tqullBi lqr to otl*r llb qrsrnl fiutt us.) Yq| m.nl r*thh nnol leontE Eulebly lqmgtrE tio rBnunacoon of ycll orptots uhh fiolgd h ttnwod(&srlD6d h tln Schsdub. TtEd{ttronel F6mtmtathbf,dd8drglt Bm[ bo O. OO % d tts Cffinh xorlst'cqrpnrClon pre m[rnofi:nrtedw on srh ]omrrFfibn. Frrilt cOryrlratnlr.L PERSOTS rND/ORoncrxrzltrofstEtT rnE EoornEDBrfnrr:tEf, coillTrcr oR ICRIII.EITI IITE IEE IIISITRED, rcU',ln) Pnron rorEElcclDllrroR ross, IElr trn n oE SI'BBOGIIION BE PN,OYIDED I'IIDER TSIS POLICY ROR rcNf, PERDONTTE} BI YOUFORrElTPEnSOXIXD/OR OXI}XIANIIOI City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers AII American Asphalt PoJ-icy +wC593205703 8/7/!6 Irc28(a{r} rcot03[ Fd.{{r) Project #210002 / RE: FY 15/16 Annual Crack Seal & Pothole Repairs Zurtch AEerlcan Ins. Co. Scmth JobDrponl[L c[ oPEnlIIOrf hgr I cll FORM Proiect lnformation Project Award Datet 7l'll2o17PWC-100 City of Lake Elsinore City of Lake Elsinore 130 South Main Street Lake Elsinore,CA 92530 Annual Crack Seal && Pothole Rspair s55000.00 ss5000.00 None Apply Fom Type: AWARDING BODY INFORMATION NamE: Address: PROJECT IilFORTANON P.oiect Namo: Brief Description: Conlract Amount: Total Project Co3t: Alternative tuodel: Descriplion of Locatlon: Annual Cmck Seal & Pothole^ -. - -- projec-t#: Keparr Catherine Eakins ceakins@lake-elsinore.org 9516743124 210002 001oPwo 1 RIVERSIDE Primary Contact: Primary Email: Work PhonE: Contract #: Number of Prime ContractoB: City of Lake Elsinore city limits County: Project lnformation 2 PWC-100 Project Name: Annual Crack Seal & project#: 210OO2PotholeRepair PROJECT INFORMATION Project Oates Contract #:0010PWO Status: New Submission EstimatedorActualStart: 71112016FirstAdverti3sdBid: Estimated or Actual Completion: Propositions 7t912015 6/30/201 8 Will this projecl receive (or has it received) any funding from Proposition 84 (The Safe Drinking Water, Water Quality and Supply, Flood Control, Riv6r and Coastal Protection Bond Act of 2006)? Will this prciect rec€ivo (or has it received) any funding from Proposition 39 (Califomia Clean Energy Jobs Act of 201 2)? Compliance and Agreements: ls language included in the Contract Award to sffectuate the requirements of Sedion 1771,1774 - 1776, 1777 .5,'1813 and 1815 of the Labor Code? Will you operate a DIR-Apprcved Labor Compliance Program(LCP) for this proiect? ls there a PO6ct Labor Agreement (PLA) associated with this project? Contractor lnformation Project tanager Email Address jperez@lake-elsinore.org GenEral Contractor'l No No Name Julian Perez Ti{e Sup6ryisor No No Work Phone 951-674-5170 293 CSLB/Certificaie NAMENumber Address Email Classification AMENDMENT NO. 1 TO AGREEMENT FOR CONTRACTOR SERVICES (ON -CALL) ALL AMERICAN ASPHALT FY 16/17 Annual Crack Seal & Pothole Repairs, Project No. Z10002 This Amendment No. 1 to Agreement for Contractor Services (On -Call) ( "Amendment No. 1 ") is made and entered into as of July 1, 2016 by and between the City of Lake Elsinore, a municipal corporation ( "City), and All American Asphalt ( "Contractor "). RECITALS A. The City and Contractor have entered into that certain Agreement for Contractor Services dated as of October 13, 2015 (the "Original Agreement'). Except as otherwise defined herein, all capitalized terms used herein shall have the meanings set forth for such terms in the Original Agreement. B. The Original Agreement provided for compensation to Contractor in an amount not to exceed Fifty -Five Thousand dollars ($55,000). C. The term of the Original Agreement was for eight (S) months and allows the City to extend the term on an annual basis, for a total of two (2) years. D. The parties now desire to extend the term for such services as set forth in this Amendment No 1. NOW, THEREFORE, in consideration of the mutual covenants and conditions set forth herein, City and Contractor agree as follows: 1. Section 2, Time of Performance, of the Original Agreement is hereby amended to add the following: Unless earlier terminated as provided elsewhere in the Original Agreement, this Amendment No. 1 shall continue in full force and effect until June 30, 2017. The City may, at its sole discretion, extend the term of this Agreement on an annual basis not to exceed one (1) additional renewal term, such notice to be exercised by the City Manager. 2. Except for the changes specifically set forth herein, all other terms and conditions of the Original Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties have caused this Amendment No. 1 to be executed on the respective dates set forth below. CITY" CITY OF LAKE ELSINORE, a municipal corporation 4k Gtanf`Y;9X,d. City Manager Date: ATTEST: Attachments: Exhibit B — Original Agreement CONTRACTOR" All American Asphalt, a California corporation Edward J. Carson, *ma , Date: CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 07/12/2016 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 IIELOW. 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 SUBROGATION IS WAIVED, subject to the terns 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 CA LIC OB29370 1 -925- 244 -7700 1 COTACT Certificates Department Edgewood Partners Insurance Centers (EPIC) PHONE Alt Inland Empire - Branch ID 145421 NQ. EX• (925) 244 -7700 AIC Na (92' -5) 901 -0671 E -MAIL EPICcerte0e icbrokere.comP.O. Box 5003 ADARr=6$ P INSURERS AFFORDING COVERAGE NAI San Ramon, CA 94583 INSURERA:ARCH SPECIALTY INS CO 21199 INSURED INSURERB ZURICH AMER INS CO 16535 All American Asphalt INSURERC:AMERICAN GUAR & LIAB INS 26247 P.O. Box 2229 INSURER Corona, CA 92878 -2229 1 INSURER F: - COVERAGES r..FPTIFIrATF KIII1Ur4F12- 47177AA A loelaeIAKI unucoo. 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 INTS'R TYPE OF INSURANCE AGD AM BR. WVD POLICY NUMBER DPCIO0585600 POLICY EFF 08101116 POL Y EXP MM/D 08/01/17 LIMITS EACH OCCURRENCE 1,000,000AXCOMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR PA S 100,000 MED EXP Any one person) S PERSONAL dADVINJURY S 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER POLICY JEGT D LOC GENERALAGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG 2,000,000 OTHER AUTOMOBILE LIABILITY BAPS57108804 08/01/16 08/01/17 COM81NED SINGLE LI IT e amdenil 2,000,000 X SANYAUTOBODILYINJURY (Per pe(son) ALL OWNED SCHEDULED AUTOS _., AUTOS BODILY INJURY (Per acodent) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per a dent 5 C UMBRELLALIA13 OCCUR SXS019797000 08/01/16 08/01/17 EACH OCCURRENCE 10,000,000 X a 10,000,000EXCESSLIARCLAIMS -MADE AGGREGATE DED TX I RETENTIONS 10,000 Following -Form B WORKERS COMPENSATIONANDEMPLOYERS' LIABILrIY Y i N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED NIA WC593205703 08/01/16 08/01/17 X PER OETRH- LITE S 1,000,000ELEACHACCIDENT EL DISEASE - EA EMPLOYE 1,000,000MandatorylnNH) If yyes, descnbe under E L OISFE - POLICY LIMIT 2,000,000DESCRIPTIONOFOPERATIONSbelcw I d DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project NZ10002 / RE: FY 15/16 Annual Crack Seal & Pothole Repairs Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation [2] v. n, I c nVILUMIN IrANL,CLLA I IL I I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lake Elsinore THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Main Street AUTHORIZED REPRESENTATIVE Lake Elsinore, CA 92531 — I USA 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD DCannon -is 47377043 MEMO To: Whom it may concern From: Edgewood Partners Insurance Centers (EPIC) Named Insured: All American Asphalt et al Policy Number(s): DPC100585600, BAP557108804, WC593205703, SXS019797000 RE: Notice of Cancellation Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non - payment of premium. Sincerely, Kathy Lope-k Account Manager tel: 925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license OB29370 epicbrokers.com THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies Insuranoe provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF- INSURED RETENTION COVERAGE FORM SECTION II — WHO IS AN INSURED is amended to include as an additional Insured those persons or organlzelions who are required under a written contract with you to be named as an addhional Insured, but only with respect to liability for'bodlly Injury', 'property dameW, or "personal and advertising Injury' caused, in whole or In park by your ads or omissions or the ads or omissions of your suboontractors: A. In the performance of your ongoing operatlons or "your work", including 'your work" that has been completed; or B. In connection with your premises owned by or rented to you. As used in this endorsement. the words Wand 'your' refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #Z10002 / RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise slated herein. The Information below Is required only when this endorsement Is Issued subsequent to preparation of the pol Icy) Pdlcy Number DPC100585600 Named Insured: All American Asphah et all Endorsemerd Effective Date: August 1, 2016 4063 00 CGL0006 DO 05 07 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - BROAD FORM, CGL POLICY ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SECTION IV — COMMERCIAL GENERAL LIASILIITY CONDITIONS, the following paragraph Is added to Condition 4. Other Insurance: Where the Named Insured Is required by a written contract to provide insurance that Is primary and norwontributory, and the written contract so requiring Is executed by the Named Insured before any 'occurrence" or offianse, this Insurance will be primary, but only If and to the extent required by that written contract All other terms and conditions of this Policy remain unchanged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #Z10002 /RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endorsement Number This endorsement Is effective on the inception date of this policy unless otherwise slated herein. The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Policy Number: DPC100585600 Named Insured: All American Asphalt at al Endorsement EffedlveDale August 1, 2016 00 CGL0130 00 09 08 Page 1 of 1 4063 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF - INSURED RETENTION COVERAGE FORM SCHEDULE Name of Parson or Organization, Where required by written contract. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDMONS, Condition & Transfer Of Rights Of Recovery Against Others To Us Is amended by the addition of the following provision: We welve any right of recovery we may have against the person or organization shown In the SCHEDULE above because of payments we make for injury or damage arising out of your operations or your work" done under a written contract with that person or organLz ation. All other terms and conditions of this Policy remain unchanged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #Z10002 /RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endorsement Number: This endorsement is effective on the inception dabs of this policy unless otherwise stated herein. The irtormation below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Policy Number: DPC100585600 Named Insured: All American Asphalt at all EndorsementEffedlveDate: August 1, 2016 00 CGLO121 00 09 09 Includes copyrighted material of Insurance Services office, Inc., Page 1 of 1 with Its permission. 