HomeMy WebLinkAboutCC Resolution 10574 (Bernard Hoffman Park Improvements)RESOLUTION NO. 10574
RESOLUTION AWARDING THE CONTRACT FOR THE BERNARD
HOFFMAN PARK IMPROVEMENTS TO UNION PACIFIC CONSTRUCTION,
INC. IN THE AMOUNT OF $127,588.45 AND ALLOCATE AN ADDITIONAL
$45,000.00 IN FUNDING OUT OF THE PARK AND RECREATION FACILITIES
FUND.
WHEREAS, on the 11th day of January, 2000, pursuant to due and legal notice
published in the manner provided by law, inviting sealed bids for proposals for the work
hereinafter mentioned, as more fully appears from the Affidavit of Publication thereof on
file in the office of the City Clerk of the City of San Rafael, California, the City Clerk of
said City did publicly open, examine, and declare all sealed bids or proposals for doing
the following work in said City, to wit:
"BERNARD HOFFMAN PARK IMPROVEMENTS"
PROJECT NO. 275-6697-616-8000
in accordance with the plans and specifications therefore on file in the office of said City
Clerk; and
WHEREAS, the bid of Union Pacific Construction, Inc. at the lump sum price
stated in its bid was and is the lowest and best bid for said work and said bidder is the
lowest responsible bidder; and
WHEREAS, there is presently approximately $110,000.00 remaining in the
project account fund, and the bid received was slightly higher than the Architect's
estimate; and
-1-
o�f�l��� 40"
WHEREAS, staff feel that an additional $45,000.00 will be required in order to
construct the project;
NOW, THEREFORE, IT IS HEREBY ORDERED AND RESOLVED;
that the bid of Union Pacific Construction, Inc. and the same is hereby accepted at said
lump sum price and that the contract for said work and improvements be and the same is
hereby awarded to said Union Pacific Construction, Inc. at the unit prices mentioned in
said bid.
IT IS FURTHER ORDERED AND RESOLVED that the Mayor and the
City Clerk of said City be authorized and directed to execute a contract with Union
Pacific Construction, Inc. for said work and to return the bidders bond upon the
execution of said contract.
IT IS FURTHER ORDERED AND RESOLVED that the City Council
authorize an allocation of $45,000.00 from the Park and Recreation Facility Fund
towards the project.
BE IT FURTHER RESOLVED that the Director of Public Works is hereby
authorized to take any and all such actions and make changes as may be necessary
to accomplish the purpose of this resolution.
I, JEANNE M. LEONCINI, City Clerk of the City of San Rafael, hereby certify
that the foregoing resolution was duly and regularly introduced and adopted at a regular
meeting of the Council of said City held on the 18"' day of January, 2000, by the
following vote, to wit:
AYES: COUNCIL MEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro
NOES: COUNCIL MEMBERS: None
ABSENT: COUNCIL MEMBERS: None
JEANT4 M. LEONCINI, City Clerk
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City of San Rafael • California
Form of Contract Agreement
for
Bernard Hoffman Park Improvements
This Agreement is made and entered into this 18th day of January, 2000 by and
between the City of San Rafael (hereinafter called City) and Union Pacific
Construction, Inc. (hereinafter called Contractor). Witnesseth, that the City and the
Contractor, for the considerations hereinafter named, agree as follows:
II - 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 shown on the plans and described
in the specifications for the project entitled: Bernard Hoffman Park Improvements , all
in accordance with the requirements and provisions of the Contract Documents as
defined in the General Conditions which are hereby made a part of this Agreement.
III- Time of Completion
(a) The work to be performed under this Contract shall be commenced within five (5)
calendar days after the date of written notice by the City to the Contractor to
proceed.
(b) The work shall be completed within forty-five (45) working days after the date of
such notice and with such extensions of time as are provided for in the General
Conditions.
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 $500 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 any 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
following 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.
ITEM
NO. ITEM
1 Playground Improvements
2 Access Ramp
UNIT EST
QTY
LS
LS
Grand Total
TOTAL
PRICE, $
71,119.45
56,469.00
127,588.45
AGREEMENT • 1
Cay
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). On not later than the 15th day of the month, the City shall, after deducting previous
payments made, pay to the Contractor 90% of the amount of the 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 filing of the notice of completion and acceptance of the work by
the Public Works Department.
(d). The Contractor may elect to receive 100% 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 Contractr, 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 after 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
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) 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.
(d) 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.
AGREEMENT 9 2
IN WITNESS WHEREOF, City and Contractor have caused their authorized
representatives to execute this Agreement the day and year first written above.
