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HomeMy Public PortalAboutAgreement_2012-12-04_LA Engineering Inc_Performance and Payment BondVANIR City of Temple City Rosemead Blvd Safety Enhancement and Beautification Project 9701 Las Tunas Drive, Temple City, CA 91780 Tel: (626) 285-2171 x 2328, Fax: (626) 285-8192 LETTER OF TRANSMITTAL #36 Date: December 4, 2012 To: Peggy Kuo, Temple City Clerk We are sending: ® Attached I ❑ In Separate Cover No. Via: I ❑ Express Mail ® Hand Delivered I ❑ Fax( ) 1 ❑ 1st Class Mail ❑ Jobsite Drop -Off I ❑ Other ❑ Submittal ❑ Request for Information ❑ Request for Payment ❑ Substitution ❑ Proposed Change Order ❑ Plans/Specifications ❑ Correspondence ❑ Request for Proposal ❑ Schedule ❑ Field Clarification ❑ Change Order ❑ Estimate Copies No. Date Item ❑ For Process/Payment Description 1 1 12/4/12 LAE Contract Documents Payment Bond Performance Bond Insurance Certificate with endorsements Remarks: Dear Peggy, We received LA Engineering's Payment and Performance Bonds as well as their Insurance Certificate. Please review and route as necessary through City Departments for review and let me know what further action is needed regarding this issue. v/r, Kristi ❑ As Requested ❑ No Exception Taken ❑ For I Signature ❑ Implement Corrections Noted ❑ For Process/Payment ❑ Revise and Resubmit Z For Review/Comments/Response ❑ Rejected M For Your Use/Information ❑ Reviewed For Information Only Remarks: Dear Peggy, We received LA Engineering's Payment and Performance Bonds as well as their Insurance Certificate. Please review and route as necessary through City Departments for review and let me know what further action is needed regarding this issue. v/r, Kristi Cc: File By: �ni¢ti Z, 70&� 4e Kristi L. Twilley Project Manager Page 1 of 1 VANIR I'. 502 N, Rcv. 1, 03/04 General Engineering Contractor December 4, 2012 Peter Espinosa, CM Vanir Construction Management, Inc. 9701 Las Tunas Drive Temple City, CA 91780 Re: Rosemead Boulevard Safety Enhancement and Beautification Project Agreement Dear Peter: Enclosed are the original Payment and Performance Bonds. Also enclosed is our Insurance Certificate with endorsements. If you have any questions, please do not hesitate to contact me directly at (626) 869-1420. I can also be reached via email at maria laeng.net. We look forward to working on this project with you. Sincerely, Mana Reames Contract Administrator Enc. An enVlo)ee-owwd copy 633 N. Bamanca Avenue, Covina, California 91773 Main Phone Number. (626) 454-5222 Website: w Jaene.net Fax Numbers: Estimating (626) 454-5226 Administration (626) 869-0902 Accounting (626) 869-0903 Dispatch (626) 869-0904 'Boild No: 024042800 Premium: $85,121.00 Premium is for contract term and is subject to adjustment based on anal contract price Executed in 2 Counterparts Temple City Rosemead Blvd Project SECTION 00410 CONTRACT PERFORMANCE BOND (CALIFORNIA PUBLIC WORK) KNOW ALL MEN BY THESE PRESENTS: P08-11 THAT WHEREAS. City of Temple City (sometimes referred to hereinafter as "Obligee") has awarded to Los Angeles Engineering, Inc. (hereinafter designated as the "CONTRACTOR: ), an agreement for the work described as follows: Cit' of Temple City — Rosemead Bivd Safety Enhancement and Beautification Project Bid No. P08-11-06.29.12 Project No. P08-11 (here -in after referred to as the "Public Work'); and WHEREAS, the work to be performed by the CONTRACTOR is more particularly set forth in that certain contract for said Public Work dated 21st November 2012 (hereinafter referred to as the "Contract'), which Contract is incorporated herein by this reference: and WHEREAS, the CONTRACTOR is required by said Contract to perform the terns thereof and to provide a bond both for the performance and guaranty thereof. NOW, THEREFORE, we, Los Angeles Engineering, Inc. the undersigned CONTRACTOR, as Principal, and Liberty Mutual Insurance Coma a corporation organized and existing under the laws of the State of Massachusetts and duly authorized to transact business under the laws of the State of California, as Surety, are held and fimrly bound onto City of Temple City in the sum of Fifteen Million Seven * Dollars ($15,773,914.50 ), said susn being not less than one hundred percent (100%) of the total amount payable by said Obligee under the temrs of said Contract, for which amount well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. * Hundred Seventy Three Thousand Nine Hundred Fourteen &.50/100 THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the bounded CONTRACTOR, his or her heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions, and agreements in said Contract and any