HomeMy WebLinkAboutCC Resolution 11549 (East SR Improvement Project - Phase III)RESOLUTION NO. 11549
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING
CONTRACT TO GHILOTTI BROS., INC. IN THE AMOUNT OF $677,407.00 FOR EAST
SAN RAFAEL IMPROVEMENT PROJECT - PHASE III, PROJECT NO. 10755
WHEREAS, on the 4`h day of May, 2004, pursuant to due and legal notice published in
the manner provided by law, inviting sealed bids for proposals for the work hereinafter mentioned,
as more fully appears from the Affidavit of Publication thereof on file in the office of the City Clerk
of the City of San Rafael, California, the City Clerk of said City did publicly open, examine, and
declare all sealed bids or proposals for doing the following work in said City, to wit:
"EAST SAN RAFAEL IMPROVEMENT PROJECT — PHASE III"
PROJECT NO. 10755
in accordance with the plans and specifications therefore on file in the office of said City Clerk; and
WHEREAS, the bid of Ghilotti Bros., Inc. at the unit prices stated in its bid was and is
the lowest and best bid for said work and said bidder is the lowest responsible bidder therefor;
NOW, THEREFORE, IT IS HEREBY ORDERED AND RESOLVED that the bid
of Ghilotti Bros., Inc. and the same is hereby accepted at said unit prices and that the contract for
said work and improvements be and the same is hereby awarded to said Ghilotti Bros., Inc. at the
unit prices mentioned in said bid.
" 'IPJA L �tvA
IT IS FURTHER ORDERED AND RESOLVED that the Mayor of said City be
authorized and directed to execute a contract with Ghilotti Bros., Inc. for said work and to return
the bidders bond upon the execution of said contract.
BE IT FURTHER RESOLVED that the Director of Public Works 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, JEANNE M. LEONCINI, City Clerk of the City of San Rafael, hereby certify that the
foregoing resolution was duly and regularly introduced and adopted at a regular meeting of the
Council of said City held on the 17th day of May, 2004, by the following vote, to wit:
AYES: COUNCIL MEMBERS: Cohen, Heller, f1i11er, Phillips & Mayor Boro
NOES: COUNCIL MEMBERS: None
ABSENT: COUNCIL MEMBERS:None
JEANA M LEONCINI, City Clerk
File No.: 18.01.54
City of San Rafael ♦ California
Form of Contract Agreement
for
EAST SAN RAFAEL IMPROVEMENT PROJECT -PHASE III
CITY PROJECT NO: 10755
This Agreement is made and entered into this 17th day of May 2004 by and
between the City of San Rafael (hereinafter called City) and Ghilotti Bros., Inc.
(hereinafter called Contractor). Witnesseth, that the City and the Contractor,
for the considerations hereinafter named, agree as follows:
II - Scope of the Work
The Contractor hereby agrees to furnish all of the materials and all of the
equipment and labor necessary, and to perform all of the work shown on the
plans and described in the specifications for the project entitled: East San
Rafael Improvement Project - Phase III, all in accordance with the
requirements and provisions of the Contract Documents as defined in the
General Conditions which are hereby made a part of this Agreement.
III- Time of Completion
(a) The work to be performed under this Contract shall be commenced within
fifteen (15) calendar days after the date of written notice by the City to
the Contractor to proceed.
(b) The work shall be completed within 100 working days after the date of
such notice 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 within the number of working days as set forth in the contract,
damage will be sustained by the City, and that it is and will be impracticable
and extremely difficult to ascertain and determine the actual damage which the
City will sustain in the event of and by reason of such delay; and it is therefore
agreed that the Contractor will pay to the City, the sum of $1,000 for each and
every calendar day's delay in finishing the work in excess of the number of
working days prescribed above; and the Contractor agrees to pay said
liquidated damages herein provided for, and further agrees that the City may
deduct the amount thereof from any moneys due or that may become due the
Contractor under the contract.
IV - The Contract Sum
The City shall pay to the Contractor for the performance of the Contract the
amounts determined for the total number of each of the units of work in
the following schedule completed at the unit price stated. The number of
units contained in this schedule is approximate only, and the final
payment shall be made for the actual number of units that are
incorporated in or made necessary by the work covered by the Contract.
