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ED Appraisal of Real Property; Grand AveAGREEMENT FOR PROFESSIONAL SERVICES FOR APPRAISAL OF REAL PROPERTY This Agreement is made and entered into this2 7/4 day of <A4NujjR y , 2015, by and between the CITY OF SAN RAFAEL (hereinafter "CITY"), and DEAN CHAPMAN & ASSOCIATES, INC., a corporation authorized to do business in California (hereinafter "CONTRACTOR"). RECITALS WHEREAS, CITY is investigating the desirability of acquiring through eminent domain all or certain portions of three parcels of improved real property located in the City of San Rafael, County of Marin, State of California, designated as Assessor's Parcel Nos. 014-132-10, 014-133-12, and 014-151-14, respectively (hereafter, the "Properties"); and WHEREAS, in comlection with its investigation, CITY desires to obtain an appraisal of the fair market value of each of the Properties; and WHEREAS, CONTRACTOR is an MAI certified appraiser qualified to prepare the appraisals needed by CITY; AGREEMENT NOW, THEREFORE, the parties hereby agree as follows: 1. PROJECT COORDINATION. A. CITY'S Project Manager. The Assistant City Attorney is hereby designated the PROJECT MANAGER for the CITY, and said PROJECT MANAGER shall supervise all aspects of the progress and execution of this Agreement. B. CONTRACTOR'S Project Director. CONTRACTOR shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for CONTRACTOR. Dean Chapman is hereby designated as the PROJECT DIRECTOR for CONTRACTOR. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR, for any reason, the CONTRACTOR shall notify the CITY within ten (10) business days of the substitution. 2. DUTIES OF CONTRACTOR. CONTRACTOR shall perform the duties and./or provide services as set forth in the CONTRACTOR's Appraisal Proposal Dated January 17, 2015, a copy of which is attached hereto marked Exhibit A and incorporated herein by reference. J. COMPENSATION. Rev. Date: 1/30 14 For the full performance of the services described herein by CONTRACTOR, CITY shall pay CONTRACTOR as set forth in the CONTRACTOR's Appraisal Proposal Dated January 17, 2015 attached hereto and incorporated herein by reference. The total cost of the three appraisals shall not exceed $16,000. 4. TERM OF AGREEMENT. The term of this Agreement shall be for three (3) months commencing on the date of this Agreement. Upon mutual agreement of the parties, and subject to the approval of the City Manager the term of this Agreement may be extended for an additional period of three (3) months. TERMINATION. A. Discretionary. Either party may terminate this Agreement without cause upon thirty (30) days written notice mailed or personally delivered to the other party. B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days written notice mailed or personally delivered to the other party, and the notified party's failure to cure or correct the cause of the termination, to the reasonable satisfaction of the party giving such notice, within such fifteen (15) day time period. C. Effect of Termination. Upon receipt of notice of termination, neither party shall incur additional obligations under any provision of this Agreement without the prior written consent of the other. D. Return of Documents. Upon termination, any and all CITY documents or materials provided to CONTRACTOR and any and all of CONTRACTOR's documents and materials prepared for or relating to the performance of its duties under this Agreement, shall be delivered to CITY as soon as possible, but not later than thirty (30) days after termination. 6. OWNERSHIP OF DOCUMENTS. The written documents and materials prepared by the CONTRACTOR in connection with the performance of its duties under this Agreement, shall be the sole property of CITY. CITY may use said property for any purpose, including projects not contemplated by this Agreement. 7. INSPECTION AND AUDIT. Upon reasonable notice, CONTRACTOR shall make available to CITY, or its agent, for inspection and audit, all documents and materials maintained by CONTRACTOR in connection with its performance of its duties under this Agreement. CONTRACTOR shall fully cooperate with CITY or its agent in any such audit or inspection. 