HomeMy WebLinkAboutCC Resolution 13912 (B St. Siding Replacement)RESOLUTION NO. 13912
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
AWARDING A CONTRACT FOR THE B STREET COMMUNITY CENTER SIDING
REPLACEMENT PROJECT, CITY PROJECT NO. 11232, TO WEDGE ROOFING,
INC., IN THE AMOUNT OF $124,990.00 (BID OPENING HELD ON TUESDAY, MARCH 24,
2015).
WHEREAS, on the 23rd day of January, 2015, pursuant to Section 11.50.170 of the San
Rafael Municipal Code, the Department of Public Works solicited informal proposals for
performing the following work in said City, to wit:
"11 Street Community Center Siding Replacement Project"
City Project No. 11232
WHEREAS, on March 24, 2015, the City's Public Works Department did receive,
examine, and declare all sealed bids or proposals for the above mentioned project; and
WHEREAS, the bid of Wedge Roofing, Inc., at the unit prices stated, was and is the
lowest and best bid for said work and said bidder is the lowest responsible bidder; and
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
RESOLVES as follows:
1. The bid of Wedge Roofing, Inc., is hereby accepted at said unit prices and that the
contract for said work and improvements is hereby awarded to Wedge Roofing,
Inc. at the unit prices mentioned in said bid.
2. The Acting Public Works Director and the City Clerk of said City are authorized
and directed to execute a contract with Wedge Roofing, Inc., in a form approved
by the City Attorney, for said work and to return the bidder's bond upon the
execution of said contract.
3. Funds totaling $175,000.00 are available in Building Fund #603 and will be
appropriated for City Project No. 11232.
4. The Acting Public Works Director is hereby authorized to take any and all such
actions and make changes as may be necessary to accomplish the purpose of this
resolution.
I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the
foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the
City Council of said City held on Monday, the 201h day of April, 2015 by the following vote, to
wit:
AYES: COUNCILMEMBERS: Bushey, Colin, Gamblin and Vice -Mayor McCullough
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Mayor Phillips
ESTHER C. BEIRNE, City Clerk
File No.: 06.01.221
City of San Rafael ♦ California
Form of Contract Agreement for Informal Bids
for
B Street Community Center Siding Replacement Project
City Project No. 11232
This Agreement is made and entered into this 24'h day of April, 2015 by and between the City of San Rafael
(hereinafter called City) and ®Wedge Roofing, Inc. (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 fiirnisli all of the materials and all of the equipment and labor necessary, and to
perform all of the work described in tine specifications for the project entitled: B Street Community Center Siding
Replacement Project, City Project No. 11232, all in accordance with lite requirements and provisions of the
Contract Documents as defined in the General Conditions which are hereby made a part of this Agreement. The
Contractor further agrees to provide the insurance as specified in the Insurance Requirements Sheet attached hereto
as Attachment A. 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.
11- Time of Completion
(a) The work to be performed under this Contract shall be commenced within FIVE (5) WORKING DAYS after
(lie date of written notice by the City to the Contractor to proceed.
(b) All work shall be completed, including all puncinlist work, within THIRTY (30) WORKING DAYS and with
such extensions of time as are provided for in the General Conditions.
III - Liquidated Damages
It is agreed that, if all the work required by the contract is not finished or completed by tite date set forth in tine
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 tine City, the sum of $500 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 fiu•ther 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 Swn
The City shall pay to the Contractor for the performance of the Contract tine 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 file 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.
I NO. ITEM
Mobilization
2. Remove Existing Exterior
3a. Metal Roofing — F.ntirePerimeter
QUANTITY UNrrs UNIT PRICE
1 1 « $ 18,750.00
1 1 Q $ 18,.000.00
I I « $ 39,240.00
TOTAL PRICE I
_ $ 18,750.00
$ 18,000.00
$ 39,240.00
3b. Metal Roofing—Auditorium Rise I 1 O $ 49,000.00 = $ 49,000.00
TOTAL BASE BID $124,990.00
V - Progress Payments
(a) On no 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 file 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) 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 Govermnent Code. Such securities,
if deposited by (lie 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 five (5) working days make such inspection.
