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PW Third and Union Street ResurfacingCity of San Rafael ♦ California Form of Agreement for Third and Union Street Resurfacing This Agreement is made and entered into this I % day of MAf-Ch 2019 by and between the City of San Rafael (hereinafter called City) and Team Ghilotti, Inc.. (hereinafter called Contractor). Witnesseth, that the City and the Contractor, for the considerations hereinafter named, agree as follows: 1- 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 specifications for the project entitled: Third and Union Street Resurfacing, 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. The required additional insured coverage for City under contractor's liability insurance policy shall be primary and noncontributory with respect to any insurance or coverage maintained by city and shall not call upon city's insurance or self-insurance for any contribution. 11- 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 Ten (10) 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 $2500 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. 1V - 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; provided that the total compensation under this Contract shall not exceed One Hundred Seventy One Thousand Two Hundred Seventy Seven Dollars and 80/100 ($171,277.80) unless a written amendment is executed by the City and the Contractor. ,A_�-ILAI aRiGIA NA� BASE BID ITEMS NO. ITEM QUANTITY UNITS UNIT PRICE TOTAL PRICE 1. Mobilization 1 LS @ $4,000.00 = $4,000 2. Signs and Traffic Control 1 LS @ $30,000.00 = $30,000 3. Full Width Grinding 35000 SF @ $1.40 $49,000 4. Hot Mix Asphalt Asphalt Concrete Overlay 570 TON @ $113.44 = $64,660.80 5. Striping and Pavement Markings a. Detail 9 1800 LF @ $1.00 = $1,800 b. Detail 22 200 LF @ $3.10 $620 c. Detail 27c 180 LF @ $5.15 $927 d. Detail 29 100 LF @ $7.00 = $700 e. Detail 37 80 LF @ $1.50 = $120 f. Detail 38 600 LF @ $1.65 = $990 g. Detail 39 240 LF @ $1.25 = $300 h. Pavement Markings 1600 SF @ $6.25 = (Yellow Thermoplastic) $10,000 i. Pavement Markings 600 SF @ $7.10 = (White Thermoplastic) $4,260 j. Red Curb 1300 SF @ $3.00 = $3,900 BASE BID $171,277.80 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 95% 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 22300 of the Public Contract 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 terns 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) 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 of equipment, 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: Lindsav Lara City Clerk CITY OF SAN RAFAEL: Ji r SC Lager Ci APPROVED AS TO FORM: N� Rob Epstein City Attorney CONTRACTOR: Team Ghilotti, Inc.. By: Robert E Lee By: [Print Name of Corporate Officer] Vice President [Title of Corporate Officer] and Joe Moreira [Print Name of Corporate Officer] General Manager / Assistant Secretary [Title of Corporate Officer] CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 cerch r3 2�o I� Jennifer Lorraine Ghilotti. Notary Public On before me, , Date jj Here Insert Name and Title of the Officer personally appeared }�� �lor� Ifo_ 21 P"bbel-i Lee Nome(s) of Signer(s) 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 h+s/her/their authorized capacity(ies), and that by hisP e#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 JENNIFER LORRAINE GHILOTTI paragraph is true and correct. o = COMM. #2125426 z WITNESS my hand and official seal. a ; sx Notary Public - California o Z Sonoma County My Comm. Ex fres Sep. 1, 2019' Signature Place Notary Seal and/or Stamp Above Sign e of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: A312'1"° - 2010 Performance Bond Premium: $2,096.00 Bond No.: 0220109 CONTRACTOR: SURETY: (Name, legal status and address) Team Ghilotti, Inc. Berkley Insurance Company This document has important legal 2531 Petaluma Blvd., South 475 Steamboat Rd. consequences. Consultation with an attorney is Petaluma, CA 94952 Greenwich, CT 06830 encouraged with respect to its completion or OWNER: modification. (Name, legal status and address) City of San Rafael y g An singular reference to Contractor, Surety, 1400 Fifth Avenue, City Hall. Room 209 Owner or other party shall be considered plural San Rafael, CA 94901 where applicable. CONSTRUCTION CONTRACT This document combines two separate bonds, a Date: Performance Bond and a Payment Bond, into one forth. This is not a single combined Amount $171,277.80 One Hundred and 801100 Seventy One Thousand Two Hundred Seventy Seven Dollars Performance and Payment Bond. Description: (Name and location) Third and Union Street Resurfacing BOND Date: March 6, 2019 (Not earlier than Construction Contract Date) $171277.80 One Hundred Seventy One Thousand Two Hundred Seventy Seven Dollars , Amount: and 801100 Modifications to this Bond: ® None O See Section 16 CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) (Corporate Seal) Team Ghilotti, Inc. Berkley Insurance Company 475 Steamboat Rd. Greenwich, CT 06830 Signature: Signature: VAt,�Aa-�_ Name Robert E. Lee, Vice President Name Erin Bautis a and Title: and Title: Attorney -in -Fact (Any additional signatures appear on the last page of this Performance Bond.) (FOR INFORAIATION ONL Y— Name, address and telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE: (Architect, Engineer or other party.) ABD Insurance & Financial Services, Inc. 5448 Thornwood Drive San Jose, CA 95123 408-684-8379 Conforms to American Institute of Archftects 2010 A312Tm Performance Bond 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 Santa Clara On MAR — 6 2019 before me, Jean L. Neu, Notary Public (insert name and title of the officer) personally appeared Erin Bautista who proved to me on the basis of satisfactory evidence to be the person(5s) whose name(IS) is/duce subscribed to the within instrument and acknowledged to me that ae/she/ttx y executed the same in MWher&k)E :authorized capacity(, and that by InWher/Q mir signature(is) 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. JEAN L. NEU WITNESS my hand and official seal. j Notary Public—Calfornia Santa Clara County Commission 4 2230024 My Comm. Expires Mar 1. 2022 Signatur (Seal) § 1 The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner for the performance of the Construction Contract, which is incorporated herein by reference. § 2 If the Contractor performs the Construction Contract, the Surety and the Contractor shall have no obligation under this Bond, except when applicable to participate in a conference as provided in Section 3. § 3 If there is no Owner Default under the Construction Contract, the Surety's obligation under this Bond shall arise after .1 the Owner first provides notice to the Contractor and the Surety that the Owner is considering declaring a Contractor Default. Such notice shall indicate whether the Owner is requesting a conference among the Owner, Contractor and Surety to discuss the Contractor's performance. If the Owner does not request a conference, the Surety may, within five (5) business days after receipt of the Owner's notice, request such a conference. If the Surety timely requests a conference, the Owner shall attend. Unless the Owner agrees otherwise, any conference requested under this Section 3.1 shall be held within ten (10) business days of the Surety's receipt of the Owner's notice. if the Owner, the Contractor and the Surety agree, the Contractor shall be allowed a reasonable time to perform the Construction Contract, but such an agreement shall not waive the Owner's right, if any, subsequently to declare a Contractor Default; .2 the Owner declares a Contractor Default, terminates the Construction Contract and notifies the Surety; and 3 the Owner has agreed to pay the Balance of the Contract Price in accordance with the terms of the Construction Contract to the Surety or to a contractor selected to perform the Construction Contract § 4 Failure on the part of the Owner to comply with the notice requirement in Section 3.1 shall not constitute a failure to comply with a condition precedent to the Surety's obligations, or release the Surety from its obligations, except to the extent the Surety demonstrates actual prejudice. § 5 When the Owner has satisfied the conditions of Section 3, the Surety shall promptly and at the Surety's expense take one of the following actions: § 5.1 Arrange for the Contractor, with the Consent of the Owner, to perform and complete the Construction Contract; § 5.2 Undertake to perform and complete the Construction Contract itself, through its agents or independent contractors; § 53 Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner for a contract for performance and completion of the Construction Contract, arrange for a contract to be prepared for execution by the Owner and a contractor selected with the Owner's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract, and pay to the Owner the amount of damages as described in Section 7 in excess of the Balance of the Contract Price incurred by the Owner as a result of the Contractor Default; or § 5.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances: .1 After investigation, determine the amount for which it may be liable to the Owner and, as soon as practicable after the amount is determined, make payment to the Owner, or .2 Deny liability in whole or in part and notify the Owner, citing the reasons for denial. § 6 If the Surety does not proceed as provided in Section 5 with reasonable promptness, the Surety shall be deemed to be in default on this Bond seven days after receipt of an additional written notice from the Owner to the Surety demanding that the Surety perform its obligations under this Bond, and the Owner shall be entitled to enforce any remedy available to the Owner. If the Surety proceeds as provided in Section 5.4, and the Owner refuses the payment or the Surety has denied liability, in whole or in part, without further notice the Owner shall be entitled to enforce any remedy available to the Owner. § 7 If the Surety elects to act under Section 5.1, 5.2 or 5.3, then the responsibilities of the Surety to the Owner shall not be greater than those of the Contractor under the Construction Contract, and the responsibilities of the