8. ASSIGNABILITY. Rev. date: I.30i 14 The parties agree that they shall not assign or transfer any interest in this Agreement nor the performance of any of their respective obligations hereunder, without the prior written consent of the other party, and any attempt to so assign this Agreement or any rights, duties or obligations arising hereunder shall be void and of no effect. 9. INSURANCE. A. Scope of Coverage. During the term of this Agreement, CONTRACTOR shall maintain, at no expense to CITY, the following insurance policies: 1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage. 2. An automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) dollars per occurrence. 3. If any licensed professional performs any of the services required to be performed under this Agreement, a professional liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, to cover any claims arising out of the CONTRACTOR's performance of services under this Agreement. Where CONTRACTOR is a professional not required to have a professional license, CITY reserves the right to require CONTRACTOR to provide professional liability insurance pursuant to this section. 4. If it employs any person, CONTRACTOR shall maintain worker's compensation and employer's liability insurance, as required by the State Labor Code and other applicable laws and regulations, and as necessary to protect both CONTRACTOR and CITY against all liability for injuries to CONTRACTOR's officers and employees. CONTRACTOR'S worker's compensation insurance shall be specifically endorsed to waive any right of subrogation against CITY. B. Other Insurance Requirements. The insurance coverage required of the CONTRACTOR in subparagraph A of this section above shall also meet the following requirements: 1. Except for professional liability insurance, the insurance policies shall be specifically endorsed to include the CITY, its officers, agents, employees, and volunteers, as additionally named insureds under the policies. 2. The additional insured coverage under CONTRACTOR'S insurance policies shall be primary with respect to any insurance or coverage maintained by CITY and shall not call upon CITY's insurance or self-insurance coverage for any contribution. The "primary and noncontributory" coverage in CONTRACTOR'S policies shall be at least as broad as ISO form CG20 0104 13. Rev. date: 1/30i 14 3. Except for professional liability insurance, the insurance policies shall include, in their text or by endorsement, coverage for contractual liability and personal injury. 4. The insurance policies shall be specifically endorsed to provide that the insurance carrier shall not cancel, terminate or otherwise modify the terms and conditions of said insurance policies except upon ten (10) days written notice to the PROJECT MANAGER. 5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said insurance coverage shall survive for a period of not less than five years. 6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement. 7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and noncontributory basis for the benefit of CITY (if agreed to in a written contract or agreement) before CITY'S own insurance or self-insurance shall be called upon to protect it as a named insured. 8. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to CITY or any other additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured; whichever is greater. C. Deductibles and SIR'S. Any deductibles or self-insured retentions in CONTRACTOR's insurance policies must be declared to and approved by the PROJECT MANAGER and City Attorney, and shall not reduce the limits of liability. Policies containing any self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or CITY or other additional insured party. At CITY's option, the deductibles or self-insured retentions with respect to CITY shall be reduced or eliminated to CITY's satisfaction, or CONTRACTOR shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. D. Proof of Insurance. CONTRACTOR shall provide to the PROJECT MANAGER all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policv lanauaee or specific endorsements evidencinLy the other insurance requirements set forth in this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and endorsements from