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CM HAZMAT Consulting for Essential Facilities Phase IAGREEMENT FOR PROFESSIONAL SERVICES FOR HAZARDOUS MATERIAL CONSULTING FOR ESSENTIAL FACILITIES PHASE I PROJECTS This Agreement is made and entered into as of the 5th day of April, 2016, by and between the CITY OF SAN RAFAEL (hereinafter "CITY"), and MONTE DEIGNAN, an individual, dba MONTE DEIGNAN AND ASSOCIATES (hereinafter "CONTRACTOR"). RECITALS WHEREAS, CITY is planning to implement the essential facilities strategic plan; and WHEREAS, this project requires hazardous materials and environmental survey services; and WHEREAS, CONTRACTOR has the expertise to perform such services. AGREEMENT NOW, THEREFORE, the parties hereby agree as follows: 1. PROJECT COORDINATION. A. CITY'S Project Manager. The CITY's Assistant City Manager is hereby designated the PROJECT MANAGER for the CITY, and said PROJECT MANAGER shall supervise all aspects of the progress and execution of this Agreement. B. CONTRACTOR'S Project Director. CONTRACTOR shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for CONTRACTOR. Monte Deignan is hereby designated as the PROJECT DIRECTOR for CONTRACTOR. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR, for any reason, the CONTRACTOR shall notify the CITY within ten (10) business days of the substitution. 2. DUTIES OF CONTRACTOR. CONTRACTOR shall perform the duties and/or provide services as described in Proposal dated March 22, 2016, attached hereto as Exhibit A and incorporated herein. DUTIES OF CITY. CITY shall pay the compensation as provided in Paragraph 4, and shall assist CONTRACTOR by providing planning documents for the proposed project and facilitating access to the construction site as needed. '7ern, 0 �TAL 4. COMPENSATION. For the full performance of the services described herein by CONTRACTOR, CITY shall pay CONTRACTOR pursuant to this Agreement an amount not exceed $30,685 as more specifically detailed in Exhibit A. Payment will be made upon receipt by PROJECT MANAGER of an invoice submitted by CONTRACTOR following completion of CONTRACTOR's work and submission of a written design -phase cost estimate for the San Rafael Public Safety Center project to CITY. 5. TERM OF AGREEMENT. The term of this Agreement shall be for a period of sixty (60) days commencing on the date first hereinabove written, or until the work is completed if that occurs before the end of that period. Upon mutual agreement of the parties, and subject to the approval of the City Manager the term of this Agreement may be extended for an additional period of thirty (30) days. 6. TERMINATION. A. Discretionary. Either party may terminate this Agreement without cause upon thirty (30) days written notice mailed or personally delivered to the other party. B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days written notice mailed or personally delivered to the other party, and the notified party's failure to cure or correct the cause of the termination, to the reasonable satisfaction of the party giving such notice, within such fifteen (15) day time period. C. Effect of Termination. Upon receipt of notice of termination, neither party shall incur additional obligations under any provision of this Agreement without the prior written consent of the other. D. Return of Documents. Upon termination, any and all CITY documents or materials provided to CONTRACTOR and any and all of CONTRACTOR's documents and materials prepared for or relating to the performance of its duties under this Agreement, shall be delivered to CITY as soon as possible, but not later than thirty (30) days after termination. 7. OWNERSHIP OF DOCUMENTS.. The written documents and materials prepared by the CONTRACTOR in connection with the performance of its duties under this Agreement shall be the sole property of CITY. CITY may use said property for any purpose, including projects not contemplated by this Agreement. 8. INSPECTION AND AUDIT. Upon reasonable notice, CONTRACTOR shall make available to CITY, or its agent, for inspection and audit, all documents and materials maintained by CONTRACTOR in connection with its performance of its duties under this Agreement. CONTRACTOR shall fully cooperate with CITY or its agent in any such audit or inspection. 9. ASSIGNABILITY. The parties agree that they shall not assign or transfer any interest in this Agreement nor the performance of any of their respective obligations hereunder, without the prior written consent of the other party, and any attempt to so assign this Agreement or any rights, duties or obligations arising hereunder shall be void and of no effect. 10. INSURANCE. A. Scope of Coverage. During the term of this Agreement, CONTRACTOR shall maintain, at no expense to CITY, the following insurance policies: 1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage. 2. An automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) dollars per occurrence. 3. If any licensed professional performs any of the services required to be performed under this Agreement, a professional liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, to cover any claims arising out of the CONTRACTOR's performance of services under this Agreement. Where CONTRACTOR is a professional not required to have a professional license, CITY reserves the right to require CONTRACTOR to provide professional liability insurance pursuant to this section. 4. If it employs any person, CONTRACTOR shall maintain worker's compensation and employer's liability insurance, as required by the State Labor Code and other applicable laws and regulations, and as necessary to protect both CONTRACTOR and CITY against all liability for injuries to CONTRACTOR's officers and employees. CONTRACTOR'S worker's compensation insurance shall be specifically endorsed to waive any right of subrogation against CITY. B. Other Insurance Requirements. The insurance coverage required of the CONTRACTOR in subparagraph A of this section above shall also meet the following requirements: 1. Except for professional liability insurance, the insurance policies shall be specifically endorsed to include the CITY, its officers, agents, employees, and volunteers, as additionally named insureds under the policies. 2. The additional insured coverage under CONTRACTOR'S insurance policies shall be primary with respect to any insurance or coverage maintained by CITY and shall not call upon CITY's insurance or self-insurance coverage for any contribution. The "primary and noncontributory" coverage in CONTRACTOR'S policies shall be at least as broad as ISO form CG20 0104 13. 