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PW Multi-Use Pathway Repairs ProjectCity of San Rafael + California Form of Contract Agreement for Multi -Use Pathway Repairs City Proiect No. 11256 This Agreement is made and entered into this .2" day of `*'- —, 2015 by and between the City of San Rafael (hereinafter called City) and W.R. Forde Associates, a general partnership (hereinafter called Contractor). Witnesseth, that the City and the Contractor, for the considerations hereinafter named, agree as follows: I - Scope of the Work The Contractor hereby agrees to furnish all of the materials and all of the equipment and labor necessary, and to perform all of the work described in the plans and specifications for the project entitled: Multi -Use Pathway Repairs, City Project No. 11256, 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 with respect to any insurance or coverage maintained by City and shall not call upon City's insurance or self-insurance for any contribution. If- 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 TWENTY (20) WORKING DAYS and with such extensions of time as are provided for in the General Provisions. III - Liquidated Damages It is agreed that, if all the work required by the contract is not finished or completed within the number of working days as set forth in the contract, damage will be sustained by the City, and that it is and will be impracticable and extremely difficult to ascertain and determine the actual damage which the City will sustain in the event of and by reason of such delay; and it is therefore agreed that the Contractor will pay to the City, the sum of $1,900 for each and every working day's delay in finishing the work in excess of the number of working days prescribed above; and the Contractor agrees to pay said liquidated damages herein provided for, and further agrees that the City may deduct the amount thereof from any moneys due or that may become due the Contractor under the contract. IV - The Contract Sum The City shall pay to the Contractor for the performance of the Contract the amounts determined for the total number of each of the units of work in the following schedule completed at the unit price stated. The number of units contained in this schedule is approximate only, and the final payment shall be made for the actual number of units that are incorporated in or made necessary by the work covered by the Contract. ITEM DESCRIPTION ESTIMATED QUANTITY UNIT UNIT PRICE TOTAL PRICE BASE BID I Mobilization I LS @ $3,000.00 = $3,000.00 2. Signs and Traffic Control I LS @ $6,000.00 = $6,000.00 3. Clearing and Grubbing I LS @ $65,000.00 = $65,000.00 4. Aggregate Base (Class 2) 145 TON @ $75.00 = $10,875.00 5. Minor Concrete ­ Minor Structures a. Type A Curb and Gutter" 10 LF @ $85.00 = $850.00 b. 6 -inch Thick PCC Driveway" 285 SF @ $25.00 = $7,125.00 c. 6 -inch Thick PCC Sidewalk" 140 SF @ $19.00 = $2,660.00 ITEM DESCRIPTION ESTIMATED QUANTITY UNIT UNIT PRICE TOTAL PRICE 6. Hot Mix Asphalt 225 TON @ $230.00 = $51,750.00 7. Decomposed Granite 660 SF @ $15.00 = $9,900.00 8. Retaining Wall 315 LF @ $35.00 1 = $11,025.00 SUBTOTAL BASE BID $168,185.00 ALTERNATE BID ITEM NO. 1 1. 1 Slurry Seal (Bahia Vista School Pathway)" 1 1,780 1 SY 1@1 $15.00 = $26,700.00 SUBTOTAL ALTERNATIVE BID ITEM NO. 1 $26,700.00 "Final Pay Item GRAND TOTAL BID S .194,885.00 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 4590 of the Government Code. Such securities, if deposited by the Contractor, shall be valued by the City's Finance Director, whose decision on valuation of the securities shall be final. VI - Acceptance and Final Payment (a) Upon receipt of written notice that the work is ready for final inspection and acceptance, the Engineer shall within 5 days make such inspection, and when he finds the work acceptable under the Contract and the Contract fully performed, he will promptly issue a Notice of Completion, over his own