CONTRACTOR. Failure to exercise this right shall not constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by PROJECT MANAGER. Rev. date: li30/ 14 4 10. INDEMNIFICATION. A. Except as otherwise provided in Paragraph B., CONTRACTOR shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by CITY, and hold harmless CITY, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of CONTRACTOR'S performance of its obligations or conduct of its operations under this Agreement. The CONTRACTOR's obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive negligence of the City Indemnitees. However, to the extent that liability is caused by the active negligence or willful misconduct of the City Indemnitees, the CONTRACTOR's indemnification obligation shall be reduced in proportion to the City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or approval of the CONTRACTOR's work or work product by the CITY or any of its directors, officers or employees shall not relieve or reduce the CONTRACTOR's indemnification obligations. In the event the City Indemnitees are made a party to any action, lawsuit, or other adversarial proceeding arising from CONTRACTOR'S performance of or operations under this Agreement, CONTRACTOR shall provide a defense to the City Indemnitees or at CITY'S option reimburse the City Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims. B. Where the services to be provided by CONTRACTOR under this Agreement are design professional services to be performed by a design professional as that term is defined under Civil Code Section 2782.8, CONTRACTOR shall, to the fullest extent permitted by law, indemnify, release, defend and hold harmless the City Indemnitees from and against any CLAIMS that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONTRACTOR in the performance of its duties and obligations under this Agreement or its failure to comply with any of its obligations contained in this Agreement, except such CLAIM which is caused by the sole negligence or willful misconduct of CITY. C. The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or completion of this Agreement for the full period of time allowed by law. 11. NONDISCRIMINATION. CONTRACTOR shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national origin or disability in connection with or related to the performance of its duties and obligations under this Agreement. 12. COMPLIANCE WITH ALL LAWS. CONTRACTOR shall observe and comply with all applicable federal, state and local laws, Rev. date: 1'3014 5' ordinances, codes and regulations, in the performance of its duties and obligations under this Agreement. CONTRACTOR shall perform all services under this Agreement in accordance with these laws, ordinances, codes and regulations. CONTRACTOR shall release, defend, indemnify and hold harmless CITY, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any noncompliance or violation of any laws, ordinances, codes or regulations. 13. NO THIRD PARTY BENEFICIARIES. CITY and CONTRACTOR do not intend, by any provision of this Agreement, to create in any third party, any benefit or right owed by one party, under the terms and conditions of this Agreement, to the other party. 14. NOTICES. All notices and other communications required or permitted to be given under this Agreement, including any notice of change of address, shall be in writing and given by personal delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if mailed, upon the date of deposit with the United States Postal Service. Notice shall be given as follows: TO CITY's Project Manager: And with a copy to: TO CONTRACTOR's Project Director: 15. INDEPENDENT CONTRACTOR. Lisa A. Goldfien, Assistant City Attorney City of San Rafael 1400 Fifth Avenue P.O. Box 151560 San Rafael, CA 94915-1560 Thomas Adams, Economic Development Coordinator City of San Rafael 1400 Fifth Avenue P.O. Box 151560 San Rafael, CA 94915-1560 Dean Chapman, MAI Dean Chapman & Associates 108 Club Terrace Danville, CA 94526 For the purposes, and for the duration, of this Agreement, CONTRACTOR, its officers, agents and employees shall act in the capacity of an Independent Contractor, and not as employees Rev. date: UN 14 of the CITY. CONTRACTOR and CITY expressly intend and agree that the