alteration thereof made as therein provided, on his or her part, to be kept and performed at the time and in the manner therein specified, and in all respects according to their intent and meaning; and shall faithfully fulfill guarantees of all materials and workmanship; and indemnify, defend and save harmless the Obligee, its officers and agents, as stipulated in said Contract, then this obligation shall become null and void; otherwise it shall be and remain in full force and effect. For value received, the Surety hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract, or to the work to be performed there under, or the Specifications accompanying the same shall in any way affect its obligations on this bond. and it Balm Temple City Rosemead Blvd Project P08 -I1 does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract, or to the work, or to the Specifications. No final settlement between the Obligee and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. CONTRACTOR and Surety agree that if the Obligee is required to engage the services of an attorney in connection with enforcement of the bond, CONTRACTOR and Surety shall pay Obligee's reasonable attorneys' fees incurred, with or without suit, in addition to the above sum. In the event suit is brought upon this bond by the CITY and judgment is recovered, the Surety shall pay all costs incurred by the CITY in such suit. including reasonable attorneys' fees to be fixed by the Court. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 3rd day of December 2012. The rate of premium on this bond is _ The total amount of premium charged: S 8 corporate surety). FIRST $100,000 100,000.00 11.340 NEXT $400,000 400,000.00 11.340 NEXT $2,000,000 2,000,000.00 7.060 NEXT $2,500,000 2,500,000.00 5.540 NEXT $2,500,000 2,500,000.00 5.170 OVER $7,500,000 8,273,914.50 4.660 TOTALS: 15,773, 914.50 PRIN C I PAUCONTRACTOR: Los Angeles Engineering, Inc. By:� Angus O'Brien, President SURETY: Mutual Insurance M 121.00 = 1,134.00 4,536.00 = 14,120.00 13,850.00 = 12,925.00 38,556.44 85,121.00 1 12 - per thousand. (This must be filled in by a Temple City Rosemead Blvd Project P08-1 I IMPORTANT: THIS IS A REQUIRED FORM. Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in California Insurance Code Section 105, and if the work or project is financed, in whole or in pail, with federal, grant or loan funds. Surety's name must also appear on the Treasury Department's most current list (Circular 570 as amended). Any claims under this bond may be addressed to: (Name and Address of Surety) (Name and Address of agent or representative for service for service of process in California) Liberty Mutual Insurance Company Millennium Corporate Solutions, Inc. 330 North Brand Boulevard, Suite #500, Glendale, CA 91203 5530 Trabuco Rd., Irvine, CA 92620 Telephone: (816) 956-4250 Telephone: (949) 697-7116 STATE OF CALIFORNIA ) *' Please See Attached** ss. COUNTY OF ) On this day of , in the year . before me. a Notary Public in and for said State, personally appeared known to me to be the person whose name is subscribed within the instrument as the Attomey-in-Fact of the (Surety) and acknowledged to me that he subscribed the name of the (Surety) thereto and his own name as Attorney -in -Fact. (SEAL) Notal -y Public in and for said State Commission NOTE: A copy of the power-of-attorney to local representatives of the bonding company must be attached hereto. 113 - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Los Angeles On December 3, 2012 before me, J. Nelson, Notary Public Date Here Ren Name anG Tnie of It,e officer personally appeared Angus O'Brien J. NELSON Commission No. 7056 2 �'A r NOTARY PUBLIC -CALIFORNIA Y LOS ANGELES COUNTY My Comm. Expires APRIL 18. 2015 Place Nctarl Seal Abcve who proved to me on the basis of satisfactory evidence to be the person whose name) is/ayb subscribed to the within instrument and acknowledged to me that he/sjX%/ti 6y executed the same in his/h/r,JMir authorized capacity(i96), and that by his/hhir/tVir signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OP PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and oilicial seal. Signature Slyralura of Nciarl Puuic OPTIONAL Though the information below is not required by law, d may prove valuable to persons 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Individual Corporate Officer—Title(s): — Partner-- Limited 0 General =t Attorney in Fact Trustee - Guardian or Conservator Other: Signer Is Representing: Top of ttturb here ! Number of Pages: Sian=_r`s Name - E! Individual G Corporate Officer —Title(s): ❑ Partner —❑ Limited I I General Attorney in Fact I Trustee -. Guardian or Conservator 0 Other: Signer Is Representing: -- = w- - D2CClNaYcral riolary AssecaCen•S3:A Ce Scte Aye.,F.O.2oz 26G2•CMLsncYitt, CA 9131?2:2-.1ff4c,lafIce /.cg I.en P5M7 P.rmv.