3. Except for professional liability insurance, the insurance policies shall include, in their text or by endorsement, coverage for contractual liability and personal injury. 4. The insurance policies shall be specifically endorsed to provide that the insurance carrier shall not cancel, terminate or otherwise modify the terms and conditions of said insurance policies except upon ten (10) days written notice to the PROJECT MANAGER. 5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said insurance coverage shall survive for a period of not less than five years. 6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement. 7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and noncontributory basis for the benefit of CITY (if agreed to in a written contract or agreement) before CITY'S own insurance or self-insurance shall be called upon to protect it as a named insured. 8. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to CITY or any other additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured; whichever is greater. C. Deductibles and SIR'S. Any deductibles or self-insured retentions in CONTRACTOR's insurance policies must be declared to and approved by the PROJECT MANAGER and City Attorney, and shall not reduce the limits of liability. Policies containing any self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or CITY or other additional insured party. At CITY's option, the deductibles or self-insured retentions with respect to CITY shall be reduced or eliminated to CITY's satisfaction, or CONTRACTOR shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. D. Proof of Insurance. CONTRACTOR shall provide to the PROJECT MANAGER or CITY'S City Attorney all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policy language or specific endorsements evidencing the other insurance requirements set forth in this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and endorsements from CONTRACTOR. Failure to exercise this right shall not constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by PROJECT MANAGER and the City Attorney. 11. INDEMNIFICATION. A. Except as otherwise provided in Paragraph B., CONTRACTOR shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by CITY, and hold harmless CITY, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of CONTRACTOR'S performance of its obligations or conduct of its operations under this Agreement. The CONTRACTOR's obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive negligence of the City Indemnitees. However, to the extent that liability is caused by the active negligence or willful misconduct of the City Indemnitees, the CONTRACTOR's indemnification obligation shall be reduced in proportion to the City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or approval of the CONTRACTOR's work or work product by the CITY or any of its directors, officers or employees shall not relieve or reduce the CONTRACTOR's indemnification obligations. In the event the City Indemnitees are made a party to any action, lawsuit, or other adversarial proceeding arising from CONTRACTOR'S performance of or operations under this Agreement, CONTRACTOR shall provide a defense to the City Indemnitees or at CITY'S option reimburse the City Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims. B. Where the services to be provided by CONTRACTOR under this Agreement are design professional services to be performed by a design professional as that term is defined under Civil Code Section 2782.8, CONTRACTOR shall, to the fullest extent permitted by law, indemnify, release, defend and hold harmless the City Indemnitees from and against any CLAIMS that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONTRACTOR in the performance of its duties and obligations under this Agreement or its failure to comply with any of its obligations contained in this Agreement, except such CLAIM which is caused by the sole negligence or willful misconduct of CITY. C. The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or completion of this Agreement for the full period of time allowed by law. 12. NONDISCRIMINATION. CONTRACTOR shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national origin or disability in connection with or related to the performance of its duties and obligations under this Agreement. 13. COMPLIANCE WITH ALL LAWS. CONTRACTOR shall observe and comply with all applicable federal, state and local laws, ordinances, codes and regulations, in the performance of its duties and obligations under this Agreement. CONTRACTOR shall perform all services under this Agreement in accordance with these laws, ordinances, codes and regulations. CONTRACTOR shall release, defend, indemnify and hold harmless CITY, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any noncompliance or violation of any laws, ordinances, codes or regulations. 14. NO THIRD PARTY BENEFICIARIES. CITY and CONTRACTOR do not intend, by any provision of this Agreement, to create in any third party, any benefit or right owed by one party, under the terms and conditions of this Agreement, to the other party. 15. NOTICES. All notices and other communications required or permitted to be given under this Agreement, including any notice of change of address, shall be in writing and given by personal delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if mailed, upon the date of deposit with the United States Postal Service. Notice shall be given as follows: TO CITY's Project Manager: TO CONTRACTOR's Project Director: 16. INDEPENDENT CONTRACTOR. Cristine Alilovich, Assistant City Manager City of San Rafael 1400 Fifth Avenue P.O. Box 151560 San Rafael, CA 94915-1560 Monte Deignan Consultant Monte Deignan and Associates P.O. Box 546 Larkspur, CA 94977 For the purposes, and for the duration, of this Agreement, CONTRACTOR, its officers, agents and employees shall act in the capacity of an Independent Contractor, and not as employees of the CITY. CONTRACTOR and CITY expressly intend and agree that the status of CONTRACTOR, its officers, agents and employees be that of an Independent Contractor and not that of an employee of CITY. 17. ENTIRE AGREEMENT -- AMENDMENTS. A. The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by reference, represent the entire Agreement of the parties with respect to the subject matter of this Agreement. B. This written Agreement shall supersede any and all prior agreements, oral or written, regarding the subject matter between the CONTRACTOR and the CITY. C. No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid or binding, except by way of a written amendment to this Agreement. D. The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this Agreement signed by the CONTRACTOR and the CITY. E. If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions of the attached exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control. 