Owner to the Surety shall not be greater than those of the Owner under the Construction Contract. Subject to the commitment by the Owner to pay the Balance of the Contract Price, the Surety is obligated, without duplication, for Conforms to American Institute of Architects 2010 A3121m Performance Bond .1 the responsibilities of the Contractor for correction of defective work and completion of the Construction Contract; .2 additional legal, design professional and delay costs resulting from the Contractors Default, and resulting from the actions or failure to act of the Surety under Section 5; and .3 liquidated damages, or if no liquidated damages are specified in the Construction Contract, actual damages caused by delayed performance or non-performance of the Contractor. § 8 If the Surety elects to act under Section 5.1, 5.3 or 5.4, the Surety's liability is limited to the amount of this Bond. § 9 The Surety shall not be liable to the Owner or others for obligations of the Contractor that are unrelated to the Construction Contract, and the Balance of the Contract Price shall not be reduced or set off on account of any such unrelated obligations. No right of action shall accrue on this Bond to any person or entity other than the Owner or its heirs, executors, administrators, successors and assigns. § 10 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. § 11 Any proceeding, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be instituted within two years after a declaration of Contractor Default or within two years after the Contractor ceased working or within two years after the Surety refuses or fails to perform its obligations under this Bond, whichever occurs first. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. § 12 Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears. § 13 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. § 14 Definitions § 14.1 Balance of the Contract Price. The total amount payable by the Owner to the Contractor under the Construction Contract after all proper adjustments have been made, including allowance to the Contractor of any amounts received or to be received by the Owner in settlement of insurance or other claims for damages to which the Contractor is entitled, reduced by all valid and proper payments made to or on behalf of the Contractor under the Construction Contract. § 14.2 Construction Contract. The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and changes made to the agreement and the Contract Documents. § 14.3 Contractor Default. Failure of the Contractor, which has not been remedied or waived, to perform or otherwise to comply with a material term of the Construction Contract. § 14.4 Owner Default. Failure of the Owner, which has not been remedied or waived, to pay the Contractor as required under the Construction Contract or to perforin and complete or comply with the other material terms of the Construction Contract. § 14.5 Contract Documents. All the documents that comprise the agreement between the Owner and Contractor § 15 If this Bond is issued for an agreement between a Contractor and subcontractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. Conforms to American Institute of Architects 2010 A312Tm Performance Bond § 16 Modifications to this bond are as follows: (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY (Corporate Seal) Signature: Name and Title: Address: Signature: Name and Title: Address: Conforms to American Institute of Architects 2010 A3121m Performance Bond (Corporate Seal) No. 13I -10192b POWER OF ATTORNEY BERKLEY INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. .b KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly 7, organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made, constituted and appointed, and does by these presents make, constitute and appoint: Bryan D. Martin; Erin Bautista; Jean L. Neu; Stephen: n •- E. Leveroni; Debra Ann Perry; or Angelina A. Campano of ABD Insurance & Financial Services, Inc. of San Mateo, CA its 5 true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver �? any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall exceed Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, Cn without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following o > resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25, 2010: RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief Executive c Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant Secretary are ° hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute oL bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal v of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and o 'o revoke any power of attorney previously granted; and further a RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner Land to the extent therein stated; and further v RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and 3 further o RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any fl = power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as 3 though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any .L