(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 disported amounts when adjudicated in cases where such payment
has not already been guaranteed by surety bond.
(c) The making and acceptance of the final payment shall constitute a waiver of all claims by the City, other than
those arising from any of the following: (1) unsettled liens; (2) faulty work appearing within twelve (12)
months after final payment; (3) requirements of the specifications; or (4) manufacturers' guarantees. It shall
also constitute a waiver of all claims by the Contractor, except those previously made and still unsettled.
(d) If after the work has been substantially completed, frill 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 clams.
IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this
Agreement the day and year first written above.
ATTEST:
Esther C. Beirne
City Clerk
APPROVED AS TO FORM:
Rob Epstein
City Attorney
CITY OF SAN RAFAEL:
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Kevin McGowan
Acting Public Works Director
INTERNATIONAL FIDELITY INSURANCE COMPANY
PERFORMANCE BOND — PUBLIC WORK
Bond Executed in Duplicate
Bond No. 0676261
Premium $ 2,100.00
KNOW ALL MEN BY THESE PRESENTS: That Wedge Roofing, Inc.
as Principal, and International Fidelitv Insurance COMDanv , a corporation organized under the laws of
the State of New Jersey, and authorized to transact a general surety business in the State of California, as Surety, are
held and firmly bound unto City of San Rafael
as Obligee in the sum of
One Hundred Twenty Four Thousand Nine Hundred Ninety & 00/100 --
Dollars ($ 124.990.00 )for the payment whereof, in the lawful money of the United States, said Principal and Surety
bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these presents.
The Condition of the foregoing obligation is such that: whereas, the above bounded Principal has entered into a
contract dated April 24, 2015 with the obligee to do the following work, to wit:
B Street Community Center Siding Replacement Project
City Project No. 11232
as is more specifically set forth in said contract, to which contract reference is hereby made;
Now therefore, if the said Principal shall well and truly perform the work contracted to be performed Linder said
contract in accordance with the plans and specifications, then the above obligation to be void, otherwise to remain in
full force and virtue.
No right of action shall accrue under this bond to or for the use of any person other than the Obligee named herein.
Signed and sealed this 24th day of April , 2015
Wedge Roofing, Inc. International Fidelity Insurance Company
Principal Surety
�torneyy-i:n--Fact
Lawrence J. Coyne,
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
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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-.........M.a.r.!"............. )
On April 24th, 2015 before me, „ K. Holtemann, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared ....... Lawrence J. Cofne
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(&)- whose name(&) is/efe
subscribed to the within instrument and acknowledged to me that he/sh@Ahey executed the same in
his/49644eir-authorized capacity(iei;�, and that by his/�rlthait signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(&) acted, executed the instrument.
I(. MCLTEMANN
Cornnftsion # 2084805
aNotary iPu blic - Califorir a
a
z Maidn County
My Corinirro IFxpires Oct 31, 2018
Place Notary Seal 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,
Signatur,,°
Signature of Notary Public
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 D
Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signers)
Signer's Name: gner's Name:
Corporate Officer — Title(s): I Corporate Officer — Title(s):
Partner — :! Limited General I Partner — Limited I General
Individual Attorne I act Individual Attorney in Fact
I Trustee ian or Conservator Trustee Guardian or Conservator
I ! Other: Other:
Signer I presenting: Signer Is Representing: .....
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02014 National Notary Association • www.Nationa[Notary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
INTERNATIONAL FIDELITY INSURANCE COMPANY
PAYMENT BOND
Bond Executed in Duplicate Bond No. 0676261
Premium included in Performance bond
KNOW ALL MEN BY THESE PRESENTS: That Wedge Roofing, Inc.
as Principal, and International Fidelitv Insurance Comnanv a corporation organized under the laws of
the State of New Jersey, and authorized to transact a general surety business in the State of California, as Surety, are
held and firmly bound unto
City of San Rafael
as Obligee in the sum of
One Hundred Twenty Four Thousand Nine Hundred Ninety & 001100 --
Dollars ($ 124.990.00 ) for the payment whereof, in the lawful money of the United States, said Principal and
Surety bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these
presents.