^.Call TaWFaaI o3-87Sa2' Y y ar 'v `0 m� � C vy O.2 `m > THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 54.55334. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. _ American Fre and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: ThatAmercan Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized underthe laws of the State of Ohio, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein Collectively Called the `Companies'), pursuant to and by authodty herein set forth, does hereby name, constitute and appolnt CORINNE HERNANDEZ; REBECCA HAAS -BATES; RICHARD SERGIO SECHARA; WILLIAM SYRKIN........................ _............................... ............................. ........ _....... '"__._____ all of the city of IRVINE state of CA each individually if there be more than one named, is true and lawful adomey-in-fact to make, execute, seal, acknowledge and deliver, for and on is behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and aftested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this PowerofAftorneyhasbeensubscribedbyanautlrodzedotficerorofficialof the Companies and the oorporratesealsof the Companies have been affixed thereto this zmh day of dune , 2012 . 1C0.N kiq tY IN&p txsuR a4'' P J'r4 q4 4�U9= °\yam atSURAry�F S2 AFh F,¢j� t' Uc W � lS �`� O� ',�yw y� n?eAhrE O La ¢(IP{� �� .'�,' 1,F. �% Go(�E'OR-'1f i7 m UFGFPCfizi6i h-ysi dB01 i vs Sf✓:1L J2 o SERI, p � roux ;¢I '`tri iv, SEAT. p�;CO/y�Q4 pry UHtO��d'2..xusa 'IiEN�E, �`� �RRCE CO�¢p� STATE OF WASHINGTON as COUNTY OF KING American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company Peerless Insurance Company West American Insurance Company By:�."r"`risr, Gregory W. Davenport, Assistant Secretary Onthis 28th dayof dune 2012 before me personally appeared Gregory W.Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, Peerless Insurance Company and WestAmerican Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. By: Puaue KD Riley, NotPublic This PowerofAtomey is made and executed pursuant to and by authority of the following By-laws antl`df f'....n It ofAmerican Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, WestAmerican Insurance Company and Peerless Insurance Company, which resolutions are now in full force and effect reading as follows: ARTICLE IV—OFFICERS—Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shag appoint such attorneys -in -fact, as may be necessary to ad in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such atomeys-in-fact subject to the limitations set forth in their respective powers of aftomey, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomey-tin-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recogninrices and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assislant secretary of the Company, wherever appearing upon a certified copy of any power of atamey issued by the Company in connection with surety bonds, shall be valid and tiding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seats of said Companies this 3rd day of Decemb�ery/////20 12 tNSV� „'xt,W3ugi„_ y\0`'URhMCF,� �,S�MF^�r� "% eacn;p�5`- 'k Av�/ rP>raterp 4d' � LNCGRPORRAiE6 k, (Soeo(a 2901 By: ^��t^ D� �_ °'\ /�`�w 4E"�f� i David M. Carey, Assislarl Secretary 4� °'kr�eattw`^1'� �wE/� GRgwCE CO��4 POA-AFCC, LMIC, OCIC, PIC & WAIC LMS 12813 091012 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT u n _n n. n n. n,L.-n:•_n. niLn », n nt.. c.9+ ro. a,N n n.. i .»..n nLn. axf n State of California County of Orange On 12/03/2012 before me, A. Wilkison, Notary Public Date Here Insert Name and TMe of the Officer personally appeared William Syrkin ^,^T^,^,^ -_-1 A. WILKISON Commission # 1866283 z _m Notary Public - California z Z ' Orange County s M Comm. Expires Sep6,2013t Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(&) whose name(&,) is/we subscribed to the within instrument and acknowledged to me that he/shekhey executed the same in his/hefi%49if authorized capacity(fes), and that by his/herftheitt signature(&} on the instrument the person(,*, or the entity upon behalf of which the persona} acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature 5i9nahxe of Notary Pudic OPTIONAL Though the information below is not required bylaw, it may prove valuable to persons 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: Performance Bond No. 024042800 Document Date: 12/03/2012 Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: William Syrkin L Individual