AGREEMENT • 1
COPY
ITEM
NO. ITEM
1 Traffic Control
2 Mobilization
3 Construction Staking
4 Prepare Water Pollution Control Program
(WPCP)
5 Temporary Railing (Type K)
6 Remove Chain Link Fence
7 Remove Pipe
8 Remove Inlet
9 Remove Concrete (Curb, Gutter,
Sidewalk, etc)
10 Clear & Grubbing
11 Keycut Asphalt Concrete Pavement
12 Roadway Excavation (Including Removal
of AC)
13 Aggregate Subbase - Class 4
14 Aggregate Base - Class 2
15 Asphalt Concrete (Type A)
16 Asphalt Concrete (Swale)
17 Asphalt Concrete Dike (Type E)
18 Reinforced Concrete Pipe (375 mm)
19 Reinforced Concrete Pipes (600 mm)
20 Drainage Inlet (Type A, UCS # 220)
21 Drainage Inlet (Modify)
22 Drainage Inlet (GDO)
23 Minor Concrete (Curb & Gutter)
24 Minor Concrete (Sidewalk)
25 Minor Concrete (Type Al -150)
26 Minor Concrete (Median Curb)
27 Minor Concrete (Median Island)
28 Minor Concrete (Wheelchair Ramp)
29 Chain Link Fence (Type CL -1.83)
30 Traffic Signal and Lighting Modification
31 Striping and Pavement Marking
32 Roadside Sign
33 Relocate Road Sign
34 Install New Sign Panel
35 Salvage Roadside Sign
36 Relocate Street Name Sign to New Pole
37 Erosion Control
38 Lead Compliance Plan
39 State Furnished Equipments per
Encroachment Permit
Total Construction Cost
677,407.00
AGREEMENT • 2
UNIT
ITEM
UNITS I
QTY
I PRICE, $ I
TOTAL, $
LS
1
10,000.00
10,000.00
LS
1
53,475.00
53,475.00
LS
1
15,000.00
15,000.00
LS
1
1,350.00
1,350.00
LS
1
35,000.00
35,000.00
M
130
12.50
1,625.00
LS
1
5,000.00
5,000.00
EA
2
1,250.00
2,500.00
LS
1
5,000.00
5,000.00
LS
1
60,000.00
60,000.00
M
340
0.50
170.00
M3
945
50.00
47,250.00
M3
440
65.00
28,600.00
M3
290
110.00
31,900.00
Tonne
500
125.00
62,500.00
LS
1
1,700.00
1,700.00
M
160
28.00
4,480.00
M
11
900.00
9,900.00
M
5
1,000.00
5,000.00
EA
3
1,600.00
4,800.00
EA
2
3,500.00
7,000.00
EA
1
6,100.00
6,100.00
M
240
105.00
25,200.00
M2
69
100.00
6,900.00
M
190
70.00
13,300.00
M
65
125.00
8,125.00
M2
90
110.00
9,900.00
EA
4
1,500.00
6,000.00
M
51
88.00
4,488.00
LS
1
139,000.00
139,000.00
LS
1
36,000.00
36,000.00
EA
10
550.00
5,500.00
EA
6
350.00
2,100.00
EA
6
200.00
1,200.00
EA
4
100.00
400.00
EA
2
350.00
700.00
LS
1
2,000.00
2,000.00
LS
1
2,500.00
2,500.00
LS
1
15,744.00
15,744.00
677,407.00
AGREEMENT • 2
V - Progress Payments
(a). On not later than the 6th day of every month the Public Works Department
shall prepare and submit an estimate covering the total quantities under
each item of work that have been completed from the start of the job up to
and including the 25th day of the preceding month, and the value of the
work so completed determined in accordance with the schedule of unit
prices for such items together with such supporting evidence as may be
required by the City and/or Contractor .
(b). On not later than the 15th day of the month, the City shall, after deducting
previous payments made, pay to the Contractor 90% of the amount of the
estimate as approved by the Public Works Department.
(c). Final payment of all moneys due shall be made within 15 days after the
expiration of 35 days following the filing of the notice of completion and
acceptance of the work by the Public Works Department.
(d).The Contractor may elect to receive 100% of payments due under the
contract from time to time, without retention of any portion of the payment
by the public agency, by depositing securities of equivalent value with the
public agency in accordance with the provisions of Section 4590 of the
Government Code. Such securities, if deposited by the Contractr, shall be
valued by the City's Finance Director, whose decision on valuation of the
securities shall be final.
