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PW Street Resurfacing 2015-2016; Ghilotti ConstructionITEM City of San Rafael ♦ California Form of Contract Agreement For Street Resurfacing 2015-2016 City Project No. 11275 This Agreement is made and entered into this lb7W day of Ouv, u 41!- s2,o/6 by and between the City of San Rafael (hereinafter called "City") and Ghilotti Construction Company, Inc. (hereinafter called "Contractor"). Witnesseth, that the City and the Contractor, for the considerations hereinafter named, agree as follows: I - Scope of the Work The Contractor hereby agrees to furnish all of the materials and all of the equipment and labor necessary, and to perform all of the work described in the plans and specifications for the project entitled: Street Resurfacing 2015- 2016, City Project No. 11275, all in accordance with the Specifications and Contract Documents dated July 2016, which are hereby made a part of this Agreement. II- Time of Completion (a) The work to be performed under this Contract shall be commenced within Five (5) Working Days after the date of written notice by the City to the Contractor to proceed. (b) All work shall be completed, including all punchlist work, within Eli htv (80) Working Days and with such extensions of time as are provided for in the General Provisions. III - Liquidated Damages It is agreed that, if all the work required by the contract is not finished or completed within the number of working days as set forth in the contract, damage will be sustained by the City, and that it is and will be impracticable and extremely difficult to ascertain and determine the actual damage which the City will sustain in the event of and by reason of such delay; and it is therefore agreed that the Contractor will pay to the City, the sum of $1,900 for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed above; and the Contractor agrees to pay said liquidated damages herein provided for, and further agrees that the City may deduct the amount thereof from anN moneys due or that may become due the Contractor under the contract. IV - The Contract Sum The City shall pay to the Contractor for the performance of the Contract the amounts determined for the total number of each of the units of work in the folloNNing schedule completed at the unit price stated. The number of units contained in this schedule is approximate only, and the final payment shall be made for the actual number of units that are incorporated in or made necessary by the work covered by the Contract. DESCRIPTION ESTIMATED UNIT UNIT PRICE TOTAL PRICE QUANTITY 1. Mobilization (Not to exceed 3% of Bid) I 2. Signs and Traffic Control 1 3. Clearing and Grubbing 1 4. Minor Concrete Minor Structures a. Type A Curb and Gutter 1,300 b. Four -Inch Thick PCC Sidewalk 2,000 c. Eight -Inch Thick PCC Sidewalk 130 d. Case 'C' Curb Ramp 31 Page I of 4 LS n $40,000.00 = $40,000.00 LS n $215,000.00 = $215,000.00 LS a $100,000.00 = $100.000.00 LF a $35.00 $45,500.00 SF « $15.00 $30,000.00 SF n $20.00 $2,600.00 EA « $5,000.00 = $155,000.00 ITEM DESCRIPTION e. Modified Case 'C' Curb Ramp (Warner Ct) f Modified Case `A' Curb Ramp (Shoreline Park Pathway) g. Six -Inch Thick PCC Valley Gutter h. Reconstruct Catch Basin Deck, Curb, and Gallery Inlet i. Modified Turning Structure with Manhole Lid j. New Type 'C' Catch Basin 5. Sidewalk Underdrains a. Whitewood Drive at Pedestrian Pathway (East Side) b. Spinnaker Point Drive/Catalina Blvd Area 5. 6" Storm Drain Pipe 6. 12" Trench Drain 7. Full Width Grinding" 8. Cold Planing a. 6' Edge Grind b. 20' Conform Grind 8. Hot Mix Asphalt a. Full Depth Asphalt Concrete Pavement b. Deep Lift Patching C. Asphalt Concrete Overlay 9. Mirco-Surfacing" 10. Adjust Existing Facility to Grade a. Install Sewer Cleanout Utility Box b. Adjust Manhole Castings to Grade c. Adjust Water Valve Cover to Grade (In Roadway Only) d. Adjust Gas Valve Cover to Grade (In Roadway Only) e. Adjust Monument to Grade f. Adjust Rodhole to Grade 11. Roadside Signs Page 2 of 4 ESTIMATED QUANTITY UNIT UNIT PRICE TOTAL PRICE 2 EA a $5,000.00 = $10,000.00 1 EA a $5,000.00 = $5,000.00 1,100 SF @ $15.00 = $16,500.00 5 EA a $3,000.00 = $15,000.00 2 EA n $5,000.00 = $10,000.00 2 EA a $5,000.00 = $10,000.00 1 EA a $500.00 = $500.00 9 EA a $500.00 = $4,500.00 95 LF a $70.00 = $6,650.00 60 LF n $250.00 = $15,000.00 195.016 SF a $0.40 $78,006.40 9,100 LF a $3.00 = $27,300.00 530 LF @ $10.00 $5,300.00 105 TON a $250.00 = $26,250.00 160 TON « $250.00 = $40,000.00 5,800 