Subcontractor Prequalification CA Contractor's License #86393 AB

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1 Subcontractor Prequalification CA Contractor's License #86393 AB COMPANY INFORMATION Company Name License # Year Established Address City State ZIP Office Phone Fax Website PRIMARY CONTACT INFORMATION Name Title Address Cell # ADDITIONAL INFORMATION PAST THREE YEARS ACTIVITY Total Sales Volume Largest Job(s) Completed Current Year Previous Year 1 Previous Year 2 INSURANCE COVERAGE Bonding Capacity Current EMR (%) TRADE AND/OR CSI CODES Subcontractor Trade(s) Amt Types of Work Performed Areas of Work Performed State Licenses Commercial/Industrial Kern County Arizona Infrastructure Los Angeles County California Federal Government Orange C o u n ty Nevada Hospital/Medical Facilities Riverside County Other Institutional Sacramento County Public Works San Bernardino County Union/Non-Union Residential (multi-unit and/or multi-family) San Diego County Union Retail San Francisco Bay Area 9 Counties Open Shop Schools San Joaquin Valley Prevailing Wage Tenant Improvements Tilt-Up Santa Barbara County Ventura County Disadvantaged Affiliation Qualifying Agency DBE Disadvantaged Business Enterprise CA DOT DVBE Disabled Veteran Business Enterprise Cal Trans H HUB Zone City of Los Angeles IOB Indian Owned Business Department of Minority Business Resources MBE Minority Business Enterprise Federal/Military Enterprise SB Small Business HUB Zone Enterprise SBE Small Business Enterprise LACMTA SD Small Disadvantaged Business Minority Business Development SSB Service Disabled Veteran Owned Small Business Port of Long Beach VSB Veteran Owned Small Business State of California VSBE Very Small Business Enterprise US Small Business WSB Woman Owned Small Business INSURANCE I have read and understand Oltmans Construction s insurance requirements as posted on REFERENCES: Please attach a current list of references and past/present projects. When submitting a reference list include: contact name, title, company, business address, and phone number. SUBMISSION: Please your completed subcontractor prequalification form to planroom@oltmans.com. Note: It is the responsibility of the subcontractor to track projects currently bidding. The subcontractor shall follow-up with the Project Manager and/or Estimator assigned to the project. For a list of current bid opportunities, please visit or planroom@oltmans.com. Thank you for considering On behalf of our entire team, we look forward to working with you soon! Corporate Office Mission Mill Road Whittier, CA Northern California 780 Montague Expressway, Suite 106 San Jose, CA Thousand Oaks 270 Conejo Ridge Avenue, Suite 210 Thousand Oaks, CA

INSURANCE REQUIREMENTS All insurance must be written by a U.S. Insurance company, show the complete insurance company name including any state or subsidiary designation, and be rated in the current edition of the A.

2 INSURANCE REQUIREMENTS All insurance must be written by a U.S. Insurance company, show the complete insurance company name including any state or subsidiary designation, and be rated in the current edition of the A.M. Best Property & Casualty Guide as A, X or better. Oltmans requires complete submission of your insurance certificate prior to starting work onsite. Failure to submit within five (5) working days will force us to void your contract. 1. WORKERS COMPENSATION (binders are not accepted) Employers Liability limits: $1,000,000 Bodily Injury by Accident $1,000,000 Bodily Injury by Disease - Each Employee $1,000,000 Bodily Injury by Disease - Policy Limit Required Waivers with policy numbers listed: Waiver of Subrogation in favor of Oltmans Construction and all owners. 2. GENERAL LIABILITY (binders are not accepted) General Liability limits: $2,000,000 General Aggregate $2,000,000 Products and Completed Operations Aggregate $2,000,000 Personal and Advertising Injury $2,000,000 Each Occurrence Trade Specific (binders are not accepted) $3,000,000 Excess Liability for Fire Sprinklers $5,000,000 Asbestos/Pollution Liability $5,000,000 Crane Operators Required Waivers and Endorsements with policy numbers listed: Per Project Aggregate, Additional Insured Endorsement, Primary and Non-Contributory Wording Endorsement including Ongoing and Completed Operations, and Waiver of Subrogation in favor of Oltmans Construction and all owners. 3. AUTO LIABILITY (binders are not accepted) Automobile liability including owned, hired and non-owned autos. If any autos are not covered within your policy, please provide a company letter stating that these autos are not covered and will not be present at any job sites for Oltmans Construction Company. Auto Liability limits: $2,000,000 Combined Single Limit Required Waivers and Endorsement with policy numbers listed: Additional Insured Endorsement, Waiver of Subrogation in favor of Oltmans Construction and all owners. 4. ADDITIONAL INSURED and the Owner(s) must be named as the Additional Insured on the General Liability and Auto Certificates and on the Additional Insured Endorsements (see examples). Required Endorsements with policy numbers listed: Additional Insured Endorsements 5. CANCELLATION PARAGRAPH Your certificate must state that will be given at least a 30-day written notice of cancellation. Submit certificates of insurance via or fax, only insurance@oltmans.com Fax: (562) Questions or concerns may be addressed by ing the above address, or by calling (562) ext. 3451

3 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Person or Organization: Mission Mill Road Whittier, CA SCHEDULE Owner: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Oltmans Oltmans Construction Construction Co. & Owner(s) Co. & Owner(s) or "Blanket or "Blanket as required as required by written by written contract" contract" WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1

4 Policy Number: LHA COMMERCIAL GENERAL LIABILITY CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Oltmans Construction Co along with Vineyard Industrial II, LLC Sares Regis Group Operating Inc., Commingled Pension Trust Fund, JP Morgan Chase Bank, N.A., SRG Development LP CG Insurance Services Office, Inc., 2012 Page 1 of 1

5 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: & Owner(s) or "Blanket as 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 8. 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 "productscompleted operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG Insurance Services Office, Inc., 2008 Page 1 of 1

6 Policy Number: COMMERCIAL AUTO Effective: UGCA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE FORM ADDITIONAL INSURED ENDORSEMENT Name Of Person Or Organization: SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The inclusion of additional interest or interests will not operate to increase the limit of our liability. An additional premium of $ & Owner(s) or "Blanket as required by written contract" is fully earned at the time of issue. UGCA ISO Copyrighted Material Included Page 1 of 1

7 POLICY NUMBER: COMMERCIAL AUTO CA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: Name(s) Of Person(s) Or Organization(s): SCHEDULE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition 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 "accident" or the "loss" under a contract with that person or organization. & Owner(s) or "Blanket as required by written contract" CA Insurance Services Office, Inc., 2011 Page 1 of 1

8 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work 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 & Owner(s) or "Blanket as required by written contract" This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by WC (Ed. 4-84) 1983 National Council on Compensation Insurance.

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SUBCONTRACTOR PRE QUALIFICATION COVER SHEET Thank you for your interest in working with TSA Contracting, Inc. We are a commercial building contractor specializing in ground-up and tenant improvement construction.