The Condition of the foregoing obligation is such that: whereas, the above bounded Principal has entered into a
contract dated Apri124, 2015 with the obligee to do the following work, to wit:
B Street Community Center Siding Replacement Project
City Project No. 11232
Now, therefore, if the above bounded Principal, contractor, person, company or corporation, or his or its sub-
contractor, fails to pay any claimant named in Section 3181 of the Civil Code of the State of California, or amounts
due under the Unemployment Insurance Code, with respect to work or labor performed by any such claimant, that the
Surety on this bond will pay the same, in an amount not exceeding the aggregate sum specified in this bond, and also,
in case suit is brought upon this bond, a reasonable attorney's fee, which shall be awarded by the court to the
prevailing party in said suit, and attorney's fees to be taxed as costs in said suit.
This bond shall inure to the benefit of any person named in Section 3181 of the Civil Code of the State of California so
as to give a right of action to them or their assigns in any suit brought upon this bond.
This bond is executed and filed to comply with the provisions of the act of Legislature of the State of California as
designated in the Civil Code, Sections 3247-3252 inclusive, and all amendments thereto.
Signed and Sealed this 24th day of April , 2015
Wedge Roofing, Inc. International Fidelity Insurance Company
Principal Surety
Lawrence J. Coyne, Attorney in Fact
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
c....:.. --1CCc eX;<A
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 Califomia )
County of Marin )
On April 24th, 2015 before me, K. Holtemann, Notary Public
n
Date Here Insert Name and Title of the Officer
personally appeared Lawrence J. Oo1me
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(&)- whose name(&) is/am
subscribed to the within instrument and acknowledged to me that he/&haft&y executed the same in
his/he64h& authorized capacity4es), and that by hisA4@44 aak signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(&) acted, executed the instrument.
K. HOLTEMANN
Commission # 2084805
Notary Public California.
Z ' - Marin County
Comm. Expires Oct 31, 2018
Place Notary Seal 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..
Signature of Notary Public
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. —I ---
Description of Attached Document
Title or Type of Document: Document D
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
1 Corporate Officer — Title(s):
I I Partner — I I Limited 11 General
I Individual ! Attorne act
I Trustee tan or Conservator
Other:
Signer I presenting:
8Tgner's Name:
Corporate Officer — Title(s)°
Partner — Limited General
Individual Attorney in Fact
Trustee Guardian or Conservator
Other:
Signer Is Representing:
02014 National Notary Association • www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907
Tel (973.) 624-7200 POWER OF ATT O R N E Y
INTERNATIONAL FIDELITY INSURANCE COMPANY
ALLEGHENY CASUALTY COMPANY
ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207
KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under
the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of
Pennsylvania, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint
LAWRENCE J. COYNE, KELLY HOLTEMANN, THOMAS E. HUGHES, STANLEY D. LOAR, JOAN DELUCA
Novato, CA.
their true and lawful attorneys) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity
and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute rule, reggulation, contract or otherwise
and the execution of such instruments) 1p ursuance of these presents, shall be as binding upon the said INtERNATIONAL FIDELITY INSURANCL
COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and
acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE
COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors
of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY
CASUALTY COMPANY at a meeting duly held on the 15th day of August, 2000:
"RESOLVED, that (1) the President, Vice President, Chief Executive Officer or Secretary of the Corporation shall have the power to appoint, and to revoke
the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf
of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the
nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents
for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any
such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given or the execution of any
bond, undertaking recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when
so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the
Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed."
IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and
attested these presents on this 22nd day of July, 2014.
,u r x� STATE OF NEW JERSEY'S
" County of Essex
S �!
1904t
ROBERT W. MINSTER
Chief Executive Officer (Intemational Fidelity
Insurance Company) and President (Allegheny
Casualty Company)
On this 22nd day of July 2014, before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly
sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY
COMPANY ; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were
duly affixed by order of the Boards of Directors of said Companies.