4063 POLICYNL*AKR BAPS57108804 COW. AUTO CA 20 40 82 00 THIS ENDORSEM ENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This arrdorseTwd modries Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form 9" unless modried by this endorsernert. This endorserriert Identifies person(s) or orgardzatton(s) who are 'insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsemerd does not alter coverage provided in the Coverage Form. This endorsement changes the policy eRecM on the Inception date of the policy unless axAb x date Is Indicated below. EndorsanwA E fective: 8/1/16 Countersigned By: Authorized esertative Nand Insured: All American Asphalt SCHEDULE Narrw d Person(s) orbs): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON — CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Schedule Project City of Lake Elsinore, its elected or appointed officers, Project #Z10002 / RE: FY 15/16 Annual Crack Seal officials, employees, agents and volunteers & Pothole Repairs If no entry appears above, Wonnatlon required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown In the Schedule Is at 'insured" for LW My Coverage, but only to the indent that person or organization qualifies as an Insured" under the Who Is An Insured Provision contained In Secion 9 of the Coverage Form. CA 20 I81G 90 Copyright, Insurance Services Officce, Inc.. 1996 Page 1 d 1 0 4063 BAP557108804 POLICY MABER CONO EACt& AUTO CAM"0310 THIS ENDCR.AMW ENT CHANGES THE FOUCY PLEASE READ R CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endcxsemarrt modtfaes hmrarw provkled under the *Akm v: MAN e. "• R mh rasped to oaverape provided by this sWorwwt. the provkbms d the Cmewe Form apply unless M& fled by the wdoriwMil. This rrw* charges the policy effsdtm on theinception date of the poky unless another date is indicated below. liarsd 11- IN All American Asphalt Endmanwit Efbcln Dub: 8 / 1 / 16 KmrMs) orpamori(s)OrOrwwCwwx* ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY The Trandw Of F"MS Of Rromwy w%dwrrt Otfrsre To Us Condition does not apply to the pwwKs) or mss) shown In the SeWuae, but ordy to Ow ddwrd that subrop Wn as waked prior to the go)- cadent" or the lass under awritred with the person or ogMikabon. Schedule City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers will be shown In Ow Project Project #Z10002 / RE: Pothole Repairs FY 15/16 Annual Crack Seal 4069 CAM" 4310 0 Irourawe Servloes Office, Inc.. 2M Peps 1 of 1 13 V11OfKERS' COMPENSATION AND EN+PLOYERS' LIABILITY INSURANCE POUCY WC 04 43 06 6d. 484) WAIVER OF OL R RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-- - CAU FOR NIA V* two the right to recover our payments from anyone ltabb for an injury covered by this policy. Va wil not enforce our rigtt ag2krW the person or orgar"lon named In the Schedule. (This agreement applies only to the adent that you perform work under a written contract that requires you to obtain this a0rrawmt from us.) You must maintain payrol records accurately w gregaft the remuneration of your effvkr while engaged In the work described In the Scheduia The addoonal premim for this andwoernant shaN be 0.00 % of the C.alkwnie workers' c sallon pre - mkm athsrwiee due on such remuneration. Parson or OrUwAralon ALL PZRSOKS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTIN CONTRACT OR AGREMN? VITH THE INSUR19D , il[ WUTED PRIOR TO THE ACCIDP.NT OR LOSS, THAT 1l;AIVXR OF SUBROGATION U PROVIDED UNDER THIS POLICY FOR VIM PZRFORNICD BY YOU FOR THAT PERSON AND /OR ORGANIZATION SChKkAa Job DascrWon ALL CA OPERATION City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers All American Asphalt Policy #WC593205703 8/1/16 Project #Z10002 / RE: FY 15/16 Annual Crack Seal & Pothole Repairs Zurich American Ins. Co. 252(444) VC 04 03 06 (Ed, 4-0) Ppr 1 of 1 4063 Form W=9 Request for Taxpayer Give Form to the Rev. December 2014) identification Number and Certification requester. Do not Department of the Treasury Send t0 the IRS. Internal Revenue Service 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. ALL AMERICAN ASPHALT N 2 Business name /disregarded entity name, if different from above m9 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to certartz entities, not individuals; see Individual /sole proprietor or C Corporation S Corporation Partnership Trust/estate instructions on page 3): CL e 4.1 single- member LLC Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) Exempt payee code (if any) o 2 Note. For a single- member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting w the tax classification of the single - member owner. code (if any) CL V Other (see Instructions) lo- Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) Requester's name and address (optional) a P.O. Box 2229 6 City, state, and ZIP code Y) Corona, Ca 92878 Citv of Lake Elsinore 7 List account numbers) here (optional) W311 ti Will Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid { Social security number i backup withholding. For individuals, this is generally your social security number ( However, for a page - m - resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer identification number guidelines on whose number to enter. 9 F51 - 2 1 5 1 9 5 1 0 1 4 1 3 Certification Under penalties of perjury, I certify that: The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature of Here U.S. person Date General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W -9 (such as legislation enacted after we release it) is at www.irs.gov1fw9. Purpose of Form An individual or entity (Form W -9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: Form 1099 -INT (interest earned or paid) Form 1099 -DIV (dividends, including those from stocks or mutual funds) Form 1099 -MISC (various types of income, prizes, awards, or gross proceeds) Form 1099 -B (stock or mutual fund sales and certain other transactions by brokers) Form 1099 -S (proceeds from real estate transactions) Form 1099 -K (merchant card and third party network transactions) Form 1098 (home mortgage interest), 1098 -E (student loan interest), 1098 -T tuition) Form 1099 -C (canceled debt) Form 1099 -A (acquisition or abandonment of secured property) Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not retum Form W -9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding If you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S, person, your allocable share of any partnership Income from a U.S. trade or business Is not subject to the withholding tax on foreign partners' share of effectively connected Income, and 4. Certify that FATCA codes) entered on this form (if any) Indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Cat. No. 10231X Form W-9 (Rev. 12 -2014) CITY OF ,. L i C LSIHOR r 130 SOUTH MAIN STREET LAKE ELSINORE, CA 92530 BUSINESS LICENSE CFRTIFIrATiR BUSINESS LICENSE This business license is issued for revenue purposes only and does not grant authorization to operate a business. This business license is issued without verlflCation that the holder is subject to or exempted from licensing by the state, county, federal government, or any other governmental agency. Business Name: ALL AMERICAN ASPHALT Business Location: P O BOX 2229 CORONA, CA 92878 Owner Name(s): MARK LUER ALL AMERICAN ASPHALT P O BOX 2229 CORONA, CA 92878 CITY OF LAKE ELSINORE ADMINISTRATIVE SERVICES- LICENSING 130 South Main Street Lake Elsinore, CA 92530 951.674.3124 TO BE POSTED IN A CONSPICUOUS PLACE BUSINESS LICENSE NO. 001333 Business Type: GENERAL ENGINEERING CONTRACTOR Description: GENERAL ENGINEERING & EARTHWORK/PAVING CONTRACTOR Issue Date: 2/1/2016 Expiration Date: 1/31/2017 THIS IS YOUR LICENSE • NOT TRANSFERABLE EXHIBIT B ORIGINAL AGREEMENT ATTACHED] EXHIBIT B AGREEMENT FOR CONTRACTOR SERVICES (ON -CALL) ALL AMERICAN ASPHALT FY 15116 Annual Crack Seal & Pothole Repairs, Project No. Z10002 This Agreement for Contractor Services (On -Call) (the "Agreement ") is made and entered into as of October 13, 2015, by and between the City of Lake Elsinore, a municipal corporation ( "City ") and All American Asphalt, a California corporation ( "Contractor"). RECITALS A. The City has determined that it requires the following services: Road repair at various locations Citywide. Services to include but not limited to pothole repair, overlay, and crack seal. B. The City has prepared a notice inviting bids and Contractor has submitted to City a proposal, dated September 24, 2015, both of which are attached hereto as Exhibit A collectively, the "Contractor's Proposal ") and incorporated herein, to provide services and related work to the City pursuant to the terms of this Agreement. C. Contractor possesses the skill, experience, ability, background, certification and knowledge to perform the services and related work described in this Agreement on the terms and conditions described herein. D. City desires to retain Contractor to perform the services and related work as provided herein and Contractor desires to provide such services and related work as set forth in this Agreement. AGREEMENT 1. Scope of Services. Contractor shall perform the services and related work described in Contractor's Proposal (Exhibit A). Contractor shall provide such services and related work at the time, place, and in the manner specified in Contractor's Proposal (Exhibit A), subject to the direction of the City through its staff that it may provide from time to time. Contractor acknowledges that the Scope of Services provides for 24 hour -a -day, 7 day -a -week, on -call support on an as needed basis. 2. Time of Performance. a. Time of Essence. Time is of the essence in the performance of this Agreement. The time for completion of the services and related work to be performed by Contractor is an essential condition of this Agreement. Contractor shall prosecute regularly and diligently the services and related work contemplated pursuant to this Agreement consistent with Contractor's Proposal (Exhibit A) and shall provide, furnish and pay all labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required to perform such the services and related work. b. Performance Schedule. Contractor shall commence the services and related work pursuant to this Agreement upon receipt of a written notice to proceed and shall On -Call Contract All American Asphalt Project Z10002 Page 1 perform all services and related work within the time period(s) established in the Contractor's Proposal (Exhibit A). When requested by Contractor, extensions to the time period(s) specified may be approved in writing by the City Manager. C. Terra and Compliance with Task/Work Order System. Unless earlier terminated as provided elsewhere in this Agreement, this Agreement shall continue in full force and effect for a period of eight (8) months, commencing on October 13, 2015 and ending on June 30, 2016. The City may, at its sole discretion, extend the term of this Agreement on a 12 -month basis not to exceed two (2) additional twelve (12) month renewal terms by giving written notice thereof to Contractor not less than thirty (30) days before the end of the contract term, such notice to be exercised by the City Manager. Contractor hereby agrees and acknowledges that any and all work or services performed pursuant to this Agreement shall be based upon the issuance of a Task/Work Order by the City. Contractor acknowledges that it is not guaranteed any minimum or specific amount of work or services as all work or services shall be authorized through a Task/Work Order issued by the City. 3. Compensation and Cost of Living Adjustment. Compensation to be paid to Contractor shall be in accordance with the fees set forth in Contractor's Proposal (Exhibit A), which is attached hereto and incorporated herein by reference. In no event shall Contractor's compensation exceed FIFTY FIVE THOUSAND DOLLARS ($55,000) without additional written authorization from the City. Notwithstanding any provision of Contractor's Proposal to the contrary, out of pocket expenses set forth in Exhibit A shall be reimbursed at cost without an inflator or administrative charge. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment. The compensation paid to Contractor may be adjusted on each July 1 following the first anniversary of the commencement of the term of this Agreement, provided that The request for cost of living adjustment shall be presented to the City no later than June 1 st of a particular year and, if approved by the City, will become effective on July 1st of that year. Any adjustment will be based on the Los Angeles- Riverside - Orange County Consumer Price Index (CPI) but in no event shall the price adjustment exceed five percent (5 %). 4. Method of Payment. Contractor shall promptly submit billings to the City describing the services and related work performed during the preceding month to the extent that such services and related work were performed. Contractor's bills shall be segregated by project task, if applicable, such that the City receives a separate accounting for work done on each individual task for which Contractor provides services. Contractor's bills shall include a brief description of the services performed, the date the services were performed, the number of hours spent and by whom, and a description of any reimbursable expenditures. City shall pay Contractor no later than forty -five (45) days after receipt of the monthly invoice by City staff. 5. Suspension or Termination. a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Contractor at least ten 10) days prior written notice. Upon receipt of such notice, the Contractor shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends Page 2 or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Contractor the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Contractor will submit an invoice to the City, pursuant to Section entitled "Method of Payment" herein. 