Parking Lot Reconstruction Services (Roquet Paving)-2004-09 AGREEMENT BETWEEN THE CITY OF GRAND
TERRACE AND ROQUET PAVING INC.,
(CONTRACTOR) FOR THE PROVISION OF PARKING
LOT RECONSTRUCTION SERVICES.
THIS AGREEMENT IS ENTERED INTO THIS DAY OF 2004 BY AND BETWEEN
THE CITY -OF GRAND TERRACE ("CITY"),AND CONTRACTO FOR THE CIVIC CENTER
PARKING LOT RECONSTRUCTION SERVICES.
RECITALS
WHEREAS, CONTRACTOR is a licensed contractor who is qualified and a licensed in the
State of California.
WHEREAS, CITY desires to utilize the services of CONTRACTOR to perform parking lot
reconstruction services.
NOW,THEREFORE,THE PARTIES AGREE AS FOLLOWS:
SECTION 1. SERVICES OR SCOPE OF WORK
Contractor shall perform a variety of services for the Civic Center Parking Lot Reconstruction as
follows:
A. For and in consideration of the payments and agreements hereinafter mentioned to be made and
performed by said City, said Contractor agrees with said City to perform and complete"in a
workmanlike manner all work required under the City's Specifications, to furnish at his own
expense all labor, materials, equipment, tools and services necessary therefore, except those
materials, equipment, tools and services as may be stipulated in said specification to be furnished
by said City and to do everything required by this Agreement and the said Specifications.
B. In entering into a Maintenance Contract for a subcontract to supply goods, services or materials
pursuant to a Maintenance Contract, the Contractor or subcontractor offers and agrees to assign to
the City all rights, title, and interest in and to all causes of action it may have under Section 4 of
the Clayton Act (15 U.S.C. Sec. 15) or under the Cartwright Act (Chapter 2 commencing with
Section 16700) of Part 2 of Division 7 of the Business and Professions Code, arising from
purchases of goods, services, or materials pursuant to the Maintenance Contract or the subcontract.
This assignment shall be made and become effective at the time the City tenders final payment to
the Contractor without further acknowledgment by the parties.
C. Bid Performance
Said Bond or Check, as described in the Bid Package, shall be given as a guarantee that
CONTRACTOR, if awarded the Contract, will enter into said. Contract with the CITY OF
GRAND TERRACE within ten (10) calendar days after receipt of an Award of Contract Notice
from the CITY, and that the CONTRACTOR will furnish the necessary Insurance Certificates, a
Faithful Performance Bond, and a Labor and Materials Bond.
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg. 1
In the case of refusal or failure upon the part of the CONTRACTOR to enter into said Contract,
the Check or Bid Bond, as the case may be, which accompanied the Bid shall be forfeited to the
CITY.
D. DEFINITION OF PROPOSED ITEMS OF WORK
The unit prices to be paid for .the items listed on the proposal form EXHIBIT B, shall
include full compensation for fiirnishing all permits, labor, materials, tools and equipment
necessary to complete,all work required to accomplish the following items in accordance
with the Standard Specifications, these Special Conditions and any detail drawings or
plans.
1. Reconstruction of the City Hall Parking Lot
Work included under this item shall consist of furnishing all permits, labor,
materials, fees, environmental notices and equipment to complete the parking lot
reconstruction in accordance with the applicable sections of the Standard
Specifications, these Special Conditions and the 2001 California Codes.
The Contractor shall remove.and.dispose of all debris, asphalt, and any subgrade
materials. All debris generated from the Contractors operation shall become the
property of the Contractor and shall be disposed of at a legally acceptable disposal
site furnished by the Contractor and hauled on a route approved by all authorized
agencies and the Director of Public Works. Payment for the disposal of all debris
shall be considered as included in the various contract items of work .and no
additional compensation shall be made therefore.
Details:
4 Demo and remove entire parking lot of all asphalt, approximately 29,945/sf, of any
stamped concrete and any subgrade materials and dispose thereof:
(see attachment"A"for aerial diagram of the defined parking lot)
4 Replace the west driveway entrance off Barton Road in front of the library with 8" of
concrete over welded wire mesh totaling 4,500 sq.ft.