IN TESTIMONY WHEREOF, I have hereunto set m hand affixed my Official Seal,
at the City of Newark, New Jersey the day and year first above written.
•�,i5s�o,y•
�•V�
NOTARY
M . II -
PUBLIC C3
A NOTARY PUBLIC OF NEW JERSEY
y� •.°* rax0{9.•' S My Commission Expires April 16, 2019
OF NEV4
"Ill Ipoll"O' CERTIFICATION
I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have
compared the foregoing copy of the Powpj of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said
Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole
of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF, I have hereunto set my hand this ,:)"'t"'" day of �f ,` t "Z)�
' J
MARIA BRANCO, Assistant Secretary
r1 WEDGE -2 OP ID: CM
CERTIFICATE OF LIABILITY INSURANCE ° 04128 2015"'
04/28/2015
PRODUCER Phone: 707-782-9200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Don Ramaticl Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 551 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
Petaluma, CA 94953
Tony Rossotti ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE I NAIC #
INSURED Wedge Roofing Inc. 1 INSURER A West American Insurance Co. 144393
5 Casa Grande hoad 1
Petaluma, CA 94954.5653I INSURER 6
INSURER C 1
I INSURER D 1
I I INSURER E I
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.. F�E�S�ryE y��
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
*10 days notice for nonpayment of premium.
RE: Operations of the named Insured for the certificate holder
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA 94901
CERTIFICATE HOLDER CANCELLATION
SANRA13 SHOULOANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX PIRATIO N
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
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.
AUTHORIZEDREPRESENTATIVE / C�
O 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
City of San Rafael
Public Works
111 MorphewStreet
San Rafael„ CA 94915-1560
ACORD 25 (2009101)
WEDGE -2 OP ID: CM
CERTIFICATE OF LIABILITY INSURANCE I D041281201YY)
04/28/2015
PRODUCER Phone: 707-782-9200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Don Ramaticl Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 551 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
Petaluma, CA 94953 ALTER THE COVERAGE AFFORDED BY THE POL(C1ES BELOW.
Tony Rossaltl
INSURERS AFFORDING COVERAGE I NAIC #
INSURED Wedge Roofing Inc. INSURER A State Compensation Ins. Fund 35076
5 Casa Grande Road
Petaluma, CA 94954-5653 INSURER B
INSURER C
INSURER D.
I INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
'10 days notice for nonpayment of premium.
RE: Operations of the named insured for the certificate holder
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA 94901r
CERTIFICATE HOLDER CANCELLATION
SANRA13 SHOULDANY OFTHEABOVE 13ESCRIBED POLICIES BE CANCELLED BEFORE THEEXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
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.
AUTHORIZED REPRESENTATIVE C
O 1980-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
City of San Rafael, Its agents
officers & employees
Public Works
111 Morphew Street
San Rafael„ CA 949154580
ACORD 25 (2009101)
WEDGE -2 OP ID: CM
CERTIFICATE OF LIABILITY INSURANCE I D0412812015Y)
04/28/2015
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(les) 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 cerliticate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER °NAMEcT Tony Rossottl
Don Ramallcl Insurance, Inc. j PHONE. Em:707-782-9200 ( .Not; 707-782-9300
P.O. Box 551
Petaluma, CA 94953 EMAIL
Tony Rossolll ADDRESS:
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remake Schedule, It more space Is required)
Please see holder notes.
Job: B Street Community Center Sidingg Re laaement
Address: 562 B Street, San Rafael, CA 94301
CERTIFICATE HOLDER
SANRAI3
City of San Rafael, Its agents
officers 8r employees
Public Works
111 Morphew Street AUTH01tIIEDREPRE3ENTATIVE
San Rafael„ CA 94915-1560
O 1988.2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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.
ACORD 25 (2010105)
INSURER(S) AFFORDING COVERAGE
NAIC /
INSURERA:AMTrUst North America, Inc.
120478
INSURED Wedge Roofing, Inc.
INSURER B: Nati Fire Ins. Co. of Hartford
5 Casa Grande Road
Petaluma, CA 94954-5653
INSURER C:
i
INSURER D:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER:
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,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��ggEXCLUSIONS
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-
I E L DISEASE- POLICY LIMIT I S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remake Schedule, It more space Is required)
Please see holder notes.