6. Ownership of Documents. All plans, studies, documents and other writings prepared by and for Contractor, its officers, employees and agents and subcontractors in the course of implementing this Agreement, except working notepad internal documents, shall become the property of the City upon payment to Contractor for such work, and the City shall have the sole right to use such materials in its discretion without further compensation to Contractor or to any other party. Contractor shall, at Contractor's expense, provide such reports, plans, studies, documents and other writings to City upon written request. City acknowledges that any use of such materials in a manner beyond the intended purpose as set forth herein shall be at the sole risk of the City. City further agrees to defend, indemnify and hold harmless Contractor, its officers, officials, agents, employees and volunteers from any claims, demands, actions, losses, damages, injuries, and liability, direct or indirect (including any and all costs and expenses in connection therein), arising orIt of the City's use of such materials in a manner beyond the intended purpose as set forth herein. a. Licensing of Intellectual Property. This Agreement creates a nonexclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies. drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ( "Documents & Data "). Contractor shall require that all subcontractors agree in writing that City is granted a nonexclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were prepared by design professionals other than Contractor or provided to Contractor by the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. b. Confidentiality. All ideas, memoranda, specifications, plans, procedures, drawings, descriptions, computer program data, input record data, written information, and other Documents & Data either created by or provided to Contractor in connection with the performance of this Agreement shall be held confidential by Contractor. Such materials shall not, without the prior written consent of City, be used by Contractor for any purposes other than the performance of the services under this Agreement. Nor shall such materials be disclosed to any person or entity not connected with the performance of the services under this Agreement. Nothing furnished to Contractor which is otherwise known to Contractor or is generally known, or has become known, to the related industry shall be deemed confidential. Contractor shall not use City's name or insignia, photographs relating to project for which Contractor's services are rendered, or any publicity pertaining to the Contractor's services under this Agreement in any magazine, trade paper, newspaper, television or radio production or other similar medium without the prior written consent of City. Page 3 7. Contractor's Books and Records. a. Contractor shall maintain any and all ledgers, books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for services, or expenditures and disbursements charged to City for a minimum period of three 3) years, or for any longer period required by law, from the date of final payment to Contractor to this Agreement. b. Contractor shall maintain all documents and records which demonstrate performance under this Agreement for a minimum period of three (3) years, or for any longer period required by law, from the date of termination or completion of this Agreement. C. Any records or documents required to be maintained pursuant to this Agreement shall be made available for inspection or audit, at any time during regular business hours, upon written request by the City Manager, City Attorney, City Auditor or a designated representative of these officers. Copies of such documents shall be provided to the City for inspection at City Hall when it is practical to do so. Otherwise, unless an alternative is mutually agreed upon, the records shall be available at Contractor's address indicated for receipt of notices in this Agreement. d. Where City has reason to believe that such records or documents may be lost or discarded due to dissolution, disbandment or termination of Contractor's business, City may, by written request by any of the above -named officers, require that custody of the records be given to the City and that the records and documents be maintained in City Hall. Access to such records and documents shall be granted to any party authorized by Contractor, Contractor's representatives, or Contractor's successor -in- interest. 8. Inde endent. Contractor. It is understood that Contractor, in the performance of the work and services agreed to be performed, shall act as and be an independent contractor and shall not act as an agent or employee of the City. 9. PERS Eligibility Indemnification. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and /or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City. Notwithstanding any other federal, state and local laws, codes, ordinances and regulations to the contrary, Contractor and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City, including but not limited to eligibility to enroll in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits. 10. Interests of Contractor. Contractor (including principals, associates and management employees) covenants and represents that it does not now have any investment or interest in real property and shall not acquire any interest, direct or indirect, in the area Page 4 covered by this Agreement or any other source of income, interest in real property or investment which would be affected in any manner or degree by the performance of Contractor's services hereunder. Contractor further covenants and represents that in the performance of its duties hereunder no person having any such interest shall perfomn any services under this Agreement. Contractor is not a designated employee within the meaning of the Political Reform Act because Contractor: a. will conduct research and arrive at conclusions with respect to his /her rendition of information, advice, recommendation or counsel independent of the control and direction of the City or of any City official, other than normal agreement monitoring; and b. possesses no authority with respect to any City decision beyond rendition of information, advice, recommendation or counsel. (FPPC Reg. 18700(a)(2).) 11. Ability of Contractor. City has relied upon the training and ability of Contractor to perform the services hereunder as a material inducement to enter into this Agreement. Contractor shall therefore provide properly skilled personnel to perform all services under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily to be expected of competent contractors in Contractor's field of expertise. 12. Compliance with Laws. Contractor shall use the standard of care in its profession to comply with all applicable federal, state and local laws, codes, ordinances and regulations. 13. Licenses. Contractor represents and warrants to City that it has the licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor to practice its profession. Contractor represents and warrants to City that Contractor shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractor to practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 14. Indemnity. Contractor shall indemnify, defend, and hold harmless the City and its officials, officers, employees, agents, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contractor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to property, or violation of law. It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By Page 5 execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. 15. Insurance Requirements. a. Insurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the contract, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' Compgnsation Coverage. Contractor shall maintain Workers' Compensation Insurance and Employer's Liability Insurance for his /her employees in accordance with the laws of the State of California. In addition, Contractor shall require each subcontractor to similarly maintain Workers' Compensation Insurance and Employer's Liability Insurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non - renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all rights of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. In the event that Contractor is exempt from Worker's Compensation Insurance and Employer's Liability Insurance for his /her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation Insurance in a form approved by the City Attorney. ii. General Liability Coverage. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as Insurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11188) or Insurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and Insurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liability Coverage. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non -owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as Insurance Services Office Automobile Liability form CA 0001 (ed, 12/90) Code 1 ( "any auto "). No endorsement may be attached limiting the coverage. b. Endorsements. Each general liability and automobile liability insurance policy shall be with insurers possessing a Best's rating of no less than A:VII and shall be endorsed with the following specific language: Page 6 i. The City, its elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self- insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. V. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents or volunteers. vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days written notice has been received by the City. C. deductibles and Self - Insured Retentions. Any deductibles or self- insured retentions must be declared to and approved by the City. At the City's option, Contractor shall demonstrate financial capability for payment of such deductibles or self - insured retentions. d. Certificates of Insurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 16. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. If to City: City of Lake Elsinore Attn: City Manager 130 South Main Street Lake Elsinore, CA 92530 With a copy to: City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 Page 7 If to Contractor: All American Asphalt Attn: Edward J. Carson 400 East Sixth Street Corona, CA 92879 17. Entire Agreement. This Agreement constitutes the complete and exclusive statement of Agreement between the City and Contractor. All prior written and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. 18. Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 19. Assignment and Subcontracting. The parties recognize that a substantial inducement to City for entering into this Agreement is the reputation, experience and competence of Contractor. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Contractor shall not subcontract any portion of the work to be performed under this Agreement without the written authorization of the City. If City consents to such subcontract, Contractor shall be fully responsible to City for all acts or omissions of those subcontractors. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 20. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of the same or any other provision under this Agreement. 21. Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 22. Controlling Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 23. Litigation Expenses and Attorneys' Fees. If either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing parry shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys' fees. 24. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. If the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interest. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. If the dispute remains unresolved after mediation, either party may commence litigation. Page 8 25. Authority to Enter Agreement. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. The City Manager is authorized to enter into an amendment or otherwise take action on behalf of the City to make the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non - monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. 26. Prohibited Interests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulting from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 27. Equal Opportunity Employment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non - discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 28. Prevailing Wages. Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ( "Prevailing Wage Laws "), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation, if applicable, the Prevailing Wage Laws). It is agreed by the parties that, in connection with the work or services provided pursuant to this Agreement, Contractor shall bear all risks of payment or non - payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, and its officials, officers, employees, agents, and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The foregoing indemnity shall survive termination of this Agreement. 29. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. In approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. Signatures on next page] Page 9 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above. CITY" CITY OF LAKE ELSINORE, a municipal corporation Grant lyos, City Manager ATTEST: r Ac-43 city C APP OVEN AS TO OR : Chf Attorney Attachments: Exhibit A — Contractor's Proposal CONTRACTOR" All American Asphalt, a California corporation By: Edward J. &arrson Its: .,QAt VP Page 10 EXHIBIT A CONTRACTOR'S PROPOSAL ATTACHED] EXHIBIT A EXHIBIT A CITY OF LAKE ELSINORE PROJECT NO. Z10002 FY 15116 ANNUAL CRACK SEAL & POTHOLE REPAIRS PROPOSER:. All American Asphalt Contractor Name) DDnDnQA1 ITC &AC AC rill I (11A/C- ITEM DESCRIPTION OF ITEMS ESTIMATED QUANTITY UNIT PRICE TOTAL COST NO. FIGURES) FIGURES) 1 Remove and Replace 3 Inches (maximum) 5,000 SF Soo sections jb 1 2 1 % Inch edge mill 10,000 SF 1 C r QO17 3 Install 1 Inch AC leveling course 335 TON 114 - 10 4 Install 1 '/2 inch AC Hot Mix Asphalt 500 TON 1 ( Overlay 1000 TOTAL FOR ITEMS Based on estimated quantities of items 1 through 4 SCHEDULE ATotal Bid: _. '_ Igures -) SCHEDULE ATotal Bid: h 1r",1n c 5ev. --, '-w.ec.., In,r± a... r SQ t' • J CLj 2Q r' c t hA t. ( Words *) BID MAY BE REJECTED IF TOTAL IS NOT SHOWN FOR BOTH FIGURES AN2 WORDS. Payment bond required in this amount - no personal checks will be accepted): 9 a i LLI 9 or,•. Er' 1 r F r. Y ly ylv W CO A Q q .r, W o= i ..d. C/) L o O J c W V X b N rn T t G N AO _ L J N C C CL CK W 9r M v Co OZ a a: 3 C v A O d w Q M LW xW OG O O Y O a3dr0 d c m m 0 0 a V C a V CE 0 U a z O U z Cn Wl!J Z Q z W Z < W wC/) z Z UJ W O rnN F- LU N z 6i a m to 0 O Q K W N 0 N a YSY2 N N J Q 2 Q o0 N U N U w X QZ m0 Q 0. u N QLu LU Z J N r 1x I i yF CO A q .r, W i ..d. L o O X b N T t G N AO _ L J N C C CL co 9r M v Co a a: 3 C v Z U N U wWxW1! n O O YAa3dr0 d c m m 0 0 a C a V Ld O JR, N m a h ayON Rz GJ E LIJ A N ~ N H Z Z ro< 0 y ` E H rn o ` m' m o 00 0 to 0 O Q K W N 0 N a YSY2 N N J Q 2 Q o0 N U N U w X QZ m0 Q 0. u N QLu LU Z J N r 1x I i yF CITY OF _^ LAKE LSINOKE DREAM F.xTRI -ME City of Lake Elsinore Attn: Finance Department 130 South Main Street Lake Elsinore, CA 92530 951) 674 -3124 All American Asphalt VENDOR APPLICATION All American Asphalt Individual Name (if sole proprietor): First Business Address: 400 E. Sixth Street Address Corona _ CA City State Principal Contact for Firm: Edward J. Carlson OFFICE USE ONLY VENDOR NUMBER INPUT DATE 951) 736 -7600 E -Mail r publicworks@allamericanasphalt.com Taxpayer ID # or Social Security # 95- 2595043 MI Last Remittance Address (if different) PO Box 2229 Address 92879 Corona Zip City Title1VicePresident CA 92878 -2229 State Zip Phone: 951) 736 -7600 Type of Entity: Sole Proprietor Corporation Partnership Tax Exempt /Non -profit Government or Trust Is business licensed to do business in the City of Lake Elsinore? Q Yes No City of Lake Elsinore Business License is required if conducting business within the City of Lake Elsinore (LEMC 5.08.010) City Business License # 001333 _ Expiration Date: 1/31/16 Check all that apply: Goods only 0 Goods and Services Legal Services Medical Services Brief description of type of supplies and /or services offered (required): Asphalt Paving, Paving Fabric, Slurry, Concrete Rents /Leases paid to you as agent Other: The undersigend hereby certifies that the above and foregoing information is a full, true, and correct statement of the facts. Edward J. Carlson, Vice President I Q 12-8 I Signature Title Date 1. Terms: The City of Lake Elsinore is Net 45 days. 2. The City of Lake Elsinore is not tax exempt. 3. Purchase order required for $2,000.00 or more. 4. W -9 form must be completed to be accepted. 1 DATE (MWDD/YYYY) WSJ /J CERTIFICATE OF LIABILITY INSURANCE 10/27/2015 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 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 CA LiL` 0829370 1 -925- 244 -7700 Edgewood Partnern Insurance Centers (EPIC) Inland Empire - Branch ID 145421 P.O. Box 5003 San Ramon, CA 94583 NAME: Certificates Department PONS (925) 244 -7700 f925) 901 -0671 MAILDR g• EPICcertadle icbrokers.com INSURE: S AFFORDING COVE RAGE NAIC0 INSUkrgA: ARCH SPECIALTY INS CO 21199 INSURED All American Asphalt P.O. BOX 2229 Corona. CA 92878 -2229 INSURER B: ZURICH AVER INS CO 16535 INSURER C NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURER D: INSURER E INSURER F: r`nVFRAPF-Q r`9:RTIFI1 ATF MIIMRFR- 45324527 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 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. FNSR TYPE OF INSURANCE POLICY NUMBER I DDIYYY K I IMNVDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY AUTHORIZED REPRESENTATIVE OPP002265807 08/01/15 08/01/16 EACHOCCURRENCE S 1,000,000 CLAIMS -MADE LX OCCUR PREMISES urrenca 100,000 MED EXP (Any one person) 5 PERSONAL 8 ADV INJURY 1,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2.000,000POLICY JECT F1 LOC OTHER: B AUTOMOBILE LIABILITY BAPS57108803 08/01/15 08/01/16 NGLELIMIT y 2,000,000 BODILY INJURY (Per person) X ANY AUTO BODILY INJURY (Per accident) SALLOWNEDSCHEDULED AUTOS _ AUTOS X HIRED AUTOS X NON -OWNEDAUTOS PROPERTY DAMAGE C UMBRELLA LIAB X OCCUR 8311665655 08/01/15 08/01/16 EACH OCCURRENCE 10,000,000 AGGREGATE 10,000,000XEXCESSLIABCLAIMS -MADE DED I X I RETENTION$ 10,000 Following -Form B WORKERS COMPENSATIONANDEMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE [ OFFICER/MEMBER EXCLUDED? Mandatory In NH) NIA WC593205702 08 /01 /15 08/01/16 X STTAA7LITE I ER E.L. EACH ACCIDENT S 1,000,000 EL DISEASE - EA EMPLOYE 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000Ifyeadesmbeunder DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached II more space Is required) Project #Z10002 / RE: FY 15/16 Annual Crack Seal is Pothole Repairs Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation [21 r=cnr!Mi AVM Un1 nco rAN17`01 I ATIlnIJ ACORD 25 (2014101) sleles -ont 45324527 W 1V5t$ -ZU14 AL;VKU Uumrwr•cA I RJrY. AN ngnas rnservva. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lake Elsinore THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 130 South Main Street AUTHORIZED REPRESENTATIVE Lake Elsinore, CA 92531 I USA ACORD 25 (2014101) sleles -ont 45324527 W 1V5t$ -ZU14 AL;VKU Uumrwr•cA I RJrY. AN ngnas rnservva. The ACORD name and logo are registered marks of ACORD MEMO To: Whom it may concern From: Edgewood Partners Insurance Centers (EPIC) Named Insured: All American Asphalt et al Policy Number(s): GPP0022658 -07, BAP5571088 -03, WC5932057 -02, BE11665655 RE: Notice of Cancellation Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non - payment of premium. Sincerely, Kathy Loper Account Manager tel: 925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license OB29370 epicbrokers.com THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF - INSURED RETENTION COVERAGE FORM SECTION II — WHO 18 AN INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with you to be named as an additional Insured, but only with respect to liability for "bodily injury, 'property damage', or "personal and advertising injury" caused. In whole or In part, by your acts or omissions or the acts or omissions of your subcontractors: A. In the performance of your ongoing operations or "your work', Including 'your work' that has been completed; or B. In connection with your premises owned by or rented to you. As used in this endorsement, the words 'you' and 'your" refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #Z10002 / RE: FY 15116 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endorsement Number: This endorsement Is effective on the inception date of this policy unless otherwise stated herein. The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) PollcyNumber GPP0022658 -07 Named Insured: All American Asphalt at al Endorsement Effective gate: August 1, 2015 4063 00 CGL0006 00 05 07 Page t of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - BROAD FORM, CGL POLICY ENDORSEMENT This endorsement modifies Insurance provided under 11he following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following paragaph is added to Condition 4. Other Insurance: Where the Named Insured Is required by a wrltlen contract to provide Insurance that Is primary and non-wntrlbAory, and (lie written cordract so requin g Is executed by the Narned insured bef ©re any "acc»rre)ee" or offense, this Insurance will be prmary. but only If and to the extent required by that written contract All other terms and conditions of this Palley remal n unchanged. Schedule City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers P roject Project #Z10002 / RE: FY 15116 Annual Crack Seal Pothole Repairs Endorsement Number This endorsement is effective on the inception dais of this policy unless otherwise stated herein. The Information below Is required only when this endorsement Is Issued subsequent to preparatlon of the policy.) Policy Number: GPP0022658 -07 Named Insured: All Amerlcen Asphalt et al Endorsement Effecllve Date August 1, 2015 00 CGL0130 00 09 06 Page 1 of 1 4063 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF - INSURED RETENTION COVERAGE FORM SCHEDULE Noma of Person or Organization: Where required by written contract. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDMONS, Condition IL Transfer Of Rights Of Recovery Against Others To Us Is amended by the addition of the following provision: We waive any nght of recovery we may have ,agalnsl the W.rson or organization shown In the SCHEDULE above becrausa of payments we make for Injuiy or darluige arising out of your operations or your work" done under a written contract with that person or organization. All other terms and conditions of this Policy remain unchanged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #Z10002 /RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy) Policy Number, GPP002265 -07 Named Insured: All Amertcan Asphalt at al Endorsement Effecllve late: August 1, 2015 00 CGL0121 DO 09 06 Includes copyrighted material of Insurance Services Office, Inc„ Page 1 of 1 with Its permission. 4063 POLICYNUMBER BAP5571088 -03 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modMes Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modifled by this endorsement. This endorsement IdentMee person(s) or orgenizatlon(s) who are Insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not titer coverage provided In the Coverage Forth. This endorsement chanties the poky effective on the inception date of the poky unless another date Is indicated below. Endorsernent Effective: 8 / 1 / 15 Countersigned By: Authorized Re eseritative Named Insured: All American Asphalt SCHEDULE Name of Persons) or Orgaftdian(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON- CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Schedule Project City of Lake Elsinore, its elected or appointed officers, Project #Z10002 / RE: FY 15/16 Annual Crack Seal officials, employees, agents and volunteers & Pothole Repairs If no entry appears above. Infomidlon required to complete this endorsement YAN be shown In the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liabliky Coverage, but only to the extent the person or orgenizeibn qualifies as an 'insured' under the fto is An Insured Provision contained in Section II of the Coverage Form. CA 21148 02 99 Copyright, Insurance Services Offiee, Inc., 1969 Page 1 of 1 O 4063 POLICY NUMBER BAP 5 5 710 8 8— 0 3 COMMERCIAL AUTO CA 04 44 091 O THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modl- fled by the endorsement. This endorsement changes the policy affective on the Inception date of the policy unless another date Is Indicated below. Namadlroumd: All American Asphalt Endorsement Efbduw tom: 8/1/15 SCHEDULE Nams(s) Of Person(s) Or Orp riftilon(s): ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule. C not shown above. will be shown In the Declarations. The Transfer Of Rights Of Reoorary Against Others To Us Condition does not apply to the person(s) or organtzation(s) shown In the Schedule, but only to the extent that subrogation is walved prior to the Ise - cldent" or the loss" under a contract with that parson or organization. Schedule City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers Project Project #Z10002 /RE: FY 15/16 Annual Crack Seal Pothole Repairs 4063 CA 04 44 0310 0 Insurance Servtces Office, Inc., 2009 Page 1 d 1 0 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 09 06 Ed. 4aQ WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA V* hem 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. (This agreement applies only to the eAeent that you perform work under a written contract that requires you to obtain this agreen*nr from us.) You must maintain payroll records accurralsly segregating the remuneration of your employees while engaged In the work described In the Schedule. The addltkmel premlum for this endorsement shall be 0.00 % of the California workers' compensation pre- mium otherwise