Corporate Officer—Title(s): Partner — ❑Limited ❑General _ M Attorney in Fact Top of thumb here L Trustee Guardian or Conservator Other: Signer Is Representing: Liberty Mutual Insurance Company Number of Pages: Three Signer's Net El Individual ❑ Corporate Officer—Title(s): E: Partner —❑ Limited [:General rT Attorney in Fact ❑ Trustee u Guardian or Conservator 0 Other: Signer Is Representing: Top of thumb here 02007 National Notary Aswr-atron, tl5 De Sob Am, Po Sox 2402, Cmrhsorth, CA 913132402• virrs.Nelionaftmryorg Item 115907 Reenter, Cap Toll -Free 68008]8.682] NO 9-1.41 STA'T'E OF CALIFORNIA DEPARTMENT OF INSUR.ANCE SAN FRANCISCO AMENDED Certificate of Authority THIs Is TO CF.P.T( y, That, pursnane to the Insurance Code of ibe State of California, LIBERTY MUTUAL I1fSURANCE COMPANY of BOSTO2i, MASSACHUSETTS , organrzrd under thv tants of MASSACHUSETTS , subject to its Articles of Incortsoradiun or other fundamental organizational documents, is hereby authorized to transact u•itliin this State, sublect to all provisonsof this Cortificate,the follmotng classes of inotranre: FIRE, MARINE, SJR'�m, DISABILITY, PLATE GLASS, LIABILITY, WOWZMEWS COMPENSATION, COMMON CARRIER LIABILITY, BOILER AND MACHINERY, BURGLARY, CREDIT, SPRINKLER, TEAM ANTS VERICLI, AUTOMOBILE, AIRCRAFT and MISCELLANEOUS as sacb classes are now or may hereafter be defined it; for tnsnraner Laws of the State of Caltformia, THIS CEwrivic:Ara is expressly conditioned upon the bidder iMreof wiz� and bereafter being in full compliance with all, and not in tioiation of assy, (if the applicable laws and lau fui requfrewerrta made under authuray of tix laws of the State of California as long as sueb laws or reipeiremexts are is effect and applicable, and as such laws and requirements noun arc, or may hereafter be chauged or amended. IN WITNESS Wtltxt.Ul,'effective as of the . 15TH day of.. . 11.01 MEA'— __.. ._. _ , 1)61 , I herr hereunto set my hand and caused my official seal to he affixrd thin 1571? Jay of .I$OVEM§BER. I961.. F. BRRITTON MCCONNELL fa;n .!.4b» i.ere By / DePnn I Premium included in Performance Bond Bond No. 024042800 Executed in: 2 Counterparts Temple City Rosemead Blvd Project POS -11 SECTION 00400 PAYMENT BOND (CALIFORNIA PUBLIC WORK) KNOW ALL MEN BY THESE PRESENTS: THAT WHEREAS. City of Temple City (sometimes referred to hereinafter as "Obligee") has awarded to Los Angeles Engineering, Inc. (hereinafter designated as the "CONTRACTOR"). an agreement for the work described as follows: City of Temple City — Rosemead Blvd Safety Enhancement and Beautification Project Bid No. POS -11-06.29.12 Project No. POS -11 (here -in after referred to as the "Public Work"), and WHEREAS, said CONTRACTOR is required to furnish a bond in connection with said Contract. and pursuant to California Civil Code Section 3247; NOW. THEREFORE, We, Los Angeles Engineering, Inc. , the undersigned CONTRACTOR, as Principal; and Liberty Mutual Insurance Company a corporation organized and existing under the laws of the State of Massachusetts , and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto City of Temple City and to any and all persons, companies, or corporations entitled by law to file stop notices under California Civil Code Section 3181, or any person, company, or corporation entitled to make a claim on this bond, in the sum of Fifteen Million Seven' Dollars (S 15,773,914.50 ), said sum being not less than one hundred percent (1000,'o) of the total amount payable by said Obligee under the terns of said Contract, for which payment will and truly to be made, we bind ourselves, our heirs, executors and administrators, successors and assigns, jointly and severally, firmly by these presents. ' Hundred Seventy Three Thousand Nine Hundred Fourteen & .50/100 THE CONDITION OF THIS OBLIGATION IS SUCH that if said Principal, its heirs. executors, administrators, successors, or assigns, or subcontractor, shall fail to pay any person or persons named in Civil Code Section 3181; or fail to pay For any materials, provisions, or other supplies, used in, upon, for, or about the performance of the work contracted to be done, or for any work or labor thereon of any kind, or for amounts due under the Unemployment Insurance Code, with respect to work or labor thereon of any kind; or shall fail to deduct. withhold, and pay over to the Employment Development Department; any amounts required to be deducted, withheld, and paid over by Unemployment Insurance Code Section 13020 with respect to work and labor thereon of any kind, then said Surety will pay for the same, in an amount not exceeding the amount herein above set forth. and in