Job: B Street Community Center Sidingg Re laaement
Address: 562 B Street, San Rafael, CA 94301
CERTIFICATE HOLDER
SANRAI3
City of San Rafael, Its agents
officers 8r employees
Public Works
111 Morphew Street AUTH01tIIEDREPRE3ENTATIVE
San Rafael„ CA 94915-1560
O 1988.2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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.
ACORD 25 (2010105)
HOLDERCODE SANRA13 WEDGE -2 PAGE 2
NOTEPAD: INSUREDSNAME Wedge Roofing, Inc. OP ID: CIA Dato 0412012015
It is agreed that The City of San Rafael, its officers, employees, agents
and volunteers are named as a ditional insureds with regara to general
liability per forms CGM M) and CG2037JO4/13). Primary and
noncontributory wording applies to general liability per form CG2404
(05/09).
POLICY NUMBER-PAL1053849 00
COMMERCIAL GENERAL UABILITY
CG 2010 0413
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 Oroanization(s)
The City of San Rafael, its officers, employees,
agents and volunteers
Location(s) Of Covered Operations
B Street Community Center
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 insureds) 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 insureds) at the
location of the covered operations has been
completed; or
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.
CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2
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
Insurance shown In the Declarations;
whichever is less.
This endorsement shall not Increase
applicable Limits of Insurance shown In
Declarations.
Of
the
the
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413
POLICY NUMBER: PAL1053849 00
COMMERCIAL GENERAL LIABILITY
CG 20 37 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organizations) Location And Description Of Completed Operations
The City of San Rafael, its officers, employees, B Street Community Center
agents and volunteers
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — 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" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described In the Schedule of this endorsement
performed for that additional insured and
Included In the "products -completed operations
hazard'.
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 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 or 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 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 20 0104 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
• ! ! i i
lk
Z Ril
M91i I♦ !
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS 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 0104 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
MAYOR
CITY OF SAN RAF' AEL Gang O. Phillips
Department of VICE MAYOR
Andretu Cuyugan McCullough
Public Works COUNCIL MEMBERS
Maribeth Bushey
Kate Colin
John Gamblin
INSURANCE REQUIREMENTS SHEET
SUBJECT: COMMERCIAL GENERAL LIABILITY, AUTOMOBILE AND WORKERS'
COMPENSATION INSURANCE (MAJOR PUBLIC WORKS CONTRACTS)
The City of San Rafael requires that all Contractors and Subcontractors performing work under a Public
Works contract with the City carry commercial general liability, automobile, and workers' compensation
insurance. The Contractor and Subcontractors shall insure the City, its elective and appointive Boards,
Commissions, Officers, Agents and Employees, as follows:
Commercial General Liabilitv:
Automobile Liabilitv:
Workers' Conloensation Liabilitv:
Minimum of $1,000,000 per occurrence and
$2,000,000 aggregate coverage.
Minimum of $1,000,000 coverage.
Statutory coverage.
The required commercial general liability insurance policy shall provide or shall be endorsed to provide
that the City, its officers, employees, agents and volunteers are additional named insureds under the
policy, that such policy shall be primary and tion -contributory and will not seek contribution from the
City's insurance or self-insurance. The "primary and non-contributory" coverage shall be at least as broad
as CG 20 0104 13.
The limits of insurance required in this Agreement may be satisfied by a combination of primary and
mnbrella 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 non-contributory basis for the benefit of
City (if agreed to in a written contractor or agreement) before City's own insurance or self-insurance shall
be called upon to protect it as a named insured.
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 City.
It shall be a requirement under the contract that any available insurance proceeds broader than or in
excess of the specified nlininunn 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 nlininuon coverage and limits specified in the contract; or (2) the broader coverage and nlaximmnl
limits of coverage of any insurance policy or proceeds available to the named insured; whichever is
greater.