TON rr $110.00 = $638,000.00 15,511 SY a $2.30 = $35,675.30 6 EA @ $350.00 = $2,100.00 51 EA @ $1,200.00 = $61,200.00 59 EA a $100.00 = $5,900.00 2 EA @ $1,000.00 = $2,000.00 30 EA @ $1,000.00 = $30,000.00 1 EA @ $1,000.00 = $1.000.00 1 LS a $3,025.00 = $3,025.00 ITEM DESCRIPTION ESTIMATED QUANTITY UNIT UNIT PRICE TOTAL PRICE 12. Traffic Stripes, Pavement Markings, and Painting a. Install 4" White Stripe 140 SF a $3.00 $420.00 b. Install Detail 9 Striping 1,300 LF a $1.10 $1,430.00 c. Install Detail 22 Striping 460 LF @ $2.40 = $1,104.00 d. Install Detail 27b Striping 210 LF @ $0.90 $189.00 e. Install Detail 29 Striping 90 LF @ $4.40 = $396.00 f. Install Detail 38 Striping 1,500 LF @ $2.20 = $3,300.00 g. Install Detail 40 Striping 220 LF a $1.00 $220.00 h. Install Pavement Markings (Thermoplastic) 5,250 SF a $3.00 $15,750.00 i. Install Pavement Markings (Paint) 90 SF a $3.00 - $270.00 j. Paint Curb Red 1,300 LF a $2.00 $2,600.00 k. Paint Curb Yellow 250 LF a $2.00 $500.00 GRAND TOTAL BID $1,663,185.70 V - Progress Payments (a) On not later than the 6th day of every month the Public Works Department shall prepare and submit an estimate covering the total quantities under each item of work that have been completed from the start of the job up to and including the 25th day of the preceding month, and the value of the work so completed determined in accordance with the schedule of unit prices for such items together with such supporting evidence as may be required by the City and or Contractor . (b) As soon as possible after the preparation of the estimate, the City shall, after deducting previous payments made, pay to the Contractor 950o of the amount ofthe estimate as approved by the Public Works Department. (c) Final payment of all moneys due shall be made within 15 days after the expiration of 35 days following the tiling of the notice of completion and acceptance of the work by the Public Works Department. (d) The Contractor may elect to receive 1000,0 of payments due under the contract from time to time, without retention of any portion of the payment by the public agency, by depositing securities of equivalent value with the public agency in accordance with the provisions of Section 4590 of the Government Code. Such securities, if deposited by the Contractor, shall be Valued by the City's Finance Director, whose decision on valuation of the securities shall be final. VI - Acceptance and Final Payment (a) Upon receipt of written notice that the work is ready for final inspection and acceptance, the Engineer shall within 5 days make such inspection, and when he finds the work acceptable under the Contract and the Contract fully performed, he will promptly issue a Notice of Completion, over his own signature, stating that the work required by this Contract has been completed and is accepted by him under the terms and conditions thereof, and the entire balance found to be due the Contractor, including the retained percentage, shall be paid to the Contractor by the City within 15 days atter the expiration of 35 days following the date of recordation of said Notice of Completion. (b) Before final payment is due the Contractor shall submit evidence satisfactory to the Engineer that all payrolls, material bills, and other indebtedness connected with work have been paid, except that in case of disputed indebtedness or liens the Contractor may submit in lieu of evidence of payment a surety bond satisfactory to Page 3 of 4 the City guaranteeing payment of all such disputed amounts when adjudicated in cases where such payment has not already been guaranteed by surety bond. (c) Contractor shall provide a "Defective Material and Workmanship Bond" for 50% of the Contract Price, before the final payment will be made. (d) The making and acceptance of the final payment shall constitute a waiver of all claims by the City, other than those arising from any of the following: (1) unsettled liens; (2) faulty work appearing within 12 months after final payment; (3) requirements of the specifications; or (4) manufacturers' guarantees. It shall also constitute a waiver of all claims by the Contractor, except those previously made and still unsettled. (e) If after the work has been substantially completed, full completion thereof is materially delayed through no fault of the Contractor, and the Engineer so certifies, the City shall, upon certificate of the Engineer, and without terminating the Contract, make payment of the balance due for that portion of the work fully