(see A-1 of the aerial diagram)
Fine grade and repave the remaining parking lot with 4" of asphalt over native,
approximately 23,845/sf
4 Asphalt to be placed in two lifts
4 Re-striped parking lot to contain the same number of spaces as existing. Include red
and green curbs and handicapped designation
Install a 3' wide concrete drain ribbon from the south entrance off Palm Ave. north
(approximately 300/1f) connecting to a new 2' wide concrete drain ribbon
(approximately 38/lf) ending at the new concrete driveway. Concrete ribbons are to be
a minimum of 6"thick.
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg. 2
(see A-4 and A-5 of the aerial diagram)
4 Replace bumper blocks in the same location as currently noted
(see A-6 of the aerial diagram)
NOTE: Parking Lot Reconstruction does not include the roadway on the east side of the building
from the Building and Safety Office to Barton Road.
The Contractor shall be responsible for all traffic management and the obtaining
and placing of any required temporary construction warning signs and traffic
delineators.
The Contractor shall work between the hours of 7:30 a.m. - 5:30 p.m., Monday
through Friday.
The Contractor shall work with the city to provide access to the corporate yard.
(see A-8 of the aerial diagram)
SECTION 2. SERVICES PROVIDED '
CONTRACTOR shall provide all labor, supervision and equipment required to perform said services.
SECTION 3. COMPENSATION
Contractor shall be paid pursuant to the Schedule and Prices submitted in Exhibit B.
The total reconstruction of the Civic Center Parking lot not is to exceed $73,580 without written
consent by the CITY.
SECTION 4. BUSINESS LICENSE
CONTRACTOR shall, within five (5) days of executing this contract, obtain a current City of Grand
Terrace business license,during the term of this contract or any extension thereto.
SECTION 5. INDEPENDENT CONTRACTOR
The parties agree that CONTRACTOR is an independent contractor who is being paid to produce a
result. CONTRACTOR is in no way an employee of CITY. CONTRACTOR controls the means of
accomplishing the work. CONTRACTOR shall pay all Federal and State payroll taxes for employees
of CONTRACTOR and said employees shall in no way be deemed or construed to be employees of
CITY for any purposes.
SECTION 6. EFFECTIVE DATE/TERM
This agreement shall become effective upon the date of execution of the Agreement by both parties.
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg.3
This contract shall terminate on October 1, 2004 unless renewed. All work must be completed within
45 days of the contract effective date.
SECTION 7. TERMINATION
City shall have the right to terminate this agreement at a date earlier than specified for default. Before
CITY exercises said right it shall give CONTRACTOR 10 days notice of the facts constituting the
default and a chance to cure any deficiencies within that time. If those deficiencies have not been
cured, CITY shall have the right to send CONTRACTOR notice that the contract has been terminated
for default pursuant to this paragraph by giving notice as provided herein.
SECTION 8. ASSIGNMENT
No assignment of this contract may be made without the express written consent of CITY.
SECTION 9. NOTICE
The parties may give notice under this contract by sending such notice certified mail addressed as
follows:
TO CITY: CITY OF GRAND TERRACE
22795 Barton Rd.
Grand Terrace, CA 92313
ATTN: STEVE BERRY
TO CONTRACTOR:
Roquet Paving Inc.
PO BOX 887
Colton, CA 92324
Such notice shall be deemed received five (5) days after mailing, whether signed for or not.
SECTION 10. GRATUITIES
CONTRACTOR warrants that neither it nor any of its employees, agents or representatives has offered
or given any gratuities to CITY'S employees, agents or representatives with a view toward securing
this contract or securing favorable treatment with respect thereto.
SECTION 11. CONFLICT OF INTEREST
CONTRACTOR warrants that he has no blood or marriage relationship, and that he is not in any way
associated with any architect, engineer or other preparer of the plans and specifications for this project.
CONTRACTOR acknowledges that CITY has detailed Conflict of Interest rules, agrees to abide by
those rules, and agrees that any breach of those.rules shall give CITY the right to rescind, cancel or
otherwise terminate this agreement, at CITY'S discretion.
SECTION 12. INTEGRATION
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg. 4
This agreement constitutes the entire agreement and understanding be the parties hereto, and it
shall not be considered modified, altered, changed, or amended in any respect unless in writing and.
signed by the parties hereto.
