HomeMy WebLinkAboutC30220 - WCS Playground Imprvmnts (729-11) Contract No. C30220
CITY OF PALM DESERT
PUBLIC WORKS DEPARTMENT
STAFF REPORT
REQUEST: AWARD CONTRACT NO. C30220 TO ROBERTSON
INDUSTRIES, INC., FOR THE WASHINGTON CHARTER
SCHOOL PLAYGROUND IMPROVMENTS (PROJECT 729-11)
SUBMITTED BY: Mark Greenwood, P.E., Director of Public Works
CONTRACTOR: Robertson Industries
4401 E. Baseline Road, Suite 105
Phoenix, Arizona 85402
DATE: October 28, 2010
CONTENTS: Agreement
Contractors Proposal
Vicinity Map
Recommendation
By Minute Motion:
1. Waive irregularities in Contractor's Proposal submitted by
Robertson Industries, Inc.;
2. Award Contract No. C30220 to Robertson Industries, Inc., of
Phoenix, Arizona, for the Washington Charter School Playground
Improvements in the amount of $74,407.01;
3. Set aside a 10 percent contingency in the amount of $7,440.70;
and
4. Authorize the Mayor to execute the agreement
Funds are available in Account No. 233-4618-454-4001 Park and Recreation Facilities,
Citywide Park Improvements. No General Fund money is being used for this
expenditure.
Backqround
The City has a Joint Use Agreement, dated April 27, 2000, with Desert Sands Unified
School District for the use of the playground and surrounding area located on the east
Staff Report
Award Contract No. C30220 for the Washington Charter School Playground Improvements
(Project 729-11)
October 28, 2010
Page 2 of 3
side of Washington Charter School. Per this agreement, the City maintains all of the
landscape and playground equipment.
Staff has determined that the current playground surfacing and equipment is
deteriorating, and must be replaced to insure that all state and federal safety
requirements continue to be met. This includes the replacement of a three-bay swing
set and the poured-in-place safety surfacing.
On October 5, 2010, bids were received and opened for the Washington Charter School
Playground Improvements, and the results are as follows:
Contractor Location Bid Amount
Robertson Industries, Inc. Phoenix Arizona $74,407.01
T. J. Janca Construction, Inc. Orange, California $92,500.00
The specifications required that specific material testing be submitted with the
Contractor's Proposal. Robertson Industries, Inc., did not provide this documentation
at the time of bid opening; however, they have since delivered the required safety
testing documentation to staff. Staff requests that City Council waive this irregularity
and award the subject contract.
Fiscal Analvsis
There is no fiscal impact associated with this action other than the contract amount.
Funds are budgeted in Account No. 233-4618-454-4001 Park and Recreation Facilities,
Citywide Park Improvements for this purpose.
Prepared By: Depart d:
Jay czak, Park Facilities Manager Mark Green ood, P.E.,
Director of Public Works
� �,i L
�
Paul S. Gibson, Director of Finance
CITY COUNCILI�E�I'ION
Approval: APPROVED DENTEU
RECEIVED OTHER
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MEETi G DA�� � `-" ��
Jo . Wohlmuth, Cit nager AYF,S: ' �7 ' � r '' � �� �
NOES: ` �
AI3SENTz �� '
AIiSTAIN: '�-
VERIFIED BY: ` �y ��
Original on File with Ci lerk's Office
AGREEMENT
THIS AGREEMENT is made and entered into this 28th day of October, 2010, by
and between City of Palm Desert, California, hereafter called "CITY" and Robertson
Industries, Inc. hereinafter called "CONTRACTOR".
WITNESSETH
RECITALS:
CONTRACTOR has submitted to CITY its Contractor's Proposal for the construction of
CITY Project,
1. WASHINGTON CHARTER SCHOOL PLAYGROUND IMPROVEMENTS,
PROJECT NO. 729-11, CONTRACT NO. C30220, in strict accordance with the
Contract Documents identified below, CITY has accepted said Proposal.
2. CONTRACTOR states that it has re-examined its CONTRACTOR'S Proposal
and found it to be correct, has ascertained that its Subcontractors are properly
licensed and possess the requisite skill and forces, has examined the site and
Contract in accordance with the Contract Documents for the money set forth in
its Proposal to be paid as provided in the Contract Documents.
AGREEMENT:
IT IS AGREED BY THE PARTIES AS FOLLOWS:
1. Contract Documents: The entire contract consists of the following: (a) The
Agreement; (b) The Notice Inviting Bids; (c) The Instruction to Bidders; (d) The
Contractor's Proposal; (e) The Bidder's Bond; (f) The Performance Bond; (g)
The Payment Bond; (h) The General Specifications; (i) The Special Provisions;
(j) The Standard Specifications as modified in other portions of the Contract
Documents; (k) The Plans; (I) Addenda Nos. 1 ; (m) The Determination of
Prevailing Wage Rates for Public Work; (n) Any Change Orders issued; (o) Any
additional or supplemental specifications, notices, instructions and drawings
issued in accordance with the provisions of the Contract Documents. All of said
Documents presently in existence are by this reference incorporated herein as if
here set forth in full and upon the proper issuance of their documents they shall
likewise be deemed incorporated.
2. Contractor shall and will do all things necessary to construct the work generally
described in Recital No. 1 in accordance with the Contract Documents and will
complete said work within 5 Calendar Days from the Notice to Proceed date to
the satisfaction of the Engineer.
3. Contractor agrees to indemnify, defend and save CITY and its officers, agents
and employees, and the Engineer harmless from:
a. Any and all liability, claims, damages, losses or injuries to any person or
other entity, including injury to Contractor's employees, and all claims
which arise from or are connected with the negligent performance of or
failure to perform the work or other obligations of this Agreement, or which
are caused or which are claimed to be caused by the negligent or
intentional acts or omissions of Contractor, its subcontractors, its agents
or employees, and, all expenses of investigating and defending against
same,
b. Any and all liability, claims, damages, losses or injuries to any and all
contractors, subcontractors, material-men, laborers, or any other person,
firm or corporation furnishing or supplying work, services, materials or
supplies in connection with the performance of the Agreement.
c. Attention is directed to the General Specifications - Claims, Liability, and
Indemnity Agreement/Hold Harmless sections, which specifications are
made part of this Agreement as set forth in Agreement paragraph 1,
above.
d. Attention is directed to Section 6-9, "Liquidated Damages" of the Standard
Specifications and is hereby amended to substitute the "City of Palm
Desert" in place of "Agency." Liquidated damages shall be $1,000.00
dollars per calendar day of delay.