person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued. 2 IN WITNESS WIIEREOF, the Company Ilan c 'sed these presents to bieygned and attested by its appropriate officers and its ffi 0 o corporate seal hereunto axed this�_e-day of Attest: Berkle Insurance Company (Seal) I3y By _R_ o F' Ira•<L`eden an Jef •e fter o U Executive Vice President & Secretary en o i esident WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. -d ° STATE OF CONNECTICUT) CL ss: E, COUNTY OF FAIRFIELD ) N o Sworn to before me, a Notary Public in the State of Connecticut, this day of ° by Ira S. Lederman and Jeffrey M. f lafter who are sworn to me to be the Executive Vice President and Secretar, /an the Senior Vice President, respectively, of"Berkle), Insurance Compartg1ARIAC. RUND13AI<EN NOTARY PUBLIC I G� •� �' �'`� ^ MY COMMISSION EXPIRES otary Public, State of Connecticut o APRIL 30, 2019 CERTIFICATE Z I, the undersigned, Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct Z and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked or rescinded and that the authority of the Attorney -in -Fact set forth therein, who executed the bond or undertaking to which this Power of Attorney is attached, is in full force and effect as 3 Q v of this date. Given under my hand and seal of the Company, this (P -M` day of (Seal) Vincent P. Forte Please verify the authenticity of the instrument attached to this Power by: Toll -Free Telephone: (800) 456-5486; or Electronic Mail: BSGlnquiry@berkleysurety.com Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com Please include with all communications the bond number and the name of the principal on the bond. Where a claim is being asserted, please set forth generally the basis of the claim. In the case of a payment or performance bond, please also identify the project to which the bond pertains. Berkley Surety is a member company of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 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 On MU -r C�h lb � ( CI before me, Jennifer Lorraine Ghilotti. Notary PiNir Date Here Insert Name and Title of the Officer personally appeared PL,0be.rk C (ZQ— NameN of Signer) who proved to me on the basis of satisfactory evidence to be the person(gwhose name's) is/are subscribed to the within instrument and acknowledged to me that he/she t Fey executed the same in his/heTtthetr authorized capacity(ies), and that by his/,"Te;,theW signature(4on the instrument the person(*, 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 JENNIFER LORRAINE GHILOTTI paragraph is true and correct. o ` COMM. #2125426 Z Notary Public • California X WITNESS my hand and official seal. Sonoma County My Comm. Ex ires Se , 1 2019 Signature r �1-Q- Place Notary Seal and/or Stamp Above Sig ure of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: 02017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: A312Tm - 2010 Payment Bond CONTRACTOR: (Name, legal status and address) Team Ghilotti, Inc. 2531 Petaluma Blvd., South Petaluma, CA 94952 OWNER: (Name, legal status and address) City of San Rafael 1400 Fifth Avenue, City Hall, Room 209 San Rafael, CA 94901 CONSTRUCTION CONTRACT Date: SURETY: Berkley Insurance Company 475 Steamboat Rd. Greenwich, CT 06830 Bond No. 0220109 Amount $171 ,277.80 One 0/1Hundred Seventy One Thousand Two Hundred Seventy Seven Dollars and Description: (Name and location) Third and Union Street Resurfacing BOND Date: March 6, 2019 (Not earlier than Construction Contract Date) One Hundred Seventy One Thousand Two Hundred Seventy Seven Dollars and Amount: $171,277.80 80/100 Modifications to this Bond: ® None CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Team Ghilotti, Inc. O See Section 18 SURETY Company: Berkley Insurance Company 475 Steamboat Rd. Greenwich, CT 06830 G . Signatu Signature: Name Robert E. Lee, Vice President Name Eri Bauti a and Title: and Title: Attorney -in -Fact (Any additional signatures appear on the last page of this Payment Bond.) (FOR INFORMATION ONLY—Name, address and telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE: ABD Insurance & Financial Services, Inc. (Architect, Engineer or other party:) 5448 Thornwood Drive San Jose, CA 95123 408-684-8379 Conforms to the American Institute of Architects 2010 A3127m Payment Bond This document has Important legal consequences. Consultation with an attorney Is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, owner or other party shall be considered plural where applicable. This document combines two separate bonds, a Performance Bond and a Payment Bond, Into one form. This Is not a single combined Performance and Payment Bond. (Corporate Seal) 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 Santa Clara On MAR - 6 2019 before me, Jean L. Neu, Notary Public (insert name and title of the officer) personally appeared Erin Bautista who proved to me on the basis of satisfactory evidence to be the person(5s) whose name(s) is/duce subscribed to the within instrument and acknowledged to me that he/she/fusty executed the same in kvtss/herkkx3ivauthorized capacity( , and that by kWher/Rmir 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. JEAN