18. SET-OFF AGAINST DEBTS. CONTRACTOR agrees that CITY may deduct from any payment due to CONTRACTOR under this Agreement, any monies which CONTRACTOR owes CITY under any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments, unpaid checks or other amounts. 19. WAIVERS. The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent acceptance by either party of any fee, performance, or other consideration which may become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other parry of any term, condition, covenant of this Agreement or any applicable law, ordinance or regulation. 20. COSTS AND ATTORNEY'S FEES.. The prevailing party in any action brought to enforce the terms and conditions of this Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs (including claims administration) and attorney's fees expended in connection with such action. 21. CITY BUSINESS LICENSE 1 OTHER TAXES. CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY business license as required by the San Rafael Municipal Code CONTRACTOR shall pay any and all state and federal taxes and any other applicable taxes. CITY shall not be required to pay for any work performed under this Agreement, until CONTRACTOR has provided CITY with a completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and Certification). 22. APPLICABLE LAW. The laws of the State of California shall govern this Agreement. IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL JIM C TZ, City an ger ATTEST: ESTHER C. BEIRNE, City Clerk APPROVED AS TO FORM: ROBERT F. EPSTEIN, tityAttey CONTRACTOR By:—A' el-_ Name: Title: OW F'1 Exhibit A filJ , March 22, 2016 Mr. Bill Johal Kitchell CEM 2750 Gateway Oaks Drive Suite 300 Sacramento, CA RE: Asbestos / Environmental Consulting Proposal for City of San Rafael Fire Stations Monitoring San Rafael, California Dear Mr. Johal: We are pleased to provide the labor rates and materials fees at the proposed work at the various San Rafael sites. The labor rates listed are for consultant work at the site, and for addition specialists, such as a CIH that may be used for special needs: • The base labor rate for certified asbestos consultant / lead inspector: $95/ hour. • The base labor rate for certified industrial hygienist (CIH): $150/ hour. • Overtime rates after normal work hours: 150% of base rate The materials costs for this project are as follows: • Bulk PLM asbestos samples, 24 hour turn around: $20 each sample • Bulk PLM asbestos Roof samples, 24 hour turn around: $50 each sample • Bulk FAA lead samples, 24 hour turn around: $30 each sample • Bulk FAA lead samples, Rush turn around: $45 each sample • Air TEM asbestos samples, 24 hour turn around: $125 each sample • Air TEM asbestos samples, Rush turn around: $150 each sample • Mileage fees for transport to site or laboratory: $0.50 / mile If any comments or questions arise, please don't hesitate to contact me at (415) 927-9038 or by cel- lular at (415) 990-8936. Respectfully submitted, Monte Deignan Cal/OSHA Certified Asbestos Consultant 93-0879 Monte Deignan & Associates Environmental Consulting P.O. Box 546 Larkspur, CA 94977 (415) 927-9038 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. ! Project I 03/03/16 660 1313 5th Avenue Description Quantity Cost Total PROJECT AND LOCATION Asbestos Survey for City of San Rafael Office Building at 1313 5th Ave. in San Rafael, CA Includes additional samples at roof and full survey at adjacent parking offices CONSULTANT CHARGES Building Survey for Asbestos 3 95.00 285.00 Write, edit, or oversee reports 8 95.00 760.00 Subtotal 1,045.00 MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard 25.00 0.00 PLM asbestos analysis, Roofing or Tar Based samples 8 50.00 400.00 Subtotal 400.00 TRAVEL CHARGES Travel time to job site / laboratory 1 95.00 95.00 Mileage 40 0.50 20.00 Please refer to MDA Terms and Conditions Total $1,560.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 LAttn : Deputy Chief Robert Sinnott Date I Estimate No. Project L- 02/19/16 658 I San Rafael 51 Description PROJECT AND LOCATION Supplemental Asbestos Survey for City of San Rafael Station 51 at 1039 C Street San Rafael, CA CONSULTANT CHARGES Building Survey for Asbestos Write, edit, or oversee reports Subtotal MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard PLM asbestos analysis, Roofing or Tar Based samples Subtotal TRAVEL CHARGES Travel time to job site / laboratory Mileage Proposal Quantity I Cost I Total I -I Please refer to MDA Terms and Conditions _ I Total 4 95.00' 380.001 12 95.00 1,140.00 1,520.00 15 18.00 270.00 6 50.00 300.00 570.00 1 95.00 95.00 40 0.50 20.001 i $2,205.00 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. i Project 02/18/16 656 San Rafael Station 52 Description Quantity Cost Total PROJECT AND LOCATION Asbestos Survey for City of San Rafael Station 52 at 210 Third Street San Rafael, CA Includes tower, station, and training classroom 0.00 0.00 CONSULTANT CHARGES Building Survey for Asbestos 5 95.00 475.00 Write, edit, or oversee reports 12 95.00 1,140.00 Subtotal 1,615.00 MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard 40 18.00 720.00 PLM asbestos analysis, Roofing or Tar Based samples 10 50.00 500.00 Subtotal 1,220.00 TRAVEL CHARGES Travel time to job site / laboratory 1 95.00 95.00 Mileage 40 0.50 20.00 Please refer to MDA Terms and Conditions i Total $2,950.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. Project 02/18/16 657 San Rafael Station 57 Description PROJECT AND LOCATION Asbestos Survey for City of San Rafael Station 57 at 3530 Civic Center Dr. San Rafael, CA CONSULTANT CHARGES Building Survey for Asbestos Write, edit, or oversee reports Subtotal MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard PLM asbestos analysis, Roofing or Tar Based samples Subtotal TRAVEL CHARGES Travel time to job site / laboratory Mileage Proposal Quantity Cost Total 3 95.00 285.00 12 95.00 1,140.00 1,425.00 30 18.00 540.00 6 50.00 300.00 840.00 1 95.00 95.00 40 0.50 20.00 Please refer to MDA Terms and Conditions I Total $2,380.