HomeMy WebLinkAboutCC Resolution 10273 (City Hall Boiler Replacement)RESOLUTION NO. 10273
RESOLUTION OF AWARD OF CONTRACT FOR THE CITY HALL
BOILER REPLACEMENT TO RELIANCE ENTERPRISES IN THE
AMOUNT OF $47,693.00, AND REALLOCATING AN ADDITIONAL
$25,000.00 FROM THE BUILDING MAINTENANCE FUND (001-4427)
TOWARDS THE PROJECT.
BE IT RESOLVED by the Council of the City of San Rafael as follows:
WHEREAS, The City Hall Boiler is over 33 years old and in need of
replacement, and
WHEREAS, Lefler Engineering began design work on the above-mentioned
project in 1998, and produced plans and specifications for the project, and
WHEREAS, on the 13"' day of July, 1998, 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:
"CITY HALL BOILER REPLACMENT
PROJECT NO. 001-4427-405-8000
in accordance with the plans and specifications therefor on file in the office of said City
Clerk; and
WHEREAS, the bid of RELIANCE ENTERPRISES, at the unit prices stated
in its bid was and is the lowest and best bid for said work and said bidder is the lowest
responsible bidder.
NOW, THEREFORE, IT IS HEREBY ORDERED AND RESOLVED that
the bid of RELIANCE ENTERPRISES for $47,693.00 is hereby accepted at said unit
prices and that the contract for said work improvements be and the same is hereby
awarded to said RELIANCE ENTERPRISES at the unit prices mentioned in said bid.
BE IT FURTHER ORDERED AND RESOLVED that the Mayor and the City
Clerk of said City be authorized and directed to execute a contract with RELIANCE
ENTERPRISES for said work and to return the bidders bond upon the execution of said
contract.
BE IT FURTHER ORDERED AND RESOLVED that the City Council
authorize the allocation of an additional $25,000 .00 from the Building Maintenance
Fund (001-4427) towards this project.
BE IT FURTHER RESOLVED that the Director of Public Works 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 20 day of July, 1998, by the following
vote, to wit:
AYES: COUNCIL MEMBERS: Cohen, Heller, Miller, Phillips and Mayor Boro
NOES: COUNCIL MEMBERS: None
ABSENT: COUNCIL MEMBE S: None ` /^
• �CJ�
ku i JEWE W LEO CINI, City Clerk
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City. of San Rafael • California
Form of Contract Agreement
for
CITY HALL BOILER REPLACEMENT
This Agreement is made and entered into this 20th day of July, 1998 by and between
the City of San Rafael (hereinafter called City) and Reliance Enterprises (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: City Hall Boiler Replacement , 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 by October 31, 1998 and with such extensions of
time as are provided for in the General Conditions.
IIII - 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.
NO. ITEM QUANTITY UNITS UNIT PRICE TOTAL PRICE
1. ( Sample Form of Schedule) @ _
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
AGREEMENT • 1
C t--O�
V y
APPROVED AS T
Gary T. Ragghidnti
City Attorney
CONTRACTOR: RELIANCE ENTERPRISES
Donald M. Helfer, P dent
for
AGREEMENT 0 3
PRICES OF ITEMS
NOTE: In the event of error or conflict in the prices set forth below, the "Unit Price" will
govern. In the event that the "Unit Price" is illegible or indistinguishible it shall be
established by dividing the "TotalPrice" by the "Number of Units."
I NO. ITEM QUANTITY UNITS UNIT PRICE
1. Demolition
2. Remove & reinstall generator air
intake
3. Install new boiler (B-1)
4. Install new heating hot water
pump (P-1)