signature, stating that the work required by this Contract has been completed and is accepted by him under the terms and conditions thereof, and the entire balance found to be due the Contractor, including the retained percentage, shall be paid to the Contractor by the City within 15 days 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. IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the day and year first written above. ATTEST: CITY OF SAN RAFAEL: Esther C Beirne Kevin McGowan City Clerk Acting Public Works Director APPROVED AS TO FORM: W.R. Forde Associates By: Robert F. Epstein Printed Name� . ..... City Attorney Title: Partne Donald J. Russell President, Donald J. Russell Inc. General Partner of File No.: 22.04.43 W. R. Forde Associates EXECUTED IN DUPLICATE FAITHFUL PERFORMANCE BOND Bond No 9178208 PUBLIC WORK (The premium charged on this bond is $ 3,798.00 — , being at the rate of 24.20 first $100,000 and per thousand of the contract price) $14.52 next $400,000 KNOW ALL MEN BY THESE PRESENTS: THAT, WHEREAS the -City of San Rafael State of California, entered into a contract dated June 1 2015 with W. R. FORDE ASSOCIATES hereinafter designated as the "Principal," for the work described as follows: Multi -Use Pathway Repairs, City Project No. 11256 and WHEREAS, the said Principal is required under the terms of said contract to furnish a bond for the faithful performance of said contract. NOW, THEREFORE, We, the Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND ' a corporation organized and existing under the laws of the State of MARYLAND , and duly authorized to transact business under the laws of the State of California, as Surety, are held and firmly bound unto City of San Rafael in the penal sum of One Hundred Ninety Four Thousand Eight Hundred Eighty Five ................................. Dollars ($ 194,885.00 _), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the above bounden Principal, his or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform the covenants, conditions and agreements in the said contract and any alteration thereof made as therein provided, on his or their part, to be kept and performed at the time and in the manner therein specified, and in all respects according, to their true intent and meaning, and shall indemnify and save harmless the City of San Rafael its officers and agents, as therein stipulated, then this obligation shall become null and void; otherwise it shall be and remain in full force and virtue. And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN WITNESS WHEREOF, We have hereunto set our hands and seals this I day of June — 2015 W. R,-FORDE ASSOCIATES By Principal DONALD J. RWELL, INC, GENERAL PARTNER DONALD J. RUSSELL PRESIDENT FIDELITY AND DEPOSJ COMPANY OF MARYLAND PRF71 00 1 CA0201 f By JEFF VRICKSON t� _ V Atforne. -in-Fact 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 Callfomla County of NAPA On JUNE 1, 2015 before me, K. M. WILLBACK, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared JEFFREY D. ERICKSON Name(; of Signer(y) who proved to me on the basis of satisfactory evidence to be the person(%) whose narne(4 WANK subscribed to the within instrument and acknowledged to me that he1xbm2Mft executed the same in his/kmitheir authorized capacitykb*, and that by hlsA)adjhRix 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 Califomia that the foregoing paragraph is true and correct. K. M. WILLBACK WITNESS my hand and official seal. Commission # 2057918 Z Notary Public - California Zz Z Napa County ?! r Signature Mg Comm. Ex ares Feb 14, 2018 Signature of Notary Public Place Notary Seal Above , OPTIONAL Though this section is optional, 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: Number of Pages: _ Signer(s) Other Than Capacity(ies) Claimed by Signer(s) Signer's Name: • Corporate Officer — Title(s): • Partner — 0 Limited 0 General • Individual 0 Attorney in Fact • Trustee 0 Guardian or