L. NEU WITNESS my hand and official seal. _ , `""j Notary Public _ California Santa Clara County Commission " 2230024 My Comm. Expires Mar 1, 2022 Signatur� (Seal) § 1 The Contractor and Surety, jointly and severally bind themselves, their heirs, executors, administrators, successors and assigns to the Owner to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which is incorporated herein by reference, subject to the following terms. § 2 If the Contractor promptly makes payment of all sums due to Claimants, and defends, indemnifies and holds harmless the Owner from claims, demands, liens or suits by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Construction Contract, then the Surety and the Contractor shall have no obligation under this Bond. § 3 If there is no Owner Default under the Construction Contract, the Surety's obligation to the Owner under this Bond shall arise after the Owner has promptly notified the Contractor and the Surety (at the address described in Section 13) of claims, demands, liens or suits against the Owner or the Owner's property by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Construction Contract and tendered defense of such claims, demands, liens or suits to the Contractor and the Surety. § 4 When the Owner has satisfied the conditions in Section 3, the Surety shall promptly and at the Surety's expense defend, indemnify and hold harmless the Owner against a duly tendered claim, demand, lien or suit. § 5 The Surety's obligations to a Claimant under this Bond shall arise after the following: § 5.1 Claimants, who do not have a direct contract with the Contractor, .1 have furnished a written notice of non-payment to the Contractor, stating with substantial accuracy the amount claimed and the name of the party to whom the materials were, or equipment was, furnished or supplied or for whom the labor was done or performed, within ninety (90) days after having last performed labor or last furnished materials or equipment included in the Claim; and .2 have sent a Claim to the Surety (at the address described in Section 13). § 5.2 Claimants, who are employed by or have a direct contract with the Contractor, have sent a Claim to the Surety (at the address described in Section 13). § 6 If a notice of non-payment required by Section 5.1.1 is given by the Owner to the Contractor, that is sufficient to satisfy a Claimant's obligation to furnish a written notice of non-payment under Section 5. 1.1 § 7 When a Claimant has satisfied the conditions of Sections 5.1 or 5.2, whichever is applicable, the Surety shall promptly and at the Surety's expense take the following actions: § 7.1 Send an answer to the Claimant, with a copy to the Owner, within sixty (60) days after receipt of the Claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed; and § 7.2 Pay or arrange for payment of any undisputed amounts. § 73 The Surety's failure to discharge its obligations under Section 7.1 or Section 7.2 shall not be deemed to constitute a waiver of defenses the Surety or Contractor may have or acquire as to a Claim, except as to undisputed amounts for which the Surety and Claimant have reached agreement. If, however, the Surety fails to discharge its obligations under Section 7.1 or Section 7.2, the Surety shall indemnify the Claimant for the reasonable attorney's fees the Claimant incurs thereafter to recover any sums found to be due and owing to the Claimant. § 8 The Surety's total obligation shall not exceed the amount of this Bond, plus the amount of reasonable attorney's fees provided under Section 7.3, and the amount of this Bond shall be credited for any payments made in good faith by the Surety. § 9 Amounts owed by the Owner to the Contractor under the Construction Contract shall be used for the performance of the Construction Contract and to satisfy claims, if any, under any construction performance bond. By the Contractor furnishing and the Owner accepting this Bond, they agree that all funds earned by the Contractor in the performance of the Construction Contract are dedicated to satisfy obligations of the Contractor and Surety under this Bond, subject to the Owner's priority to use the funds for the completion of the work. Conforms to the American Institute of Archhects 2010 A312Tm Payment Bond ___6 § 10 The Surety shall not be liable to the Owner, Claimants or others for obligations of the Contractor that are unrelated to the Construction Contract. The Owner shall not be liable for the payment of any costs or expenses of any Claimant under this Bond, and shall have under this Bond no obligation to make payments to, or give notice on behalf of, Claimants or otherwise have any obligations to Claimants under this Bond. § 11 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. § 12 No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the state in which the project that is the subject of the Construction Contract is located or after the expiration of one year from the date (1) on which the Claimant sent a Claim to the Surety pursuant to Section 5.1.2 or 5.2, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were fumished by anyone under the Construction Contract, whichever of (1) or (2) first occurs. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. § 13 Notice and Claims to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears. Actual receipt of notice or Claims, however accomplished, shall be sufficient compliance as of the date received. § 14 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. § 15 Upon request by any person or entity appearing to be a potential beneficiary of this Bond, the Contractor and Owner shall promptly furnish a copy of this Bond or shall permit a copy to be made. § 16 Definitions § 16.1 Claim. A written statement by the Claimant including at a minimum: .1 the name of the Claimant; .2 the name of the person for whom the labor was done, or materials or equipment furnished; 3 a copy of the agreement or purchase order pursuant to which labor, materials or equipment was furnished for use in the performance of the Construction Contract; .4 a brief description of the labor, materials or equipment furnished; .5 the date of which the Claimant last performed labor or last furnished materials or equipment for use in the performance of the Construction Contract; .6 the total amount earned by the Claimant for labor, materials or equipment furnished as of the date of the Claim, .7 the total amount of previous payments received by the Claimant; and .8 the total amount due and unpaid to the Claimant for labor, materials or equipment furnished as of the date of the Claim § 16.2 Claimant. An individual or entity having a direct contract with the Contractor or with a subcontractor of the Contractor to furnish labor, materials or equipment for use in the performance of the Construction Contract. The term Claimant also includes any individual or entity that has rightfully asserted a claim under an applicable mechanic's lien or similar statute against the real property upon which the Project is located. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the work of the Contractor and the Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment were furnished. § 163 Construction Contract. The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and all changes made to the agreement and the Contract Documents. § 16.4 Owner Default. Failure of the Owner, which has not been remedied or waived, to pay the Contractor as required under the Construction Contract or to perform and complete or comply with the other material terms of the Construction Contract. § 16.5 Contract Documents. All the documents that comprise the agreement between the Owner and Contractor. Conforms to the American Institute of Architects 2010 A312r" Payment Bond § 17 If this Bond is issued for an agreement between a Contractor and subcontractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. § 18 Modifications to this bond are as follows: (Space Is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Signature: Name and Title: Address: Conforms to the American Institute of Architects 2010 A3121 Payment Bond Signature: Name and Title: Address: No. BI -10192b POWER OF ATTORNEY BERKLEY INSURANCE COMPANY WILMINGTON, DELAWARE NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. .b KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly r, organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made, constituted and appointed, and does by these presents make, constitute and appoint: Bryan D. Martin; Erin Bautista; Jean L. Neu; Stephen E. Leveroni; Debra Ann Perry; or Angelina A. Campano of ABD Insurance & Financial Services, Inc. of San Mateo, CA its a true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver L = any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall CZ exceed Fifty Million and 00/100 U.S. Dollars (U.S350,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following o v resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25, 2010: c yRESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief Executive °o Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant Secretary are ° hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute oL bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and revoke any power of attorney reviously and rther R o RESOLVED, that such power er of attorney granted; limitthe acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further L > RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and 3 -2 further o , RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have np, ceased to be such at the time when such instruments shall be issued. -n IN WITNESS WIIEREOF, the Company has c iced these presents to be signed and attested by its appropriate officers and its 0 o corporate seal hereunto affixed this day of ' LL -,r c o Attest: Berkle Insurance Company (Sea!) By By oF" Ira• . L denAan Jef •e Executive Vice President & Secretary en o�-After -esident WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. -o ° STATE OF CONNECTICUT) o. o COUNTY OF FAIRFIELD ) o Sworn to before me, a Notary Public in the State of Connecticut, this day of - P. , by Ira S. Ledeiman Y and Jeffrey M Ilafter who are