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. I Project 03/22/16 666 I 1313 5th St. Asb Mon Est J Description PROJECT AND LOCATION Asbestos Oversight and Monitoring for Buildings at 1313 5th St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors Monitoring at job site during abatement, part time Air Sampling during / after abatement Prepare / generate progress reports Subtotal MATERIALS CHARGES / FEES TEM analysis fee Subtotal TRAVEL CHARGES Travel time to job site Mileage Proposal Quantity Cost Total 5 95.00 475.00 16 95.00 I 1,520.00 3 95.00 285.00 4 i 95.00 380.00 2,660.00 3 125.00 375.00 375.00 4 95.00 380.00 120 0.50 60.00 I Total —$3,475.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date i Estimate No. Project 03/22/16 669 SRFD Sta 51 Asb Mon Est Description PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 51 at 1039 C St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors Monitoring at job site during abatement, part time Air Sampling during / after abatement Prepare / generate progress reports Subtotal MATERIALS CHARGES / FEES TEM analysis fee Subtotal TRAVEL CHARGES Travel time to job site Mileage Proposal Quantity Cost Total Total i 6 95.00 570.00 24 95.00 2,280.00 3 95.00 285.00 8 95.00 760.00 3,895.00 4 125.00 500.00 500.00 8 95.00 760.00 200 0.50 100.00 $5,255.00 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. Project 03/22/16 668 SRFD Sta 52 Asb Mon Est Description Quantity Cost Total PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 52 at 210 Third St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors 6 95.00 570.00 Monitoring at job site during abatement, part time 24 95.00 2,280.00 Air Sampling during / after abatement 3 95.00 285.00 Prepare / generate progress reports 8 95.00 760.00 Subtotal 3,895.00 MATERIALS CHARGES / FEES TEM analysis fee 3 125.00 375.00 Subtotal 375.00 TRAVEL CHARGES Travel time to job site 8 95.00 760.00 Mileage 200 0.50 100.00 I Total 1 $5,130.00 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date I Estimate No. Project 03/22/16 667 SRFD Sta 57 Asb Mon Est Description Quantity Cost Total PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 57 at 3530 Civic Center Drive in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors 6 95.00 570.00 Monitoring at job site during abatement, part time 24 95.00 2,280.00 Air Sampling during / after abatement 3 95.00 285.00 Prepare / generate progress reports 8 95.00 760.00 Subtotal 3,895.00 MATERIALS CHARGES / FEES TEM analysis fee 3 125.00 375.00 Subtotal 375.00 TRAVEL CHARGES Travel time to job site 6 95.00 570.00 Mileage 200 0.50 100.00 Total $4,940.00 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 14/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTJeff Kortan EMPIRE WEST INS SERVICES INC MME (916) 967-1130 ;AI'r( Nn,(888)204-4268 4125 Temescal St Ste C�+I�ss,je f@empirewest.net Fair Oaks, CA 95628 OFO411O INSURER(S) AFFORDING COVERAGE NAICp INSLIRFR A' Rockhill Ins. Co. INSURED Monte Deignan and Associates INSURER B: 410 Elm Ave. INSURER C: Larkspur, CA 94939 INSURER D: (415) 927-9038 INSURER IF INSURER F -COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ' -Nuut. anon- /MM DD/YYYYI POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR wvo POI.ICV NUMBER GENERAL LIABILITY EACH OCCURRENCE UAMAUL IU KLNI tU X COMMERCIAL GENERAL LIABILITY PREMISES (En nrcurrenrel = CLAIMS -MADE D OCCUR MED EXP (Anvoneoerson) A X Pollution Liab. ENVP001763-04 3/27/2016 3/27/2017 PERSONAL B ADV INJURY GENT AGGREGATE LIMIT APPLIES PER: 7 POLICY 1 X 1 Pc - 1 ^ 1 LOC AUTOMOBILE LIABILITY _ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS P AUTOS — UMBRELLA LIABOCCUR EXCESS LIAR HCLAIMS-MADE OFD I I RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPFRATIONS hel— A Professional Liab. ENVP001763-04 3/27/2016 3/27/2017 Claims Made Retro Date 3/27/02 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101,Additional Remarks Schedule, if more space is required) Certificate holder is named as additional insured as respects operations as required by written contract. GENERAL AGGREGATE PRODUCTS - COMP/OPAGG $ 2.000,000 $ 50.000 $ 5.000 $ 2,000,000 $ 2,000,000 $ 2.000,000 COMBINED SINGLE LIMIT fEaarridenll S BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident1 EACH OCCURRENCE $ AGGREGATE $ i S IWC STATU- I IOTH- TnPV I IRAITC FR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ FI DISEASE - POL ICY LIMIT -, Limits included in above insured's CERTIFICATE HOLDER CANCELLATION City of San Rafael SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1400 Fifth Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 151560 ACCORDANCE WITH THE POLICY PROVISIONS. San Rafael, CA 94915-1560 Attn: City Manager AUTHORIZED REPRESENTATIVE I� I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ENVP001763-04 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s). Of Covered Operations Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete thise Schedule, if not shown, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip - in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 2' CG 20 10 07 04 © ISO Properties, Inc., ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. 2004 Page 1 of 1 Fcmt W-9 Request for Taxpayer Give Form to the Deceinber identification Number and Certification requester. Do not i?epar•�ren; of the Treasury Send t8 the IRS. Intern l Rs1en;re Service Nate (as shovin on your income tax rer,:rn) Monte J. Aeignan t i I &udrless namardisregarded en`.: -,y name, if different from above IMonte aeignan & Associates SIL Check appropriate box for faderal tax classification: N C individualisole proprietor ❑ c Corporation ❑ 5 corporation ❑ Partnership ❑ Tnistrestate cC >+ o _ ❑ f.`:^thea liability coniaany. Enter the tax c'.assificadon (C=C corporaticn, S=S corporation, F=parmersN ► ❑ Exe; npt payao 2 C N ` G CL [j Qther (see instructions) r Addre4s inurrtter, Street, ano apt. or surte no.) Requester's name and address (optional) U a 410 Elm Ave. ch� City, ,;ate, and ZIP code Larkspur, CA 94935 List account numbei(s) here (optianai) IM Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line j Social cocurity number to avoid backup withholding. For individuals, this is your serial security number (SSKI. However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other j 5 ( 6 ( 59 0 - 5 0 6 19 entities, it is your employer identification number (EIN). If you do not haven number, see Hat, to get e i TIN on page 3. Note. If the account Is in more than one name, see the chart on page a for guidelines on whose Employer identification number number to enter. F—F11 1 I I 1 -IF1 EM Certification __.m.