Conservator 0 Other: Signer Is Representing: Document Date: Named Above: Signer's Name: 171 Corporate Officer — Title(s): • Partner — El Limited 0 General • Individual 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator E] Other: Signer Is Representing: Bond No. 9178208 PAYMENT BOND PUBLIC WORK Section 3247-3252 inclusive, Civil code) (Premium included in Faithful Performance Bond) KNOW ALL MEN BY THESE PRESENT: That, Whereas City of San Rafael has awarded to W. R. FORDE ASSOCIATES as Principal, a contract for the work described as follows: Multi -Use Pathway Repairs, City Project No. 11256 AND WHEREAS, said Principal is required ad to furnish a bond in connection with said contract, to secure the payment of claims of laborers, mechanics, materialmen, and other persons as provided by law: NOW, THEREFORE, We the undersigned Principal and Surety are held and firmly bound unto the of San Rafael in the amount required by law, the sum of One Hundred Ninety Four Thousand Eight Hundred Eighty Five............................................................................ Dollars ($ 194,885.00 ) for which payment well and truly be made we bind ourselves, our heirs, executors and administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, That if said Principal, his or its heirs, executors, administrators, successors or assigns, or subcontractors, shall fail to pay any of the persons named in Civil Code Section 3181, or amounts due under the Unemployment's Insurance Act with respect to work or labor performed by any such claimant, or for any amounts required to be deducted, withheld, and paid over the Employment Development Department from the wages of employees of the principals and his subcontractors pursuant to section 13020 of the Unemployment Insurance Code, with respect to such work and labor, that the Surety or Sureties herein will pay for the same in the amount not exceeding the sum specified in this bond, otherwise the above obligation shall be void. In case suit is brought upon this bond, the said surety will pay a reasonable attorney's fee to be fixed by the court. PAY71001 CA0202f In witness Whereof, We have hereunto set our hand and seals this I day of June 2015 W. R. FORDE ASSOCIATES Principal By . DONALD J. RUSbEfL, INC. GENERAL PARTNER DONALD J. RUSSELL PRESIDENT FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: I—)— K�L, .TEFF RICKSON , Attorney -In -Fact 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 NAPA On JUNE 1, 2015 before me, K. M. WILLBACK, NOTARY PUBLIC Date Here Insert Name and Title of the Officer personally appeared JEFFREY D. ERICKSON Name(V of Signer(s) who proved to me on the basis of satisfactory evidence to be the person($) whose narne(so is/NKK subscribed to the within instrument and acknowledged to me that he/j_K&Ztb= executed the same in his/ka(Umirauthodzed capacity#e*, and that by hisAmdtheb:signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. LLBACK K. M. WILL BACK �BACK Commission # 205791B Notary Public - California z z M M Napa County z y CommCornm. Egires Feb 14, 2018 I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature, ` �� L?4 c Signature of Notary Public Place Notary Seal Above , OPTIONAL Though this section is optional, 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: Number of Pages: — Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: • Corporate Officer — Title(s): • Partner — 0 Limited 0 General • Individual 0 Attorney In Fact • Trustee 0 Guardian or Conservator • Other: Signer Is Representing: Signer's Name: • Corporate Officer — Title(s): • Partner — 0 Limited 0 General El Individual 0 Attorney in Fact E3 Trustee 0 Guardian or Conservator E] Other: Signer Is Representing: . . . . . . . . . . ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Jeffrey D. ERICKSON, Robert E. CHOVICK, Michael BOGGES, Clay THOMPSON, Bryan RICHMOND and Karen M. WILLBACK, all of Napa, California, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURE'T'Y COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 14th day of July, A.D. 2014. ATTEST: BY Assistant Secretary Gerald F. Haley ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND lug, t 8CAL Vice President Thomas O. McClellan State of Maryland City of Baltimore On this 14th day of July, A.D. 2014, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS 0. MCCLELLAN, Vice President, and GERALD F. HALEY, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly swom, deposeth and saith, that helshe is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instnunent by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written, Maria D. Adamski, Notary Public My Commission Expires: July 8, 2015 POA -F 016-3343A EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attomevs-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY,3WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this __L day of 20� wo ocioJINS �.r EAL Michael Bond, Vice President WRFORDE-01 SKERR E NYYY) CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD 11110� F 6 18/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0303587 NAME: CONTACT ISU Sander Jacobs Cassayre Insurance Services PHONE FAX 3200 Villa Lane (AIC, No, Ext): (707) 252-8822 (NO No): (707) 253-8255 Napa, CA 94558 E-MAIL ifacobs.com ADDRESS: no@sanderj INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Gemini Insurance Company 10833 INSURED INSURER B: West American Ins. Co. 44393 W. R. Forde Associates INSURER C: Houston Casualty Company 42374 984 Hensley Street INSURER 0: STATE COMPENSATION INS. FUND OF CA 35076 Richmond, CA 94801-2117 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE -LISTED BELOWHAVE " 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. INR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LT , I I , RpTrm A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,DOO CLAIMS -MADE X OCCUR X VCGPD21674 04/01/2015 04101/2016 DAMAGE TO RENTED PREMISES (Ea occurrence) S 50 000- MED EXP (Any one person) S 5,000 PERSONAL & ADV INJURY S 1,00010001 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY X PRO- JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 Deductible S 5,000 COMBINEDSINdff LIMIT - S 11 1 ,00 000 - 0, 1 AUTOMOBILE LIABILITY (Ea accident) B X ANY AUTO BAW1655976085 04101/2015 0410112016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS fi HIRED AUTOS NON OWNED PROPERTY DAMAGE S AUTOS (Per accident) X UMBRELLA LIAB ...X OCCUR EACH OCCURRENCE S 5,000,000 C EXCESS LIAR CLAIMS -MADE H15XC5032701 04/0112015 04101/2016 AGGREGATE S 5,000,000 DED RETENTION $. ..... . ... -S _wOkkERS COMPENSATION PER OTH, AND EMPLOYERS'LIABILITY IN X STATUTE ER D ANY PROPRIETOWY PARTNER/EXECU7ME 767625814 10101/2014 1010112015 E.L. EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S Ifes DESCRIPTION describe under S6RIPTI N OF OPERATIONS beIow E.L. DISEASE - POLICY LIMIT .. S DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Multi -Use Pathway Repairs, City Project No. 11256 When required by written contract the City of San Rafael, its officers, employees, agents and volunteers are included as Additional Insured per policy form CG2010 04/13 attached. Coverage is Primary/Non-Contributory per policy form CG2001 04/13 attached. 30 days notice of cancellation except 10 days for non -pay. Auto 30 day cancellation endorsements attached. GL 30 day cancellation endorsement applies (forthcoming from carrier). WC 30 day cancellation applies it was issued at policy inception 2013 and per State Fund is automatically renewed each year but a new endorsement cannot be generated. ........ . . . . . . . . ..aa......