the event suit is brought upon this bond, also will pay such reasonable attorneys' fees as shall be fixed by the court, awarded and taxed as provided in California Civil Code Sections 3247 et. seq. This bond shall inure to the benefit of any person named in Civil Code Section 31 81 giving such person or his/her assigns a right of action in any suit brought upon this bond. -107- Temple City Rosemead Blvd Project P08-11 It is further stipulated and agreed that the Surety of this bond shall not be exonerated or released from the obligation of the bond by any change, extension of time for performance, addition, alteration or modification in. to, or of any contract, plans, or specifications, or agreement pertaining or relating to any scheme or work of improvement herein above described; or pertaining or relating to the furnishing of labor, materials, or equipment therefore; nor by any change or modification of any terms of payment or extension of time for payment pertaining or relating to any scheme or work of improvement herein above described; nor by any rescission or attempted rescission of the contract, agreement or bond; nor by any conditions precedent or subsequent in the bond attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or agreement or under the bond; nor by any fraud practiced by any person other than the claimant seeking to recover on the bond; and that this bond be construed most strongly against the Surety and in favor of all persons for whose benefit such bond is given; and under no circumstances shall the Surety be released from liability to those for whose benefit such bond has been given.. by reason of any breach of contract between the CITY and the CONTRACTOR or on [lie part of any Obligee named in such bond; that the sole condition of recovery shall be that the claimant is a person described in California Civil Code Sections 3110 and 3112, and who has not been paid the full amount of his or her claim; and that the Surety does hereby waive notice of any such change, extension of time, addition, alteration or modification herein mentioned. IN WITNESS WHEREOF, we have hereunto set our hands and seals this 3rd day of December 2012 . PRIMCIPAUCONTRACTOR Los Angeles Engineering, Inc Bv: V J� Angus O'Brien, President SURETY: Liberty Mutual Insurance Company B v: Willia yrkin -ton ey-in-Fact EM Temple City Rosemead Blvd Project P08 -I1 IMPORTANT: THIS IS A REQUIRED FORM. Surety companies executing bonds must possess a certificate of authority from the California Insurance Commissioner authorizing them to write surety insurance defined in California Insurance Code Section 105, and if the work or project is financed, in whole or in part, with federal, grant or loan funds. Surety's name must also appear on the Treasury Department's most current list (Circular 570 as amended). Any claims under this bond may be addressed to: (Name and .Address of Surety) Liberty Mutual Insurance Company 330 North Brand Boulevard, Suite #500, Glendale, CA 91203 Telephone: (818) 956-4250 STATE OF CALIFORNIA COUNTY OF (Name and Address of agent or representative for service for service of process in California) Millennium Corporate Solutions, Inc. 5530 Trabuco Rd., Irvine, CA 92620 Telephone: (949) 697-7116 ** Please See Attached" ss. On this day of _ in the year before me. _ a Notary Public in and for said State personally appeared _ , known to me to be the person instrument as the Attorney -in -Fact of the that lie subscribed the name of the _ name as Attornev-in-Fact. Notary Public in and for said State Commission expires: whose name is subscribed within the (Surety) and acknowledged to me (Surety) thereto and his own (SEAL) NOTE: A copy of the power-of-attorney to local representatives of the bonding company must be attached hereto, 109- GAL€FGRNIA ALL-PURPOSE ACKNOWLEDGMENT State of California 1 County of Los Angeles J!} Oil December 3, 2012 before me, J. Nelson, Notary Public _ Qa$g Here I Sert Nar.,e a•d Tale of me 01 cer personally appeared Angus O'Brien J. NELSON U Commission No. 1933056 p ! NOTARY PUBLIC -CALIFORNIA Z� LOS ANGELES COUNT' . Mycd ,Expims APR0.18, 2015 F:aca `:xary sed Ata ,e who proved to me on the basis of satisfactory evidence to be the person whose name'/l Wye subscribed to the within instrument and acknowledged to me that he/sp(e/tf�4y executed the same in his/nyfFnr authorized capaciy(i9), and that by hisfVr/thlir signatureX on the instrument the person,(6S, or the entity upon behalf of which the person�4 acted, executed the instrument. I certify under PENALTY Or PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature JM � SiGraLr_ d Nc'a-; Fu.i c OPTIONAL