completed and accepted. Such payment shall be made under the terms and conditions governing final payment, except that it shall not constitute a waiver of claims. VII - Assignment of Warranties; Waiver of Subrogation (a) Contractor hereby assigns to City all warranties, guarantees, or similar benefits such as insurance, provided by or reasonably obtainable from the manufacturers or suppliers ofequipment, material or fixtures that Contractor has installed or provided in connection with the work performed under this Agreement. (b) Contractor hereby agrees to waive and arrange by contract for its subcontractors to waive any subrogation rights which any insurer of Contractor or its subcontractors might otherwise acquire in connection with the insurer's payment to Contractor or its subcontractors of any insured loss with respect to work performed under this Agreement. Contractor further agrees to obtain and to arrange for its subcontractors to obtain for City's benefit any endorsements from insurers that may be necessary to effect such waiver of subrogation. Specifically, any worker's compensation insurance policies of the Contractor or its subcontractors shall be endorsed with a waiver of subrogation in favor of City for any work performed by Contractor or its subcontractors under this Agreement, and copies of such endorsements shall be provided to City. IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the day and year first written above. ATTEST: C - Rp—j Esther C. Beirne City Clerk APPROVED AS TO FORM: Roberl F. Epstein City Attorney File No.: 16.06.85 Page 4 of 4 CITY OF SAN RAFAEL: Jn Scl rt. Ci M pager Chilotti Construction Company, Inc. By-: -- - Printed Title: r. L Liberty Mutual SURETY CONTRACT BOND - CALIFORNIA Executed in Triplicate FAITHFUL PERFORMANCE - PUBLIC WORK Bond #070021987 Initial premium charged for this bond is $10,839.00 subject to adjustment upon completion of contract at applicable rate on final contract price. KNOW ALL BY THESE PRESENTS, That Ghilotti Construction Company, Inc. of 246 Ghilotti Avenue, Santa Rosa, CA 95407 as Principal, and the Liberty Mutual Insurance Company a corporation organized and existing under the laws of the State of Massachusetts and authorized to transact surety business in the State of California, as Surety, are held and firmly bound unto City of San Rafael in the sum of One Million Six Hundred Sixty-three Thousand One Hundred Eighty-five Dollars And Seventy Cents DoIIars ($1,663,185.70 ), for the payment whereof, well and truly to be made, said Principal and Surety bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these presents. TME CONDITION OF THE FOREGOING OBLIGATION IS SUCH, That WHEREAS, the above -bounden Principal has entered into a Contract, dated August 18 , 2016 , with the City of San Rafael to do and perform the following work, to -wit: Street Resurfacing 2015-2016, City Project No. 11275 NOW, THEREFORE, if the above -bounden Principal shall faithfully perform all the provisions of said Contract, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED FURTHER THAT, Any suit under this bond mast be instituted before the expiration of two (2) years fi-om the date of substantial completion of the work to be performed under the Contract. Signed and sealed this 23rd day of August , 2016 � trtst,,p JoµPO�fFOy�tn 1912 0 CHUS��dD LMS -10815 10199 Ghilotti Construction Company, Inc. Principal I All Yazdi General Manages Liberty Mutual Insurance pany By Jana B. Pilgard, Attorney -in -Fact ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Placer On August 23, 2016 before me, Kathy Rangel, Notary Public (insert name and title of the officer) personally appeared Jana B. Pilgard 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) KATHY RANGEL COMM. # 2007083 E CU7 ' NOTARY PUBLIC o CALIFORNIA n PLACER COUNTY 0 Comm. Exp. FEB. 11, 2017 Liberty Mutual SURETY CONTRACT BOND - CALIFORNIA PAYMENT BOND Bond #070021987 Executed in Triplicate KNOW ALL BY THESE PRESENTS, That we, Ghilotti Construction Company, Inc. and the Liberty Mutual Insurance Company a corporation organized and existing under the laws of the State of Massachusetts and authorized to transact surety business in the State of California, as Surety, are held and firmly bound unto City of San Rafael , as Obligee, in the sum of One Million Six Hundred Sixty-three Thousand One Hundred Eighty-five Dollars And Seventy Cents Dollars ( $1,663,185.70 ), for the payment whereof, well and truly to be made, said Principal and Surety bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THE FOREGOING OBLIGATION 1S SUCH, That WHEREAS, the above -bounden Principal has entered into a contract, dated 18th day of August , 2016 with the Obligee to do and perform the following work, to -wit: Street Resurfacing 2015-2016, City Project No. 11275 NOW, THEREFORE, if the above -bounden Principal or his/her subcontractors fail to pay any of the persons named in Section 9100 of the Civil Code of the State of California, or amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract, Surety will pay for the same, in an amount not exceeding the amount specified in this bond, and also, in case suit is brought upon this bond, a reasonable attorney's fee, to be fixed by the court. This bond shall inure to the benefit of any and all persons, companies or corporations entitled to file claims under Section 9100 of the Civil Code of the State of California, so as to give a right ol'action to them or their assigns in any suit brought upon this bond. Signed, sealed and dated this 23rd day of No premium is charged for this bond. It is executed in connection with a bond for the performance of the contract. jQ'`011PON1f`o'yn� r m 19120 r 3 y o r`d�1 SSA CHus� �a LMS -10616 10/99 August , 2016 Ghilotti Construction Company, Inc. Principal Al Yazdl General Manager Liberty Mutual Insurance Compiny By�? Jana B. <Pilgard, Attorney -in -Fact ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Placer On August 23, 2016 before me, Kathy Rangel, Notary Public (insert name and title of the officer) personally appeared Jana B. Pilgard 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 � v (Seal) /•..,;. ., KATHY RANGEL COMM # 2007083 NO UH TARY PUBLIC a CALIFORNIA n ' �:�•r s i PLACER COUNTY �� Comm. Exp. FEB. 11, 2017 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 7347850 American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WestAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutua Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the aws of the State of Indiana (herein collectively called the 'Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Dona Lisa Buschmann; J. Buschmann; Jana B. Pilqard; Kathy Ranqel; Robert D. Laux all of the city of Roseville , state of CA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 27th day of April , 2016 PND C ISG X11 IN5(, �tNSU,+ h WSUq American Fire and Casualty Company „,w,;F<� yJP,oeroryr R9? a S,t:,ofq �Yr� �Q,�' ,vor .,,`rte The Ohio Casualty Insurance Company V r Liberty Mutual Insurance Company s 1906 0 0 0 1919o n 1912 ° 1991 s West merican Insurance Company D a) t 1 * * * * By: 1 C STATE OF PENNSYLVANIA ss David M. Carey�_Assistant Secretary COUNTY OF MONTGOMERY tiOn this 27th day of April 2016 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and 0 a> Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he, as such, being authorized so to do, p execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. `m > IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written. t4 gP PAST COMMONWEALTH OF PENNSYLVANIA a/-` U� -� Q��NWey Ff� Notarial Seal v rQ v Teresa Pastella, Notary Public By: d of Plymouth Twp., Montgomery County O ` Teresa Pastella, Notary Public a.. My Commission Expires March 28, 2017 rOp7q V �� Member, Pennsylvania Association of Notaries Cd Ry CP m This Power of Attorney is made and executed pursuant to an by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: 0) ARTICLE IV—OFFICERS —Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, O C acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective E powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so O ip executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. M r ARTICLE XIII — Execution of Contracts — SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, >0) and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -tact, as may be necessary to act in behalf of the Company to make, execute, 0seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attomey executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 3rd day of August 20 16 y�PN�ort sG9 JP��NNtNSGg9 JP�tN;Ui+^rq• �U��vio UR�.r. n a 1906 p o 1919 n y 1912 s 1991 By: 2 Gregory W Davenport, Assistant Secretary bpi ^y-` �� ,D O �'•ib�MF�t"�4 �� % ��ist �l iE` t i < ib y,rinti^.'a !a y Cl 7 CH ! "r„�nnh 233 of 250 LMS_12873_122013 O vN 0 LU d C E 0 a Q M O� 3M OE LM �o so w � O C 'O d yo r00 N M 0 00 I—O r AC R ® I DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/23/2016 