5. Reconnect piping to boiler and
pump
6. Pipe insulation
7. Install new flue
8. Extend housekeeping pad
9. Revise and reconnect electrical
wiring
10. Reconnect control wiring
11. Water balance
12. Testing and start up
1
1
1
1
1
L.S. @ 3,381.00 =
L.S. @ 453.00 =
L.S. @ 15,486.00 =
L.S. @ 2,034.00 =
TOTAL PRICE
3,381.00
453.00
15,486.00
2,034.00
L.S. @ 11,824.00 = 11,824.00
1 L.S.
@
931.00 =
931.00
1 L.S.
@
8,702.00 =
8,702.00
1 L.S.
@
759.00 =
759.00
1 L.S.
@
1,836.00 =
1,836.00
1 L.S.
@
620.00 =
620.00
1 L.S.
@
1,000.00 =
1,000.00
1 L.S.
@
667.00 =
667.00
GRAND TOTAL BID $ 47,693.00
PROPOSAL • 3
ISR
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Insurance&Llabil ly
EXECUTED IN TWO (2) ORIGINAL COUNTERPARTS
PERFORMANCE BOND
ST. PAUL FIRE AND MARINE
INSURANCE COMPANY
St. Paul, Minnesota
A Capital Stock Company
Approved by The American Institute of Architects
A.I.A. Document No. A-311 Feb., 1970 Edition
BOND NO. JS0914
PREMIUM: $429.00
FIRST TERM PREMI'J'" RILLY
EARNED
KNOW ALL MEN BY THESE PRESENTS: That ...... R-E--CCRPORAT1ON DBA RELIANCE ENTERPRISES
.........................
250 COLGAN AVENUE SANTA ROSA,_CA 95407
....................................�..............---------................------------...
(flare insert the name and address or legal title of the Contractor)
as Principal, hereinafter called Contractor, and, ST. PAUL FIRE AND MARINE INSURANCE COMPANY, a corporation
organized under the laws of the State of Minnesota, with its Ifome Office in the City of St. Paul, Minnesota, as Surety,
hereinafter called Surety, are held and firmly bound unto
CITY TYOFSANRAFAE..
.................. .. ._ .....DEPARTMENTOFPUBLICWORK
.. _.. .•S...._.._....
............................ 1400.- 5TH., AVENUE.... SAN... RAFAE.L.,...CA... 94.9.1.6-.1689...........................................................................................
(Here insert the name and address or legal title of the Owner)
as Obligee, hereinafter called Owner, in the amount of ... .F.QRTY... 5.EV.EN... T.HQ.USAN.O... SIX ... HUNDRED ... NINETY .......................
THREE ... ARD ... N9/_.1.Q9--.--.-----.-----.-.----------------------.--.---.---.---dollars ($........ 4.7_,693.8(1-.--.--.--.-),
for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
WHEREAS, Contractor has by written agreement dated, .................7 -20__...._,_,......_.• -•„.,_...•__.,__._..._.._._...._..............19...... q8
entered into a contract with Owner for ............ C[TY ... (IALL-..HQI-LER.-REPL-AC.EMEN.T,...PRQJE.CT..N.Q_...A01..49.2.7.-.4.Q-ra--8000
.......... ........ ••------- ..... ......... 1..1.11. ...... •---------•---------- •-------------------------- .... ... --------- -..... --...... ...-.. ...- .-...............------------ ........ .
in accordance with drawings and specifications prepared by ................................. _...................................... _.................. ....................
.................................................................................-------------------------.......----------........---..............................................----------------.........................
(here insert full name, title and address)
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform said Contract,
then this obligation shall be null and void; otherwise it shall remain in full force and effect.
The Surety hereby waives notice of any alteration or extension of succession of defaults under the contract or contracts of completion
time made by the Owner. arranged under this paragraph) sufficient funds to pay the cost of com-
pletion less the balance of the contract price; but not exceeding, including
• � ----- r-.- .i... c.—t., mw hr It2htr herrundpr
CALIFORNIA ALL-PURPO_ .: ACKNOWLEDGMENT No. 5907
t�t,.f�CC'•G YAGf1C'��t%..ly"•r•^.�'C%_../':"!, :C;C t:"r•'� i . � �i'r
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A State of CALIFORNIA
County of rnNnMA
l On 7-20-98 before me, CHERYL GRIGGS, NOTARY PUBLIC i
DATE
�
NAME, TITLE OF OFFICER - E.G, -JANE DOE, NOTARY PUBLIC-
1
personally appeared SHERRY PHILLIPS
Al
NAMEIS) OF SIGNER(S)
O personally known to me - OR - ❑
proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
i
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their i
signature(s) on the instrument the person(s),
i
or the entity upon behalf of which the
iperson(s)
acted, executed the instrument.