status of CONTRACTOR, its officers, agents and employees be that of an Independent Contractor and not that of an employee of CITY. 16. ENTIRE AGREEMENT -- AMENDMENTS. A. The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by reference, represent the entire Agreement of the parties with respect to the subject matter of this Agreement. B. This written Agreement shall supersede any and all prior agreements, oral or written, regarding the subject matter between the CONTRACTOR and the CITY. C. No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid or binding, except by way of a written amendment to this Agreement. D. The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this Agreement signed by the CONTRACTOR and the CITY. E. If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions of the attached exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control. 17. SET-OFF AGAINST DEBTS. CONTRACTOR agrees that CITY may deduct from any payment due to CONTRACTOR under this Agreement, any monies which CONTRACTOR owes CITY under any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments, unpaid checks or other amounts. 18. WAIVERS. The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent acceptance by either party of any fee, performance, or other consideration which may become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other party of any term, condition, covenant of this Agreement or any applicable law, ordinance or regulation. 19. COSTS AND ATTORNEY'S FEES. The prevailing party in any action brought to enforce the terms and conditions of this Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs Rev. date: 1/30/ 14 (including claims administration) and attorney's fees expended in connection with such action. 20. CITY BUSINESS LICENSE / OTHER TAXES. CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY business license as required by the San Rafael Municipal Code CONTRACTOR shall pay any and all state and federal taxes and any other applicable taxes. CITY shall not be required to pay for any work performed under this Agreement, until CONTRACTOR has provided CITY with a completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and Certification). 21. APPLICABLE LAW. The laws of the State of California shall govern this Agreement. IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL NANCY MACKL -, City Manager ATTEST: _ c - Age, A--.& ESTHER C. BEIRNE, City Clerk 2.4" 0/.L't, ►�R ,B _ Rev. date: 1/30'14 CONTRACTOR Name: DEAN CHAPMAN Title: PRESIDENT DEAN CHAPMAN & ASSOCIATES REAL ESTATE APPRAISERS AND CONSULTANTS A CALIFORNIA CORPORATION 108 CLUB TERRACE DANVILLE, CALIFORNIA 94526 PHONE (925) 831-1311 January 17, 2015 Benjamin Stock Attorney at Law Burke, Williams & Sorensen, LLP 1901 Harrison Street, Suite 900 Oakland, California 94612-3501 Re: Appraisal Proposal APN: 014-133-12, 014-152-34, 014-151-14 (Marin County) Easterly side of Grand Avenue, San Rafael, CA Dear Mr. Stock, Thank you for the opportunity to provide you with a proposal to appraise three properties identified above in San Rafael, California. The Assessor's maps for the properties are also attached to this letter. It is understood that the assignment will include an appraisal of each property (assumed to be the legal larger parcel) in the before condition, that is, the condition of the property prior to the Grand Avenue Improvement project (see attached). The project will require a fee acquisition from each property as shown on the attached plan. The purpose of each appraisal is to develop an opinion of Just Compensation for each property related to the project and acquisition. This assignment will include the hypothetical condition that the Grand Avenue Improvement project does not exist in the before condition. A narrative appraisal report of each Subject will comply with Standard Rule 2-2(a) of the Uniform Standards of Professional Appraisal Practice. The total fee for all three appraisals will be $16,000 and delivered to you within approximately 6 weeks after receipt of your written authorization to proceed along with preliminary title reports, appraisal maps, and any other documents related to the improvement project. The appraisal fee will be due upon the date that the appraisal