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(les) 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 Woodruff -Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 CONTACT NAME: Cass Hamann PHONE „tt.415-391-2141 E-MAIL . chamann@wsandco.com FAAIC. No,: 415-989-9923 INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Executive Risk Indemnity, Inc. 35181 INSURED GHILCON-01 INSURERS: Federal Insurance Company 20281 Ghilotti Construction Company, Inc. INSURERC:Chubb Indemnity Insurance Company 12777 246 Ghilotti Avenue Santa Rosa CA 95407 I INSURER D : I INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1165297663 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 TYPE OF INSURANCE AUUL bUdn POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) IMM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y 54303067 3/3112016 3/31/2017 EACH O ffY RREtJCE $2,000,000 DAMAGCLAIMS-MADE FX OCCUR PREMISESI((Eaoccurrence) $200,000 GEN L AGGREGATE LIMIT APPLIES PER: POLICY [K JECT F] LOC OTHER B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAR SCHEDULED AUTOS NON -OWNED AUTOS OCCUR EXCESS LIAB CLAIMS -MADE 54303066 DED I I RETENTION$ WORKERS COMPENSATION Y 54303068 AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE❑ N I A ED? OFFICER/MEMBER EXCLUD (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 3/31/2016 3/31/2017 4/2/2016 4/2/2017 I MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $2,000,000 GENERAL. AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 UUM81NVU,INULV LIMII (Ea accident) $1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE $ (Per accident) IEACH OCCURRENCE IAGGREGATE S X I PERT STATUTE I I OR' EL EACH ACCIDENT $1,000,000 E L DISEASE - EA EMPLOYEE $1,000,000 EL DISEASE - POLICYLIMT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: GCC Job #5710, City Project No. 1127 - Street Resurfacing 2015-2016 - San Rafael CA City of San Rafael is included as Additional Insured per the attached form CG 20 10 07 04. Waiver of Subrogation applies to the Workers Compensation per attached form WC 99 03 04 07 08. Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of San Rafael THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 111 Morphew Street ACCORDANCE WITH THE POLICY PROVISIONS. San Rafael CA 94901 AUTHORIZED REPRESENTATIVE I , © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 54303067 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): Locations) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, 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 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7- 08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 4/2/16 (DATE) Policy No. of the 54303068 issued to Ghilotti Construction Co. Endorsement No. at 12:01 A. M. standard time, forms a part of (NAME OF INSURANCE COMPANY) Cass Hamann Author zed Representative 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. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of total California premium. Schedule Person or Organization Where required by written contract WC 99 03 04 (Ed. 7-08) Job Description CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Public Works Project Manager: Stephanie Gindlesperger Extension: 3454 Contractor Name: Ghilotti Construction Company Contractor's Contact: TBD Contact's Email: TBD ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT DATE Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor N/A 8/2/2016 ® SG b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement 8/3/2016 ® LAG and return to Project Manager 8/3/2016 ® LAG b. Confirm insurance requirements, create Job on (already on PINS, send PINS insurance notice to contractor file) 3 Project Manager Forward at least two originals of final agreement to 8/16/2016 ® SG contractor for their signature 4 Project Manager When necessary, * contractor -signed agreement ❑ N/A agendized for Council approval ® SG *PSA > $20,000; or Purchase > $35,000; or Or Public Works Contract > $125,000 8/15/2016 Date of Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 5 Project Manager Forward signed original agreements to City 8/25/2016 Attorney with printed copy of this routing form ® SG 6 City Attorney Review and approve hard copy of signed 8�j3�l& agreement 7 City Attorney Review and approve insurance in PINS and , and bonds (for Public Works Contracts) 8 City Manager/ Mayor Agreement executed by Council authorized official Q (U 9 City Clerk Attest signatures, retains original agreement and v forwards copies to Project Manager