WITNESS my hand and official seal.
nom, rHRILGRIGGS
1
�,R-I' • � nsslon # If 113741
C,311to"o
L r oma Coup'-
SIGN�URE OF NOTA94/
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OPTIONAL
1
1 Though the data below is not required by law, it may
prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
DESCRIPTION OF ATTACHED DOCUMENT
i ❑ INDIVIDUAL
i
CORPORATE OFFICER
1
l❑
j
TITLE OR TYPE OF DOCUMENT
` TITLE(S)
1
L❑ PARTNER(S) ❑ LIMITED
❑ GENERAL
FRI ATTORNEY-IN-FACT
NUMBER OF PAGES
t ❑ TRUSTEE(S)
�� ❑ GUARDIAN/CONSERVATOR
❑ OTHER:
1
DATE OF DOCUMENT 1-
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l SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
$T___PgUL FTRF AND MARINE INSURANCE
COMPANY SIGNER(S) OTHER THAN NAMED ABOVE i
"r+.+r'rr'rr'r+��..�r��w .. .. ..i_.r'<�•c'1GC.r.J.�.�'�;
ru�c'.r"/.r_i�C.r::'r.�'�C/.'.'Lr�.G:riC%�it'.r✓C%'r;{.tiC'�/./' '•--!�'�C:'•!./C'U
01993 NATIONAL NOTARY ASSOCIATION - 8236 Remmet Ave., P.O. Box 7184 - Canoga Park, CA 91309-7184
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1'ropeA bab�thly
Irnurance
ST. PAUL FIRE AND MARINE
INSURANCE COMPANY
EXECUTED IN TWO (2) ORIGINAL COUNTERPARTS
LABOR AND MATERIAL PAYMENT BOND
Approved by The American Institute of Architects
A.I.A. Document No. A-311 Feb., 1970 Edition
'f'he bond is issued simultaneously with another bond in favor of the
owner conditioned for the full and faithful performance of the contract.
St. Paul, Minnesota
A Capital Stock Company
BOND NO. JS0914
PREMILM INCLUDED IN THAT
OF PERFORMANCE BOND
R -E CORPORATION DBA RELIANCE ENTERPRISES
KNOW ALL MEN BY T11ESE PRESENTS: That----------------------•---...............------.....---......---•--....---•--------...........-------•..........-----
250 COLGAN AVENUE, SANTA ROSA, CA 95407
------------------------------------------------------•----•----....---- • ••----._.........-----------------......................-----........--•--•--••-----.......------...............------•---------........... •......
(stere insert the name and address or legal title of the Contractor) ,
as Principal, hereinafter called Principal, and, ST. PAUL FIRE AND MARINE INSURANCE COMPANY, a corporation
organized under the laws of the State of Minnesota, with its Home Office in the City of St. Paul, Minnesota, as Surety,
hereinafter called Surety, are held and firmly bound unto
...............CITY ... OF__SAN... RAFAEL, DEPARTMENT OF PUBLIC WORKS
1400..5TH. AVENUE.,. SAN. RAFAEL_,-_ CA._949.1.6.-1680
. ..................
(Here insert the name and address or legal title of the Owner)
as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinbelow defined, in the amount of
FORTY..SEI(EN..ll-OUSANR.-SIX.. HUNDRED.. NINEF..THREE..MD. NQA00---------------------- Dollars ($...4 , 693, 00- _-................. )7
(Here insert a sum equal to at least one-half of the contract price)
for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
WHEREAS, Principal has by written agreement dated. ........ 7-20 ................
....................---
*................... ------ * ...
----.... __.__..19 ...... ., 9E
entered into a contract with Owner for ..... CI.TY..NALL.. BOIL.ER... REPLAEE�ME•NT�... PROJECT••••••- ...••-•••••••----•--•---•---•--•--•-•-----•-
.... .... ........... ....... ............. NO,�... 401. -442.7. -.40.5 -AGOG ..................... ...-........................................................................ ........... .....--.........
in accordance with drawings and specifications prepared by ....................................................... ......
--•---••..................•-•--••-----•--............---.....---•------.................---.....................---------..................---..............................................---•-----••---........_........