report is delivered electronically. It is understood that testimony relative to this assignment may be required in the future. Time spent to prepare for, and give testimony relative to, this case will be billed at my standard hourly rate of $350. If you would like me to proceed, please sign the attached copy of this letter, sign the Statement of Limiting Conditions, and return at your earliest convenience. Exhibit A Should you have any questions or comments regarding this proposal, please don't hesitate to call. Very truly yours, DEAN CHAPMAN & ASSOCIATES, INC. Dean Chapman, MAI, SR/WA Certified General Real Estate Appraiser #AG006074 PROFESSIONAL SERVICES AGREEMENT/CONTRACT COMPLETION CHECKLIST AND ROUTING SLIP Below is the process for getting your professional services agreements/contracts finalized and executed. Please attach this "Completion Checklist and Routing Slip" to the front of your contract as you circulate it for review and signatures. Please use this form for all professional services agreements/contracts (not just those requiring City Council approval). This process should occur in the order presented below. Step Responsible Department 1 City Attorney 2 Contracting Department 3 Contracting Department 4 City Attorney 5 City Manager / Mayor / or Department bead 6 City Clerk Description Review, revise, and comment on draft agreement. Forward final agreement to contractor for their signature. Obtain at least two signed originals from contractor. Agendize contractor -signed agreement for Council approval, if Council approval necessary (as defined by City Attorney/City Ordinance*). Review and approve form of agreement; e and ru endorsements e cei f�c t a �Ily... bonds, and inst} 1 s Agreement executed ly Cou authorized official. City Clerk attests signatures, retains original agreement and forwards copies to the contracting department. To be completed by Contracting Department: Project Manager: Lisa Goldfien, Asst. City Attorney Completion Date Project Name: Professional Services Ap-reement with Dean Chapman & Assoc. appraisers Agendized for City Council Meeting of (if necessary): N/A If you have questions on this process, please contact the City Attorney's Office at 485-3080. * Council approval is required if contract is over $20,000 on a cumulative basis. Policy No. 97 -WV -4397-1 ADDITIONAL INSURED ENDORSEMENT DESIGNATED PREMISES ONLY Policy No.: 97 -WV -4397-1 Named Insured: Dean Chapman & Associates Name of Additional Insured: The City of San Rafael, its officers, employees, agents and volunteers Address of Additional Insured: 14005 th Avenue San Rafael, CA 94901 Interest of Additional Insured: CONTRACT EMPLOYER Location of Premises: 1400 5th Avenue San Rafael, CA 94901 FE -6320 (7/88) The word "insured",wherever used in this policy, also includes the designated person or organization named above as Additional Insured under the provisions of the policy Sections shown below as applicable by an "X" to the extent indicated. ❑ SECTION I. This applies only to COVERAGE A — BUILDINGS. ❑ SECTION I. This applies only to COVERAGE B — BUSINESS PERSONAL PROPERTY. Description of Property: [TAB here and type DESCRIPTION OF PROPERTY] ® SECTION II. This applies only to COVERAGE L -BUSINESS LIABILITY and COVERAGE M - MEDICAL PAYMENTS and then only with respect to the ownership, maintenance or use of the premises designated above and operations necessary or incidental thereto. These SECTION II coverages do not apply to: 1. structural alterations or new construction performed by or on behalf of the designated person or organization; 2. personal injury caused by the designated person or organization; 3. liability the designated person or organization assumed under a contract; or 4. products -completed operations hazard arising out of goods or inventory which are not sold or distributed by you or arising out of the manufacturing or packaging of such goods or inventory. All other provisions of the policy apply. FE -6320 (7/88) Printed in U.S.A. ujsz Policy No.: 97 WV4397 1 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 97 WV4397 1 Named Insured: CHAPMAN, DEAN DBA DEAN CHAPMAN & ASSOCIATES Additional Insured (include address): THE CITY OF SAN RAFAEL, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS 1400 FIFTH AVENUE SAN RAFAEL FE -6609 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE -6609 Printed in U.S.A. �c CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) ,b 01., 2,, ,(,j, PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION Joanne B. ya:ant, .Agent State Far -(ca, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2570 Savi Ra.lnorr Va.