Though the inform_tion balow is not required by fz:, d may prove valuable to panions relying on Gie document 2nd could oravent fraudulent ramov t and reaaachn, ent of this form to 2noG;er documrt Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signers Name: ❑ Individual Corporate Officer—Title(s): Partner—F3 Limited CjGeneral .I Attorney in Fact �. Trustee Tzo cC =b hee i Guardian or Conservator Oitler: Signer Is Representing: I I { L ( Number of Pages: Signer's Name: E! Individual Corporate O -Nicer — Title(s): Partner — ❑Limited 0General 01 Attorney in Fact Trustee Tco of na-b Cert I Guardian or Conservator u Other: I Signer Is Representing: I { 'I Q=el Nd^.s.21N:<ryAS=z5ca-S3i3 De scr, Au?„F,O.&x 241 -("..�a'SNef:, GA 91313-2:G3 •'rv•Kn�N2.Ctul:IC2t!IXS Iter =5s7 P.e;ye.^.Cdlti Frei E�4B?%�^A2? L if C d C A _ L THIS ROWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5455335 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. _ American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BYTHESE PRESENTS: ThatAmedcan Fire& Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of Ohio, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, CORINNE HERNANDEZ; REBECCA HAAS -BATES; RICHARD SERGIO BECHARA: WILLIAM SYRKIN..... _........................................................................... all of the city of IRVINE state of CA each individually if there be mon: than one named, its true and lawful attomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizanoes and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. I N W ITN E SS WHEREOF, this Power ofAdorney has been subscribed by a n authodzed officer orofficial of the Companies and the corporate seals o f the Compa n ies have been affixed [hereto this 29th day of dune , 2012 . A/g'�an K'Rs ��gx INsq ,� �;:w� a'su�'cs st neex�� `K°rwl �,Oa?ckAr�,�"6 �a u. a�. "�r,�y� S�incoxrawFu o'� c��c� I vox<re 2 n SN:AG�+ i SF,AL �° S +s1a g bt '� z SEAS. '� v� �ps 9ypMrO ids .�,/1 55 1YC S �< �p�x �kE-w6, N"a � �G'PRryGF G4tRr STATE OF WASHINGTON ss COUNTY OF KING American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company Peerless Insurance Company West American Insurance Company By: Gregory W Davenport, Assistant Secretary On this 29th day of dune , 2012 before me personally appeared Gregory W Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, Peerless Insurance Company and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle Washington, on the day and year first above written. n1,0 Y,ICgy 0 NGTARY - By: aua=tc s KD Riley, Not Public This Power ofAttomey is made and executed pursuant to and by authority of the following By-laws and kiiflt'oiizabons of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless Insurance Company, which resolutions are now in full force and effect reading as follows: d ARTICLE IV–OFFICERS–Section 12. Power ofAttomey. Any officer or other official of the Corporation authorized for that purpose inwriting by the Chairman or the President, and subject p e to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, E y^ acknowledge and deliver as surety any and all undertakings,bonds, recognizances and othersurety obligations. Such aftomeys-in-fact subject to the limitations setforth in their respective w` powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as 9 signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under cthe provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. « ` ARTICLE XIII – Execution of Contracts – SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, Z1L= and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such Instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation – The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomey-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligafions. Authorization – By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and biding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 3rd day of December 2' 12 Y INe(r� „`Fcft�Eua'�,c tii�R9HCF SS RME{f�� +voMre m $ •S`- � ;� a� � eAar3asr F S p E A L4COAPepATCP 1 /- (9(see(a rxr w dSOri �, � By: I.,QD3 ��''sNGq `+SAL% David M. Carey, Assistant Secretary F k'�x�ax9u' 'Y�EwE,NxE//JNa gNCE 80% POA-AFCC, LMIC, OCIC, PIC 8 WAIC LMS -12873N1012 a s � l a 11 � T � a+. 