Any deductibles or self-insured retentions in the required insurance policies must be declared to and
approved by the City, 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
or subcontractor shall procure a bond guaranteeing payment of losses and related investigations, claims
administration, attorney's fees, and defense expenses.
Contractor and subcontractors shall provide to the City all of the following: (1) Certificates of Insurance
evidencing the required insurance coverage, (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 policy
language or specific endorsements evidencing 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 and subcontractors. 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 City.
The insurance policies shall provide for a retroactive date of placement coinciding with the effective date
of this contract.
The insurance policies shall include, in their text or by endorsement, coverage for contractual liability and
personal injury.
If the insurance is written on a Claims Made Form, then, following termination of the contract, said
insurance coverage shall survive for a period of not less than five years.
The City reserves the right to decrease the amount of work specified herein at any time.
WEDGE -2 OP ID: CM
CERTIFICATE 4F LIABILITY INSURANCE I DATE
04122881122015015 Y)
PRODUCER Phone: 707-762-9200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Don Ramaticl Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 551 HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petaluma, CA 94953 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tony Rossoltl
INSURERS AFFORDING COVERAGE I NAIL #
INSURED Wedge Roofing Inc,
5 Casa GI INSURER West American Insurance Co. 144393
rande kOR6
Petaluma, CA 94954-5653 I INSURER B
I INSURER C
INSURER D
I I INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. pp pp y ��p�p7���
(LTR INSRf TYPE OF INSURANCE POLICY NUMBER DATLA�MMJSD YI DATE fMMIDDIY_ Y O I I LIMITS
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
'10 days notice for nonpayment of premium.
RE: Operations of the named Insured forthe certificate holder
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA 94901
CERTIFICATE HOLDER CANCELLATION
SANRA13 SHOULDANY OFTHEASOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30" DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZEDREPRESENTATIVE
O 1966.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
City of San Rafael
Publlc Works
111 MorphewStreot
San Rafael„ CA 94915-1560
ACORD 25 (2009101)
PROPERTY DAIAAGE
(PER ACCIDENT)
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AUTO 014LY - EA ACUDENT f
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WEDGE -2 OP ID: CM
CERTIFICATE OF LIABILITY INSURANCE I D04281201 YY)
04128!2015
PRODUCER Phone: 707-782-9200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Don Ramaticl Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. Box 551 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petaluma, CA 94953 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Tony RossoUl 1
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
`10 days notice for nonpayment of premium.
RE: Operations of the named insured for the certificate holder
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA94901r
CERTIFICATE HOLDER CANCELLATION
SANRA13 SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
City of San Rafael, Its agents NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
officers 8r employees
Public Works IMPOSE IVO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR
111 Morphew Street REPRESENTATIVES.
San Rafael„ CA 94915.1560 AUTHORIZED REPRESENTATTVE
ACORD 25 (2009101) O 1968-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
INSURERS AFFORDING COVERAGE NAIC #
INSURED Wedge Roofing Inc.
5 Casa Grande koad
INSURER A State Compensation Ins. Fund 35076
Petaluma, CA 94954.5653
I INSURER B
INSURER C
INSURER D
I
I INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED
HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
LTR INSR1 TYPE OF INSURANCE POLICY NUMBER
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10/01/2014 10101/2015 I E L EACH ACCIDEIII $ 1,000,000I
OFFICERIMEM7BER EXCLUDED? ❑
(Mandatory In NH)
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1 000 000
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OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
`10 days notice for nonpayment of premium.
RE: Operations of the named insured for the certificate holder
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA94901r
CERTIFICATE HOLDER CANCELLATION
SANRA13 SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
City of San Rafael, Its agents NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
officers 8r employees
Public Works IMPOSE IVO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR
111 Morphew Street REPRESENTATIVES.
San Rafael„ CA 94915.1560 AUTHORIZED REPRESENTATTVE
ACORD 25 (2009101) O 1968-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
WEDGE -2 OP ID: CM
CERTIFICATE OF' LIABILITY INSUR04!228!201155
ANCE °A�t8/2
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 pollcy(les) 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 I REACT Tony Rossottl
Don Ramaticl Insurance, Inc. PHONE I FAX . Not: 707-782-9300
P.O. Box 551 I (AIC, No. Exu:707-782-9200
Petaluma, CA 94953 EMAIL
Tony Rossottl ADDRESS:
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Please see holder notes.