sworn to me to be the Executive Vice Presider t and Secr•etar n the Senior Vice President, respectively, ol'Berkley Insurance CompartOARIAC. RUNDBAI<EN , T v NOTARY PUBLIC ^ MY COMMISSION EXPIRES otary Public, State of Connecticut o APRIL30, 2019 CERTIFICATE VZ I, the undersigned, Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct Z '^ and complete copy of the original Power of Attorney, that said Power of Attorney has not been revoked or rescinded and that the authority of the CLQ °; Attorney -in -Fact set forth therein, who executed the bond or undertaking to which this Power of Attorney is attached, is in full force and effect as of this date. 3 �• Given under my hand and seal of the Company, this & 1 D-day of (Seal) Vincent P. Forte Please verify the authenticity of the instrument attached to this Power by: Toll -Free Telephone: (800) 456-5486; or Electronic Mail: BSGinguiry@berkleysurety.com Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com Please include with all communications the bond number and the name of the principal on the bond. Where a claim is being asserted, please set forth generally the basis of the claim. In the case of a payment or performance bond, please also identify the project to which the bond pertains. Berkley Surety is a member company of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. CALIFORNIA ALL-PURPOSE ACKNOWLIEDGMENT CIVIL CODE § 1189 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 1 County of ono rnCL— On MCu'ch before me, J} Jennifer Lorraine Ghilotti. Notary Public -�� � I � , Date Here Insert Name and Title of the Officer personally appeared deo b�+ �• l� Name(s)-of Signer(syk who proved to me on the basis of satisfactory evidence to be the persort{s) whose names) is/are-subscribed to the within instrument and acknowledged to me that he/s4efthey executed the same in hist rr eir authorized capacibAies), and that by his/her it signature(s�on the instrument the person(s), or the entity upon behalf of which the person(4 acted, executed the instrument. JENNIFER LORRAINE &HILOTTt COMM. #2125426 z ° g, Notary Public • California � z Sonoma County My Comm. Expires Se . 1, 2019 Place Notary Seal and/or Stamp Above 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 ature of Notary Pubic Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ACORO® CERTIFICATE OF LIABILITY INSURANCE llk� DATE(MMIDD/YYYY) 1 3/6/2019 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 have ADDITIONAL INSURED provisions or 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 ABD Insurance & Financial Services Attn: Construction Department 3 Waters Park Drive, Building 3, Suite 100 San Mateo, CA 94403 NAME: CONTACT Construction Certs PHONE FAX 650 488-8565 Alc No : 650-488-8566 E-MAIL ADDRESS: ConstructionCertRe uest theabdteam.com INSURERS AFFORDING COVERAGE NAIC q ✓ INSURERA: Executive Risk Indemnity Inc 35181 www.theabdteam.com OH55918 INSURED Team Ghilotti, Inc. 2531 Petaluma Blvd., South INSURER 8: Federal Insurance Company 20281 INSURER C: INSURER D: Petaluma CA 94952 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 47412385 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFF MMIPOLDDYMM/DD/YYYY POLICY EXP LIMITS A V COMMERCIAL GENERAL LIABILITY ✓ 54309508 10/1/2018 10/1/2019 EACH OCCURRENCE $1000000 CLAIMS -MADE F✓ OCCUR PREM SES JE.occurrence) $100,000 MED EXP (Any one person) $5,000 ✓ X, C, U Included PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY✓� JE Q F] LOC PRODUCTS - COMP/OP AGG $2,000,000 Deductible $10,000 OTHER: B AUTOMOBILE LIABILITY 54309507 10/1/2018 10/1/2019 (CMEe aBINEDISINGLE LIMIT $110001000 BODILY INJURY (Per person) $ ✓ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE $ Per accident ✓ HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY $1,000 Com ./Collision $ Deductible UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED7 N / A ✓ 54309509 10/1/2018 10/1/2019 �/ STATUTE ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I I I E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: TGI Job #8230 - City Project No. 11360. Third and Union Street Resurfacing. City of San Rafael, its officers, employees, agents and volunteers are named as additional insured as respects to the general liability on a primary and non-contributory basis, as required by written contract. Wavier of subrogation applies to workers compensation as required by written contract. Endorsements attached. CERTIFICATE HOLDER CANCELLATION RE: TGI Job #8230 - City Project No. 11360 of San Rafael M0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fifth Ave ACCORDANCE WITH THE POLICY PROVISIONS. San Rafael CA 94901 AUTHORIZED REPRESENTATIVE Scott Gaddy ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 97912385 10 19 GL AL(Phys Dam; XS WC PROF POLL INST FLTR I Sylvia Esperson 1 3/6/2019 1:53:20 PM (PST) Page 1 of 9 This certificate cancels and supersedes ALL previously issued certificates. 