___...._........, Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer Identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the iRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page d. ...—., . Sign ` porSignature of /A ides Here I U.S.u.s. poreon►G.r' .. nate. cF General Instructions Section references are to the internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S, person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. if applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S, trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note, If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U,S. person if you are: • Ar. individual who is a U.S, citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States ur under the laws of the United States, • An estate (other than a foreign estate), or • A domectic trust (as defiled in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore. if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) PCA State Form 0 Providing Insurance and Financial Services 900 Old River Road Bakersfield CA 93311.9501 StateFarin A Attached as requested are your replacement insurance identification cards. If the attached cards are not accepted by a law enforcement agency or your Department of Motor Vehicle office, please contact your agentto receive additional assistance. Thankyou for choosing State Farm foryour insurance needs. IMPORTANT - IDENTIFICATION CARDS STATE FARLVI StateFarrn CALIFORNIA INSURANCE CARD State Farm Mutual Automobile Insurance Company 900 Old River Road Bakersfield CA 93311.9501 INSURED DEIGNAN, MONTE J MUTL VOL POLICY NUMBER V081080 -1304-05H EFFECTIVE YR 2012 MAKE FORD FEB 042016 TO AUG 042016 MODEL F250 SD VIN 1FT7W2BT2CED18547 AGENT KUNTZ INSURANCE AGENCY INC 0099.1314 StateFarm THIS CARD MUST BE KEPT IN THE INSURED MOTOR VEHICLE FOR PRODUCTION UPON DEMAND. �a IF YOU HAVE AN ACCIDENT - NOTIFY THE POLICE IMMEDIATELY 1. Get names, addresses, and phone numbers of persons involved and witnesses. Also get driver license numbers of persons involved and license plate numbersletates of vehicles. 2. Don't admit fault or discuss the acc dent with anyone but State Farm or police. 3. Promptly notify your agent, og on to statefarm.comO, or visit State Farm Pocket Agengto rile a claim. For Emergency Road Service cap 1-977-627.5757. EXAMINE POLICY EXCLUSIONS CAREFULLY. THIS FORM DOES NOT CONSTITUTE ANY PART OF YOUR INSURANCE POLICY. How to identify your coverage. See policy for full name and definition PHONE (415)459-0200 NAIC 25178 A Liability H Emergency Road Service U Uninsured Motor Vehicle COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS C Medical Payments L Physical Damage Ul Uninsured Motor Vehicle PD PRESCRIBED BY LAW. 0 Comprehensive RI Car Rental and Travel Expenses Z Loss of Earnings COVERAGES A C D50 G200 H U Ut G Collision S Death, Dismemberment and J Loss of Sight KEEP A CARD IN YOUR CAR. TH S CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES. THE FORM MAY BE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD, OR A PHOTOCOPY OF A CARD, WITH YOUR VEHICLE REGISTRATION RENEWAL A toll free number is available for Emergency Road Service and is located on your insurance card. — IMPORTANT - IDENTIFICATION CARDS STATE FAR.N4 StateFarm CALIFORNIA THIS CARD MUST BE KEPT IN THE INSURED MOTOR ' INSURANCE CARD VEH CLE FOR PRODUCTION UPON DEMAND. State Farm Mutual Automobile Insurance Company IF YOU HAVE AN ACCIDENT - NOTIFY THE POLICE IMMEDIATELY 900 Old River Road Bakersfield CA 93311-9501 1. Get names, addresses, and phone numbers of persons involved and witnesses. INSURED DEIGNAN, MONTE J MUTL Also get driver license numbers of persons involved and license plate VOL numberalstates of vehicles. 2. Don't admit fault or discuss the accident with anyone but State Farm or police. 3. Promptly notify your agent, log on to statefarm.com®, or visit State Farm Pocket Agent® to rile a claim. For Emergency Road Service call 1377-627-5757. POLICY NUMBER V081080 -1304-05H EFFECTIVE EXAMINEPOLCYIXCLUSIONSCAREFULLY. MS FORM DOES NOT YR 2012 MAKE FORD FEB 042016 TO AUG 042016 CONSTITUTE ANY PART OF YOUR/NSURANCEPOLICY. MODEL F250 SD VIN 1 Fi 7W2BT2CED18547 How to identify your coverage. See policy for full name and definition AGENT KUNTZ INSURANCE AGENCY INC 0099.1314 A Liability H Emergency Road Service U Uninsured Motor Vehicle PHONE (415)459.0200 NAIC 25178 COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS C Medical Payments L Physical Damage U1 Uninsured Metor Vehicle PD PRESCRIBED BY LAW. D Comprehensive RI Car Rental andTrovel Expenses Z Lass of Earnings COVERAGES A C D50 G200 H U U1 G Collision S Death, Dismemberment and Loss of Sinld 1 KEEP A CARD IN YOUR CAR. TH S CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES. THE FORM MAY BE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD, OR A PHOTOCOPY OF A CARD, WITH YOUR VEHICLE REGISTRATION RENEWAL DEC 30 2015 A t.,rt IF ---h— in nvatlahte for Finarcenev Road Service and is located on Voir insurance card. 143295.2 (oteccatc 11--20.2,)14 DRIVER INFORMATION Assigned Driver(s) The following ddver(s) are assigned to the vehicle(s) on this policy. Name MONTE J DEIGNAN Driving Experience as of February 04, 2016 45 years Other Household Driver(s) In addition to the Principal Driver(s) and Assigned Driver(s), your premium may be influenced by the drivers shown below and other individuals permitted to drive your vehicle. This list does not extend or expand coverage beyond that contained in this automobile policy. The drivers listed below are the drivers reported to us that most frequently drive other vehicles in your household. MARY DENTON Principal Driver & Assigned Drivers For each automobile, the Principal Driver is the individual who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that he or she most frequently drives. ;� State Far Marital Gender Status Male Married Your premium may be influenced by the information shown for these drivers. COVERAGE AND LIMITS See your policy for an explanation of these coverages. A Liability 2,000,000 Bodily Injury & Property