4. Should any litigation or arbitration be commenced between the parties
concerning the works of improvements as referenced herein, the prevailing party
in any such litigation, being the CITY or the Contractor, should be entitled to a
reasonable sum for attorney's fees incurred in any such litigation relating to this
Contract.
5. This Agreement shall be binding upon all parties hereto and their respective
heirs, executors, administrators, successors, and assigns.
6. Contractor shall be paid in the manner set forth in the Contract Documents the
amount of its Proposal as accepted by CITY, subject to such additions and
deductions as may be made pursuant to the Contact Documents and applicable
law.
Satisfactory Performance: The prime Contractor agrees to pay each
Subcontractor under this prime contract for satisfactory performance of its
contract no later than 10 days from the receipt of each payment the prime
Contractor receives from City of Palm Desert. Any delay or postponement of
payment from the above referenced time frame may occur only for good cause
following written approval of the City of Palm Desert.
Release of Retention: The prime Contractor agrees further to release retention
payments to each Subcontractor within 30 days after the Subcontractor's work is
satisfactorily completed. Any delay or postponement of payment from the above
referenced time frame may occur only for good cause following written approval
of the City of Palm Desert.
7. Execution of the Agreement by the parties constitutes their agreement to abide
by all applicable provisions of the California Labor Code; constitutes contractor's
certification that he is aware of the provisions of said Code and will comply with
them; and furtfler constitutes Contractor's certification as follows:
"I am aware of the provisions of Section 3700 of the California Labor Code which
requires every employer to be insured against liability for worker's compensation
or to undertake self insurance in accordance with the provisions of that Code,
and I will comply with such provisions before commencing the performance of the
work of this contract."
IN WITNESS WHEREOF the parties hereto have executed or caused to be
executed by their duly authorized officials, this Agreement which shall be deemed an
original on the date first above written.
ROBERTSON INDUSTRIES, INC.:
BY: ATTEST BY:
Signature to be notarized
TITLE: TITLE:
CITY OF PALM DESERT:
BY: ATTEST BY:
Signature to be notarized
TITLE: Mavor of Palm Desert, CA TITLE: City Clerk of Palm Desert, CA
APPROVED AS TO CONTENT: APPROVED AS TO FORM:
MARK GREENWOOD, P.E. DAVID J. ERWIN
DIRECTOR OF PUBLIC WORKS CITY ATTORNEY
State of California )
)
County of )
On before me,
personally appeared
, who 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 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
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS: That whereas the City of Palm Desert has
awarded to Robertson Industries, Incorporated hereinafter designated as the "Principal",
a contract for:
WASHINGTON CHARTER SCHOOL PLAYGROUND IMPROVEMENTS
PROJECT N0.729-11
CONTRACT NO. C30220
WHEREAS, said Principal is required under the terms of said contract to furnish a good
and sufficient bond for the performance of said contract:
NOW THEREFORE, WE, the
Principal, and as Surety, are held and
firmly bound unto the City of Palm Desert hereinafter called the City, in the penal sum of
Seventy Four Thousand, Four Hundred and Seven Dollars and One Cent
($74,407.01), being 100% of the contract amount in lawful money of the United States
of America for the payment of which sum well and truly to be made, we hereby bind
ourselves, our heirs, executors, administrators, and successors, jointly and severally,
firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that if the above bounded Principal,
his executors, heirs, administrators, and successors, or assigns, shall in all things stand
to and abide by, and well and truly keep and perform the covenants and agreements in
the said contract and any alterations thereof made as therein provided, on his or their
part, to be kept and performed at the time and in the manner therein specified, and in all
respects according to their true intent and meaning, and shall indemnify and save
harmless the City, its officers and agents, as therein stipulated, then this obligation shall
become null and void; otherwise, it shall be and remain in full force and virtue.
And the said Surety, for value received, hereby stipulates and agrees that no change,
extension of time, alteration or addition to terms of the contract or to the work to be
performed thereunder or the specifications accompanying the same shall in any wise
affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alterations or additions to the terms of the contract or to the work or
the specifications.
Should it become necessary for the City to institute a lawsuit or any other legal
proceeding to enforce the terms and conditions of this bond, then all costs of said
proceeding, including attorneys' fees, shall be awarded to the prevailing party.
IN WITNESS WHEREOF, identical counterparts of this instrument, each of which shall
for all purposes be deemed an original thereof, have been duly executed by the
Principal and Surety above named, on this day of , 2010
SURETY PRINCIPAL
BY: BY:
INSURANCE COMPANY and/or AGENT
ADDRESS
TELEPHONE NUMBER
State of California )
)
County of )
On before me,
personally appeared
, who 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 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
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT WHEREAS, the City of Palm Desert (sometimes referred to hereinafter as
"Obligee") has awarded to Robertson Industries Incorporated (hereinafter designated as
the "CONTRACTOR"), an agreement dated October 28, 2010 described as follows:
WASHINGTON CHARTER SCHOOL PLAYGROUND IMPROVEMENTS, PROJECT
NO. 729-11, CONTRACT NO. C30220, (hereinafter referred to as the "Contract"); and
WHEREAS, said CONTRACTOR is required to furnish a bond in connection with said
Contract, and pursuant to Section 3247 of the California Civil Code;
NOW, THEREFORE, we, � , the undersigned
CONTRACTOR, as Principal, and a corporation
organized anci existing under the laws of the State of , and
duly authorized to transact business under the laws of the State of California, as Surety,
are held and firmly bound unto the City of Palm Desert and to any and all persons,
companies or corporations entitled to file stop notices under Section 3181 of the
California Civil Code, in the sum of Seventv Four Thousand, Four Hundred and
Seven Dollars and One Cent ( 74 407.01), said sum being not less than one hundred
percent (100%) of the total amount payable by the said Obligee under the terms of the
said Contract, for which payment well and truly to be made, we bind ourselves, our
heirs, executors and administrators, successors and assigns, jointly and severally, firmly
by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that, if said CONTRACTOR, his or
its heirs, executors, administrators, successors or assigns, or Subcontractors, shall fail
to pay for any materials, provisions or other supplies, implements, machinery or power
used in, upon, for or about the performance of the Public Work contracted to be done,
or to pay any person for any work or labor of any kind, or for bestowing skills or other
necessary services thereon, or for amounts due under the Unemployment Insurance
Code with respect to such work or labor, or for any amounts required to be deducted,
withheld, and paid over to the Employment Development Department from the wages of
employees of said CONTRACTOR and his or its Subcontractors pursuant to Section
13020 of the Unemployment Insurance Code with respect to such work and labor as
required by the provisions of Section 3247 through 3252 of the Civil Code, or for any
amounts required to be deducted, withheld, and paid over to the Franchise Tax Board
or Internal Revenue Service from the wages of employees of the CONTRACTOR or his
or its Subcontractors, the Surety or Sureties hereon will pay for the same in an amount
not exceeding the sum specified in this bond, otherwise the above obligation shall be
void. In addition to the provisions herein above, it is agreed that this bond will inure to
the benefit of any and all persons, companies and corporations entitled to serve stop
notices under Section 3181 of the Civil Code, so as to give a right of action to them or
their assigns in any suit brought upon this bond.