SECTION 13. NO WAIVER
The failure of.the CITY at the time to require performance by the CONTRACTOR of any provisions
hereof shall in no way affect the right of the CITY thereafter to enforce same. Nor shall waiver by the
CITY of any breach of any provisions hereof be taken or held to be a waiver of any succeeding breach
of such provision or as a waiver of any provision-itself.
SECTION 14. INSURANCE
The Contractor shall supply insurance and licensing as follows:
Commercial General Liability:
Primary insurance shall be provided on IOSCGL form No. CG 00 01 11 85 or 88'. Total limits shall be
no less than 1 million dollars per occurrence for all coverage's and 2 million dollars general aggregate.
City and its employees and agents shall be added as additional insureds using ISO additional insured
endorsement form CG 20 10 11 85 (in no event will City accept an endorsement form with an edition
date later than 1990). Coverage shall apply on a primary.non-contributing basis in relation to any
other insurance or self-insurance, primary or excess, available to City or any employee or agent of
City. Coverage shall not be limited to the vicarious liability or supervisory role of any additional
insured: Umbrella Liability Insurance (over primary) shall apply to bodily injury/property damage,
personal injury/advertising injury, at a minimum, and shall include a "drop down"provision providing
.,,primary coverage above a maximum $25,000.00 self insured retention for liability not covered by
primary policies but covered by the umbrella policy. Coverage shall be following. form to any
underlying coverage. Coverage shall be provided on a "pay on behalf' basis, with defense costs
payable in addition to policy limits. There shall be no cross liability exclusion. Policies shall have
concurrent starting and ending dates.
Worker's Compensation:
Shall be written on a policy form providing workers' compensation statutory benefits as required by
law. Employer's liability limits shall be no less than one million dollars per accident or disease.
Employer's liability coverage shall be scheduled under any umbrella policy described above. Unless
otherwise agreed, this policy shall be endorsed to waive any right of subrogation as respects the City,
its employees or agents.
The Contractor shall also provide the City with a Certificate of Worker's Compensation Insurance and
completed Declaration Regarding Licenses Status form. Contractors must also have a valid City of
Grand Terrace Business License.
Auto Insurance•
CONTRACTOR shall provide Auto Insurance as follows:
r
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg. 5
Business Auto/Umbrella Liability:Insurance. Primary coverage shall be written on ISO
Business Auto Coverage form CA 00 01 06 92 including symbol 1 (Any Auto). Limits shall be no
less than (one) 1 million dollars per accident. Starting and ending dates shall be concurrent. If
Contractor owns no autos, a non-owned auto endorsement to the General Liability policy
described above is-acceptable.
SECTION 15 LEGAL ACTION
Should the City bring any legal or equitable.action for the purpose of protecting or enforcing its rights
under this Agreement, the City shall recover, in addition to all other relief, its reasonable attorney's
fees and court costs.to be fixed by the Court.
SECTION 16 ATTORNEY'S FEES
The parties agree that should any dispute arise concerning the interpretation of this contract, or
regarding the performance or non-performance .of this contract, that the prevailing party shall be
entitled to reasonable attorney's fees.
SECTION 17 EXTRA WORK,
The Contractor hereby agrees that he will not proceed with any Extra Work unless he has been
authorized in writing to do so by CITY.
WITNESS WHEREOF,the parties hereto have set their hands and seals the day and year first above
written.
ATTEST: CITY OF GRAND TERRACE
By:
City Clerk May r
APPROVED AS TO FORM: CONTRACTOR
By: Ro UFET PAV10j :T NC,
City Attorney IN,Title: /'/�
resi;4"%f-
City of Grand Terrace-Parking Lot Reconstruction Services Agreement-Pg. 6
PROJECT BID' SPECIFICATIONS FOR THE CITY OF GRAND TERRACE
Parking Lot Reconstruction GTB-04-02
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IN r�ea,r..r L`_ � Attachment A
u 1. . ..