Damage C Medical Payments 5,000 D 50 Deductible Comprehensive G 200 Deductible Collision H Emergency Road Service U Uninsured Motor Vehicle Bodily Injury 100,0001300,000 U1 Uninsured Motor Vehicle Property Damage Amount Due If any coverage you carry is changed to give broader protection with no additional premium charge, we will give DISCOUNTS These adjustments have already been applied to your premium. Multicar Policy Number: V081080 -804-05H Prepared December 30, 2015 $292.97 $12.07 $91.22 $244.74 $3.70 $23.93 $1.14 $669.7 you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. (continued on next page) Page number 3 of 5 Esther Beirne From: Lawrence Moss Sent: Wednesday, May 04, 2016 11:17 AM To: Esther Beirne Subject: FW: PSA for Hazardous Material Consulting - Monte Deignan Attachments: 05 03 16 Checklist -LG and PSA for Hazardous Material Consulting -Monte Deignan.pdf Esther: Insurance submitted and complies with requirements. Larry From: Laraine Gittens Sent: Wednesday, May 04, 2016 11:05 AM To: Lawrence Moss Subject: PSA for Hazardous Material Consulting - Monte Deignan Hi Larry— Please see the attached PSA with Monte Deignan for your review of insurance certificates and endorsements. Thanks! Laraine Laraine K. Gittens Legal Assistant I Office of the City Attorney City of San Rafael 1400 Fifth Avenue San Rafael, CA 94901 Tel: (415) 485-3080 Fax: (415) 485-3109 email: laraine.qittens @ citvofsanrafael.orq CONFIDENTIALITY NOTICE: This email and any attached files are CONFIDENTIAL and PRIVILEGED, intended only for the use of the individual or entity named as the recipient. If you have received this email in error, please destroy it and notify the sender by reply to laraine.gittens@citvofsanrafael.ora. Thank you. State Farm StateFarm Providing Insurance and Financial Services' c 900 Old River Road Bakersfield CA 93311.9501 Attached as requested are your replacement insurance identification cards. If the attached cards are not accepted by a law enforcement agency or your Department of Motor Vehicle office, please contact your agent to receive additional assistance. Thank you for choosing State Farm for your insurance needs. ------------------------------------------ !�:-t IMPORTANT - IDENTIFICATION CARDS STATE FARIM StateFarm CALIFORNIA INSURANCE CARD State Farm Mutual Automobile Insurance Company 900 Old River Road Bakersfield CA 93311-9501 INSURED DEIGNAN, MONTE J MUTL VOL POLICY NUMBER V081080-BO4-05H EFFECTIVE YR 2012 MAKE FORD FEB 042016 TO AUG 042016 MODEL F250 SD VIN 1FT7W2BT2CED18547 AGENT KUNTZ INSURANCE AGENCY INC 0099.1314 PHONE 415)459.0200 NAIC 25178 CCOOEV,EERAAGEPROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRSCBED By COVERAGES A C D50 G200 H U U1 StateFarm THIS CARD MUST BE KEPT IN THE INSURED MOTOR VEHICLE FOR PRODUCTION UPON DEMAND. IF YOU HAVE AN ACCIDENT - NOTIFY THE POLICE IMMEDIATELY 1. Get names, addresses, and phone numbers of persons involved and witnesses. Also get driver license numbers of persons involved and icense plate numbers/states of vehicles. 2. Dont admit fault or discuss the accident with anyone but State Farm or police. 3. Prompttynotify your agent, log on to statefarm.com®, or visit State Farm Pocket Agent® to file a claim. For Emergency Road Service cd 1-877-627.5757. EXAMINE POLICY EXCLUSIONS CAREFULLY. THIS FORM DOES NOT CONSTITUTE ANY PART OF YOUR INSURANCE POLICY. How to identify your coverage. See policy for full name and definition A Liability H Emergency Road Service U Uninsured Motor Vehicle C Medical Payments L Physical Damage Ut Uninsured Motor Vehicle PD 0 Comprehensive RI Car Rental and Travel Expenses Z Loss of Earnings 6 olh i n S Death, Dismemberment and Loss of Siriln KEEP A CARD IN YOUR CAR. THIS CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES. THE FORM MAY BE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD, OR A PHOTOCOPY OF A CARD, WITH YOUR VEHICLE REGISTRATION RENEWAL A tall tree number is available for Emergency Road Service and is located on your insurance card. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ---- IMPORTANT — - IMPORTANT - IDENTIFICATION CARDS STATE FARD4 StateFarm CALIFORNIA 65) INSURANCE INSURANCE CARD Cas VSY' State Farm Mutual Automobile Insurance Company 900 Old River Road Bakersfield CA 93311-9501 INSURED DEIGNAN, MONTE J MULL POLICY NUMBER V081080-B04.05H EFFECTIVE YR 2012 MAKE FORD FEB 042016 TO AUG 042016 MODEL F250 SD VIN iFT7W2BT2CED18547 AGENT KUNTZ INSURANCE AGENCY INC 0099-B14 PHONE 1415)459.0200 NAIC 25178 COVERAGED ROOVIDE BY THE POLICY MEETS THE MINIMUM LIABILITY LIMITS PRESCRIBCOVERAGES A C D50 G200 H U Ut StateFarm THIS CARD MUST BE KEPT IN THE INSURED MOTOR VEHICLE FOR PRODUCTION UPON DEMAND (9 ) IF YOU HAVE AN ACCIDENT - NOTIFY THE POLICE IMMEDIATELY 1. Get names, addresses, and phone numbers of persons involved and witnesses. Also get driver license numbers of persons involved and license plate numbers/states of vehicles. 2. Dont admit fault or discuss the accident with anyone but State Farm or police. 3. Promptly notify your agent, log on to statefarm.com®, or visit State Farm Pocket Agent® to file a claim. For Emergency Road Service call 1377-627-5757. EXAMINE POLICY EXCLUSIONS CAREFULLY. THIS FORM DOES NOT CONSTITUTE ANY PART OF YOUR INSURANCE POLICY. How to identify your coverage. See policy for full name and definition liability H Emergency Road Service U Uninsured Motor Velticle Medical Payments L Physical Damage Ul Uninsured Motor VeNcle PD Comprehensive RI Car Rental and Travel Expenses Z Loss of Earnings Collision S Death, Dismemberment and Loss of Sinls i KEEP A CARD IN YOUR CAR. HIS CARD IS INVALID IF THE POLICY FOR WHICH IT WAS SSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES. THE FORM MAY BE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD, OR A PHOTOCOPY OF A CARD, WITH YOUR VEHICLE REGISTRATION RENEWAL A *,it t m .,,,,.,br to —Unhla fav Fmprnenm Rn ad Service and is located on vour insurance card. DEC 30 2015 143295.2 (oleccalc) 1-i-20-2014 DRIVER INFORMATION Assigned Driver(s) The following driver(s) are assigned to the vehicle(s) on this policy. Name MONTE J DEIGNAN Driving Experience as of February 04, 2016 45 years Other Household Driver(s) In addition to the Principal Driver(s) and Assigned Driver(s), your premium may be influenced by the drivers shown below and other individuals permitted to drive your vehicle. This list does not extend or expand coverage beyond that contained in