'iv. nA. n • R)_A. A A 0 nA 0 3 "l A A. A 5Yn0 32n'•a n 4 AYn y n1YnH PTt„ T State of California 1 County of Orange J} On 12/03/2012 before me, A. Wilkison, Notary Public Dale Here Insert Name and TRIG of the ORcer personally appeared William Syrkin Names) ol5igner(s) A. WILKISON Commission # 1866283 a .m - Notary Public - California i z� Orange County > My Comm. Expires $e 26, 2013 who proved to me on the basis of satisfactory evidence to be the person(s) whose names) is/are subscribed to the within instrument and acknowledged to me that he/sheRhey executed the same in his/heAheic authorized capacity(ies), and that by hisilhafAl%4 signature(4 on the instrument the person(*, or the entity upon behalf of which the persons} acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature f A UM -P ova Plead Notary Seat Above Signature of Notary Pobllo' OPTIONAL Though the information below is not required by law, it may prove valuable to persons 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: Payment Bond No. 024042800 Document Date: 12/03/2012 Signer(s) Other Than Named Above: _ - Capacity(ies) Claimed by Signer(s) Signer's Name: William Syrkin Individual Corporate Officer—Title(s): — Partner —❑ Limited C General ❑� Attorney in Fact G Trustee Guardian or Conservator G Other: Signer Is Representing: Liberty Mutual Insurance Company RIGHT THUMBPAM OF SIGNER LE Number of Pages: Three Signer's Name: ❑ Individual ❑ Corporate Officer —Title(s): _ Vl Partner —❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee LI Guardian or Conservator 0 Other: Signer Is Representing: FdGIRTNOMDPmNT GF SIGNER C 2007 National Nomry As iallon• 9360 De Sob Ave.. PO. Box 24M -Cha ffi. CA 9131a2402•www.NalidnalNotaryorg Item45907 Reorder.Call aFaa,1&868765BT! Na 2131 STATE OF CALIFORNIA DEPARTMENT OF INSURANCE SAN FRANCISCO AMENDED Certificate of Authority Toss Is ra L7>strsrr, That, parmant to the Insurance Code of the State of California, LIBERTY MUTUAL INSURANCE COI&ANY of BOSTON, YASSACHUSETTS , orgunrzrd under the lags of MASSACBUSETTS , subject to its tlrhedes of Incorporation ar other fundamental organizational documents, is hereby authorsced to transact within fhji State, subwet to all provinvos of this Certificate, the fol6ving classes of insuraner: FIRE, 'AAR!NE, S'R47`Y, DISABILITY, PLATE GLASS, LIABILITY, WORnTENsS COMPENSATION, COMMaN CARRIER LIABILITY, BOILER AND MACHINERY, BURGLARY, CREDIT, SPRINKLER, TEADT AND VEHICLE, AUTOMOBILE, AIRCRAFT and MISCELLANEOUS as such classes are now or may hereafter be defined in the Insurance Laws of the State of Caltfmwia. Tits CsnrmcAm is expressly conditioned upon the bolder hereof now and hereafter being in fuN Compliance svith all, and rrot in ziolat"ran of any, of the applicable fates and hamful regwre menu made render authtmty of the fazes of for State of Califrrroia as tont; as web later or requirements are ire elivel and appikable, and ax such laws and requirements now are, or may hereafter be changed or amendrd, Iv WITNESS 1yi mt urov, ef$eclite as of the _.15TH , deg. Of-. . NOY£hhBER...._.... . - , 1961 , I have hereunto .set my hand and ransrd my ufitciai seal lobe a,(dsxed this 15TF day of .. NOVE111BFR . ..., 7461 . F. BRITTON MOCONNF.LL By n.aa.. OP ID: JR A16. ® CERTIFICATE OF LIABILITY INSURANCE OATDIYYYY) 11130 11/30/12 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). PRODUCERCONTACT 949-553-9600 The Wes, Inch Company Insurance 949-553-0670 Services, Inc. 1 Park Plaza, Suite 400 Irvine, CA 92614 Jamie Younger NAME: PNONE FAX uc No En: AIC No: E-MAIL ADDRESS: CUSTOMER I : LOSAN-2 INSURERS AFFORDING COVERAGE NAIC N INSURED Los Angeles Engineering, Inc. 633 N. Barranca Ave. Covina, CA 91723 INSURER A: Old Republic General Ins. CorpK 24139 INSURER B: National Union Fire Ins. Co. K19445 INSURER C: INSURER 0: WSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. ILTR TYPE OF INSURANCE AD D POLICY NUMBER MMNDNYYri MMIDDYEYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERALLIABILITY �I y I CLAIMS -MADE aOCCUR X X 1CG37191201 04/01112 04101113 AMA T T D PREMISEES Ea REoccurrence $ 100.000 MED EXP (My one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 X BI1PD DED: $5,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: (PRODUCTS - COMPIOP AGG $ 2,000,000 POLICY X PRO- 17 LOC $ A AUTOMOBILE LIABILITYX X ANY AUTO �( lCA37191201 04/01112 04101113 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY IWURY(Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTYDAMAGE (Perawdent) $ $ NON -OWNED AUTOS X SEE NOTES $ �( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 6,000,000 B EXCESS LIAB CLAIMS -MADE BE 080737281 04101112 04101113 DEDUCTIBLE $ $ X RETENTION $ 10,000 A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNERMXECUTNE Y/N OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA X 1CW37191201 04101/12 04/01113 WC STATU. OTRH. E.L. EACHACCIDENr $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe uru DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if nwre space Is requirern