(Here insert full name, title and address)
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall promptly make payment to all claimants as
hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract, then this obligation shall
be void, otherwise it shall remain in full force and effect, subject, however, to the following conditions:
1. A claimant is defined as one having a direct contract with the work or labor was done or performed. Such notice shall be served by
Principal or with a subcontractor of the Principal for labor, material, mailing the same by registered mail or certified mail, postage prepaid,
or both, used or reasonably required for use in the performance of the in an envelope addressed to the Principal, Owner or Surety, at any
contract, labor and material being construed to include that part of place where an office is regularly maintained for the transaction of
water- ¢as. owwer, hKht, heat, oil, gasoline, telephone service or rental business, or served in any manner in which legal process may be served
CALIFORNIA ALL-PURPL _ E ACKNOWLEDGMENT No. 5907
(:.if�C_�r'.C".�%_/�C�'C/:��/✓...: �._/�„.���c�ie'r:�i ':�; i•.+--~'r�i%+._ � ,-'�.^'r^';_ :',..-..;rr.-•r;>•->•-•,: ... - "r"/.CiCC.Gr.
I State of CALIFORNIA
County of SONOMA
V.
1 l
On 7-20-98 before me, CHFRYI GRT[ -,GS, NnTARY Rligl Tr
1,
DATE NAME, TITLE OF OFICER - E G. -JANE DOE. NOTARY PUBLIC-
personally appeared SHERRY PHILLIPS
1
NAME(S) OF SIGNER(S) 1
11 ® personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence
i to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged 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), i
or the entity upon behalf of which the
person(s) acted, executed the instrument. i
t �
1
WITNESS my hand and official seal. i
1 L c P,fGG,,
7 s.I3n g 1110741 ` l
II : '. � ;,'RaIIc — Callforttiu y n P
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I -.-- • SIGNAT�RE OF NOTAR�
t
OPTIONAL
t
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
t fraudulent reattachment of this form.
1
CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT
l
( ❑ INDIVIDUAL 1
❑ CORPORATE OFFICER
TITLE OR TYPE OF DOCUMENT
` TITLE(S) t
t
i ❑ PARTNER(S) ❑ LIMITED t
1 ❑ GENERAL l
C� ATTORNEY-IN-FACT NUMBER OF PAGES l
` ❑ TRUSTEE(S)
i ❑ GUARDIAN/CONSERVATOR
❑ OTHER:
DATE OF DOCUMENT i
t
1 t
t SIGNER IS REPRESENTING: t
t NAME OF PERSON(S) OR ENTITY(IES) t
i ST. PAUL FIRE AND MARINE INSURANCE COMPANY
SIGNER(S) OTHER THAN NAMED ABOVE i
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t
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®1993 NATIONAL NOTARY ASSOCIATION - 8236 Remmet Ave., P.O. Box 7184 - Canoga Park, CA 91309.7184
31. VA UL IYIICL MARINE INSURANCE COMPANY CERTIFICATE OF
Surety 385%shingu Street, Sl. Paul, Minnest, '5102 AUTHORITY NO.
Ci4FIFIED For verifiaalion of til, aenficky of ibis Pow, of Auurney, you may telephone lull free 1-800-421-3880 and ask liar
COPY NO• the Power of Auurney Clerk. Please refer hi the Certificate of Authority Nu. and the named individual(s).
F-15' 6 GENERAL POWER OF ATTORNEY - CERTIFIED COPY
(Original on file at Home Office of Company. See Certification.)
i.NO%% ,1.1. MI'N BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, u corporation organized and existing under the laws of the State
of Miu,kcsola, having its Principal off ice in the City of St. Paul, Minnesota, dues hereby constitute and appoint:
Richard A. Jaffee, Sherry Phillips, Catherine A. Pinney, individually,
Santa Rosa, California
its true and lawful auorney(s)-in-last tit execute, seal and deliver for and on its behalf us surety, any and all bonds and undertakings, recognizances, contracts of
indemnity and other writings obliginory Ili the nature Ihereol, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or
otherwise,
NOT TO EXCE® IN PENALTY THE SUM OF FIVE MILT, ION DOLLARS($5,000,000)EACH
and the execution of all such insir a icnl(s) in pursuance of these presents, shall tic as binding upon said St. Paul Fire and Marine Insurance Company, as fully and
amply, Io all intents and purposeS, as if the Same had been duly executed and acknowledged by its regularly elected officers at its principal office.