(..1.ey° Blvd stx: A-201. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR San Ramon, Ca 94583 ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL )W. . —.. - 77) I da I LaMj INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA State Farm General Insurance Company 25151 .:'5151 CHAPMAN, DEAN IINSURERB State Farm Mutual Auto Insurance Company 2517H :'.5178 DBA DEAN CHAPMAN & ASSOCIATES IINSURER I INSURER D 108 CLUB TER DANVILLE, CA 94526-1659 INSURER COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT I TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY P=RTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED iEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN M 1 HAVE BEEN REDUCED BY PAID :LAIMS. INSR ADDT POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDD/YY)LIMITS A X GENERAL LIABILITY 97–WV-4397-1 G 12/10/2014 12/10/2015 EACH OCCURRENCE s 1.1 o,yo„VC.,I,C.,po"uC.b X COMMERCIAL GENERAL LABILITY DAMAGE TO RENTED I PREMISES (Ea occurrence) S , 0(.X o;j� 01 = CLAIMS MADE ('.1CCUIR I MED EXP (Any one person) 5 "��i 4.X (PERSONAL &ADV INJURY 5 _ I GENERAL AGGREGATE S ..: , C100, ('X O r3 G�EN'L AGGREGATE UMrT APPLES PER I PRODUCTS COMP/OP AGG S . , O J° 00, X1 F_]PECOT POLICYLCJt',; "'''� •'^ AUTOMOBILE LIABILITY COMBINED S'NGLE c.IMIT 5 Y4.JiY I)4JJI.N r I Y r.➢L'; (Eaaccdent . , ANY ALTO'l:^"� ALL OWNED AUTOS,,.Y",("(�I;'((;;t(;)r;li'j,,;;';',.'r,r";v0,r'/"'j BODILYINJURY S SCHEDULED AUTOS (Per person) — HIRED AUTOS Boo LY INJURY S NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY – EA ACC DENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S IOCCUR F–I CLAIMS MADE I AGGREGATE S I S DEDUCTIBLE I S RETENTION S S WORKERS COMPENSATION AND I WC I OT EMPLOYERS' LIABILITYER ORS LATU- ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L. EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE 5 If yes, describe under SPECIAL PROVISIONS below E L. DISEASE - POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project Name: Grand Avenue Pr''"y4;;xtrrro'A::mv.{'-olv;. I'Lt:ji7i:t. The city of San Rafael, its officers, agents, employees, arid volunteers, as aditionally named insureds under the policies CERTIFICATE HOLDER CANCELLATION City of San Rafael SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1400 Fifth Avenue DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN San Rafael, CA 94 915 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001108) The registration notices indicate ownership of the marks by their respective owners ©ACORD CORPORATION 1988, 2007 132849 03-13-2007 All rights reserved AUTHORIZED REPRESENTATIVE R! char d i s,:iiocjc� LSA4 for lc,,anne Bryant. ACORD 25 (2001/08) IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) Policy No. 97 -WV -4397-1 FE -6320 (7/66) ADDITIONAL INSURED ENDORSEMENT o DESIGNATED PREMISES ONLY Policy No.: 97 -WV -4397-1 Named Insured: Dean Chapman & Associates Name of Additional Insured: The City of San Rafael, its officers, employees, agents and volunteers Address of Additional Insured: 14005 1h Avenue San Rafael, CA 94901 Interest of Additional Insured: CONTRACT EMPLOYER Location of Premises: 1400 51h Avenue San Rafael, CA 94901 The word "insured",wherever used in this policy, also includes the designated person or organization named above as Additional Insured under the provisions of the policy Sections shown below as applicable by an "X" to the extent indicated. ❑ SECTION I. This applies only to COVERAGE A — BUILDINGS. ❑ SECTION I. This applies only to COVERAGE B — BUSINESS PERSONAL PROPERTY. Description of Property: [TAB here and type DESCRIPTION OF PROPERTY] ® SECTION II. This applies only to COVERAGE L -BUSINESS LIABILITY and COVERAGE M - MEDICAL PAYMENTS and then only with respect to the ownership, maintenance or use of the premises designated above and operations necessary