Except 10 Days Notice of Cancellation for Non -Payment of Premium. RE: LAE Job #1440 - Rosemead Blvd. Safety Enhancements and Beatification Project, City of Temple City, CA; City Project No. P08-11; Bid No. P08-11-7.31.12; Federal Project No. CML -5365(007). SEE NOTES* lai wv/auaiwv/wcwv TEMPE23 City of Temple City 9071 Las Tunas Dr. Temple City, CA 91780 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE___ ©1988.2009 ACORD CORPORATION. All rights reserved ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: At CG37191201 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera - tions WHERE REQUIRED BY WRITTEN CONTRACT, BUT ONLY WHEN COVERAGE FOR COMPLETED OPERATIONS IS SPECIFICALLY REQUIRED BY THAT CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed productscompleted operations hazard". CG 20 37 07 04 Q ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: Al CG37191201 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ldbill1[d Name Of Additional Insured Pemon(s) Or Organization(s): Locations Of Covered O erations WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above. will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or "personal and advertising injury" caused, in whole or in part. by: 1. Your ads or omissions: or 2. The acts or omissions of those acting on your behalf: in the performance of your ongoing operations for the additional insured(s) at the locations) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work. including materials, parts or equip- ment furnished in connection with such work, on the project (other than service. mainten- ance or repairs) to be performed by or on be- half of the additional insured(s) at the location of the covered operations has been complotod; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek conlnbulion from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractorother than the person or organization shown in the schedule above for the same operation and job location If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV— Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Los Angeles Engineering, Inc. Policy Number _ AICG37191201 Endorsement No. Policy Period Period 12 _..........._ '', 0 4/0100-12 to 04/01/2013 _ Endorsement Effective Dale: ._._101/ 04/01/2012 Producers Name: —__ T Producer Number: A AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 DATE POLICY NUMBER: AlCG37191201 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above. will be shown in the Declarations. The following is added to Paragraph a. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive 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 ongoing operations or "your work' done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office. Inc.. 2008 Page 1 of 1 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION ADDITIONAL INSURED WHERE REQUIRED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM The following is added to Section II — Liability Coverage. A. — Coverage, 1. Who Is An Insured: d. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which required you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lessor of: 1. The coverage or limits of this policy. or 2. The coverage or limits required by said contract or agreement, iNameo insured '.., Los Angeles Engineering, Inc. Policy Number AlCA37191201 I Endorsement No. Policy Period 04/012012 to I Endorsement Effective Date: 04/01/2012 AUTHORIZED REPRESENTATIVE CA EN GN 0020 03 07 POLICYNUMBER: AlCA37191201 COMMERCIALAUTO CA 04 44 03 10 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 underthe 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 modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Los Angeles Engineering, Inc. Endorsement Effective Date: 04101MI2 SCHEDULE Names) Of Person(s) Or Organization(s): 'PHEFE lt]2 rI' FEP It) 'A I1TTE`: : NTE %�'T Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condilion does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 0 Insurance Services Office, Inc., 2009 Page 1 of 1 13 OLD REPUBLIC GENERAL INSURANCE CORPORATION WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING, We have the right to recover our payments train 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 extent [net you perform -pork under a written contract that requires you to obtain this agreement from us This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is S0.00 Namec Insured Los Angeles Engineering. Inc. Policy Number AlCW37191201 Enoorsemem No. Policy Porioc 04/01/2012 to 04/01 /2013 Endorsement Effective Date: 0410112012 Producer s Name. Producer Number: AUTHORIZED REPRESENTATIVE WC 99 03 15 (01/07)