Date: 943 D NAME OF PROJECT: Reconstruction of the City of Grand Terrace Parking lot ' -
Contracto e T rhu Kq
Bidding Schedule 1
Item Description Units Unit Price in Words Unit Price Item Price
1. Removal of all asphalt, Approx.
stamped concrete and any 36,400 SY
subgrade materials including sq.ft. Dollars& , 4 9 Cents . 4 7 1 17
disposal
2. 8" Concrete driveway over Approx.
4" Class Base II with welded 4,500 S.F.
wire mesh sq.ft. Dollars& 0. Cents 5-,o0 ` �a -00' uo
- - J
3. Replace remaining parking Approx.
lot with 4" asphalt with 6" of 31,900 SY
Class II Base Dollars& Cents O, a SJ 0 Y 0, M
4. Install 2' wide concrete drain Approx. -
ribbons 350 L.F
L.F. )y . Dollars& SO Cents /y,S o S U 7 S, uo
5. Install 3' wide concrete drain Approx.
ribbons 300 L.F.
L.F. ? Dollars& 6.1 Cents 17, 61�
6. Install 2"x4"redwood header Approx. L.F.
350'
Dollars& 0 Cents y�ao
7. Re-strip entire parking lot
containing the same number L.S. (. d S�,�,` L.S.
of spaces as existing. Include
red & green curbing and Dollars& Cents
handicapped designation
8. Traffic Control L.S. l cLA,.12 5S&/'.
L.S. �¢
Dollars& Cents
I
Total $ P D y , (go, oo I
I
I
I
- f
- I
ORIGINAL THE PREMIUM IS PREDICATED ON
THE FINAL CONTRACT PRICE AND
IS SUBJECTTO ADJUSTMENT
ISSUED IN TWO ORIGINAL COUNTERPARTS BOND NO: 929337992
COUNTERPART NO.2 PREMIUM: $1,154.00
Performance Bond
KNOW ALL PERSONS BY THESE PRESENTS,That We Roquet Paving, Inc. of P O Box'887, Colton CA
92324, hereinafter referred to as the Principal, and Western Surety Company as Surety, are held and
firmly bound unto City of Grand Terrace, hereinafter referred to as the Obligee, in the sum of Seven -
Three Thousand Five Hundred Eighty and 00/100 Dollars ($73,580.00), for the payment of which we bind
ourselves, our legal representatives, successors and assigns,jointly and severally, firmly by these
presents.
WHEREAS, Principal has entered into a contract with Obligee, dated the day of for
Parking Lot Reconstruction Project
NOW, THEREFORE, if the Principal shall faithfully perform such contract or shall indemnify and save
harmless the Obligee from all cost and damage by reason of Principal's failure so to do, then this
obligation shall be null and void; otherwise it shall remain in full force and effect.
ANY PROCEEDING, legal or equitable, under this Bond may be instituted in any court of competent
jurisdiction in the location in which the work or part of the work is located and shall be instituted within two
years after Contractor Default or within two years after the Contractor ceased working or within two years
after the Surety refuses or fails to perform its'obligations under this Bond, whichever occurs first. If the
provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to
sureties as a defense in the jurisdiction of the suit shall be applicable.
NO RIGHT OF ATION shall accrue on this Bond to or for the use of any person or corporation other than
the Obligee named herein or the heirs, executors, administrators or successors of the Obligee.
SIGNED, SEALED AND DATED THIS 8th day of September, 2004.
Roquet Paving,.Inc.
i (Primal)
By: wC/
(Seal)
WesternVety Company
AA§)�A Surety) ,
By:
Julia B. Leonard, Attorney-in-Fact (Sea])'-
,
1
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
State of CALIFORNIA
County of RIVERSIDE
On before me, S.L. KYSETH, NOTARY PUBLIC ,
Name and Title of Officer(e.g.,"Jane Doe,Notary Public")
personally appeared JULIA B. LEONARD,ATTORNEY IN FACT ,
Name(s)of Signer(s)
® personally known to me -OR- ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies),' and that by his/her/their
signature(s) on the instrument the person(s), or the entity upon
S. L KYSE7H behalf of which the person(s) acted, executed the instrument.
CM1711 ion#1Z'4061
ZrNc ►Y�'ub►tc--Ca00mra f WITNESS my hand Zseal.