VI - Acceptance and Final Payment
(a) Upon receipt of written notice that the work is ready for final inspection
and acceptance, the Engineer shall within 5 days make such inspection,
and when he finds the work acceptable under the Contract and the
Contract fully performed, he will promptly issue a Notice of Completion,
over his own signature, stating that the work required by this Contract has
been completed and is accepted by him under the terms and conditions
thereof, and the entire balance found to be due the Contractor, including
the retained percentage, shall be paid to the Contractor by the City within
15 days after the expiration of 35 days following the date of recordation of
said Notice of Completion.
(b) Before final payment is due the Contractor shall submit evidence
satisfactory to the Engineer that all payrolls, material bills, and other
indebtedness connected with work have been paid, except that in case of
disputed indebtedness or liens the Contractor may submit in lieu of
evidence of payment a surety bond satisfactory to the City guaranteeing
payment of all such disputed amounts when adjudicated in cases where
such payment has not already been guaranteed by surety bond.
(c) The Contractor shall provide a "Defective Material and Workmanship Bond"
for 50% of the Contract Price, before the final payment will be made.
(d) The making and acceptance of the final payment shall constitute a waiver of
all claims by the City, other than those arising from any of the following: (1)
unsettled liens; (2) faulty work appearing within 12 months after final
payment; (3) requirements of the specifications; or (4) manufacturers'
guarantees. It shall also constitute a waiver of all claims by the Contractor,
except those previously made and still unsettled.
(e) If after the work has been substantially completed, full completion thereof is
materially delayed through no fault of the Contractor, and the Engineer so
AGREEMENT • 3
certifies, the City shall, upon certificate of the Engineer, and without
terminating the Contract, make payment of the balance due for that portion
of the work fully completed and accepted.
Such payment shall be made under the terms and conditions governing final
payment, except that it shall not constitute a waiver of claims.
IN WITNESS WHEREOF, City and Contractor have caused their authorized
representatives to execute this Agreement the day and year first written above.
ATTEST:
anne M. Leoncini
City Clerk
APF
I
I
L,Gai
City
CITY OF SAN RAFAEL:
-/- --2
Ae tBo
Mayor
GHILOTTI BROS., INC:
�' �� pees i D Enl T'j=61�u�LE-ft
for
AGREEMENT • 4
CNA
For All the Commitments You Make
(BOND ISSUED IN DUPLICATE)
BOND NO. 929258661
PREMIUM: $ 5,564.00
PERFORMANCE BOND
CALIFORNIA PUBLIC WORK
KNOW ALL MEN BY THESE PRESENTS: That we GHILOTTI BROS. , INC.
Principal,
and WFS'T'FRN STIRFTTY rnMPANY Surety,
a corporation organized and existing under the laws of the State of SOUTH DAKOTA and
authorized to transact surety business in the State of California, are held and firmly bound unto
r.Trr'V nR CAN RAPAP7.
Obligee,
in the sum of SIX HUNDRED SEVENTY—SEVEN THOUSAND FOUR HUNDRED NINE AND NO/100THS -----
---------------------------------------------------------------- . Dollars ($ 677,409.00 I
for the payment of which we bind ourselves, our legal representatives, successors and assigns, jointly and severally,
firmly by these presents.
for
WHEREAS, Principal has entered into a contract with Obligee, dated MAY 17, 2004
EAST SAN RAFAEL IMPROVEMENT PROJECT — PHASE III
PROJECT NO. 10755
copy of which contract is by reference made a part hereof.
NOW, THEREFORE, if Principal shall faithfully perform such contract or shall indemnity and save harmless the
Obligee from all cost and damage by reason of Principal's failure so to do, then this obligation shall be null and void;
otherwise it shall remain in ful! force and effect. No right of action shall accrue under this bond to or for the use of
any person other than the said Obligee.
Signed, sealed and dated MAY 18, 2004
GHILOTTI BROS., INC. (Seal)
,? i Principal
By ?2�i
MICHAEL GfI 0 TI, P IDENT/TREA,STTRER
WESTERN SURETY C MPANY
r
KELLY HOLTEMW AiTornc•l in -Fact
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
} ss.