The Surety, for value received, hereby stipulates and agrees that no change, extension
of time, alteration or addition to the terms of the said Contract or to the work to be
performed thereunder or the Specifications accompanying the same shall in any way
affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alteration or addition to the terms of the Contract or to the
Specifications.
No final settlement between the Obligee and the CONTRACTOR hereunder 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 the enforcement of the bond, each shall pay Obligee's
reasonable attorney's fees incurred, with or without suit, in addition to the above sum.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this
day of , 20
PRINCIPAL/CONTRACTOR: SURETY:
(Typed Name of CONTRACTOR) (Typed Name of Surety)
By: By:
(Signature) (Signature of Attorney-in-Fact)
(Typed Name and Title) (Typed Name of Attorney-in-Fact)
The rate of premium on this bond is $ per thousand.
The total amount of premium charged: $
(the above must be filled in by corporate surety).
IMPORTANT: Surety companies executing bonds must possess a certificate of
authority from the California lnsurance Commissioner authorizing them to write surety
insurance defined in Section 105 of the California lnsurance Code, and if the work or
project is financed, in whole or in part, with federal, grant or loan funds, it must also
appear on the Treasury Department's most current list (Circular 570 as amended).
THIS IS A REQUIRED FORM.
Any claims under this bond may be addressed to:
(Name, Address and Telephone No. of Surety)
(Name, Address and Telephone No. of agent or representative for service of process in
California if different from above)
Acknowledgment
State of California )
)
County of )
On before me,
personally appeared
, who 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 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
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature (Seal)
C - CONTRACTOR'S PROPOSAL
WASHINGTON CHARTER SCHOOL PLAYGROUND IMPROVEMENTS
PROJECT NO. 729-11
CONTRACT NO. C30220
TO: CITY OF PALM DESERT, "CITY"
DATE:
BIDDER: "CONTRACTOR"
The UNDERSIGNED, "CONTRACTOR", having carefully examined the site and the
Contract Documents for the construction of, WASHINGTON CHARTER SCHOOL
PLAYGROUND IMPROVEMENTS, PROJECT NO. 729-11, CONTRACT NO. C30220,
hereby proposes to construct the work in accordance with the Contract Documents,
including acknowledgement of Addenda No(s)�for the amount stated in this
Proposal.
By submitting this Proposal, CONTRACTOR agrees with CITY:
That unless withdrawn in person by CONTRACTOR or some person authorized in
writing by CONTRACTOR — not by telephone or telegram — before the time specified in
the Notice Inviting Bids for the public opening of bids, this Proposal constitutes an
irrevocable offer for 60 calendar days after that date.
The CITY has the right to reject any or all Proposals and to waive any irregularities or
informalities contained in a Proposal.
That the contract shall be awarded only by the governing body of CITY. Said contract
shall onty be deemed awarded after the CONTRACTOR'S complete submission of all
contract documents, bonds, insurance documentation, and the CITY shall obtain all
necessary signatures of the governing body, at which time the contract shall be deemed
awarded.
To submit to CITY such information as CITY may require to determine the Bidder's
�nancial standing experience and to pertorm the work.
That the accompanying certified or cashier's check or Bid Bond constitutes a guarantee
that if awarded the contract, CONTRACTOR will execute the Agreement and deliver the
required bonds and certificates of insurance within 10 days after notice of award. If
CONTRACTOR fails to execute and deliver said documents, the check or bond is to be
charged with the costs of the resultant damages to CITY, including but not limited to
publication costs, the difference in money between the amount bid and the amount in
excess of the bid which costs CITY to do or cause to be done the work involved, lease
and rental costs, additional salaries and overhead, increased interest and costs of
Page C-1
funding the project, attorney expense, additional engineering and architectural expense
and cost of maintaining or construction alternate facilities occasioned by the failure to
execute and deliver said documents.
It is understood that the quantities shown hereon, except for those quantities marked
"Lump Sum", are estimates and the final payment will be based upon the actual work
pertormed, subject to such adjustment and alterations as elsewhere provided herein.
¢;
1 PLAYGROUND tMPROVEMENTS 1 Lg ��. r , � $
/�`�� ��� 7� ��.� 7 ��
� �
TOTAL BID PRICE
$ ��1 �� jc` I
,
The costs of any work shown or required in the Plans and Specifications, but not
specifically identi�ed as a Pay Item are included in the related Pay Item(s), and no
additional compensation shall be due CONTRACTOR by virtue of CONTRACTOR'S
compliance with the Plans and Specifications.
TOTAL AMOUNT BASE BID IN FIGURES $ �''��, ��- d�r �:'�
TOTAL AMOUNT BASE BI� IN WORDS >v' '� `�� �;��,�;A� �„ x , �,-ati� �
}^ - �. �.0 w:..,...�
..., ,�.. � ���, a��, .�..,, ,� � �-�,`� �� - � ,
`' �` �w,�,:� .
C: t� � ,�' v1 _a
IN WITNESS WHEREOF CONTRACTOR executed this proposal as of date set forth on
Page C-1:
By: ��c,����d �,I
Signature .
Title: (/1/"��'L v t' �j�
CONTRACTOR
Page C-2
State of Cafi�er�' )
)
County of��( �" )
Subscribed and sworn to or affirmed) before me n this day of
(month), —��— (Year), bY
, proved to me on the basis of satisfactory evidence o be the person(s)
who appeared before me.