ATTEST: CITY OF SAN
RAFAEL:
anne M. Leoncin\ Albert Boro
City Clerk Mayor
APPRO �S CONTRACTOR:
Ga T. Raggh' n
City Attorney � for
UNIUN PACIFIC CONSTRUCTION
501 Lakeville Suite F INC.
Petaluma, CA 94952
UNION PACIFIC CONSTRUCTION, INC.
501 Lakeville Suite F
Petaluma, CA 94952
AGREEMENT • 3
American Motorist Insurance Compan-w), IVEMPeR.
PREMIUM BASED ON FIN.L CONTRACT PRICE
Executed in Duplicate Bond Number : 3SM96072800
Premium: $2914. 0 0
PUBLIC WORKS
PERFORMANCE BOND
Union Pacific Construction, Inc.
KNOW ALL MEN BY THESE PRESENTS: That we, as Principal, and
American Motorists Insurance Company, a corporation organized and existing under the laws of the State of
Jllinois, authorized to transact Surety business in the State of California as Surety arc held and firmly bound unto
Q e Huri a Twe t n Thousand Five Hundred
City of San Rafael , as Obligee, in the sum of Eghty g t an�57�g��--------DOLLARS
($127.,588.45 ) lawful money of the United States of America, for the payment whereof, well and truly to
be trade, we hereby bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and
severally, firmly by these presents_
WHEREAS, the above bounden Principal has been awarded and has entered into a contract dated January 18, 2000
with said Obligee to do and perform the following work, to wit: Bernard Hoffman Park Improvements
and will more fully appear in contract, reference to which is hereby made.
NOW, THEREFORE THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the above bounden
Principal shall well and truly perform, or cause to be performed, each and all of the requirements and obligations
of said contract this bond shall be null and void, otherwise it shall remain in full force and effect.
SIGNED, SEALED, DATED: January 21, 2000
Union Pacific Construction, Inc. American Motorists Insurance Company
1 (Principal) /� (Surety)
Moody �errorney In Fact
DIRECT CORRESPONDENCE TO:
® LOU JONES & ASSOCIATES, PO BOX 41375, 7470 N. FIGUEROA ST., LOS ANGELES, CA 90041
PHONE (323) 257-8291 • FAX (323) 256-7218
Public works Pcdormance Bond - 11-02-98dor
CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
State of California
County of San Francisco
On January 21, 2000 before me, Joyce Lee Kinney, Notary Public
personally appeared ******************M. Moody******************
❑x personally known to me - OR - ❑ proved to me on the basis of satisfactory
evidence to be the person whose name is
subscribed to the within instrument and
acknowledged to me that she executed the
same in her authorized capacity, and that
by her signature on the instrument the
person, or the entity upon behalf of which
the person acted, executed the instrument.
., JOYCE LEE KINNEY WITNESS my hand and official seal.
ow
COMM. #1207099
L) NOTARY PUBLIC -CALIFORNIA o
CL SAN FRANCISCO COUNTY
, M My Comm. Expires Jan. 7, 2003
ignature of Notary
American Motorist- Insurance Company- 1CmmPef_
Bond Number : 3SM96072800
Premium Included in Performance Bond
Executed in Duplicate
PUBLIC WORKS PAYMENT BOND
Union Pacific Construction, Inc.
KNOW ALL MEN BY THESE PRESENTS: That we, as Principal, and
A VIERICAN MOTORISTS INSURA\CE COMPANY, an Illinois Corporation authorized to transact Surety Business in the
State of California, as Surery, are held and firmly bound unto City of San Rafael as Obligee, in the sum of
One Hundred Twenty Seven Thousand Five
Hundred Eighty Fight and 49 j 1Q1---DQLLARS ( $127,588.45 ) lawful money of the United States of America, for the
payment whereof, well and roily to be made, we hereby bind ourselves, our heirs, executors, administrators, successors, and
assigns, jointly and sevcrally, firmly by these presents.
WIfEREAS, the above bounded Principal has been awarded and has entered into a contract, dated January 18, 20 Ath
said Obligee to do and perform the following work, to wit: Bernard Hoffman Park Improvements
as will more fully appear in said contract, reference to which is hereby made and,
WHEREAS, said Principal is required by the provisions of Chapter 7, Title 15, Part 4, Division 3 of the Civil code m furnish a
bond in connection with said contract, as hereinafter set fordt-
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION, is such, That, if said Principal, his or its heirs, executors,
adeniuistrators, successors or assigns or sub -contractors, shall fail to pay for any materials, provisions, provender, or other
supplies or teams, implements or machinery used in, upon, for or about the performance of the work contracted to be done, or
for any work or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such
work or labor, as required by the provisions of Chapter 7, Title 15, Part 4, Division 3 of the Civil Code, and provided that the
claimant shall have complied with the provisions of said Code, or for any amounts required to be deducted, withheld, and paid
over to the Franchise Tax Board from the wages of employees of the Principal and his subcontractors pursuant to Section 18806
of the Revenue and Taxation Code, with respect to such work and labor, the Surety hereon will pay for the same in an amount
not exceeding the sum specified in this bond; otherwise die above obligation shall tie void. In case suit is brought upon this
bond, the said Surety will pay a reasonable allDmay's fee to be fixed by the court.