due on such remuneration. Parson or Orgsnftdon ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PLUORNED BY YOU FOR THAT PERSON AND /OR ORGANISATION Schedule Job Deaxiptlon ALL CA OPERATION City of Lake Elsinore, its elected or appointed officers, officials, employees, agents and volunteers All American Asphalt Policy #WC5932057 -02 8/1/15 wC 252 (4$4) WC 04 03 06 (Ed. 4.64) Project #Z10002 /RE: FY 15/16 Annual Crack Seal & Pothole Repairs Zurich American Ins. Co. Page 1 or 1 4063 Form w'9 Request for Taxpayer Give Form to the Rev. December 2 Identification Number and Certification requester. Do not send to the IRS. re s7.14=1. fre TreasuryService 1 Name (as shown on your income tax return). Name Is required on this line; do not leave this line blank. All American Asphalt r`i 2 Business nameldlsregarded entity name, If different from above drn 4 Exemptions (codes apply only toc3Checkappropriateboxforfederaltaxclassification; check only one of the following seven boxes: certain entitles, not Individuals; see G Indivlduallsole proprietor or C Corporation S Corporation Partnership Trust/estate Instructions on page 3): single - member LLC Exempt payee code (If any) Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) iS Note. For a single- member LLC that Is disregarded, do not check LLC; check the appropriate box In the line above for Exemption from FATCA reporting the tax classification of the single - member owner. code (if any) Other (sea inslruClfons) pppa to. —ft m.FrrrnW ouha• fe. U.S.) 5 Address (number, street, and apt. or suite no.) Requester's name and address (optional) PO Box 2229 City of Lake Elsinore a City, state, and ZIP rode 130 South Main Street Corona, CA 92878 -2229 Lake Elsinore CA 92530 7 List account number(s) here (optlonaf) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this Is generally your social security number ( However, for e disregarded the Part I instructions on 3. For otherpageresidentalien, sole proprietor, or entity, see page titles It is our em to er identification number (EIN) If you do not have a number see How to get aenIypy TIN on page 3. or Note. If the account is In more than one name, see the instructions for line 1 and the chart on page 4 for _Employer identification number guidelines on whose number to enter. 9 5- 2 5 9 5 0 4 3 Ill:Frallill Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature of Here I U.S. person Date 10 ke, - General Instructions mt(h "i 1 [;I$ ka5, <_e(- `e t Section references are to the Internal Revenue Code unless otherwise noted. Future developments Information about developments affecting Form W -9 (such as legislation onacU d after we release it) is at www.irs.govlfw9. Purpose of Form An Individual or entity (Form W -9 requester) who Is required to file an Information return with the IRS must obtain your correct taxpayer idenllficatlon number (TIN) which may be your social security number (SSN), IMNIdual taxpayer Identification number (ITIN), adoption taxpayer Identlftcation number (ATIN), or employer Identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an Information return, Examples of Information retwma mclude, but are not limited to, the following: Form 1099 -INT (interest earned or paid) Form 1099 -DIV (dividends, including those from stocks or mutual funds) Form 1099 -MISC (various types of income, prizes, awards, or gross proceeds) Form 1099 -8 (stock or mutual fund sales and certain other transactions by brokers) Form 1099 -S (proceeds from real estate transactions) Form 1099 -K (merchant card and third party network transactions) Form 1098 (home mortgage interest), 1098 -E (student loan Interest), 1098 -T tuition) Form 1099 -C (canceled debt) Form 1099 -A (acquisition or abandonment of secured property) Use Form W -9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN. If you do nor relurn Form W -9 to the requester with a TIN, you might be subject to backup,vithholding. Sea What is backup wlrhholding? on page 2. By signing the filled -out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from 'backup withholding If you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership Income from a U.S. trade or business Is not subject to the withholding tax on foreign partners' share of offecilvely connected Income, and 4. Certify that FATCA code(s) entered on this form Of any) indicating that you are exempt from the FATCA reporting, Is correct. See What is FATCA raporftng? on page 2 for further information. Cat. No 10231X Form W -9 (Rev. 12 -2014) AGREEMENT FOR CONTRACTOR SERVICES (ON-CALL) ALL AMERICAN ASPHALT FY 15/16 Annual Crack Seal & Pothole Repairs, Project No. 210002 This Agreement for Contractor Services (On-Call) (the "Agreement") is made and entered into as of October 13,2015, by and between the City of Lake Elsinore, a municipal corporation ("City") and All American Asphalt, a California corporation ("Contractor"). RECITALS A. The City has determined that it requires the following services: Road repair at various locations Citywide. Services to include but not limited to pothole repair, overlay, and crack seal. B. The City has prepared a notice inviting bids and Contractor has submitted to City a proposal, dated Septembet 24, 2015, both of which are attached hereto as Exhibit A collectively, the "Contractor's Proposal") and incorporated herein, to provide services and related work to the City pursuant to the terms of this Agreement. C. Contractor possesses the skill, experience, ability, background, certification and knowledge to perform the services and related work described in this Agreement on the terms and conditions described herein. D. City desires to retain Contractor to perform the services and related work as provided herein and Contractor desires to provide such services and related work as set forth in this Agreement. AGREEMENT 1. Scope of Services. Contractor shall perform the services and related work described in Contractor's Proposal (Exhibit A). Contractor shall provide such services and related work at the time, place, and in the manner specified in Contractor's Proposal (Exhibit A)' subject to the direction of the City through its staff that it may provide from time to time. Contractor acknowledges that the Scope of Services provides for 24 hour-a-day, 7 day-a-week, on-call support on an as needed basis. 2. Time of Performance. a. Time of Essence. Time is of the essence in the performance of this Agreement. The time for completion of the services and related work to be performed by Contractor is an essential condition of this Agreement. Contractor shall prosecute regularly and diligently the services and related work contemplated pursuant to this Agreement consistent with Contractor's Proposal (Exhibit A) and shall provide, furnish and pay all labor, materials, necessary tools, expendable equipment, and all taxes, utility and transportation services required to perform such the services and related work. b. Performance Schedule. Contractor shall commence the services and related work pursuant to this Agreement upon receipt of a written notice to proceed and shall On,Call Contracl AllAmerican Asphalt Project 21OOO2 Page 1 perform all services and related work within the time period(s) established in the Contractor's Proposal (Exhibit A). When requested by Contractor, extensions to the time period(s) specified may be approved in writing by the City Manager. c. Term and Compliance with TaskMork Order Svstem. Unless earlier terminated as provided elsewhere in this Agreement, this Agreement shall continue in full force and effect for a period of eight (8) months, commencing on October 13,2015 and ending on June 30, 20'16. The City may, at its sole discretion, extend the term of this Agreement on a 12-month basis not to exceed two (2) additional twelve (12) month renewal terms by giving written notice thereof to Contractor not less than thirty (30) days before the end of the contract term, such notice to be exercised by the City Manager. Contractor hereby agrees and acknowledges that any and all work or services performed pursuant to this Agreement shall be based upon the issuance of a Taskruork Order by the City. Contractor acknowledges that it is not guaranteed any minimum or specific amount of work or services as all work or services shall be authorized through a Task/Work Order issued by the City. 3. Compensation and Cost of Livinq Adiustment. Compensation to be paid to Contractor shall be in accordance with the fees set forth in Contractor's Proposal (Exhibit A), which is attached hereto and incorporated herein by reference. ln no event shall Contractor's compensation exceed FIFTY FIVE THOUSAND DOLLARS ($55,000) without additional written authorization from the City. Notwithstanding any provision of Contractor's Proposal to the contrary, out of pocket expenses set forth in Exhibit A shall be reimbursed at cost without an inflator or administrative charge. Payment by City under this Agreement shall not be deemed a waiver of defects, even if such defects were known to the City at the time of payment. The compensation paid to Contractor may be adjusted on each July l following the first anniversary of the commencement of the term of this Agreement, provided that The request for cost of living adjustment shall be presented to the City no later than June 1st of a particular year and, if approved by the City, will become effective on July 1st of that year. Any adjustment will be based on the Los Angeles-Riverside-Orange County Consumer Price lndex (CPl) but in no event shall the price adjustment exceed five percent (5%). 4. Method of Pavment. Contractor shall promptly submit billings to the City describing the services and related work performed during the preceding month to the extent that such services and related work were performed. Contractor's bills shall be segregated by project task, if applicable, such that the City receives a separate accounting for work done on each individual task for which Contractor provides services. Contractor's bills shall include a brief description of the services performed, the date the services were performed, the number of hours spent and by whom, and a description of any reimbursable expenditures. City shall pay Contractor no later than forty-five (45) days after receipt of the monthly invoice by City staff. 5. Susoension or Termination. a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Contractor at least ten 10) days prior written notice. Upon receipt of such notice, the Contractor shall immediately cease all work under this Agreement, unless the notice provides otherwise. lf the City suspends Page 2 or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. ln the event this Agreement is terminated pursuant to this Section, the City shall pay to Contractor the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Contractor will submit an invoice to the City, pursuant to Section entitled "Method of Payment" herein. 