_ ---- - - - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . . . . . . . ............. AUTHORIZED REPRESENTATIVE City of San Rafael P.O. Box 151560 San Refaelr,CA 94915-1560 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Policy: VCGP021674 Insured Name: WR FORDE ASSOCIATES CG 20 0104 13 Effective Date: 04/01/2015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 1 of 1 Policy: VCGP021674 Insured Name: WR FORDE ASSOCIATES CG 20 10 04 13 Effective Date: 04/0112015 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations I (W '\S()N RI: 1,;i I -,`d, f [Ai AND NON NVNFiPROR-C I -S W N(),; Rll` I I Df -N ITA L A 'ND NK)N WNLD C 'IS F, ON I I( PRd JJ � ( F. 'Amv pc�,�(m it oll",mlz166711 Mm4 'Mill �md ."4Iwh pLl,,on (11 AH IuLvelli ktr which vou 'Ind [fitlddltiolm[ hlwc kw�ti.t ll;lv' t1«V wq.'a,I ill r4rmmm plkw ttS wl Hi vv[ ltmIII I, cmffl,�!cl p Ion [o an m,cnm:ilcc dw (:mp;�,,s "hodfl, dial tnurlv", "popers�, �un��gc" or -�Mrtpclty or �md mid mh,'crwmlin)uly", dmt ,u ch PCTSOl 01 'Iddi,d Ia Cr 4kn ;: (kfilionul im,nlcd wl Vour pnl[cy Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 1 oft 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 2 of 2 COMMERCIAL AUTO CA 88 63 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ N.CAREFULLY. AMENDMENT OF CANCELLATION PROVISIONS Any bann or provision of the Cancellation Conditions of the policy or any endorsement amending orreplac- ing such Conditions is amended bythe following: A. If we uanoa| this policy for any reason other than nonpayment of pn*mium, we will notify the person or organization shown in the Schedule below. In no event will the notice to the person or organization scheduled below exceed the notice to the first named insured. B. Our obligation to send notice to the person or organization listed inthe Schedule below will terminate at the earlier of the current policy period expiration or when you no longer have a|ega| or contractual � obligation to such person or organization to maintain insurance coverage under epo|ioy which requires � that such person or organization be notified in the event of cancellation. SCHEDULE � � 1. Name orPerson mrOrganization: City of San Rafael � 2. Mailing Address: 2O BOX 1-51560 Sao Rafael, ca 949I5 3. Number Days Advance Notice: 30 All other berms and conditions of this policy remain unchanged m u012Liberty Mutual Insurance GEMINI INSURANCE COMPANY A STOCK COMPANY (herein called "die Company") COMMON POLICY DECLARATIONS Policy No.: VCGP021674 Renewal/Rewrite of: Named Insured and Mailing Address WR FORDS ASSOCIATES DONALD J RUSSELL INC WR FORDE CONSTRUCTION CO INC 984 HENSLEY STREET RICHMOND, CA 94801 VCGP021132 Ca Surplus Lines Tax & Fee Breakdown Premium: $93,280.00 3.0% State Tax: $ 2,798.40 0.2% Stamp Fee: $ 186.56 Company Fee: Wholesale Broker Fee: Policy Period: From 04,01 2015 to 04 01 2016 at 12:01 a.m. Standard Time at the address of the Named Insured as stated herein THE NAMED INSURED IS: Partnership BUSINESS DESCRIPTION: GENERAL ENGINEERING CONTRACTOR AUDIT PERIOD: 0 Annual ❑ Other IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGES FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. Commercial General Liability Coverage Part $ 93,280 TOTAL PREMIUM $ 93,280 Form (s) and Endorsement (s) made a part of this policy at inception. See attached schedule: This policy is not binding unless sealed and countersigned by Gemini Insurance Company or its Authorized Representative. Countersigned On: 3/31/2015 At: Greenwich, Connecticut 0 Authorized Representative THESE COMMON POLICY DECLARATIONS AND, IF APPLICABLE, THE COMMERCIAL PROPERTY COVERAGE, THE COMMERCIAL GENERAL LIABILITY DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART (S), FORM (S) AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBER POLICY SEE VE 0525 08 11 - Califomia Disclosure Notice COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy: VCGP021674 Effective Date: 04/01/2015 Named Insured: WR FORDE ASSOCIATES LIMITS OF INSURANCE Each Occurrence Limit $1,000,000 General Aggregate Limit(Other than Products -Completed Operations) $2,000,000 Products -Completed Operations Aggregate Limit $2,000,000 Personal & Advertising Injury Limit $1,000,000 Damage to Premises Rented to