This bund shall inure to the benefit of any and all persons, companies and corporations entitled to file claims under Section 3181
of the Civil Code, so as to give a right of action to them or their assigns in any suit brought upon the bond.
SIGNED, SEALED, DATED: January 21, 2000
Union Pacific- Construr'tion,., Tnr, i
- - (Principal)
American Motorists insurance Company
(Surety)
By: � /"�'�/_
M. Moody, r /Aanmey 1n Fact
DMECT CORRESPONDENCE TO:
LOU JONES & ASSOCIATES, PO BOX 41375, 7470 N. FIGUEROA ST., LOS ANGELES, CA 90041
In PHONE (323) 257-8291 • FAX (323) 256-7218
Public Works Pxymcnt Bond - I I-M-98,doc
CALIFORNIA ALL-PURPOSE ACKNOWLEDGEMENT
State of California
County of San Francisco
On January 21, 2000 before me, Joyce Lee Kinney, Notary Public
personally appeared ******************M. Moody******************
x❑ personally known to me - OR - ❑ proved to me on the basis of satisfactory
evidence to be the person whose name is
subscribed to the within instrument and
acknowledged to me that she executed the
same in her authorized capacity, and that
by her signature on the instrument the
person, or the entity upon behalf of which
the person acted, executed the instrument.
• �"'�
JOYCE LEE KINNEY
COMM. #1207099
L) + ati
NOTARY PUBLIC -CALIFORNIA o
CL
SAN FRANCISCO COUNTY
�.
My Comm. Expires Jan. 7, 2003 �r
WITNESS my hand and official seal.
/ mature o Notary
I'CEMPER.
Home Office: Long Grove, IL 60049
POWER OF ATTORNEY
Know All Men By These Presents:
That the Lumbermens Mutual Casualty Company, the American Motorists Insurance Company, and the American Manufacturers Mutual
Insurance Company, corporations organized and existing under the laws of the State of Illinois, having their principal office in Long Grove,
Illinois, (hereinafter collectively referred to as the "Company") do hereby appoint
M. Moody, J. M. Albada, Brian F. Cooper, Joyce Lee Kinney and Patrick T. Moughan of San Francisco,
California
their true and lawful agent(s) and attorney(s)-in-fact, to make, execute, seal, and deliver during the period beginning with the date of issuance
of this power and ending on the date specified below, unless sooner revoked for and on its behalf as surety, and as their act and deed:
Any and all bonds and undertakings
EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver any bond or undertaking which guarantees the payment or
collection of any promissory note, check, draft or letter of credit.
This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond within the dollar limit
of authority as set forth herein.
This appointment may be revoked at any time by the Company.
The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said Company as fully and amply
to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal office in
Long Grove, Illinois.
This Power of Attorney is executed by authority of resolutions adopted by the Executive Committees of the Boards of Directors of the Company
on February 23, 1988 at Chicago, Illinois, true and accurate copies of which are hereinafter set forth and are hereby certified to by the
undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with
the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys -in -fact, and to authorize them to execute on
behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and
other writings, obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process."
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the Executive
Committee of the Boards of Directors of the Company at a meeting duly called and held on the 23rd day of February, 1988:
"VOTED, That the signature of the Chairman of the Board, the President, any Vice President, or their appointees designated in writing and filed
with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile
on any power of attorney or bond executed pursuant to resolution adopted by the Executive Committee of the Board of Directors on February 23,
1988 and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to
be valid and binding upon the Company."
In Testimony Whereof, the Company has caused this instrument to be signed and their corporate seals to be affixed by their authorized officers,
this January 6, 2000.