County of Marin J
On 5119'0-1 before me, Patricia Wilson, Notary Public
Date Name and The of Officer (e.g., "Jane Doe, Notary Public*)
personally appeared Michael M. Ghilotti ---------------------
Name(s) of Signer(s)
X personally known to me
❑ proved to me on the basis of satisfactory
evidence
PATRICIA WILSON
_ Commission C 1355339 Z
Not ory Public - Catt[glrnia
Z Marin County
My Camra. Expit s Jul 19, 2M
to be the personal whose nameK) isNM
subscribed to the within instrument and
acknowledged to me that heAMKey executed
the same in his/br authorized
capacity(jgjid, and that by hisjNt&e{r
signaturefo) on the instrument the personjl§), or
the entity upon behalf of which the person(
acted, executed the instrument.
WITNESS my hand and official seal.
��UL4��
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: �QlTY rr�a
Document Date: �, 8 I Number of Pages: _Dy,� o
Signer(s) Other Than Named Above: NIS
Capacity(les) Claimed by Signer
Signer's Name: Michael M. Ghilotti
❑ Individual
-V Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Attorney -in -Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
President/Treasurer
Ghilotti Bros., Inc.
AW -W,
f Holm
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0 1999 National Notary Association - 9350 De Soto Ave., P.O. Box 2402 - Chatsworth, CA 91313-2402 - www.nationainotaryorg Prod. No. 5907 Reorder. Call Toll -Free 1-B00-876.6027
CALIFORNIA ALL�PURPOSE ACKNOWLEDGMENT
State of California
County of SONOMA
ss.
On 5/18/04 before me, LAWRENCE J. COYI`TE, NOTARY PUBLIC
Date Name end Title of Officer (e.g., "Jane Doe, Notary Public")
personally appeared ---------EFLLY HOLTEMANN------------ -----------
Name(s) of Signer(s)
® personally known to me
❑ proved to me on the basis of satisfactory
evidence
P!.?i:r'y PU!ihi. l.UlifrnTtlC7 �
inl lUn IO fount, 4
N%/- GT lim.B-n.vesOCtZ),AjW4
Place Notary Seal Above
to be the person(x) whose name(s) is/mm
subscribed to the within instrument and
acknowledged to me thatAm�shefttq� executed
the same in �iherLtimxk authorized
capacity(fes�, and -that by Mher/lbaix
signature(a) on the instrument the person(.), or
the entity upon behalf of which the person;(
acted,' executed the instrument.
WITNESS my hand and official seal.
L 7l✓.�vl�'tcGe' t --
Signature df NotPublic
OPTIONAL
Though the information below is not required by law, if may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: MAY 18, 2004
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer--Title(s):
❑ Partner — ❑ Limited ❑ General
EX Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
024 I- A C•
N/A
Signer Is Representing: WESTERN SURETY COMPANY
Number of Pages: ONE
-.I •li ',t_ - -1
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0 1999 National Notary Association • 9350 De Solo Ave.. P.D. Box 24112 " Chatsworth, CA 91313-2402 • vnrw.nationalnotery.org Prod. No. 5907 Reorder. Cali 7o l-Froe 1.8DD-978.8827
N�'/estern Su ety Cor,pany
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Bonnie K Erymire, Lawrence J Coyne, Kelly Holtemann, Goran G. E. Ryn, Individually
of Petaluma, CA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed,
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 29th day of April, 2003.
"Errs WESTERN SURETY CO.MPANY
aw�4�po��^oy`
i�Sfgv;p---
�rh OPMd�
Paul �!Bruflat, =nw,ice President
State of South Dakota
ss
County of Minnehaha
On this 29th day of April, 2003, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that be is the Senior Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires +~''""""'""''''''''"`"''"'''''`''' +
f D. KRELL i
November 30, 2006f NOTARY PUBLIC s�LII
rsE SOUTH DAKOTA r
+•,b4Sh•r•,�tiYtih•+htitiY544.s+ti +
1 D. Y.rell, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this_ 8� rel _ day of ______HAY _P00A
tea: WESTERN SURETY COMPANY
?��aroAgsf jam=:
rhea
� D�l1VL 1�JiJ111i 11`I 1J�i'LlllrilL J
CNA
For All the Commitments You Make' BOND NO. 929258661
PREN=: INCLUDED
PAYMENT BOND
CALIFORNIA PUBLIC WORK
KNOWN ALL MEN BY THESE PRESENTS, That we, GEILOTTI BROS. , INC.