6. Ownership of Documents. All plans, studies, documents and other writings prepared by and for Contractor, its officers, employees and agents and subcontractors in the course of implementing this Agreement, except working notepad internal documents, shall become the property of the City upon payment to Contractor for such work, and the City shall have the sole right to use such materials in its discretion without further compensation to Contractor or to any other party. Contractor shall, at Contractor's expense, provide such reports, plans, studies, documents and other writings to City upon written request. City acknowledges that any use of such materials in a manner beyond the intended purpose as set forth herein shall be at the sole risk of the City. City further agrees to defend, indemnify and hold harmless Contractor, its officers, officials, agents, employees and volunteers from any claims, demands, actions, losses, damages, injuries, and liability, direct or indirect (including any and all costs and expenses in connection therein), arising out of the City's use of such materials in a manner beyond the intended purpose as set forth herein. a. Licensino of lntellectual Propertv. This Agreement creates a nonexclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otheMise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require that all subcontractors agree in writing that City is granted a nonexclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were prepared by design professionals other than Contractor or provided to Contractor by the City. City shall not be limited in any way in its use of the Documents & Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. b. Confidentialitv. All ideas, memoranda, specifications, plans, procedures, drawings, descriptions, computer program data, input record data, written information, and other Documents & Data either created by or provided to Contractor in connection with the performance of this Agreement shall be held confidential by Contractor. Such materials shall not, without the prior written consent of City, be used by Contractor for any purposes other than the performance of the services under this Agreement. Nor shall such materials be disclosed to any person or entity not connected with the performance of the services under this Agreement. Nothing furnished to Contractor which is otherwise known to Contractor or is generally known, or has become known, to the related industry shall be deemed confidential. Contractor shall not use City's name or insignia, photographs relating to project for which Contractor's services are rendered, or any publicity pertaining to the Contractor's services under this Agreement in any magazine, trade paper, newspaper, television or radio production or other similar medium without the prior written consent of City. Page 3 7. Contractor's Books and Records. a. Contractor shall maintain any and all ledgers, books of account, invoices, vouchers, canceled checks, and other records or documents evidencing or relating to charges for services, or expenditures and disbursements charged to City for a minimum period of three 3) years, or for any longer period required by law, from the date of final payment to Contractor to this Agreement. b. Contractor shall maintain all documents and records which demonstrate performance under this Agreement for a minimum period of three (3) years, or for any longer period required by law, from the date of termination or completion of this Agreement. c. Any records or documents required to be maintained pursuant to this Agreement shall be made available for inspection or audit, at any time during regular business hours, upon written request by the City Manager, City Attorney, City Auditor or a designated representative of these officers. Copies of such documents shall be provided to the City for inspection at City Hall when it is practical to do so. Otherwise, unless an alternative is mutually agreed upon, the records shall be available at Contractor's address indicated for receipt of notices in this Agreement. d. Where City has reason to believe that such records or documents may be lost or discarded due to dissolution, disbandment or termination of Contractor's business, City may, by written request by any of the above-named officers, require that custody of the records be given to the City and that the records and documents be maintained in City Hall. Access to such records and documents shall be granted to any party authorized by Contractor, Contractor's representatives, or Contractor's successor-in-interest. 8. lndependent Contractor. lt is understood that Contractor, in the performance of the work and services agreed to be performed, shall act as and be an independent contractor and shall not act as an agent or employee of the City. 9. PERS Eliqibilitv lndemnification. ln the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of the City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City. Notwithstanding any other federal, state and local laws, codes, ordinances and regulations to the contrary, Contractor and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City, including but not limited to eligibility to enrolt in PERS as an employee of City and entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits. 10. lnterests of Contractor. Contractor (including principals, associates and management employees) covenants and represents that it does not now have any investment or interest in real property and shall not acquire any interest, direct or indirect, in the area Page 4 covered by this Agreement or any other source of income, interest in real property or investment which would be affected in any manner or degree by the performance of Contractor's services hereunder. Contractor further covenants and represents that in the performance of its duties hereunder no person having any such interest shall perform any services under this Agreement. Contractor is not a designated employee within the meaning of the Political Reform Act because Contractor: a. will conduct research and arrive at conclusions with respect to his/her rendition of information, advice, recommendation or counsel independent of the control and direction of the City or of any City official, other than normal agreement monitoring; and b. possesses no authority with respect to any City decision beyond rendition of information, advice, recommendation or counsel. (FPPC Reg. 18700(aX2).) 11. Ability of Contractor. City has relied upon the training and ability of Contractor to perform the services hereunder as a material inducement to enter into this Agreement. Contractor shall therefore provide properly skilled personnel to perform all services under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily to be expected of competent contractors in Contractor's field of expertise. 12. Compliance with Laws. Contractor shall use the standard of care in its profession to comply with all applicable federal, state and local laws, codes, ordinances and regulations. 13. Licenses. Contractor represents and warrants to City that it has the licenses, permits, qualifications, insurance and approvals of whatsoever nature which are legally required of Contractor to practice its profession. Contractor represents and warrants to City that Contractor shall, at its sole cost and expense, keep in effect or obtain at all times during the term of this Agreement, any licenses, permits, insurance and approvals which are legally required of Contractor to practice its profession. Contractor shall maintain a City of Lake Elsinore business license. 14. lndemnitv. Contractor shall indemnify, defend, and hold harmless the City and its officials, officers, employees, agents, and volunteers from and against any and all losses, liability, claims, suits, actions, damages, and causes of action arising out of any personal injury, bodily injury, loss of life, or damage to property, or any violation of any federal, state, or municipal law or ordinance, to the extent caused, in whole or in part, by the willful misconduct or negligent acts or omissions of Contractor or its employees, subcontractors, or agents, by acts for which they could be held strictly liable, or by the quality or character of their work. The foregoing obligation of Contractor shall not apply when (1) the injury, loss of life, damage to property, or violation of law arises from the sole negligence or willful misconduct of the City or its officers, employees, agents, or volunteers and (2) the actions of Contraclor or its employees, subcontractor, or agents have contributed in no part to the injury, loss of life, damage to property, or violation of law. lt is understood that the duty of Contractor lo indemnify and hold harmless includes the duty to defend as set forth in Section 2778 ol lhe California Civil Code. Acceptance by City of insurance certificates and endorsements required under this Agreement does not relieve Contractor from liability under this indemnification and hold harmless clause. This indemnification and hold harmless clause shall apply to any damages or claims for damages whether or not such insurance policies shall have been determined to apply. By Page 5 execution of this Agreement, Contractor acknowledges and agrees to the provisions of this Section and that it is a material element of consideration. 15. lnsuranceRequirements. a. lnsurance. Contractor, at Contractor's own cost and expense, shall procure and maintain, for the duration of the contract, unless modified by the City's Risk Manager, the following insurance policies. i. Workers' Compensation Coveraqe. Contractor shall maintain Workers' Compensation lnsurance and Employels Liability lnsurance for his/her employees in accordance with the laws of the State of California. ln addition, Contractor shall require each subcontractor to similarly maintain Workers' Compensation lnsurance and Employels Liability lnsurance in accordance with the laws of the State of California for all of the subcontractor's employees. Any notice of cancellation or non-renewal of all Workers' Compensation policies must be received by the City at least thirty (30) days prior to such change. The insurer shall agree to waive all righls of subrogation against City, its officers, agents, employees and volunteers for losses arising from work performed by Contractor for City. ln the event that Contractor is exempt from Worker's Compensation lnsurance and Employer's Liability lnsurance for his/her employees in accordance with the laws of the State of California, Contractor shall submit to the City a Certificate of Exemption from Workers Compensation lnsurance in a form approved by the City Attorney. ii. General Liabilitv Coveraoe. Contractor shall maintain commercial general liability insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. lf a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit. Required commercial general liability coverage shall be at least as broad as lnsurance Services Office Commercial General Liability occurrence form CG 0001 (ed. 11l88) or lnsurance Services Office form number GL 0002 (ed. 1/73) covering comprehensive General Liability and lnsurance Services Office form number GL 0404 covering Broad Form Comprehensive General Liability. No endorsement may be attached limiting the coverage. iii. Automobile Liabilitv Coveraqe. Contractor shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non-owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence. Automobile liability coverage must be at least as broad as lnsurance Services Office Automobile Liability form CA 0001 (ed. 12190) Code 1 ("any auto"). No endorsement may be attached limiting the coverage. b. Endorsements. Each general liability and automobile liability insurance policy shall be with insurers possessing a Best's rating of no less than A:Vll and shall be endorsed with the following specific language: Page 6 i. The City, iis elected or appointed officers, officials, employees, agents and volunteers are to be covered as additional insured with respect to liability arising out of work performed by or on behalf of the Contractor, including materials, parts or equipment furnished in connection with such work or operations. ii. This policy shall be considered primary insurance as respects the City, its elected or appointed officers, officials, employees, agents and volunteers. Any insurance maintained by the City, including any self-insured retention the City may have, shall be considered excess insurance only and shall not contribute with it. iii. This insurance shall act for each insured and additional insured as though a separate policy had been written for each, except with respect to the limits of liability of the insuring company. iv. The insurer waives all rights of subrogation against the City, its elected or appointed officers, officials, employees or agents. v. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its elected or appointed officers, officials, employees, agents or volunteers. vi. The insurance provided by this Policy shall not be suspended, voided, canceled, or reduced in coverage or in limits except after thirty (30) days wriften notice has been received by the City. c. Deductibles and Self-lnsured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City. At the City's option, Contractor shall demonstrate financial capability for payment of such deductibles or self-insured retentions. d. Certificates of lnsurance. Contractor shall provide certificates of insurance with original endorsements to City as evidence of the insurance coverage required herein. Certificates of such insurance shall be filed with the City on or before commencement of performance of this Agreement. Current certification of insurance shall be kept on file with the City at all times during the term of this Agreement. 16. Notices. Any notice required to be given under this Agreement shall be in writing and either served personally or sent prepaid, first class mail. Any such notice shall be addressed to the other party at the address set forth below. Notice shall be deemed communicated within 48 hours from the time of mailing if mailed as provided in this section. lf to City:City of Lake Elsinore Attn: City Manager 1 30 South Main Street Lake Elsinore, CA 92530 City of Lake Elsinore Attn: City Clerk 130 South Main Street Lake Elsinore, CA 92530 With a copy to: Page 7 lf to Contractor: All American Asphalt Attn: Edward J. Carson 400 East Sixth Street Corona, CA 92879 17. Entire Aqreement. This Agreement constitutes the complete and exclusive statement of Agreement between the City and Contractor. All prior wriften and oral communications, including correspondence, drafts, memoranda, and representations, are superseded in total by this Agreement. 18. Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as lo form by the City Attorney. 19. Assiqnment and Subcontractinq. The parties recognize that a substantial inducement to City for entering into this Agreement is the reputation, experience and competence of Contractor. Contractor shall be fully responsible to City for all acts or omissions of any subcontractors. Assignments of any or all rights, duties or obligations of the Contractor under this Agreement will be permitted only with the express consent of the City. Contractor shall not subcontract any portion of the work to be performed under this Agreement without the written authorization of the City. lf City consents to such subcontract, Contractor shall be fully responsible to City for all acts or omissions of those subcontractors. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of the City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise is required by law. 20. Waiver. Waiver of a breach or default under this Agreement shall not constitute a continuing waiver of a subsequent breach of lhe same or any other provision under this Agreement. 21. Severabilitv. lf any term or portlon of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 22. Controllino Law Venue. This Agreement and all matters relating to it shall be governed by the laws of the State of California and any action brought relating to this Agreement shall be held exclusively in a state court in the County of Riverside. 23. Litiqation Exoenses and Attornevs' Fees. lf either party to this Agreement commences any legal action against the other party arising out of this Agreement, the prevailing party shall be entitled to recover its reasonable litigation expenses, including court costs, expert witness fees, discovery expenses, and attorneys' fees. 24. Mediation. The parties agree to make a good faith attempt to resolve any disputes arising out of this Agreement through mediation prior to commencing litigation. The parties shall mutually agree upon the mediator and share the costs of mediation equally. lf the parties are unable to agree upon a mediator, the dispute shall be submitted to JAMS or its successor in interesl. JAMS shall provide the parties with the names of five qualified mediators. Each party shall have the option to strike two of the five mediators selected by JAMS and thereafter the mediator remaining shall hear the dispute. lf the dispute remains unresolved after mediation, either party may commence litigation. Page I 25. Authoritv to Enter Aoreement. Contractor has all requisite power and authority to conduct its business and to execute, deliver, and perform the Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority to make this Agreement and to bind each respective party. The City Manager is authorized to enter into an amendment or otherwise take action on behalf of the City to make the following modifications to the Agreement: (a) a name change; (b) grant extensions of time; (c) non- monetary changes in the scope of services; and/or (d) suspend or terminate the Agreement. 26. Prohibited lnterests. Contractor maintains and warrants that it has not employed nor retained any company or person, other than a bona fide employee working solely for Contractor, to solicit or secure this Agreement. Further, Contractor warrants that it has not paid nor has it agreed to pay any company or person, other than a bona fide employee working solely for Contractor, any fee, commission, percentage, brokerage fee, gift or other consideration contingent upon or resulling from the award or making of this Agreement. For breach or violation of this warranty, City shall have the right to rescind this Agreement without liability. For the term of this Agreement, no member, officer or employee of City, during the term of his or her service with City, shall have any direct interest in this Agreement, or obtain any present or anticipated material benefit arising therefrom. 27. Equal Opportunitv EmDlovment. Contractor represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because of race, religion, color, national origin, handicap, ancestry, sex or age. Such non-discrimination shall include, but not be limited to, all activities related to initial employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff or termination. 28. Prevailinq Waqes. Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section '16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. Contractor agrees to fully comply with all applicable federal and state labor laws including, without limitation, if applicable, the Prevailing Wage Laws). lt is agreed by the parties that, in connection with the work or services provided pursuant to this Agreement, Contractor shall bear all risks of payment or non-payment of prevailing wages under California law, and Contractor hereby agrees to defend, indemnify, and hold the City, and its officials, officers, employees, agents, and volunteers, free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The foregoing indemnity shall survive termination of this Agreement. 29. Execution. This Agreement may be executed in several counterparts, each of which shall constitute one and the same instrument and shall become binding upon the parties when at least one copy hereof shall have been signed by both parties hereto. ln approving this Agreement, it shall not be necessary to produce or account for more than one such counterpart. Signatures on next page] Page I lN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the date first written above. Mg CITY' CITY OF LAKE ELSINORE, a municipal corporation Attachments: Exhibit A - Contractor's Proposal CONTRACTOR" All American Asphalt, a California corporation Edward J. Carson Page 10 on&f.- Vt, 7t EXHIBIT A CONTRACTOR'S PROPOSAL ATTACHED] EXHIBIT A EXHIBIT A CITY OF LAKE ELSINORE PROPOSAL.SCHEDULE PROJEGT NO. 21OOO2 FY 15/16 ANNUAL CRACK SEAL & POTHOLE REPAIRS pROpOSER. AllAmerican Asphalt *" ,, Contractor Name) SCHEDULE ATotal Bid: SCHEDULE ATotalBid: orc Ctxdt. BIF MAY,,HE REJE Payment bond required in this amount - no personal checks will be accepted): i-& PROPOSAL ITEMS AS FOLLOWS: ITEM NO. DESCRIPTION OF ITEMS ESTIMATED QUANTITY UNIT PRICE FTGURES) TOTAL COST FTGURES) 1 Remove and Replace 3 inches (maximum) sections 5,000 SF L't.tr Q.t1 Sr:o 2 1'/zinch edge mill 10,000 SF t,<(o ls, ooo 3 lnstall 1 inch AC leveling course 335 TON te.??,Q-to 4 lnstall 1lzinch AC Hot Mix Asphalt Overlay 500 TON s?L1 t,ooo TOTAL FOR ]TEMS Based on estimated quantities of items I through 4 I 01, at-? o. lol () 9 1--;--r-='- - t-=i:=-\r ----F- ! BU5INE55 LICENSE ThiS businesS trqense is issued lor tevenue Pulposet only and doeS nor grant authorization to operate a buriness Thls buriness license rs rssued walhout verification that the holder rs subject to or exemPted from licensing by the rtale. County, federal governm€nt. or any other governmenlal agency- Business Hame: ALL AMERICAN ASPHALT Business Location: P O BOX 2229 CORONA, CA 92878 Owner Name(s): MARK LUER ALLAMERICAN ASPHALT P O BOX2229 CORONA, CA 92878 CITY OF LAKE ELSINORE ADMIN ISTRATIV E STRUIftS.TIGNSIN6 ll0 South Main Street Lake [lsinore, CA 91530 951.67{.3124 TO BT POSTED IN A (ONSPICUOUS PI.Aff BUSINESS LICENSE NO. 001333 Business Type: GENERAL ENGINEERING CONTRACTOR lssue Oate: 21112015 Expiration Date: 1/31/2016 IHIS IS YOUR LIffNsE . NOT TEANSTERfiBTT a -i*##u": i CII.Y OF LA KE C3 LSINOI\E City of Lake Elsinore Attn: Fi nonce Deportment 130 South Main Street LokeElsinore,CA 92530 951 ) 674-31 24 VENDOR APPLICATION The undersigend, hereby c OFFICE U5E ONLY VENDOR NUMBER INPUT DATT- AllAmerican Asphalt (951) 736-7600 All American Asphalt Taxpayer lD # or Social Security # 95-2595043 lndividual Name (if sole proprietor): Remittance Address (if different) : PO Box2229 Address corona CA 92878-2229 City State liP Business Address: 400 E. Sixth Street Addres Corona CA 92879 Title Vice President Phone: e51) 736-7600 Principal Contact for Firm: Edward J. Carlson Type of Entity: Sote Proprietor I Corporation I Partnership ! fax Exempt/Non-profit f] Government orTrust ls business licensed to do business in the City of Lake Elsinorei I Ves n No City of Lake Elsinore Business License is required if conducting business within the City of Lake Elsinore (LEMC 5.0s.010)City Business License # 001333 Expiration Date' 1/31/1 6 Check all that apply: fl Goods only I cooos and services ! Rents/Leases paid to you as agent legatservices fl rraeaicatservices ! other: Brief description of type of supplies and/or services offered (required): Asphalt Paving, Paving Fabric, Slurry, Concrete that the above and foregoing information is a full, true, and correct statement of the facts. 1. Terms: The City of Lake Elsinore is Net 45 days. 3. Purchase order required for 52,000.00 or more. Edward J. Carlson, Vice President Date 2. The City of Lake Elsinore is not tax exempt. 4. W-9 form must be completed to be accepted. olzshr publicworks@allamericanasphalt.com First MI Last City ocfu CERTIFICATE OF LIABILITY INSURANCE DATE (MM/OD/YYYY) L0/27 /20Ls THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFF]RMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THrS CERTIFICATE OF TNSURANCE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE TSSUTNG TNSURER(S), AUTHORTZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. !f SUBROGATION !S 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 cA Lrc 0829370 L-925-244-7700 Edgevrood Partners Insurance C€nters (EPfC) llnland Emplre - Branch lD 145421 P.O. Box 5003 San Ramon, CA 94583 gHlllqr certificateg Departeent PN"E^,*,. (s25) 244-7700 ll$I.n"r, (92s) 901-0d71 i',itflf==. EPrccertE@epLcbroker6.com INSURER(S) AFFORDING COVERAGE NAIC # TNSURERA: ARCH SPECIALTY INS CO 2L]-99 INSURED All American Asphalt P.O. Box 2229 Corona, CA 92878-2229 rNsuPFR R ' ZURICH A!.{BR INS CO 15s35 rNsrpFR.. NATIONAL IINION FIRE INS CO OF PITTS 194,1s INSURER D : INSURER E: INSURER F CERTIFTCATE NUMBER: 4s324s27 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTMCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUMNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSUMNCE POLICY NUMBER tl LIMITS A x COMMERCIAL GENERAL LIABILITY- l.*,r.-roo. [E o."r* GPPo 02 2 55 807 08 / 0L/ t5 0e/ ot/L6 EACH OCCURRENCE g 1,000,000 DAMAGE TO RENTED PRFMISFS lFa ocdrrr€$ 100, 000 l\4ED EXP (Anv one oerson)$ PERSONAL & ADV INJURY $ 1,000,000 GEI\I I'L AGGREGATE LIMIT APPLIES PER: or,., | *.lffi fl .o. GENERAL AGGREGATE g 2, 000, 000 PROOUCTS - COMP/OP AGG $ 2, 000, 000 B l i_l OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIREO AUTOS f.--lscxeouleoIIAUToSf..-l Horl-owrueo I ^ Irurosft BAP5 57 10 8 8 03 08/ 0L/Ls 08 / 0t/t5 )MBINED SINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person)$ BODILY INJURY (Per a@ident)$ PROPERTY DAMAGE( Per a@ident)$ c UMBRELLA LIAB EXCESS LIAB x I occun_-.l o,r.-roo= B811665655 o8 / 07/ts 08/ 0L/ 16 EACH OCCURRENCE g 10,000,000 x AGGREGATE g 10, 000, 000 DED X I ngrerurroms 10,000 Following- Form $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOFYPARTNEFYEXECUTIVE OFFICEFYMEMBER EXCLUDED? Mandatory ln NH) lf y€s, dsscflbsund6rntrqaPlPTlONnFOPFtrATIONq hal^w Y/NE N/A wcs93205702 08 / oL/ Ls o8/ 0L/L6 vIPER I IOTH-^ lSrATUTE I IER E.L. EACH ACCIDENT g 1,000,000 E.L. DISEASE. EA EMPLOYEI $ 1,000,000 E.L. DISEASE. POLICY LIMIT $ 1,000, 000 DESCRIPTIONOFOPERATIONSTLOCATIONS/VEHICLES (ACORDl0l,AddltlonalRemarksSchedule,maybeattachedlfmorospacelsrcqulred) Project #210002 / RE: FY 15/15 Annual Crack S6aI & PoEhole RepairB C€rtifl.cato IIoIdar i6 Additional Ingured tf Requlred by Written contract Bxcluding Woakers CompenEatsion [21 TION City of Lake ElBinore 130 South Main St,re€t Lake Elainore, CA 92531 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @'1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks ofACORDACORD25 (201410',t1 sIeIes -ont 45324527 trEItrC MEMO Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Kaib) Lopq Account Manager To:Whom it may concern From:Edgewood Partners lnsurance Centers (EPIC) Named lnsured:All American Asphalt et al Policy Number(s):GPP0022658-07, 8Ap5571088-03, WC5932057 -02, 8E11665655 RE:Notice of Cancellation tel:925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license OB2937O epicbrokers.com THIS ENDORSETIIENT CHAHGES THE POLICY. PLEASE READ IT CAREFULLY. B LAN ITET A DtrMONAt I NSU RED E}{DORSEITI EHT THs erdomament modlfles lnsurarrce pfin lded under llx fullornirlg: COMMERCIAT GENERAT LIABIIITY COVERAGE FORU COMMERCIAT GENEBAL LIABILITY SELF.INBURED RETENNON COVEEAGE FORM EECTIOH ll - YUHO l8 AH HAURED b amanded to includa s m addifonal insursd thGB p*rtons or organlrelhns wtn are rqulred un&r s unltten ffinlrad with yrou to be rEmed as an odlllmd in$red, but oS wlth respocl to llablllty for'bodily lnltry', ?roperty damage'. or "personal and edvertsl16 lnjury" caused. ln u,hole or ln parl. by yuur ds s ofilsslons or the scls or omlssions of lotr suboontractors: A, In lhe performanca of ltur ryolng operatlons or \pur worf, lncluding Yurr rrmrk'lhat hm b*en oornplate* or B, ln csnr€dbn wilh your pramkes o$rnd by or rer{ed h ysu, Ae us6d in stie endorsam€fit lha wurds lou' and 'youf refer lo the Hamsd lnzursd. All ollxrtamns and mndltlons of thb Polir] mmain unchang€d. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #210002 / RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endlrtcrnfnl Nunber: This erdore€ment is sff€divr m the inmfiion dab otlhis pdicy unlesa oltn wisa 6Hed her6in. The lrfornallon belcrrr h reqiired only wten thls endorsomenl ls lssued subssquent to preperallon of tha pollcy.} Pollcy Nurnber GPP1022658-07 Hanred lnsured: All Arnerlcan A,sphall d 6l EndorsenrentEfffilve Dster August 1, 2015 00 cGL0006 00 05 07 Page 1 ol t THIS EXDORSEHENT CHAHGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURAHCE . BROAD FORM, CGL POLICY ENDORSEMEHT THs endorsomrnl rnodlfles lnsurarme pmvlded under lfn follorvlry: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SEGTEN fy - COllillERGSAL GEXERAL LIABIUTY COilDmOHS, the iollorirp para{fapr iB adclod lo Condlircn 4, Otlpr Ircurana. Where the Named lrr*ured i* required by a wriilen csnlroct to povlde insdranm that ls prinury and noncortribdory, and lha writlsn csrtracl so rnquirirg i* sxrcutsd by lfie Nanxd lns{rrad befsrs 6ny 'occunEfi)e' or ofhnse, tffi irsurane will be prlnxry. but o,1ly lf end 16 the exteff required by tnst vrtfisn mntract. All ollpr temls and condltlorn af this Polirry remuln unchenged. Schedule Project City of Lake Elsinore, its elected or appointed officers, officials, Project #210002 / RE: FY 15/16 Annual Crack Seal employees, agents and volunteers & Pothole Repairs Endoreemrnt Ntrnber Ttis erdorsamenl is gff€{tive m tha incefiion dab of this pdicy unless oltnfttJisa stalad harsin, The irformatlon belur b reqrired only wtren thls endorscment ls lssued subsequarit to preparslhn cf the pollcy.) Pollcy Nunher GPP002 2658-01 Narned lnsured: All Arnefc€n Asph3ll d sl Endorsenrent Effedlve Date August 1, 2015 00 cGL01 30 00 0g 06 Pagelcill 4063 THIS EHPORSEME}.TT *HAHGES THE PS*.ISY.PL6,hg,tr, NfiAE IT *ffiEVU*-I:(, U[qlVER OF $tt BROGATTOH Htl BSRSEH Ef'lT Th,s erdorssm*nt nmdifi*s insuraocs prnvlded urder $re ful9owing EO MMfr RO IAI- G EI*KHAL I-'AB!I!TY SOVHNA.OE Tfi RM CCI MM€KCAL G ENHAAL LIABIL'TY STLF. I''T${Jfr ED RHTfi NtrICI N EOVERAC# FOA M ECI.IEBUI.E lrlun* of Isreom or Organh*tlon: Where required by wrlfien trx"flrar:L U**d*r EEETlCIt{ ly - GOI(lttERClAL SS{ERAL LLABILITY COI{DffiOHS, Crydilion 8, Tran#sr Bf Rlghk Of ffes*tr€ry Ag**n*t OffiErr To Us is arnendad by fils ddition af l?m frn{irxring provhion: We ur*alve 6ny righl nf recorrery l&e rflay fum egalrxf the person or organizdio* *hown ln lfie CltEOUtE abave be{aus6 of paynmnt* wa fluke fsr infury or danrage ariErr€ out of yrw oBaraliurx er pur umrlr'done ulder e lyriltefi centrast ueilh thal p€lt6n or oryHillralim" All ottrEr terfis 6nd conditlo,te &f thB policy remain $nf,hafiged" Schedule project City of Lake Elsinore, its elected or appointed officers, officials, project #Z1OOO2I RE: Fy 15/16 Annual Crack Seat employees, agents and volunteers a pbtfrote Repairs Endorsament il"lLell bsr: his erdnrce,Tent is eflMivs wr the irwption &b qf thls @ic,y unla*s ctfrcr*isa c&fllad hmraitl. Tha lr$ornatlon belftrc is rtsryi}red ody w&en thls endors*me*rl ls lssued sub56quffit to p repsrelbn sf lhe poll*y,l Pattcy t-{u*** t' GPPoo2265 -07 I'Iarned lnsued: All Anrer*can pGphsll €* 6l En&r$emeftt Effe€ilv* Dste: August 1, 2075 00 CGL0121 00 0S 0S lne{wler eopyrlghted *raterlal ed lnsurance Servlses Offie* lnr,, Page 1 ef 1 Mth lts prmls,gicxr,4063 POLICYNUMBER BAP5571088-03 cO[tlERclILAuTo cA 20 tB 02 sg THIS ENDORAEMENT CHANGES THE POLICY. FI.EASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement nrodifies insursree provided und€r lhefollo$ring: BU$INESS AUTO COI.IERAGE FORM GAR,qGE CO\ERAGE FOR&{ MOTOR CARfi}ER CCIVERACE FORM TRLJCKEF,g CSVEftAGE FORM fth respet to coverrue providex} by this endorsernenl. the provisions of the Coverage Form appf unhss moditied by lhis endorsement. Thls endors*nent klentifies person(s) or organiz€lion(s) wfp tre'lfisureds'under the l{ho ls An lnsurd Rovisbn of the Covuoge Form. This endorserneffi does not dter coverqe provided in the Coverqe Form. Thls endorssrenl changes the polby efr*tive on the incrytion dde of the policy unless mother dde is indicdd below. Endorsenremt Efi*thru: I / L / ts Nrned lnsured: &I1 Amerlcan Asphalt Counlersigned By: thorized StrHEDULE Nanr d Farcoilr) or OEnnkthn(sl: A}IY PERSON OR OE.GA}IIZATION TO HHOM OR }IHICII YOU ARE REQUIRED TO PR.OVIDE ADDITTONAI INSUR.ED STATUS OR. ADDTT]ONAL INSUR.ED STATUS ON A PRIMARY. NON-CO}ITRIBUTOR.Y BASIS, IN A WRITTEN CONTRACT OR WR.ITTEH AGREEI,{ENT EXECUTED PRIOR TO LOSS, EXCEFT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAII. Schedule Project City of Lake Elsinore, its elected or appointed officers, project #Z1OOO2 / RE: Fy 15/16 Annual Crack Seal officials, employees, agents and volunteers & pbtnote Repairs lf no entry appetrs Sove, informdion rquired to complde this endorssnemt will be shown in tle Decl*ations as applicable to the endorsement.) Ech pason ororguizdion shown in the Schduleb an'lnsured"for LiabilityCovaage, but onlyto thesrtentthd person or organizdion qualifies * an 'lnsured" under the !'ttho ls An lnsured Provision contained in Secfion ll of the Coveruge Form. cA 20 {8 0a g9 Copyright, lnsurance Servhes Offhe, lnc., 1ffi8 POLICYNU$,{BER 8AP5571088-03 coHHERctAAtTO cA0444(B 10 THIS ENDORSEMENT CHANGES THE FOLICY. FLEASE READ !T CAREFULLY. WAIVER OF TRAH$FER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WA|VER OF SUBROGATTON) Thls e*dor*ment modifies insurmce pratrkled under the following: BUSINESS AUTO COVERAGE FORI!{ BUSI$IESS AUTO PHYSICAL DAh,iAGE CO\ERAGE FOR|I{ GARAGE CO\ERAGE FORTY{ MOTOR CAffi ER CO\IERAGE FORM Tffi.MKEffi COVEHAGE FOEM 4lth reepeel to coverrye provided by tlris mdorsernenl, the provisions d the Coveraga Form eppty unl€ss nndi- fted by the $dorsernent. Thie ffidorssnent changes tfle polhy eftective on the irEe$lon date ol the policy unbss slc{her date is intlhded bdow. ilanndlmurcd: A1l Amerlcan Asphalt EnrbrcarnntElhctvo Dsb: 8 / L / 75 SCHEDULE ilaru(sl Of Fercoils) Or OrganEator{s}: ALI PEESONS AND/OR ORGAr{TZATIONS THAT ARE REQUIRED By I{EITTEN CONTRACT OR AGREEMENT I.I]TH THE INSURED. EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT I{AT1iER. OF SUBROGATION BE PROVIDED I]NDER THIS FOIICY will be shown in the Declsr*ians. The Trarder Of Rlghts Of tuewry AgEhS Others To Us Condition does not ryply to the person(s) or orgmiedbn{s} shown in the Sclrcrlule, but only to the eudent thd suffogdlon is waived prior to the'm- Project fSiJ"?L*fi Ioss" unds acontrmt*'itfitlu person project #z1ooo2/ RE: Fy 15/16 Annuat crack seat city of Lake Elsinore, its elected or appointed officers, officials, & Pothole Repairs employees, agents and volunteers cA 0{ {4 03 10 & lnsurarce Services Offbe, 1m., 2009 FagEl dt tr IIIOH(ERS COIIIPENSATION Ar.lD EiJPLOYERS'LlAgLrY INSURINCE POUCY lltrGil{ 03ffi WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT_ CALIFORNIA lAb hsve tle rlght to recover our payffEnts from anyone liabE for an inJury covered by this polhy. $,ts will not efiforce our r@ht against the person or organizdion nglred in the Schedub. (This agrenmnt appFies only to tts exhnt thd you perfinm work under a written eontract that requies you to obtain this agrwnent trom us.) You must rnalntain poyroll r*ards mcuraEly seqregstifig the remuneration of your employees while engagred in thework Gscribed in the Schedub. The addltlond premium for thls endorsenent shall be O . O0 % of the Califomh workers' cornpens*tion pr* miurn otherwise due on such remuneration. ScMrle Ptrion or Orytntsaton Job Dg*cr*donILLBf,,RgO}IS I]IDIOR ]Ltr C& OPEn[,TIO!{ ON.CNNIST,TIOIIS IEAT ARE REOUTRED tsr ITRITTEII COT{TRTCT OR, TtrAEElfEHT WITE TEE INSURED, EXECUTED PRIOR TO TTTE ICCIDEIIT OR IOSS, rf,Ar m,rvER oE' SUBROGITION BE PROIIIDED T'I{DBR TEIS POLICI EOR IERK PERI.ORIiED BY YOU TOR TEAT FERIION A}IDIOR ORGINISI'IION City of Lake Elsinore, its elected or appointed officers, Project #210002 / RE: FY 15/16 Annual Crack Seal & officials, employees, agents and volunteers Pothole Repairs AIl American Asphalt Policy #WCs932057-02 I /1/ L5 lifi 25e 1aaa1 wc fi 0s 00 (Ed. 44{) Zurlch Amerlcan Ins, Co, Page 1 of1 4063 c\i oo)( 6 o. co oe5loaE oi? 6 Go 6 oo!, o, oa lllf-9 Request for Taxpayer ldentification Number and Gertification(Rev. December2014) Department of the Treasury lnternal Revenue Servica I Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. All American 2 Business name/disregarded entity name, if different from above 7 List account numbe(s) here (optional) dentification Number Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (ElN). lf you do not have a number, see How to get a IIN on page 3. Note. lf the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Give Form to the requester. Do not send to the lRS. 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) Apdi* to @nts fraintdtrd outsldo lhe U.S.) Requester's name and address (optional) City of Lake Elsinore 130 South Main Street or Section references ar6 to the lnternal Flevenue Code unless otherwise noted. Future developments. lnformation about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.govlfwg. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IBS must obtain your conect taxpayer identification number OIN) which may be your social security number (SSN), individual taxpayer identification number (lTlN), adoption taxpayer identification number (ATIN), or employer identification number (ElN), to report on an information retum the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: Form 1099-lNT (interest earned or paid) o Form 1099-DlV (dividends, including those from stocks or mutual funds) Form 1 099-MISC (various types of income, prizes, awards, or gross proceeds) Form 1 099-8 (stock or mutual fund sales and certain other transactions by brokers) Form 1099-5 (proceeds from real estate transactions) Form 1 099-K (merchant card and third party network transactions) 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T 1099-C (canceled debt) 1 099-A (acquisition or abandonment of secured property) o Form tuition) Form Form 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: lndividual/sole proprietor or f| C Corporation E S Corporation I Partnership ! TrusVestate single-member LLC t-imited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) > Note, For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line abov6 for the tax classification of the single-member owner. number, street, and apt. or suite no.) 6 City, state, and ZIP code Corona, CA92878-2229 Under penalties of periury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subiect to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal Revenue Service (lRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subiect to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (lRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TlN. See the instructions on page 3. Here Date> tO 2&,J- General tnstruction" f/)l&tcto V6LS, Use Form W-9 only if you are a U.S. person (including a resident align), to provide your conect TlN. lf you do not return Form W-9 to the requester with a TlN, you might be subiect to backup withholding. S@ What is backup withholding? oa page 2, By signing the filled-out form, you: 1. Certity that th€ TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subiect to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. lf applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subiect to the withholding tax on foreign partners' share of efiectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is conect. See What is FATCA reporting? on page 2 for further information. Cat. No. 10231X rorm W-9 (Rev. 12-2014) PUBLIC WORKS ROUTING Once the attached documents have been reviewed, please sign and return to Public Works, at ert.241 Reviewing Department Public Works Review Signature Date 10t29t15N. McLdfl4,oa1.,t4//u City Attorney City Manager City Clerk NAME OF VENDOR: SUPPORT DOCUMENTS: lnsurance(s) Proposal: Bonds: AllAmerican Asphalt COMMENTS: FY 15r16 Annual Crack Seal & Pothole Repair Project No.210002 rv/o/rs il l2 RECEIVED OCT 2 s 2015 CITY CLERK'S OFFICE