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA 94901
CERTIFICATE HOLDER
SANRAI3
City of San Rafael, Its agents
officers & employees
Public Works
111 Morphew Street AUTHORIZED REPRESENTATIVE
ISan Rafael„ CA 94915-1560 ':::�
O 1988-2010 ACORD CORPORATION
The ACORD name and logo are registered marks of ACORD
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.
ACORD 25 (2010/05)
All rights reserved,
INSURERS) AFFORDING COVERAGEI
NAIC
INSURER A:AMTnlst North America, [tic.
II
INSURED Wedge Roofing, Inc,
I INSURER B: Natl Fire Ins. Co. of Hartford
120478
5 Casa Grande Road
Petaluma, CA 94954-5653
I INSURERC:
I INSURER D
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER:
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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
QTR TYPE OF INSURANCE AOUL SUIJK
INSR VIVID POLICY NUMBER
POLICY EFF POLICY EXP
(MMIDDIYYYYI (MMfDDJYYYYI LIMITS
GENERAL LIABILITY
EACH OCCURRENCE S
1,000,OOC
A X COMMERCIAL GENERAL LIABILITY X PAL105384900
02/04/2015 02/04/2016 DAMAGE TO RENTED
PREMISES Ilia occurrence) f
100,000
CLAIMSAIADE � _J! OCCUR
I MED EXP (Any Ono poison) S
5,000
_ $5000 PD Ded
I PERSONAL GADV INJURY f
1,000,000
i Per Occur
I GENERAL AGGREGATE I f
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
I PRODUCTS• COIAP/OP AGG I S
2,000,000
Poua �I PF°r I -I Loc
IEmp Ben, I f
1,000,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
I
S (Ea accident)
I
ANY AUTO
I BODILY INJURY (Per person) f
ALL OPINEDSCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accidonl) f
I I
HIRED AUTOS IJ014 OWNED
AUTOS
I PROPERTY DAMAGE I S
(PER ACCIDENT)
I If
UMBRELLA UAB X OCCUR
EACH OCCURRENCE If
1,000,000
B X EXCESS LIAB CLAIMS -MADE BE032114032
02/04/2015 02104/2016 I AGGREGATE Is
1,000,000
DEC) l I RETENTION S
I is
WORKERS COMPENSATION
I I VIC STATU. I IOTH.1
AND EMPLOYERS' LIABILITY YIN
TORY LIMITS FR
ANY PROPRIETORIPARTPIFR/FXECUTIVE
I E L EACH ACCIDENT Is
OFFICER4,'EMBER EXCLUDED? NIA
(Mandatory In NH)
IEL DISEASE • EA EI IPLOYEEI f
II yyas, doscobe under
OI ,C RIPTION OF OPERATIONS belarr1
E L DISEASE • POLICY UNIT I S
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
Please see holder notes.
Job: B Street Community Center Siding Replacement
Address: 562 B Street, San Rafael, CA 94901
CERTIFICATE HOLDER
SANRAI3
City of San Rafael, Its agents
officers & employees
Public Works
111 Morphew Street AUTHORIZED REPRESENTATIVE
ISan Rafael„ CA 94915-1560 ':::�
O 1988-2010 ACORD CORPORATION
The ACORD name and logo are registered marks of ACORD
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.
ACORD 25 (2010/05)
All rights reserved,
.� HOLDER
OLDE C HAMS Wedge . E-2 E ,»�....
[N7TEPAD. HDLDERCODE 19 WEDGE-2 PAGE 2
g Roofing, Inc. OP ID: CM Date 04128/2015
It is agreed that The City of San Rafael, its officers, employees, agents
'It
volunteers are named as additional insureds with regard to general
pliability per forms CG2010(04/13) and CG2037(04/13). Primary and
noncontributory wording applies o general liability per form CG2404
i(05/09).