This Power of Auurney is executed, and may be certified to and may lie revoked, pursuant to and by authority of Article V,-Seclion 6(C), of the By -Laws adopted by
the Shareholders of ST. PAUI. FIRE AND MARINE INSURANCE COMPANY ;it a nnceting called and held on file 281h day o1' April, 1978, of which the following
is a [rue transcript of Said Section b (C'):
"'file President or any Vice President, Assistant Vice President, Secretary mr Service Center General Manager shall have power and authority
(1) To appoint Ailoineys-uu-facl, and t, authorize them to execute on behalf of [he Company. and attach the Scul of [he Company thereto, bonds and
undertakings, accognizanceS, contracts of indemnity and other wrilings obligatory in the nature thereof, and
(2) Tu appoint special Allurneys-in-fuel, who are hereby authorized to certify to copies of any power-of-attorney issued in pursuance of this section
and/or any of the Ry-LaWS of the C'omp;uhy, and
(3) To remove, ;u any time, any such Auurney-in fact or Special Auurney-in-fact and revoke the authority given him."
Further, this Power of Auurney is signed and scaled by facsimile pursuant Ili resolution of the Board of Direclors of said Company adopted at a meeting duly called and
held on the 501 day of May, 1959, of which the Inllow•ing IS it true excerpl:
-'Now thereli re [he signatures of such officers and filesoul of the Company may be affixed to any such power of attorney or any certificate relating thereto by
facsimile, and any such power of attorney or certificate hearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and
any such power sur cxeculed and ceilified by fuesimile Signatures and facsimile seal shall he valid :aid binding upon the Company in file future with respect to
any bond or undertaking to which it is attached."
�►RE # IN TESTIMONY WHEREOF. S6 Paul Fire and Murine Insurance Company has caused this instrument it) be signed and its corporate
JvF 4 seal lit be affixed by its authorized officer, this .10th day of November, A.D. 1990.
ST. PAUI. FIRE AND MARINE INSURANCE COMPANY
T z
sli E G° m STATE OF NEW JERSEY Ss—
y,an�uNn Counly of Sonucrsel
KENNI fl( J. RYAN, Secretary
On this 29th day of ,Jan�r 19 98 , before nue came the individual who executed the preceding instrument, to me
pcisonully known, unit, being by tine duly sworn, salifitfla t he/she is file thercm described and authorized officer of SL Paul Fire and Marine Insurance Company;
that the seal affixed In said insu-uuacnl is the C'orporulc Seal ill* said Company; that the said Cuupurale Seal and his/her sign;uure were duly affixed by order of the
Board of Directors of said Company.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal, al the township of Bedminster, New Jersey, the
o*Sx�ry d; y and year first above written.
F tiaetic !„W � � � !MIddlesex,
LINDA SMET-HER , Notary PubliNJ
My Commission Expires December 16, 2001
CERTIFICATION
I, the undersigned officer of SI. Paul Fire and Marine Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and
affidavi(, and the copy of the Section of file Ily-laws of said Company as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME
OFFICE OF SAID COMPANY, and Ihat file same arc correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not
bean revoked and is now in full lirrce Mond elfecl.
y t1RE ,
IN TESTIMONY WIIEREOF, I have hereunlo set my hand this
N z
r° —20TH day of .)(11 Y 19 98 MICHAEL W. ANDERSON, Secretary
Only a certified copy of Power of Auorncy bearing the Certificate of Authority No. prinled in red on the upper right corner is binding. Pholocopies, carbon copies or
other reproductions of this document are invalid and out binding upon the Company.
ANY INSTRUMENT ISSUED IN EXCESS OF THE PENALTY AMOUNT STATED ABOVE IS TOTALLY VOID AND WITHOUT ANY VALIDITY.
29550 Rev. 12.96 Printed in U.S.A.
r` .. :.:::".:':::... .... ...::::.. .... .. ................... ..... . ...... ... ..... .
ACDRD,, ERTIF[ :..