or incidental thereto. These SECTION II coverages do not apply to: structural alterations or new construction performed by or on behalf of the designated person or organization; 2. personal injury caused by the designated person or organization; 3. liability the designated person or organization assumed under a contract; or 4. products -completed operations hazard arising out of goods or inventory which are not sold or distributed by you or arising out of the manufacturing or packaging of such goods or inventory. All other provisions of the policy apply. FE -6320 (7{68) Primed in U.S.A. wsz Policy No.: 97 WV4397 1 FE -6609 SECTION II ADDITIONAL INSURED ENDORSEMENT 1 Policy No.: 97 WV4397 1 Named Insured: CHAPMAN, DEAN DBA DEAN CHAPMAN & ASSOCIATES Additional Insured (include address): THE CITY OF SAN RAFAEL, ITS OFFICERS, EMPLOYEES, AGENTS, AND VOLUNTEERS 1400 FIFTH AVENUE SAN RAFAEL WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. FE -6609 !Tinted m U $.A 111) . . ............ . .......... . Date issued Pok i qv I9uwlhev. PM& am P&I N..Y MMAr - - ---- ----- ..... . .......... (A Shwk bmwmwe Mpm,11AWAr Hw "Cmnpnj) 55 AWn Svmq Mh Fhm N"C%v N''), 1004 1 M➢fi IS A 0 AMS MUL MM ROWED POLIO. PLEASF REND C'9 CAREM & DIFCL AWIMV:,'i . . . ............... I Ustomer 10, 10018,3 %JHWd NSUVed� CHAPMAN, [)Wl X, ASSOC l A I I 10S4.11I:b lerrace Dany! 11 e, CA 94526 .... . ...... P'"m - — - UdC -, 04/22/20 14 It: 1..:.4,41. A,N! SAWA hune m Uw Wmm sWA nj "N,000 Each clann C fle-w-o-ac-Ove Me, W200) [neopflen T)aieMMOMI 'rhe undt ur unnhy Ar Emb CMMi mW W S 1100100 End clawn HWAgp"egnte i& reduced bs Munaiges and ............... 9, S2,00000 Ar.,�rnvgatc ........... ChAs EWmmm as Wmd W tW Poky, . ..... T MaH all Mws, lnuludkg nol& of eldn; M.AgM LA AINUmms & huwwu Smyms 1600 Amc1g; Shec. Samn Bm bam, CAH 1&& '931011 "M40y 3144652; Fix: 005) 9620612 .. . . .... .. . S. AununI Prevniuni� .... .... ..... 1-11-1-11- . . . ...... . .. Number o f Apjjprzk i serY .. . ... . .... ..,,..__._.._,........,,_....,_a,_.—.._,__._. -,__,,....,___ 10. Forms attached cWSM; IIA002 (10/11) LIA009 (08/4 ) LAAOEy (08/U) 1A013 4y1N,3/1 1) I M025 (03j1Q) OJAC WS109) -- -1—.11-1 —1-1.11 . ....... . . ....... -- . .. ....... Mk MWAM pme Wffl) Po icy Appl�cwion kowlIng W au&Maq& MW epUW U,V, W we Eqhmgo QW, kawuoice Lfff?"(.. ¢hc o,hauu,rnsuired and Me Cgffg y, . ... . ........ . . . . ....... . LIA00110411p) A,M Md S G gnature CERTHOLDER COPY NB P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-30-2015 GROUP: POLICY NUMBER: 1600933-2014 CERTIFICATE ID: 80 CERTIFICATE EXPIRES: 12-01-2015 12-01-2014/12-01-2015 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 79 DATED 01-28-2015 CITY OF SAN RAFAEL NB JOB:THE GRAND AVENUE IMPROVEMENT PROJECT 1400 STH AVE SAN RAFAEL CA 94901-1943 This Is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below far the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to :ts normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - DEAN CHAPMAN P S T - EXCLUDED. ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015-01-30 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SAN RAFAEL EMPLOYER DEAN CHAPMAN & ASSOCIATES DBA: A CORPORATION 108 CLUB TER DANVILLE CA 94526 [NAM,CS] (REV.7-2014) PRINTED : 01-30-2015 POLICYHOLDER COPY NB P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-30-2015 GROUP: POLICY NUMBER: 1500933-2014 CERTIFICATE ID: 80 CERTIFICATE EXPIRES: 12-01-2015 12-01-2014/12-01-2015 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 79 DATED 01-28-2015 CITY OF SAN RAFAEL NS JOB:THE GRAND AVENUE IMPROVEMENT PROJECT 1400 STH AVE SAN RAFAEL CA 94901-1943 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance Is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - DEAN CHAPMAN P S T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015-01-30 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SAN RAFAEL EMPLOYER DEAN CHAPMAN & ASSOCIATES DBA: A CORPORATION 108 CLUB TER DANVILLE CA 94526 [NAM,CS] (REV.7w2014) PRINTED : 01-30-2015 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job: Sample Rate: Regular Premium equals: Surcharge: Additional Waiver charge: Total premium equals $5,000.00 13.300 $ 665.00 3.00 $ 19.95 $ 684.95 (665.00 + 19.95)