�� `n �' ;���.�
���°m� "c� g �
� �
: � �� r�,:., ,v
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d4�� ' � �' . ,.fV t,
,r�5` f ,<
,.._.. . . . �. .. _ .. �,,.�r
Signature of Notary (Seal of Notary)
Page C-3
D — INFORMATION REQUIRED OF BIDDER
The bidder is required to supply the following information. Additional sheets may be
attached if necessary.
Address _`(��� �• �l/l aP I ��✓��i ��� 5��� �bS �h��ll�� �G OJ v�'Z.
Telephone No. tU �Z.� �j� -$g7�
Type of Firm (Individual, Partnership or Corporation) _��D(lV'T/►' 11 U1/1
Corporation organized under the laws of the State of 1 t L.
Contractor's License No. lY �� ��,Q f Exp. Date � � ZO� (
Contractor hereby swears under penalty of perjury that this information provided is true
and correct.
.
By: L Title:_���1v2L�C� V� ���
Si nature Contr tor
List the names and addresses of all owners of the firm or names and titles of all officers
of the corporation:
�i ����� ��� W�t�� v� ��
Number of years' experience as a Contractor in construction work
List at least three similar projects completed recently:
Contract Amount Class of Work Date Completed Name, Address &
Telephone No. of Owner
, . ,
C t�I .
) . ,
�� . . .
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�. `� �.)�I t t�J�. �c'd '" �f��a , . �,,�. �.L,�i:a~ ���..' �;,�. �`,,: e_u, �,. + ._t`C:
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2. (V� �i.' � �i��. � ��+��" �1 �,�q e�L.W`i�.f' � l=� f g��f.)`� 1{i,�lY"�L''y;��%1 I_= L"��V+��'(4 /N
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3. � '� "��i G,�� yl� ��� i"v.t ��t� �i.:E._ecn,�n;,i- '.��(,_'� � , f � t`� C, ,, .�`jitpf�1r .� i
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Page D-1 �
List the names and addresses of each Subcontractor who wiil perform work in or about
the work improvement, and indicate what portion of the work wiil be done by each
Subcontractor:
Subcontrac#or's Name: ° � `
��..� � 1.�,�' �t�r� t'�^,_a�,���f'� ���' /�i''
License Number: _ � .�( ? ��' � �
Address: ��% r'jG.> '��;;i i� r� � ��i u /�`��i��^ ft� � C' �, x",
Telephone: f�''� �— �<�� ..5��;1�� _ °
� ��� �> ��� �,..�c:a��
��
Work to be performed: ,G�°,�n.� `'��� ' � , � /
z✓,'r j .� '` �',t /
/k ' � �.�f ,�� (�n r���lv(.�'����t'��e`��' L n(y��/�/!"r�, ,�'fi<L/k.f,
List the name of the person who inspected the site of the proposed work for your firm
Subcon#ractor's Name:
License fVumber:
Address:
Telephone:
Work to be perFormed:
List the name of the person who inspected the si#e of the proposed work for your firm
Subcontrac#or's Name:
License Number:
Address:
Telephone:
Work to be performed:
A financiai statement or o#her in#ormation and references sufficiently comprehensive to
permit an appraisal of your current financial condition may be required by the City.
Page D 2
E - NON-COLLUSION AFFIDAVIT
To be Executed by Bidder and Submitted with Bid
STATE OF C-�4N�F6f2fdt�t--}�1����.,,_
) SS
COUNTY OF I �
, be' fir t dul swor , �eposes and says that
he/she is of � • , the party
making the fo going bid; that the bid is not made in the interest of, or on behalf of any
undisclosed person, partnership, company, association, organization, or corporation;
that the bid is genuine and not collusive or sham; that the bidder has not directly or
indirectly induced or solicited any other bidder to put in a false or sham bid, and has not
directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone
else to put in a sham bid, or that anyone shaH refrain from bidding; that the bidder has
not in any manner, directly or indirectly, sought by agreement, communication, or
conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any
overhead, profit, or cost element of the bid price, or of that of any other bidder, or to
secure any advantage against the pubic body awarding the contract of anyone
interested in the proposed contract; that all statements contained in the bid are true;
and, further, that the bidder has not, directly or indirectly, submitted his or her bid price
or any breakdown thereof, or the contents thereof, or divulged information or data
relative thereto, or paid, and will not pay, any fee to any corporation, partnership,
company, association, organization, bid depository, or to any member or agent thereof
to effectuate a co sive or sham bid.
.
By:
Signature
Title: V( �v�r �
CONTRACTOR
�
State of�C-atifornia
�
County of �} __�____+__
Subscribed and sworn to (or affirm d), before me this� day of
(month), 20�� (year), by , proved to me on the
basis of satisfactory evidence to be the person who ap eared before me.
Signature of ot� :Notary Public in and for said County and State
(seal of notary)
�;,�.� � ;�.���.��
�,
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A--�tID1�ER'S BUND
'�a Ac�a Band No.ATLA-2010-2356
��Y�osai
KNtNIV Ati.MEN BY THES�PRE3ENTS,
�t Ni9, Robertson Industries, inc.
8t1d Travelers Casualty and Surety Company o mer�ca a8 pfi�1��,
firtnly bound ur�#a 1#ie as surety� at�e heid and
� e Citx+Qf Palm De�ert in the sum of� �o�io of B�d (1q�, of bid�
�o be id to the�a1d�hy or tte t�rtsin at�amey, ft� euccessors and
PaYmerrt� we� and tru►y to be made, we bfnd our�+dives, our heir�,�execut�ar��
adm�fstrator�,s�c�cess�rs or as�ipna,Jol►�tly and sev�era!!y��rmly by!��ts.