Son BwMrd1no County,MY Comm.ExpkmIr
1 �04ure of Notary P bl
----------------------------------------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:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer ❑ Corporate Officer
❑ Titles(s): ❑ Title(s):
❑ Partner-❑ Limited ❑ General ❑ Partner-❑ Limited ❑ General
❑ Attorney-in-Fact ❑ Attorney-in-Fact
❑ Trustee ❑ Trustee
❑ Guardian or Conservator . ❑ Guardian or Conservator
❑ Other: Top of Thumb here ❑ Other: To of Thumb here
Signer Is Representing: Signer Is Representing:
17
BD-1133 09/00
In accordance with the Terrorism Risk Insurance Act of 2002, we are providing this
disclosure notice for bonds and certain insurance policies on which one or more of the
Writing Companies identified below is the surety or insurer.
To principals on bonds and insureds on certain insurance policies written by any one or
more of the following companies (collectively the "Writing Companies") as surety or
insurer: Western Surety Company, Universal Surety of America, Surety Bonding
Company of America, Continental Casualty Company, National Fire Insurance Company
of Hartford, American Casualty Company of Reading, PA, The Firemen's Insurance
Company of Newark, NJ, and The Continental Insurance Company.
DISCLOSURE OF PREMIUM
The premilum attributable to coverage for terrorist acts certified under the Act was Zero
Dollars ($0.00).
DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM
LOSSES
The United States will pay ninety percent (90%) of covered terrorism losses exceeding the
applicable surety/insurer deductible.
Form F7310
Western Surety Company
ISSUED IN TWO ORIGINAL COUNTERPARTS BOND NO: 929337992
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation
having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby
make,constitute and appoint
Mark N.Gladding,Kenneth A Coate, Julia B Leonard,Individually
of Riverside,CA,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
-In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof,duly adopted,as indicated,by
the shareholders of the corporation.
In Witness Whereot;WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 5th day of November,2003.
WESTERN SURETY COMPANY
_N„i4 1^ia�
W�h°.per Paul .Brufl?Seir, Vice President
State of South Dakota l I ss 4
County of Minnehaha
On this 5th day of November,2003,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that
he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and
which executed the above instrument;that he knows the seal of said corporation,that the seal affixed to the said'instrument is such corporate seal;that it was
so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority,and
acknowledges same to be the act and deed of said corporation.
My commission expires +
r D. KRELL s
November 30,2006 SEAL NOTARY PUBLIC EAS s
a SOUTH DAKOTA t
+SSSShss�,55y5� shyhss5+
",ell.No Public
CERTIFICATE
I,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this _-:-BTH _day of_ ---SEPTEMBER 2004
.:guAEij'+w - W-ESTERN SURETY COMPANY
4�f+Se""� NDAyI'g� �J -�-
l
UP
Nelson,Assistant Secretary
Form F4280-01-02
Authorizing By-Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attomeys in Fact or agents who shall have authority to issue bonds,policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
6
ORIGINAL
ISSUED IN TWO ORIGINAL COUNTERPARTS
COUNTERPART NO.2
Bond No. 929337992
PREMIUM: INCLUDED IN THE PREMII
PAYMENT BOND CHARGED FOR THE PERFORMANCE BONI
KNOW ALL PERSONS BY THESE PRESENTS, That Roquet Paving, Inc., as Principal, and Western
Surety Company Surety, are held and firmly bound unto City of Grand Terrace, Obligee in the sum of
Seventy-Three Thousand Five Hundred Eighty and 00/100 Dollars ($73,580.00),for the payment of which
we bind ourselves, our legal representatives, successors and assigns,jointly and severally, firmly by these
presents.
WHEREAS, the Principal has entered into a contract with the Obligee dated_for
Parking Lot Reconstruction Project
copy of which contract is by reference made a part hereof.
NOW, THEREFORE, if Principal shall, in accordance with applicable Statutes, promptly made payment to
all persons supplying labor and material in the prosecution of the work provided for in said contract, and
any and all duly authorized modifications of said contract that may hereafter be made, notice of which
modifications to Surety being waived,then this obligation to be void; otherwise to remain in full force and
effect.