this automobile policy. The drivers listed below are the drivers reported to us that most frequently drive other vehicles in your household. MARY DENTON Principal Driver & Assigned Drivers For each automobile, the Principal Driver is the individual who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that he or she most frequently drives. Marital Gender Status Male Married Your premium may be influenced by the information shown for these drivers. COVERAGE AND LIMITS See your policy for an explanation ofthese coverages. A Liability 2,000,000 Bodily Injury & Property Damage $292.97 C Medical Payments 5,000 $12.07 D 50 Deductible Comprehensive $91.22, G 200 Deductible Collision $244.74. H Emergency Road Service $3.70 U Uninsured Motor Vehicle Bodily Injury 100,0001300,000 $23.93 U1 Uninsured Motor Vehicle Property Damage $1.14 Amount Due $669.77 If any coverage you carry is changed to give broader protection with no additional premium charge, we will give DISCOUNTS These adjustments have already been applied to your premium. Multicar Policy Number: V081080 -1304-05H Prepared December 30, 2015 you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. (continued on next page) Page number 3 of 5 DATE (MM'DD,'YWY) ACCARH CERTIFICATE OF LIABILITY INSURANCE 4/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C��O��N+TACTJeff Kortan EMPIRE WEST INS SERVICES INC WO 916)967-1130 FAX 888)204-4268 4125 Temescal St Ste C L"�A�" `"'" d LAIC Nnl( AODRESS'Je -f@empirewest. net Fair Oaks, CA 95628 OFO411O INSURER(5S) AFFORDING COVERAGE NAIC# INStIRER A • Rockhill Ins. Co. INSURED Monte Deignan and Associates INSURERB: 410 Elm Ave. INSURER C Larkspur, CA 94939 INSURER D: (415) 927-9038 INSURER F, INSURFR F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ' -.0 =- POLICY EFF POLICY EXP - LIMITS LTR TYPE OF INSURANCE INSR WVa POLICY NUMBER IMMIDDIYYYYI (MM/DD/YYYYI GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY = CLAIMS -MADE 1 ^R OCCUR A X Pollution Liab. GENT AGGREGATE LIMIT APPLIES PER: POLICY 1 n l Pc� M LOC AUTOMOBILE LIABILITY _ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS H AUTOS UMBRELLA LIABHCLAIMS-MADE OCCUR EXCESS LAB DFD I 'RETENTION% WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? r N/A (Mandatory In NH) if yes, describe under DESCRIPTION OF OPFRATIONS helm EACH OCCURRENCE UHMAUL IU RtI41 tU PREMISES (Ea ocrurrenrel MED EXP (Anv one person) ENVP001763-04 3/27/2016 3/27/2017 PERSONAL SADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OPAGG A Professional Liab. ENVP001763-04 3/27/2016 3/27/2017 Claims Made Retro Date 3/27/02 DESCRIPTION OF OPERATIONS / LOCATIONS VEHICLES (Attach ACORD 101,Addifional Remarks Schedule, if more space is required) Certificate holder is named as additional insured as respects operations as required by written contract. COMBINED SINGLE LIMIT 15aarrldnntl % BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ IPer arridentl EACH OCCURRENCE AGGREGATE IWC STATU- I IOTH- TnPV I IAAITc FP E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE El. DISF_4SF - POI ICV t IMIT 2.000,000 50.000 5.000 2,000,000 2,000,000 2,000,000 Limits included in above insured's CERTIFICATE HOLDER CANCELLATION City of San Rafael SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1400 Fifth Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 151560 ACCORDANCE WITH THE POLICY PROVISIONS San Rafael, CA 94915-1560 I AUTHORIZED REPRESENTATIVE Attn: City Manager j]n�,ll t ///IIYIYtt rr ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ENVP001763-04 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Any person or organization for whom you are performing In respect to any location where the named insured is operations when you and such person or organization have performing "your work". agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Information required to complete thise Schedule, if not shown, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 07 04 C ISO Properties, Inc., That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. 2004 Page 1 of 1 PROFESSIONAL SERVICES AGREEMENT/CONTRACT COMPLETION CHECKLIST AND ROUTING SLIP Below is the process for getting your professional services agreements/contracts finalized and executed. Please attach this "Completion Checklist and Routing Slip" to the front of your contract as you circulate it for review and signatures. Please use this form for all professional services aLyree men ts/co n tracts (not just those requiring City Council approval). This process should occur in the order presented below. Step Responsible Description Completion Department Date 1 City Attorney Review, revise, and comment on raft agreement. -� y 2 Contracting Department Forward final agreemen o contractor for �QMW kliv their signature. Obtain at least two signed jC originals from contractor. 3 Contracting Department Agendize contractor -signed agreement for Council approval, if Council approval necessary (as defined by City Attorney/City Ordinance*). 4 City Attorney Review and approve form of agreement; bonds., a surancesc�certif�icates and (endorsements. tZ&4k j < �� 5 City Manager / Mayor / or Agreement executed by Council auth rized Department Head official. 6 City Clerk City Clerk attests signatures, retains original agreement and forwards copies to the 571 1C,1 b . contracting department. To be completed by Contracting Department: Project Manager: MioCh Project Name: �UYVf_V3 I Agendized for City Council Meeting of (if necessary): If you have questions on this process, please contact the City Attorney's Office at 485-3080. * Council approval is required if contract is over $20,000 on a cumulative basis. Exhibit A March 22, 2016 Mr. Bill Johal Kitchell CEM 2750 Gateway Oaks Drive Suite 300 Sacramento, CA RE: Asbestos / Environmental Consulting Proposal for City of San Rafael Fire Stations Monitoring San Rafael, California Dear Mr. Johal: MDA We are pleased to provide the labor rates and materials fees at the proposed work at the various San Rafael sites. The labor rates listed are for consultant work at the site, and for addition specialists, such as a CIH that may be used for special needs: • The base labor rate for certified asbestos consultant / lead inspector: $95/ hour. • The base labor rate for certified industrial hygienist (CIH): $150/ hour. • Overtime rates after normal work hours: 150% of base rate The materials costs for this project are as follows: • Bulk PLM asbestos