DATE (MM/DD/YY)
>< .. :� . Z _ 08/04/98
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eozzuto Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9274 Madison Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Orangevale CA 95662- COMPANY
(916) 988-4500 ( ) - AMID -CENTURY INSURANCE COMPANY
INSURED
COMPANY
Reliance Enterprises B
250 Colgan Avenue COMPANY
C
Santa Rosa CA 95404- COMPANY
(707) )545-5460 D
OOVRAGES
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
LTR
TYPE OF INSURANCE
A
GENERAL UABIUTY
X COMMERCIAL GENERAL LIABILITY
60227 87 20
CLAIMS MADE I—` -I OCCUR
06/30/99
X OWNER'S & CONTRACTOR'S PROT
A
AUTOMOBILE LIABILITY
PERSONAL & ADV INJURY 1$1 , 0 0 0, 0 0 0
ANY AUTO
X
ALL OWNED AUTOS
SCHEDULED AUTOS
FIRE DAMAGE (Any one fire) IS100, 000
X
HIRED AUTOS
X
NON -OWNED AUTOS
06/30/98
GARAGE LIABILITY
COMBINED SINGLE LIMIT $1,000,000
ANY AUTO
A
EXCESS LIABILITY
BODILY INJURY $
(Per person)
X1 UMBRELLA FORM
7 OTHER THAN UMBRELLA FORM
A
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)
LIMITS
I GENERAL AGGREGATE $2 , 000, 000
60227 87 20
06/30/98
06/30/99
(PRODUCTS-COMP/OPAGG $2, 000, 000
PERSONAL & ADV INJURY 1$1 , 0 0 0, 0 0 0
EACH OCCURRENCE 5 1 , 0 0 0, 0 0 0
FIRE DAMAGE (Any one fire) IS100, 000
MED EXP (Any one person) $5, 000
60227 87 20
06/30/98
06/30/99
COMBINED SINGLE LIMIT $1,000,000
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
AUTO ONLY - EA ACCIDENT S
OTHER THAN AUTO ONLY:
EACH ACCIDENT 1 $
AGGREGATE S
1 EACH OCCURRENCE $1,000,000
60221 35 63
06/30/98
06/30/99
AGGREGATE $1,000,000
S
A05105183
THE PROPRETOR/)(ECU n INCL
PARTNERS/EXECUTIVE Ir --I{
OFFICERS ARE: EXCL
A OTHERINLAND MARINE 602213563
I x l TORY LIMITS I IOER
10/01/97 10/01/98 I EL EACH ACCIDENT IS1, 000, 000
EL DISEASE - POLICY LIMIT I $1 , 0 0 0, 0 0 0
EL DISEASE - EA EMPLOYEE I S 1, 0 0 0, 0 0 0
06/30/98 06/30/99 MISC. TOOLS $15,000
LEASED/RENTED $10,000
HIRED EQUIPMENT
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED.
JOB: CITY HALL BOILER REPLACEMENT
*10 DAY CANCELLATION FOR NONPAYMENT OF PREMIUM.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL QIDMA,M(MAIL
CITY OF SAN RAFAEL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
DEPARTMENT OF PUBLIC WORKS �t��iii{I(X,xxII€}tcKr}�r�{c�(ii�(Xrli��f(
P.O. BOX 151560 !�
SAN RAFAEL CA 94916-1560 AUTHOR1 R ESEN —/
:ACORNS tft95j oACOFRD CORPORATION 1088
POLICY #:602278720 INSURED:RELIANCE ENTERPRISES
ADDITIONAL INSURED -
OWNERS, LESSEES OR
CONTRACTORS (FORM B)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
Where required by an "insured contract" and as evidenced by certificate of insurance on file with company
THE CITY OF SAN RAFAEL, ITS OFFICERS, AGENTS AND EMPLOYEES ARE ADDITIONAL
INSUREDS HEREUNDER BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF THE LAND
AND/OR PROPERTY AND/OR WORK DESCRIBED IN THE PUBLIC WORKS CONTRACT FOR
THE PROJECT ENTITLED, CITY HALL BOILER REPLACEMENT BETWEEN THE CITY OF
SAN RAFAEL AND RELIANCE ENTERPRISES FOR THE WORK AND THE IMPROVEMENTS
DESCRIBED THERIN.
(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 included as an insured the person or organization
shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for
you.
THIS ENDORSEMENT MUST BE ATTACHED TO A CHANGE ENDORSEMENT WHEN ISSUED
AFTER THE POLICY IS WRITTEN.
Copyright, Insurance Services Office, Inc., 1984
CG 20 10 (Ed. 11 85) Printed in U.S.A.