SIGNED, SEALED AND DATED: September 8, 2004
Ro uet Paving, loc. Wester ety Compan
Principal Surety
By: i%2 By: -
(Seal) ulia B. Leoanrd, Attorney-'n-.Fact (Seal), =
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CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
State of CALIFORNIA
County of RIVERSIDE
On before me, S.L. KYSETH, NOTARY PUBLIC ,
Name and Title of officer(e.g.,"Jane Doe,Notary Public')
personally appeared JULIA B. LEONARD,ATTORNEY IN FACT' ,
Name(s)of Signer(s)
® personally known to me -OR- ❑ proved to me on the basis of satisfactory evidence to be :the person(s) whose
name(s) is/are subscribed to the" within instrument and
acknowledged to'me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their
signature(s) on the' instrument 'the person(s), or the entity upon
S. L KYSEfH behalf of which the person(s) acted,.executed the instrument.
e Commission#127406�061
Nagy Public—Collfomia WITNESS my h d and offic'. seal.
San Bernardino Courtly
My Comm.Bq*m Sep 12,20034
Signatur6 of Notary P li
---------------------------------------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:
Document Date: Number of Pages:
Signer(s)Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer. ❑ Corporate Officer
❑ Titles(s): ❑ Title(s):
❑ Partner-❑ Limited ❑ General ❑ Partner-❑ Limited ❑ General
❑ Attorney-in-Fact ❑ Attorney-in-Fact
❑ Trustee ❑ Trustee
❑ Guardian or Conservator . ❑ Guardian or Conservator
❑ Other: Top of Thumb here ❑ Other: Top of Thumb here
Signer Is Representing: Signer Is Representing:
BDA 133 09/00
NnTTM' ..
In accordance with the Terrorism Risk Insurance Act of 2002, we are providing this
disclosure notice for bonds and certain insurance policies on which one or more of the
Writing Companies identified below is the surety or insurer.
To principals on bonds and insureds on certain insurance policies written by any one or
more of the following companies (collectively the "Writing Companies") as surety or
insurer: Western Surety Company, Universal Surety of America, Surety Bonding
Company of America, Continental Casualty Company, National Fire Insurance Company
of Hartford, American Casualty Company of Reading, PA, The Firemen's Insurance
Company of Newark, NJ, and The Continental Insurance Company.
DISCLOSURE OF PREMIUM
The prem_u ' attributable to coverage for terrorist acts certified under the Act was Zero
Dollars ($0.00)_
DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM
LOSSES
The United States vPill pay ninety percent (90%) of covered terrorism losses exceedhnig the
applicable surety/insurer deductible.
Form F731D
Western Surety Company N
ISSUED IN TWO ORIGINAL COUNTERPARTS BOND 0 929337992
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation
having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby
make,constitute and appoint
Mark N Gladdino, Kenneth A Coate,Julia B Leonard, Individually
of Riverside,CA,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
-In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof;duly adopted,as indicated,by
the shareholders of the corporation.
In Witness Whereof WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 5th day of November,2003.
RET}. WESTERN SURETY COMPANY
cTMW p�o�+
Paul 2rBrufliit,Senior Vice President
State of South Dakota 1
S
ss
County of Minnehaha
On this 5th day of November,2003,before me personally came Paul T.Bruflat,to me known,who,being by me duly sworn,did depose and say: that
he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and
which executed the above instrument;that he knows the seal of said corporation;that the seal affixed to the said-instrument is such corporate seal;that it was
so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name.thereto pursuant to like authority,and
acknowledges same to be the act and deed of said corporation.
My commission expires +
s D. KRELL s
November30,2006 r seaL NOTARY PUBLIC Ars
i s SOUTH DAKOTAsE
+,5•y555ha5,ti55,�,,hti,Sy+
D:Krell,No Public
CERTIFICATE
I,L.Nelson,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force,and further certify that the By-Law of the corporation priritedtion the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this BTH day of SEPTEMBER 2004
--WE--STERN SURETY COMPANY
L.Nelson,Assistant Secretary
Form F4280-01-02
Authorizing By-Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders
of the Company.
Section 7. All bonds,policies, undertakings,Powers of Attorney, or other obligations of the corporation shall be executed-in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds,policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds,policies, undertakings,Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
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