POLICY NUMBER:PAL1053849 00
COMMERCIAL GENERAL LIABILITY
CG 20 10 0413
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
A6:1#11
Name Of Additional Insured Person(s)
Or Orcianization(s) Location(s) Of Covered Operations
The City of San Rafael, its officers, employees, B Street Community Center
agents and volunteers
Information required to complete this Schedule, If not shown above, will be shown In the Declarations.
A. Section II — Who Is An Insured is amended to
Include as an additional Insured the person(s) or
organlzation(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 locations)
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 fumished 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
2. That portion of "your work" out of which the
lrtjury 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,
CG 2010 0413 C Insurance Services Office, Inc„ 2012 Page 1 of 2
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,
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 2010 0413
POLICY NUMBER: PAL1053849 00
COMMERCIAL GENERAL LIABILITY
CG 20 37 0413
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS _ COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations
The City of San Rafael, its officers, employees, B Street Community Center
agents and volunteers
Information required to complete this Schedule, If not shown above, will be shown In the Declarations.
A. Section II — 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" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described In the Schedule of this endorsement
performed for that addltional Insured and
Included in the "products -completed operations
hazard".
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 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 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1
COMMERCIAL GENERAL LIABILITY
CG 20010413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
0 0 0
This endorsement modifies insurance provided under the
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You have agreedi writing |nmcontract or
Condition and supersedes any provision to the agreement that this insurance would be
contrary: primary and would not seek conthbu\ion
Primary And Noncontributory Insurance from
iony|n�er kvourpnow available to the
additThis insurance Is primary huand will not seek
contribution from any other insurance available
to on additional insured under Your policy
provided that:
(1) The additional insured iwa Named Insured
under such other insurance; and
CG2O0iU413 0Insurance Services Office, Inc., 2012 Page 1m{1
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
ResponsibleI
Description
I Completion
Department
Date
1
City Attorney
I Review, revise, and comment on draft
agreement.
2
Contracting Department
Forward final agreement to contractor for
their signature. Obtain at least two signed
originals from contractor.
3
Contracting Department
Agendize contractor -signed agreement for
Council approval, if Council approval
necessary (as defined by City Attorney/City
(4�
City Attorney
Ordinance*).
Review approve form of agreement;
o
``✓✓
and
,.( ..-A,
bonds, and insurance certificates and
/-�- '� 0,—A
endorsements.
�L S b 3
5
City Manager / Mayor / or
I Agreement executed by Council authorized
Department Head
official.
6_
City Cleric
City Clerk attests signatures, retains original,
agreement and forwards copies to the
�I I yl to r s
contracting department.
To be completed by Contracting Department:
Project Manager: T .. a .. �' Project Name:. ::� a �p�, �,y,p q g... :�
Agendized for City Council Meeting of (if necessary):
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.
CITY OF SAN RAFAEL
ROUTING SLIP / APPROVAL FORM
INSTRUCTIONS: USE THIS FORM WITH EACH SUBMITTAL OF A CONTRACT, AGREEMENT,
ORDINANCE OR RESOLUTION BEFORE APPROVAL BY COUNCIL / AGENCY.
SRRA / SRCC AGENDA ITEM NO. , 1
DATE OF MEETING: April 20, 2015
FROM: Kevin McGowan
DEPARTMENT: Public Works
DATE: April 8, 2015
TITLE OF DOCUMENT:
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING A CONTRACT
FOR THE B STREET COMMUNITY CENTER SIDING REPLACEMENT PROJECT, CITY PROJECT NO.
11232, TO WEDGE ROOFING, INC., IN THE AMOUNT OF $124,990.00 (BID OPENING HELD ON
TUESDAY, MARCH 24, 2015).
a
Department Head (signal te)
*** *** *** *** *** *** *** *** *** *** *** *** *** *** *** ***
(LOWER HALF OF FORM FOR APPROVALS ONLY)
APPROVED AS COUNCIL/ AGENCY
AGENDA ITEM:
C y n g 'r (signature)
NOT APPROVED
REMARKS:
APPROVED AS TO FORM:
,o
City Attorney (signature)
File No.: 06.01.221