THE C�,?NDITi�N QF THIS t�81.IGATtON iS 8UGH, that if the oerta�t pro�l af the
ebav�baundet�p�incfpal to�erfann oertsin work deacrtbed ms i��s:
IMASHINGTBN CHARTER SCHppL p�LqyGRQl�ND lMPRDY�AENETS
pro�ect No. T2�-1 i
Carttract Np.C30ZZQ
T'he w�ork m bs done ccnetsts af fuml�hinp s11 metertals� equipment, #ovis� I�Gar, ar�d
tncc�ct�ntels �as required by the S�ns end Cor�rac� pc�u�� �r the 1)
�nd�srtd rem�vat af four urrused p�pe c�alc�mns, s� e�ds�ng#I� t�y sYri
p�t�and plkie ev�et�t. (2j 7he ir�#a�atbn oi a new three bnY swing e�et.(j
tJerr�tttbon�d�r+emov�l af exts�r�g reaNl�r�surfa�e,and the Insta l l a t tat o f new resttfenf
sur�dng. The aod�t�n0 pfaY�ound ara��$apt�dmateh►s�000 square feet.
and dated October 5,20�0 ���� �th� ����� �,
g���8���1d�1 PTitK�?SI Robertson Industries, Inc.
duly ent�er into end execute a aart�ct � sucfi ehail
delfver fhe Partarmerx�8ond�nd P,a �°n� �►�d sheq execu6s �and
�Y�� � then this ob1 ��Bond and ir�noe ce���,qulted
�nd oe�r�al�!n fc�li far+ce end e�n '�all beaome null ar�d v+pid; otheswrse It sh�q bs
St�auid it be�ome r�e,c�sary far the City ta insqtute. e..
Proceedin� bo enforr.e #�e terme �nd cor�dttlans of thie bn�or�a t�s of ��aidl
D►qc�+edl ir�ud! °
�9. ng at�mey's tee�r,st�a11 be aw�ded to the prevalNn�PartY
The attached Warranty Limitation Rider is a part of this bond.
THE REMaIMDE�t dF THIS pAGE IS LLFt'INi'E�VTIpNq�,{,Y g�.p�K
F 1-1
IN WITNESS WNECi�OF,We hereur�to e�t our Handa and Sesls ihls atn
0� October �►�ip ,d8y
��i�oi'81V81Tt9: Robert Industries, inc.
Gontractar"s$ignature;
Titie: ��
�
AddTess� � 0� a�f 1� �o �yl p � ,S r� P �0,1 � r'�
T��,,,�; �va - �s/ 9
S1JI�Bty'B N8111�l; Travelers Casualty and Surety Company of America
Si�r+�t�re sign,�turs: G-.'lfi'�-C ' C...L.t,� °�. :�.,�!\/\�--cti..c�.�--
T�IB: Virginial�. McMan s, Aftorney-in-fact
l4t�f888: 3560 Lenox Rd. NE,#240Q, Atlanta, GA 30326
T818�EWt18; 404.995.3000
Acknc�wleslgment
State vf C,a�ttotnia �
Cott�ty ot �.>S �F��C�.%�:3 �
� �G�` , s' _ �-� t � b8fidte rne,C�p� � G��r�f} i�sc, �.�,
�.. � � t'�G'1 t3 L 1��
pet�ortelfy appee�B�d ��,�1 M �G.i�=X�r.�I�G�( �fP�C.0
..-�.�..,..._ ,�._..,� .._.._.�
M�11C P�DM� �D f!'18 b�i thH bes� tyf
sadsf�ctory evldence i+o be t�e person(�whase n�me(�is/a�sub�aibed t�p the within
instnar�te�t and�clmowl�d�ed to me th�t �
authorl�ed � Y execx�d the same in h r
�+�K�Y( )� �nd�that� by. . ���at� � ) ort #he k�etru�
persat�(�, or tha �Y t�ort behalf of wl�ch the � a�ted, exed�ed
Instrurnent, � �e
I r.erttfy undsr P�NAL7Y C3F PER�f URY t�tder the i�ws of the St�t�of C�lifoml�that the
���►A pa�9raph�S hue and c�omec�t.
WlTNESB my hend and ol�fai sesl.
Stgt�oture '�� r�-'�` Y
OODY CHWA
Commission# 1872501
Z ��F. Notary Public-Calitornia Z
Los Angeles County '
��_1 �A'MTY�C'amm,Expires Oe�31,2013�
WARItANTY LIMITATION RIDER TO BID BOND
This Rider is an attachment to and forms a part of the bid bond executed by
Travelers Casualty and Surety Company of America("Travelers"), as Surety, on
behalf of Robertson Industries, Inc ("Principal") and in favor of Ci of Palm
Desert ("Obligee") in connection with the bid submitted by the Principal on
October 5, 2010 involving proposal for Washin�ton Charter School Plavground
Improvements—Proiect No 729-11 Contract No C30220 "Contract").
--------------------------------------------------------------------------------------
It is the condition of this bid bond that the warranty obligations of Travelers under
its final performance bond, notwithstanding any provision to the contrary in the proposed
Contract or bid documents, shall not exceed one year from the date of substantial
completion of the Principal's performance under the Contract, and that any warranty
claim by the Obligee under the performance bond must be discovered and asserted
against Travelers within one year from the date of substantial completion of the Contract
by the Principal. Any extended warranties provided in the Contract by the Principal
and/or product manufacturers for workmanship or materials that exceed one year from the
substantial completion date shall be the sole obligations of the Principal and/or the
product manufacturers and shall be explicitly excluded from coverage under the
performance bond to be provided by Travelers.
By acceptance of this bid bond, the Obligee acknowledges that the warranty
obligations of Travelers Casualty and Surety Company of America in the final
performance bond shall not exceed one year from the date of the project's substantial
completion.
By submission of this bid bond, the Principal acknowledges that Travelers has no
liability to the Principal in the event that this bid bond is rejected by the Obligee.
Signed, sealed, and dated this 4th day of October, 2010.
Travelers Casualty and Surety Company of America
By: �-��,,^ G, t�t,��' ,`�, ,M,_�"_�,���{�..�r�,�.,r,'-'
Virgini B. Mc anus, At+.orney in Fact
All-Purpose
Certificate of Acknowledgment
State of Georgia
County of Fulton }
On October 04, 2010 before me, Mengli Tieu ,
DATE NAME OF NOTARY PUBLIC
personally appeared Virginia B. McManus
NAME(S)OF SIGNER(S)
p personally known to me - OR ❑proved to me on the basis of satisfactory evidence to be the
erson s whose name s is/are subscribed to the within instrument
�.��o��,�,�,�� p ) � ) �
�" �►EP��,���Q� and acknowledged to me that he/she/they executed the same in
,� ...- ••ti s�,oi his/her/their authorized capacity(ies), and that by his/her/their
��' a•' ���� ':� �+o signature(s) on the instrument the person(s), or the entity upon
� � � �,`��s e behalf of which the person(s) acted, executed the instrument.