54309508 COMMERCIAL GENERAL LIABILITY 10-02-2508 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION II — WHO IS AN INSURED is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", .'property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the insured by this endorsement is limited as follows: In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the ..written contract requiring insurance", the insurance provided to the insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. b. The insurance provided to the insured does not apply to damages, loss, cost or expense arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and c. The insurance provided to the insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that insured, and then the insurance provided to the insured applies only to such "bodily injury" or "property damage" that occurs before: (1) The end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage; or \ (2) The end of the policy period; \�I whichever is earlier. 3. The insurance provided to the insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But the insurance provided to the insured by this endorsement still is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when that person or organization is an additional insured under such other insurance. 4. As a condition of coverage provided to the insured by this endorsement: (2) Supervisory, inspection, architectural or a. The insured must give us written notice as engineering activities. soon as practicable of an "occurrence" or an 10-02-2508 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2 with its permission. 47412305 1 15-19 GL AL Phys Dam) -XS WC PROF POLL INST FLTR I Sylvia Esperson 1 3/6/2019 1:53:20 PM (PST) I Page 2 of 4 This certificate cancels and supersedes ALL previously issued certificates. offense which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the 'occurrence" or offense. b. If a claim is made or "suit' is brought against the insured, the insured must: (1) Immediately record the specifics of the claim or "suit' and the date received; and (2) Notify us as soon as practicable. The insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. c. The insured must immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. d. The insured must tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover the insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the insured by this endorsement is primary to other insurance available to the insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., 10-02-2508 (Ed. 7-15) with its permission. 97912385 1 10 19 GL AL(Phys Dam) XS WC PROF POLL 1NST FLTR Sylvia Espers.n 1 3/6/2019 1:53:20 PM (PST) I Page 3 of 9 This certificate cancels and supersedes ALL previously issued certificates 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 be completed only when this endorsement Is Issued subsequent to preparation of the policy.) This endorsement, effective on 10/1/2018 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 54309509 of the Issued t0 Team Ghilotti, Inc. Endorsement No. (NAME OF INSURANCE COMPANY) Authorized 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 1.00% of total California premium. Schedule Person or Organization WHERE REQUIRED BY WRITTEN CONTRACT WC 99 03 04 (Ed. 7-08) Job Description 47412385 1 18.19 GL-AL(Phys Dam) -XS -WC -PROF -POLL INST FLTR I Sylvia Esperson 1 3/8/2019 1:53:20 PM (PST) I Page 4 of 4 This certificate cancels and supersedes ALL previously issued certificates. 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: Shawn Graf Extension: 5347 Project Name: Third and Union Street Resurfacing Contractor's Contact: Team Ghilotti Contact's Email: seand@teamshilotti.com iRESPONSIBLE Sten I DEPARTMENT DESCRIPTION COMPLETED DATE I REVIEWER (Initials) a. Email PINS Introductory Notice to Contractor 2/28/2019 SG b. Email Contract (in Word) & attachments to City Attorney c/o I Project Manager Laraine.Gittens c� cityofsanrafael.org 2/28/2019 SG a. Review, revise and comment on draft agreement and return to Project Manager 3/4/2019 LG b. Confirm insurance requirements, create Job on PINS, send PINS 2 City Attorney insurance notice to contractor. Approval of final agreement form to send to contractor. (Provide Dept. 3/4/2019 LG 3 Department Director Director Financial Swnmal), uVAgreenlenl) Jl Forward three (3) originals of final agreement to contractor for their 4 Project Manager signature. 3/5/2019 SG When necessary, contractor -signed agreement agendized for Council approval Cit- Council approval required for Professional Services Agreements and parchasm oJgoodS and services that exceed 575,000 and for Public IVorAs 5 Project Manager Contracts that exceed S 175,000 (Enter dare gfCouncj1 AfeetingJ 3/18/2019 SG PRINT CONTINUE ROUTING PROCESS WITH HARD COPY Forward signed original agreement to City Attorney with printed copy of 6 Project Manager this routing form 3/13/2019 SG 7 City Attorney Review and approve hard copy of signed agreement 3l 1 1' NCS Review and approve insurance in PINS, and bonds (for public works 8 City Attorney contracts) 31 R 9 city Manager/Mayor Agreement executed by Council authorized official C Attest signatures, retains original agreement and forwards copies to project 10 City Clerk manager L 11 Project Manager Forward Final Copy to Contractor