Attested and Certified: Lumbermens Mutual Casualty Company
American Motorists Insurance Company
American Manufacturers Mutual Insurance Company
*°Wal Cai `s Mul /°a ° �Odsl� Iaay�i r
AR ILLINOIS
I, —�swORUE m � COAIORATIOM p
z IT
V 40f 6rT° �Y.+aWy �\\\° nf Or°�s
Robert P. Hames, Secretary by S. Kemper, III, Exec.Vice President
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
,Tf NI-11fiHY Pi, POW POLICY NUMBER: 044-'99 f INI r x'10 ita130
CERTIFICATE EXPIRES. 10-1-00
F -
CITY CiF C -PN W)F AEL
PUBLIC t4ORKC DEPT
P 41 Ro x 151115-60
SAN RAFOEL CA 94915
L
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated. _
30
This policy is not subject to cancellation by the Fund except upon tplq days' advance written notice to the employer.
JIjJ
We will also give you TSN days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with
respect to which this certificate of insurance 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.
AUTHORIZED REPRESENTATIVE PRESIDENT
Ei*PLOYERI5 LIABILITY LIMIT INCL-IiDTNG rEFE St.' GOETS. $1.000,000 PER-acr.w.ii7RENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL TINSURFD EMPLOYER EFFECTIVE
01/21/00 Ia ATTACHED TO AND FORMS A PART OF THIS POLICY.
NAME OF ADDITIONI-IL INSURED4 CITY CIF SAN RAFAEL
ENDORSEMENT #2065 ENTITLED CERT IF I COTE HOLDERS' NO -0 -CE EFFECTIVE
01/2-1/00 IS ATTACI'•IED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
UNION raw IVIG CONSTRUC1 10N. INC
UNION PACIFIC COtdSTRUCTION
501 LAKEV T LLE ST :ATF F
PFI Fal. I MA Cn 495 ,
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 102621REV_ 3-95)
ACORD CERTIFICAI _ OF LIABILITY INSURt , XECsR cw DATE(MM/DD/YY)
UNION -1 01/21/00
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Don Ramatici Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 551 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Petaluma CA 94953 COMPANIES AFFORDING COVERAGE
Larry Devlin I COMPANY
PhoneNo 707-782-9200 Fax No 707-782-9300 A Great American Insurance Co.
INSU RED
COMPANY
B
COMPANY
Union Pacific Construction C
501 Lakeville Street, Suite F I COMPANY
Petaluma CA 94952 D
COVERAGES
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.
CO TYPE OF INSURANCE
LTR
GENERAL LIABILITY
A X COMMERGAL GENERAL LIABILITY
CLAIMS MADE [ X] OCCUR
OWNER'S d CONTRACTORS PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/ INCL
PARTNERS/EXECUTIVE
OFFICERS ARE EXCL
OTHER
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ILIMITS
DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL AGGREGATE
52,000,000
PAC791757106 03/28/99 03/28/00 (PRODUCTS - COMP/OPAGG
$2,000,000
PERSONAL d ADV INJURY
$ 1,000,000
EACH OCCURRENCE
$ 1,000,000
FIRE DAMAGE (Any one fire)
$ 100,000
MED EXP (Anyone person)
I $ 5,000
COMBINED SINGLE LIMIT
$
BODILY INJURY
$
(Per person)
BODILY INJURY
$
(Per accident)
PROPERTY DAMAGE I $
AUTO ONLY - EA ACCIDENT I S
OTHER THAN AUTO ONLY
EACH ACCIDENT I $
AGGREGATE IS
EACH OCCURRENCE _
(AGGREGATE g
Is
TORY LIMITS I (DER'
EL EACH ACCIDENT Is
EL DISEASE - POLICY LIMIT 15
EL DISEASE - EA EMPLOYEE I $
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
RE: Operations of the Named Insured for the Certificate Holder
*OB: Bernard Hoffman Park Improvements
**10 day notice will be sent on non-payment o£ premium
City of San Rafael, its elective and appointive boards, commissions
30*Special officers, agents & empioyees
CERTIFICATE HOLDER CANCELLATION
CITYSA6 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
Department of Public Works eo£ San Rafael** BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGA`ON OR LIABILITY
Depa
P.O. BOX 151560 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
San Rafael CA 94915-1560 AUTHo EPRESENTATI
ACORD 25-S (1/95) OLkM�DQ 'CORPORATION 1988
COMMERCIAL GENERAL LIABILITY
CG 20 10 03 97
POLICY NUMBER: PAC791757106
INSURED: Union Pacific Construction
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 Person or Organization:
City of San Rafael
its elective and appointive boards, commissions, officers, agents & employees
Attn: Department of Public Works
San Rafael, CA 94915-1560
JOB: Bernard Hoffman Park Improvements
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
Who Is An Insured (Section II) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured.
CG 20 10 03 97 Copyright, Insurance Services Office, Inc., 1996