>` 0
��:c� �,e► t �
"��<,�o�o ���� ; g Witness my hand and official seal.
�a C� `°.;';.2�,2o�;.•f ,�
����`�yU�,�,��Pr �
�
,r SIGNATURE OF NOTARY PUBLIC
!
Though the data below is not required by law, it may prove valuabie to persons relying on the document and
prevent fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT(S)
❑ Individual(s) Type of Document
❑ Corporate Officer:
❑ Title(s) Bidder's Bond
❑ Partner(s) Number of Pages
Q Attorney-in-Fact
❑ Trustee(s) 2
❑ Subscribing Witness Date of Document
❑ Guardian/Conservator
❑ Other: October 04, 2010
Signer(s) Other Than Named Above
Robertson Industries, Inc.
SIGNER IS REPRESENTING:
NAME OF PERSON(S)OR ENTITY(IES)
Travelers Casualty and Surety Company of America
ViewDocument
� TRAVELERS
POWER OF ATTORNEY
Farmington Casualty Company St. Paul Guardian Insurance Company
Fidelity and Guaranty Insurance Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company
Seaboard Surety Company Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
Surety Bond No. ATLA-2010-2356 Principal: Robertson Industries,Inc.
OR
Project Description:Washington Charter School Playground
Improvements-Project No.729-51,Contract No.C30220 Obligee: City of Palm Desert
KNOW ALL MEN BY THESE PRESENTS: That Seaboard Surety Company is a corporation duly organized under the laws of khe State of New York,
that St. Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly
organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers
Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and
Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc. is a corporation duly
organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and
appoint Virginia B. McManus of the City of Atlanta, State of Georgia, their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more
than one is named above, to sign, execute, seai and acknowledge any and all bonds, recognizances, conditional undertakings and other writings
obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto a�xed,
this ilth day of August, 2006.
Farmington Casuaity Company St.Paul Guardian Insurance Company
Fidelity and Guaranty Insurance Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company
Seaboard Surety Company Travelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
pnsu,�
p`'pv'v�r�n�� � �h'� ��� Qo��..!NSG9 4Jp�.INSLq'1 'J��tYA Q N^0 Y
D C1 � Q:• • n p N!(. � �
� �r �f� rtONGOR�> RPOR�r'� '4 9 �
z 1981 0 � `y9� y927 � CO�OIWE �f w �`;$ '"`�oM_ `'"" ° ,�
�4�+�,�S y � �9$1 N Wt �t.S t� �t 58RL:`� � � � �HMpOFD.� < �
b�y• F�� � � �� # � � * � �`� E A L.f�!° `>\.. ► �' �� �p � 1� �
�� �'� �tS:AA�a .ry...�....r�+ �,1 ' F�ys O
.�...�' � . � ����
State of Connecticut
ay: ,�
City of Hartford ss. Geo�e W�hompson, or Vice President
On this the iith day of August,2006, before me personally appeared George W.Thompson,who acknowledged himself to be the Senior Vice President
of Farmington Casualry Company, Fide�ity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety
Company,St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St. Paul Mercury Insurance Company,Travelers Casualty
and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such,
being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a
duly authorized officer.
In Witness Whereof,I hereunto set my hand and official seal. �p.T�
My Commission expires the 30th day of]une,2011. * �� * �p,��, C ����
Marie C.Tetreault,Notary Pubiic
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington
Casualty Company, Fideliry and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters,Inc.,Seaboard Surety Company,St.
Paui Fire and Marine Insurance Company,St. Paul Guardian Insurance Company,St. Paul Mercury Insurance Company,Travelers Casualty and
Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are
now in full force and effect, reading as foilows:
RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,
any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint
Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of
authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances,contracts of indemnity,and
other writings obligatory in the nature of a bond, recognizance,or conditionai undertaking,and any of said officers or the Board of Directors at
any time may remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED,that the Chairman,the President, any Vice Chairman, any Executive Vice President,any Senior Vice President or any
Vice President may delegate aii or any part of the foregoing authority to one or more officers or employees of this Company, provided that
each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or
conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice
President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate
Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or(b) duly
executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her ce►tificate or
their certi�cates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED,that the signature of each of the following officers: President,any Executive Vice President,any Senior Vice President,
any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by
facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or
Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and
any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and
any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the
future with respect to any bond or understanding to which it is attached.
I, Kori Johanson, the undersigned, Assistant Secretary, of Farmington Casualry Company, Fidelity and Guaranty Insurance Company, Fidelity and
Guaranty Insurance Underwriters, Inc., Seaboard Surety Company,St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,
St. Paui Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by
said Companies,which 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 04th day of October,2010.
% )/� i'LL-
Kori M.Johanson,Assistant Secretary
��su,�T y,pEry �y�-+ o��,N_,INg 9 p�.IN3Uq',� �o.ir""" �a+iyrn. �YMp�
Da��y�'p�A11 L * � � �' �GRPORAT�i yQ�'�pPPORFt�:vPi � G,�� f0
< 4 J
~ IY82�0 � � � C�WE ��` �„ �`it� Ii �o rO � ���
Z �t�t � 1977g i951 �192T O �;,SEAL o eks8ai.,;, ;, cowr. ; ('"°'�xM,"'""jc � tess
sb �a �ff �O � * '�d?.•.......�A df^•. .:+ '`� F �.......� O
l�y� �,N � � �'qe�� !8 � 1S.Ad� ,p...- � t • 'Na � ' � �A�,t*
...�... �.
Ta verify the authenticity of thfs Power ofAttorney, ca//i-800-421-3880 or contact us at slpaa/have%rsbond.com. P/ease refer to
the Attorney-In-Fact number,the above named individua/s and the detai/s of the bond to which the power is altached.
; 1
i
A �LA�`�CQ(�[ Company
October 4, 2010
I, Richard Hawley authorize Adam Vance to sign the bid bond on my behalf for the
project of the City of Palm Desert, Department of Public works for Washington Charter
School Playground Improvements, Project No. 729-11, Contract No. C30220.
Regards,
0
�ur,�_ _.._.a .
Richard Hawley �"'u��
Corporate VP/GM �
Robertson Industries, Inc.