and WESTERN SURETY COMPANY as Principal,
a corporation organized and existing under the laws of the State of SOUTH DAKOTA and authorized to transact
surety business in the State of California, as Surety, are held and firmly bound unto
CITY OF SAN RAFAEL
sum of SIX HUNDRED SEVENTY—SEVEN THOUSAND FOUR HUNDRED NINE AND NO/ 100THS Obligee — the
----------------------------------------------------------------- Oollars(S 677.409.00 1,
for the payment whereof, well and truly to be made, said Principal and Surety bind themselves, their heirs, administrators,
successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the above -bounded Principal has entered into a contract, a copy of which contract is by reference made a
part hereof, dated MAY 17, 2004 with the obligee for
EAST SAN RAFAEL IMPROVEMENT PROJECT — PHASE III
PROJECT NO. 10755
NOW, THEREFORE, if the above -bounded Principal or his subcontractors shall fail to pay any of the persons 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, or any amounts required to be deducted, withheld and
paid over to the Franchise Tax Board from the wages of employees of the Principal or his sub -contractors pursuant to
Section 18806 of the Revenue and Taxation Code, with respect to such work and labor, Surety will pay for the same,
in an agreeable amount not exceeding the amount specified in this bond, and also, in case suit is brought upon this
bond, a reasonable attorney's fee, to be fixed by the court.
This bond shall inure to the benefit of any and all persons, companies or corp oratio nsentitled to file claims under 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.
Signed, sealed and dated this 18TH
G-23261 -A
day of MAY
GHILOTTI BROS., INC.
Principal
By
MICHAEL M JGHAOTTI, PRESIDENT/TREAB
WESTERN SURETY COMPANY Surety
yKELLY TWANN Attorney. in -Fact
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of Marin
On 511PIW before me, Patricia Wilson, Notary Public
Date Name and Title of Officer (e.g., 'Jane Doe, Notary Public')
personally appeared Michael M. Ghilotti--------------------- .
Name(s) of S gner(s)
N personally known to me
❑ proved to me on the basis of satisfactory
evidence
PATRIciA. wiL soN
Commission 01365369
ZfdOtOry Public - Calltomigi
,
QMYCW.EY0msjulj
9, 20D8
to be the personal whose name() isKiM
subscribed to the within instrument and
acknowledged to me that heli sit ey executed
the same in his/uci1abc authorized
capacity&§&, and that by hisAN_ ter
signaturek) on the instrument the personfg), or
the entity upon behalf of which the person(
acted, executed the instrument.
WITNESS my hand and official seal.
Signature cI Notary Public
OPTIONAL
Though the information below Is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:►_
Document Date: MC"i�� 1 �-� { Number of Pages: b\_9
Signer(s) Other Than Named Above: NIS
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual
�Z] Corporate Officer— Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Attorney -in -Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Michael M. Ghilotti
President/Treasurer
Ghilotti Bros., Inc.
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0 1999 National Notary Association - 9350 De Soto Ave., P.O. Box 2402 - Chatsworth, CA 91313.2402 - www.nationalnotary.org Prod. No. 5907 Reorder. Call Toll -Free 1-900-676-6627
CALIFORNIA ALL�PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of SONOMA
On 5/18/04before me, LAVRENCE J. COM, NOTARY PUBLIC
Date Name end Title of Officer (e.g., 'Jane Doe, Notary Public")
personally appeared -------KELLY HOLTEMANN--- ---------- -----------------
r
Name(s) of Signers)
! AWRENCE J. COYNr
tc'�_ WMrn1ss1an # 128114:,
t�fw*m
=_ Wkwy tl, - Cu . £
w; Sortom Ccurdj
Q{_ h*Car fi 50esOct2f1,M14
Piece Notary Seat Above
®personally known to me
❑ proved to me on the basis of satisfactory
evidence
to be the person(x) whose name(m) is/mm
subscribed to the within instrument and
acknowledged to me thathe executed
the same in Avisdherf#mix authorized
capacity, and that bykkdher/jbEAx
signature(;) an the instrument the person(iR), or
the entity upon behalf of which the person
acted,' executed the instrument.
WITNESS my hand and official seal.
Sighature of otary Public
OPTIONAL
Though the information below is not required by law, if may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: PAYMENT BOND
Document Date: MAY 18, 2004
Signer(s) Other Than Named Above: N/A
Capacity(les) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer — Titie(s):
❑ Partner — ❑ Limited ❑ General
IX Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
KELLY HOLTHMANN
Number of Pages:
ONE
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01999 National Notary Association • 9350 De Soto Ave.. P.O. Boz 202 • Chatsworth, CA 91313.2402 • v~.nationalnotary.org Prod. No. 5907 Rearden: Call Toll•Free 1-800.875.8927
NOTICE
In accordance with the Terrorism Risk Insurance Act of 2002, we are providing this
disclosure notice for bonds and certain. insurance policies on which one or more of the
Writing Companies -identified below is the surety or insurer.