You $50,000 Any one premises Medical Payments $5,000 Any one person RETROACTIVE DATES This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" which occurs before the Retroactive Date, if any, shown here: NONE (Enter Date or "NONE" if no Retroactive Date applies Class Description 99315 Street or Road Construction or Reconstruction Advance Premium: Minimum Term Premium: Minimum Earned Premium at Inception: Terrorism Premium: Total Premium: Estimated Exposure Premium Basis $8,000,000 Per 1,000 Gross Sales $93,280 100% $93,280 25% $23,320 Terrorism has been rejected by the Insured $93,280 Rate Premium $11.660 $93,280 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. Page 1 of I f4141 I 101 RN IN 110] a IM ]u(.`! Named Insured: WR FORDS ASSOCIATES POLICY NO.: VCGP021674 V464 FORM NUMBER End. # TITLE VE 06 00 06 14 Common Policy Conditions CG 00 01 12 07 Commercial General Liability Coverage Form CGLDEC 05 14 Commercial General Liability Declarations SCHED 03 08 Schedule of Forms POLCVLTR 03 14 Vela Policy Cover Letter CMNDEC 03 08 Common Declarations VE 67 09 03 14 01 Claims Reporting IL 00 21 09 08 02 Nuclear Energy Liability Exclusion (Broad Form) VE 05 28 09 13 03 Professional Liability Exclusion VE 0525 08 11 04 California Disclosure Notice VE 05 00 09 13 05 Electromagnetic Fields Exclusion VE 04 94 09 13 06 Lead Exclusion VE 66 08 09 13 07 Asbestos Exclusion VE 06 05 04 14 08 Deductible Liability Insurance - Per Occurrence VE 0446 09 09 09 Occupational Disease Exclusion CG 21 73 01 08 10 Exclusion of Certified Acts of Terrorism VE 0106 04 08 11 Exclusion - Trade/Patent Infringement VE 0192 08 08 12 Wrap Up Exclusion VE 7902 10 11 13 Service of Suit - State of California VE 0442 07 09 14 Tainted Drywall Exclusion CG 2417 1001 15 Contractual Liability - Railroads CG 21 96 03 05 16 Silica or Silica -Related Dust Exclusion CG 21 67 12 04 17 Fungi or Bacteria Exclusion CG 20 01 04 13 18 Primary and Noncontributory - Other Insurance Condition CG 20 37 04 13 19 Additional Insured - Owners, Lessees or Contractors - Completed Operations VE 0586 04 13 20 Additional Insured - Lessor of Leased Equipment - Automatic Status When Required in Lease Agreement With You VE 05 88 04 13 21 Premium Basis CG 20 10 04 13 22 Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization CG 2147 12 07 23 Employment Related Practices Exclusion VE 05 72 03 14 24 New Single Family Residential Project Exclusion VE 05 73 08 13 25 Multi -Family Residential Project Exclusion SCHED 03 08 Page 1 of 2 FORM NUMBER End. # TITLE VE 05 910813 26 Condominium Conversion Exclusion VEDGS2O813 27 New Small Format Multi -Family Residential Project Exclusion CE}24O4O5OQ 28 Waiver ofTransfer 0oRights ofRecovery Against Others ToUs VEO485OQ13 29 Punitive Damages Exclusion VEOG1OU013 30 Radioactive Material orContamination Exclusion CG242SO413 31 Amendment ofInsured Contract Definition VE 01 07 10 13 32 Exclusion - Exterior Insulation and Finish Systems VE 01 841213 33 Designated Construction Pnojnct(a)General Aggregate Limit 'Subject ToAMaximum Aggregate VEO681 02 14 34 Subcontractor and Independent Contractor Conditional Amendment of Deductible VEO5OGOG14 35 Amendment-PrumiumAudit VEGG4OOQ14 38 Exclusion - Continuous orProgressive Damage Claims ENDORSEMENT AGREEMENT CERTIFICATE HOLDERS' NOTICE HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 1, 2013 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME W R FORDE ASSOCIATES 984 HENSLEY ST RICHMOND, CA 94801 7676258-13 NEW NA 5-54-99-80 PAGE 1 OF ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THIS POLICY SHALL NOT BE CANCELLED UNTIL, 30 DAYS AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED IN THE MAIL BY STATE FUND TO CURRENT HOLDERS OF CERTIFICATE OF WORKERS' COMPENSATION INSURANCE. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 2, 20133 e---zdez41l AUTHORIZEDREPRESENTA IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.1-2012) 1 2065 OLD DP 217