Corporate Office: 4401 East Baseline Road • Suite 105 • Phoenix, AZ 85042
Toll Free: (800) 858.0519 • (602) 340-8873 • Fax: (602) 340-0402
www.totturF.com
�.� � ..
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� :���lyy� iss� ��
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Company Profile Page 1 of 2
i
� �
COMPANY PROFILE
Company Profile
Company Search Company I�formation
Company 5earch
Results TRAVELER5 CASUALTY AND SURETY COMPANY OF AMERICA
Company ONE TOWER SQUARE,4MN
Information HAR7FORD, CT 06183
Old Company 877-872-8737
Names
Agent Por Service Old Company Names
Effective Date
Reference
Information AETNA CASUALTY&SURETY COMPANY OF AMERICA 07/01/199�
NAIC Group List
Lines of Business �ack to top
Financial Statements
PDF's Agent For Service
Annuai Statements KAREN HARRIS
Quarterly C/O CORPORATION SERVICE COMPANY
Statements 2�30 GATEWAY OAKS DRIVE, SUITE 100
SACRAMENTO CA 95833
CA Supplements
Company Complaint back to top
Company
Performance& Reference Information
Comparison Data
Company -
Enforcement Action NAIC#: � 31194
Composite Califomfa Company ID #: z44q-g �
Compiaints Studies
Additional Info date Authorized in California: 07J31/1981 �
Find A Company License Status:
Representative In UNLIMITED-NORMAL
Your Area
Company Type: Property&Casualty
View Financial
Disclaimer 5tate of Domicile: CONNECTICtJT
back to top
NAIC Group List
NAIC Group #: 3548 Tr�velers Grp
back to top
Lines Of Business
The company is authorized to transact business within these lines of insurance.
For an explanation of any of these terms, please refer to the 9lossary.
AIRCRAFT
AUTOMOBILE
80ILfR AND MACHINERY
BURGLARY
COMMON CARRIER LiABIUTY
CREOIT
DISABILITY
FIRE
http://interactive.web.insurance.ca.govJcompanyprofile/companyprofile?event=companyPr... 1017/2010
Company Profile Page 2 of 2
LIABIIITY
MARINE
MISCELLANEOUS
PLATE GLASS
SPRINKLER
SURETY
TEAM AND VEHICLE
WORKERS'COMPENSATION
back to top
O 2008 California Department of insurance
http://interactive.web.insurance.ca.gov/companyprofile/companyprofile?event=companyPr... 10/7/2010
____--- --------------- ---- ------_
_..--_ _--- -----_. .-------- ----- ____-- _--
_._____------
A�D• CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY)
- — 08/04/2010
PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
Marsh USA,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Two Alliance Center HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
3560 Lenox Road,Suite 2400 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Atlanta,GA 30326
Attn:AUanta.CertRequest@marsh.com F:212-948-4321
457102-Casu-GAUWX-10-11 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A COIUfilbl8 C8SU81 Com an
Robertson Industries,Inc. tY P Y 31127
4401 East Baseline Road iNsuReR e:Travelers Property Casualty Company Of 25674
Suite 105
Phoenix,AZ 85042 iNsuReR c:National Union Fire ins Co Pittsburgh PA 19445
iNsuReR o:Phoenix Insurance Company 25623
_ iNsuReR E:Ohio Casualty insurance Company �24074
COVERAGES -- 4
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TNE POLICY PERIOD IND�CATED.
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.AGGREGATE IIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS ADO' TypE OF INSURANCE POLICY NUMBER P���CY EFFECTIVE POLICY EXPIRATION
LTR INSR oATE(MruDomrv� DATE(MhuDDrrvvr� LIMITS
' GENERAL LIABILITY 4015728458 EACH OCCURRENCE
A 08/01/2010 08/01l2011 1.���.�00
X COMMERCIAL GENERAL LIA8ILITY PREM SES�a ocNcurrence $ 50,000
CLAIMS MADE �QCCUR MED EXP(Any one person) $ EXCLUDED
SIR$25,000 PER OCC. _ PERSONALSAOVINJURY $ 1,000,OOOI
GENERALAGGREGATE LIMITAPPLIES PER��$�OM AGGREGATE CAP)� GENERALAGGREGATE $ 2,000,000
POLICY X �E� LOC PRODUCTS-COMPlOP AG $ 2,000,000
B AUTOMOBILE LIABILITY TJCAP9518B945-10 O8/01l2010 08/01l2011
ANYAUTO COMBINEDSINGLELIMIT � 1,000,000
X (Ea accident)
ALL OWNED AUTOS BODILY INJURY $ �
SCHEDULED AUTOS (Per person) i
HIRED AUTOS BODILY INJURY $ (
NONAWNED AUTOS (Per accident)
X COMP DED:$1,000 PROPERTYDAMAGE
(Per accident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT$
ANY AUTO OTHER THAN �ACC �
� AUTO ONLY: $ —
AGG
C EXCESS/UMBRELLALIABILITY BE35053165 �$/Q�/2Q'�Q Q$/Q�/2Q1� EACHOCCURRENCE $ 25,�0�,���
X OCCUR � CLAIMS MADE AGGREGATE $ 25,000,000
DEDUCTIBLE $
RETENTION $ 10,000 --- — $ __
WORKERS COMPENSATION AND � � WC STATU- OTH-
D TC2NU6-9520624-6-10 AOS 08l01/2010 O8/01/2011 X
EMP�OYERS'LIABILITY TRJUB-9520B25-8-10(AZ&Wi) 08/01/2010 08/01/2011
B ANY PROPRIETOR/PARTNERIEXECUTNE Y/N .L.EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? O .L DISEASE-EA EMPLOYE $ SOO,OOO
Mandatory in NH)If yes,describe under
PECIAL PROVISIONS below .L DISEASE-POLICY LIMIT $ SOO,OOO
OTHER
E EXCESS UMBRELLA EC011 53059239 08l01i2010 08/01/2011 $25,000,000 EXCESS
$25,d00,000
DESCRIPTION OF OPERATIONSILOCATIONSNEH�CLESIEXCLUSIONS AD�ED BY ENDORSEMENT/SPECIAL PROVISIONS I
For Inforrnation Only
I� -- --- I
-- --- ------J
CERTIFICATE HOLDER ATL-002035857-34 CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Robertson industries, If1C. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
4401 East Baseline Road 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Suite 105
Ph02f11X,AZ 85042 BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABI�ITY OF ANY KIND
UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZEO REPRESENTA7NE
of Marsh USA Inc. —�
Ted L.Young �'�y„P�
ACORD 25(2009101)^ O 1998-2009 ACORD CORPORATION.All Rights Reserved
The ACORD name and logo are registered marks of ACORD
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized
representative or producer,and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACord 25(2009/01)
' C{�Elgrt EfaEtsmwa�r
CGenf Representatfve
���� �"� tvtarsh USA Inc.