samples, 24 hour turn around: $20 each sample • Bulk PLM asbestos Roof samples, 24 hour turn around: $50 each sample • Bulk FAA lead samples, 24 hour turn around: $30 each sample • Bulk FAA lead samples, Rush turn around: $45 each sample • Air TEM asbestos samples, 24 hour turn around: $125 each sample • Air TEM asbestos samples, Rush turn around: $150 each sample • Mileage fees for transport to site or laboratory: $0.50 / mile If any comments or questions arise, please don't hesitate to contact me at (415) 927-9038 or by cel- lular at (415) 990-8936. Respectfully submitted, Monte Deignan Cal/OSHA Certified Asbestos Consultant 93-0879 Monte Deignan & Associates Environmental Consulting P.O. Box 546 Larkspur, CA 94977 (415) 927-9038 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date i Estimate No. Project 03/03/16 660 1313 5th Avenue Description Quantity Cost Total PROJECT AND LOCATION f Asbestos Survey for City of San Rafael Office Building at 1313 5th Ave. in San Rafael, CA Includes additional samples at roof and full survey at adjacent parking offices CONSULTANT CHARGES Building Survey for Asbestos 3 95.00 285.00 Write, edit, or oversee reports 8 95.00 760.00 Subtotal I 1,045.00 MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard 25.00 0.00 PLM asbestos analysis, Roofing or Tar Based samples 8 50.00 400.00 Subtotal 400.00 TRAVEL CHARGES Travel time to job site / laboratory 1 95.00 95.00 Mileage 40 0.50 20.00 Please refer to MDA Terms and Conditions I Total $1,560.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. Project 02/19/16 658 San Rafael 51 Description PROJECT AND LOCATION Supplemental Asbestos Survey for City of San Rafael Station 51 at 1039 C Street San Rafael, CA CONSULTANT CHARGES Building Survey for Asbestos Write, edit, or oversee reports Subtotal MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard PLM asbestos analysis, Roofing or Tar Based samples Subtotal TRAVEL CHARGES Travel time to job site / laboratory Mileage Please refer to MDA Terms and Conditions Proposal Quantity Cost Total 4 95.00 380.00 12 95.00 1,140.00 1,520.00 15 18.00 270.00 6 50.00I 300.00 570.00 1 95.00 95.00 40 0.50 20.00 Total $2,205.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Proposal Date Estimate No. Project 02/18/16 656 San Rafael Station 52 Description Quantity Cost Total PROJECT AND LOCATION Asbestos Survey for City of San Rafael Station 52 at 210 Third Street San Rafael, CA Includes tower, station, and training classroom 0.00 0.00 CONSULTANT CHARGES Building Survey for Asbestos 5 95.00 475.00 Write, edit, or oversee reports 12 95.00 1,140.00 Subtotal 1,615.00 MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard 40 18.00 720.00 PLM asbestos analysis, Roofing or Tar Based samples 10 50.00 500.00 Subtotal 1,220.00 TRAVEL CHARGES Travel time to job site / laboratory 1 95.00 95.00 Mileage 40 0.50 20.00 Please refer to MDA Terms and Conditions Total $2,950.00 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. Project 02/18/16 657 San Rafael Station 57 Description Quantity Cost Total PROJECT AND LOCATION Asbestos Survey for City of San Rafael Station 57 at 3530 Civic Center Dr. San Rafael, CA CONSULTANT CHARGES Building Survey for Asbestos Write, edit, or oversee reports Subtotal MATERIALS CHARGES / FEES PLM asbestos analysis, interior and exterior standard PLM asbestos analysis, Roofing or Tar Based samples Subtotal TRAVEL CHARGES Travel time to job site / laboratory Mileage 3 95.00 285.00 12 95.00 1,140.00 1,425.00 30 18.00 540.00 6 50.00 300.00 840.00 1 95.00 95.00 40 0.50 20.00 Please refer to MDA Terms and Conditions :Total $2,380.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. Project 03/22/16 666 1313 5th St. Asb Mon Est Description PROJECT AND LOCATION Asbestos Oversight and Monitoring for Buildings at 1313 5th St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors Monitoring at job site during abatement, part time Air Sampling during / after abatement Prepare / generate progress reports ( Subtotal l MATERIALS CHARGES / FEES TEM analysis fee Subtotal s €TRAVEL CHARGES Travel time to job site E Mileage Proposal Quantity Cost Total Total i 5 95.00 16 95.00 3 95.00 4. 95.00 3 125.00 4 95.00 120 0.50 475.00 1,520.00 285.00 380.00 2,660.00 375.00 375.00 380.00 60.00 $3,475.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Proposal Date Estimate No. Project 03/22/16 669 SRFD Sta 51 Asb Mon Est Description Quantity Cost Total PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 51 at 1039 C St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors 6 95.00 570.00 Monitoring at job site during abatement, part time 24 95.00 2,280.00 Air Sampling during / after abatement 3 95.00 285.00 Prepare / generate progress reports 8 95.00 760.00 Subtotal 3,895.00 MATERIALS CHARGES / FEES TEM analysis fee 4 125.00 500.00 Subtotal 500.00 TRAVEL CHARGES Travel time to job site 8 95.00 760.00 Mileage 200 0.50 100.00 Total $5,255.00 Monte Deignan and Associates PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date Estimate No. 03/22/16 668 Project SRFD Sta 52 Asb Mon Est Proposal Description Quantity Cost Total PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 52 at 210 Third St. in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors 6 95.00 570.00 Monitoring at job site during abatement, part time 24 95.00 2,280.00 Air Sampling during / after abatement 3 95.00 285.00 Prepare / generate progress reports 8 95.00 760.00 Subtotal 3,895.00 MATERIALS CHARGES / FEES TEM analysis fee 3 125.00 375.00 Subtotal 375.00 TRAVEL CHARGES Travel time to job site 8 95.00 760.00 Mileage 200 0.50 100.00 Total $5,130.00 Monte Deignan and Associates Proposal PO Box 546 Larkspur, CA 94977 Client: City of San Rafael Fire Dept. 1039 C Street San Rafael, CA 94901 Attn : Deputy Chief Robert Sinnott Date I Estimate No. Project 03/22/16 667 SRFD Sta 57 Asb Mon Est Description Quantity Cost Total PROJECT AND LOCATION Asbestos Oversight and Monitoring for SRFD Station 57 at 3530 Civic Center Drive in San Rafael, CA CONSULTANT CHARGES Pre -job or bid walk with contractors 6 95.00 570.00 Monitoring at job site during abatement, part time 24 95.00 2,280.00 Air Sampling during / after abatement 3 95.00 285.00 Prepare / generate progress reports 8 95.00 760.00 Subtotal 3,895.00 MATERIALS CHARGES / FEES 3 TEM analysis fee 3 125.00 375.00 Subtotal 375.00 TRAVEL CHARGES Travel time to job site 6 95.00 570.00 Mileage 200 0.50 100.00 Total $4,940.00