3475 Piedmont
� tJ1ARSH NiERGER KROLL SUifP.5200
GUY.CRRPENTER OLf�ER WYMAi4 Atl8t1f8,(3A 8Q305
404 995 3276 Fax•444 995 3279
Kadyn.Hafhaway@rnarsh.pm
wrn�ay.matsh.cam
.tanuary 23�2049
�ubjec�:
Robertsan lndccsfries, tnc dba TatTurf Workers Compe�satton�fmffs
To Whorn(t Niay Concem: , �
Please be advised Robertson IndusMes� !nc dba T�tTurt hes an Umbnelte poticy whicf� is
excess over the Work�rs Compensehon� Ger�er���i�bj�f�j,� Aufomobite and Emptoyers
Liabflity poticy limits.
Please feel free to oontact me w�th any quesEions or conoems t�egardtng this fsse�e.
Tf�ank you
. � �
K�alm Hathaway � �
Ciient RepresenEetive .
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Named Insured's
PHC Holdings,LLC - '
YlapCorc Holdings, Inc.
PlayCore Holdin�gs�LI.0 �
P1e.yCore�iscons�ia,Inc
Robertson Industzies,Iac.
��+�+Kh�Mctenn�n Comp�Nes
Policy Number: TJCAP9518B945�09-T
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This endorsemeM modifies insurance provided under the fotlowing:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endwse- a written contract or agreement that is signed and
ment, the provisiona aF the Coverage Fonn apply executed by you before the"bodily injury"or"property
unless modffied by the endorsement. damage"occurs and that is in effed during the policy
The foliowing is added to the gec8on 11 - Uabfiity P�� is an "insured"for Liability Coverage, but only
Covera�e. Paragraph A.1. VYho Is An Insur+ed Pr+o- for ci�nages to which this insu�nce appiies and only
vision: to the extent that person or organizatlon qual�ies as
an •insured' under the Who Is M lnsured provision
Any person or organizadon that you are required to oontalned in SeCtlon II.
inciude es addHional insured on the Coverage Form in
i
;
CA T4 37 06 08 O 2008 The Travelers �
Compsniee,lnc. Page 1 of 1
i
I
Policy Number:4015728458
G-1795'7 B
(Ed.09/92)
TH[S ERtDORSEIi�fEfr[T CHARtGES THE POLtCY. P�EA�E RE,4p tT CAREFULLY.
BL�KE'f �4DDtTfpN�L, �t�SUFPED EPEDOf�SEIiVfE�T
This endorr,ement modi�es insurance provided under the foliowing:
COMMERCIAL GENERAL LIABILITY COVERqGE PART �
WHO IS AN INSURED{Ser�tion 11)is amended to inciude 2. The Limifs of Insurance applicable to the additional
as an insured any person or organizafion (caped insured are those s
additionai insured) whom you are required to add as an a P�ed in the vvrftten contract-or
additionai insured on thfs policy under. 9�ent or in the Declarations for this policy,
whichever fs less. These Lfmits of Insurance are in-
't• A written contract or agreement;or � clusive and not in additlon to the Limits of insura�ce
2. An ora( apreement or contract where a cerbfic�te af shown in the Dedarations.
insurance sho�niing that person or or�anl�ation as an T�insurance provided to the addi�onai insured does not
addltionai insured has been fasued;but $PP�Y to "bodpy injury", "�p�y damagep, �p�onal
the written or orai c�ntraet or a �1�N'. or"ad�nertisin8 ir�ury"arising out of an arohitect's;
greement must be: _ en8(neer's� or surveyor's nender3ng of a fa��to render
g• �urrently in effect or becoming effe�ive duNng a�y�°�ionaf servtoes indudfng:
the term of this poficy;and 1. The prepartng, approvfig� or fetl to
b. executed pri� to the "bodil � aPP�e maps� drawfngs. opinions re �P�'e or
Y �1�rY'� ProPerty �ye�orders dest �� surveYs�
�s8�"� "personal injury', or "adverttsinD in- � 9��'specifka�ons;and
� 2. Supervisory, inspection.or en8inee�ing senrioes.
T� r�Ufe�� provided to the addltfonai insured Is lim- Any c�verage provtded hereunder shai� be exc�ess over
ited as follows: , any o�i�valid and coilec�ible insurence eva�able to the
'�. S�P��organizatton is only an additionai in• ���el���d whether prtmary� exoe�s� o�an�nt or
p�t to IiabAlty artsirig out of: Y�ther basis uMess a contre,ct sp���y requires
a. Premtses that this Msurance be primery or you request that ft apply
you own�rent,lease�or occupy;or on a primery basis.
b. "Your work"for that additional insured�by or for
you.
G-17957-B '
(Ed.09J92j Page 1 of 1
�.� .. rso c��ar�
: " [� �� � .Fort�'ay�.qL 35967
� �; C ��. - _ �:�� 23'��p�7.-3Z.�2 phone
Mtrving play forv�ard." �'����IZ �
mil.eh(a?vl. BYCAre.com �
�arch f2, �009
To V4+hom t�Mfay Concem:
PlayCore Wisconsin, tnc. agrees to prov�de at teast 3Q days ad�ance no�ice in
writing if the insuranoe coverage of PlayCore Wisc�nsin. [nc. is cancelled end at
least 1 Q days advanc� no�ce if the event of nonpayment of ifie insurance
premium refated fa such insuranoe coverage,
Sinoerely,
PEa�Corg
Nfike Hawkins
Corporate Dinector,
Risk Nfsnagement,
Insurance and Legai Affa:irs
WASHINGTON CHARTER SCHOOL PLAYGROUND
IMPROVEMENTS
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— Circula�ion Network �-- Streets
�gs y[ L� Cily Boundary ❑ Palm Desert Parcels p/20'
Zopg � aeo�. ea�e_t Notes
i oe� � c�PP�:aa��z . � ewe. az�a_3