To principals on bonds and insureds on certain. insurance policies written by any. one or
more of the following.companies (collectively the "Writing Companies") as.surety or
insurer: Western Surety Company, Universal Surety of America, Surety Bonding
Company of.Am.erica, Continental Casualty Company, National Fire Insurance Company
of Hartford; American Casualty Company of Reading, PA, The Firements Insurance
Company of Newark, NJ, and The Continental Insurance Company.
DISCLOSURE -OF PREMIUM
The premium attributable to coverage for terrorist acts certified under the Act was .Zero
Dollars ($0.00).
DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMEINT -OF TFR]31 ORISM
LOSSES
The United States will pay ninety percent (90%) of covered terrorism losses exceeding the
applicable sure -b- /insurer deductible_
Form F7310
` `lectern Surety Coi.pany
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Bonnie K Frymire, Lawrence J Coyne, Kelly Holtemann, Goran G. E. Ryn, Individually
of Petaluma, CA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bands,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 29th day of April, 2003.
qp.vxrr WESTERN SURETY C O.MPANY
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4'rMo�fi Paul eBruflat, Senior Vice President
State of South Dakota
ss
County of Minnehaha
On this 29th day of April, 2003, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires i'•~~~~""~`'~~~~~"~`'«"~~'~ r
TT1
r D. KRELL r
November 30, 2006i SE L NOTARY PUBLIC
SEALi
r SOUTH DAKOTA r
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J D�,N, Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this _ 18TH _ day of MAY 2nOA
"roe WESTERN SURETY COMPANY
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CERTIFICATE LIABILITY INSURANC CSRSD
DATE (MMIDD/YYYY)
ACORP _)F
GHILO-1
05/19/04
P: _Or UCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF I
FORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Don Ramatici Insurance, Inc.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 551
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Petaluma CA 94953
Phone:707-782-9200 Fax:707-782-9300
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
INSURER A: American Safety Indemnity Cc.
INSURER B: Nationwide Mutual Insurance
Co
Ghilotti Bros., Inc.
INSURER C: Amer.Internat'l SpecialtyLi
es
525 Jacoby StreetINSURER
D:
San Rafael CA 94901
INSURER E: State Compensation Ins. Fund
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I AUU'L
LTRINSRC TYPE OF INSURANCE POLICY NUMBER
DATMM/��)POLICY
E(DEPDEYWDfYN
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE I s 1,000,000
A X X COMMERCIAL GENERAL LIABILITY XGI034822001
10/01/03 10/01/04
UHMHUC 1U KI -N I CU
PREMISES(Eaoccurence) I $ 50, 000
CLAIMS MADE OCCUR
MED EXP (Any one person) $ Exc luded
X SIR $25,000
I PERSONAL&ADV INJURY
5 1, 000, 000
X XCU Included
I GENERAL AGGREGATE
1$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
I PRODUCTS - COMP/OP AGG
$1,000,000
POLICY PE0 n LOC
IX I
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$ 1,000,000
B X ANY AUTO ACP7830621590
10/01/03 10/01/04
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS
(Per person)
X HIRED AUTOS
BODILY INJURY
$
X NON -OWNED AUTOS
(Per accident)
X Ded . $1000 APD
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
I AUTO ONLY - EA ACCIDENT
$
ANY AUTO
I
OTHER THAN EA ACC
AUTO ONLY: AGG
15
S
EXCESSIUMBRELLA LIABILITY
I EACH OCCURRENCE
$ 6,000,000
C XI OCCUR CLAIMSMADE BE7414752
10/01/03 10/01/04 AGGREGATE
$ 6,000,000
$
DEDUCTIBLE
I
$
X RETENTION $10,000
I
5
WORKERS COMPENSATION AND
WGSIAIU- H-1
X ITORY LIMITS I 101
EMPLOYERS' LIABILITY
E 315129303
10/01/03 10/01/04 I E.L. EACH ACCIDENT
$ 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
I E.L. DISEASE - EA EMPLOYE
S 1,000,000
If yes, describe under
15 1,000,000
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE: Operations of the Named Insured for the Certificate Holder.
*Ten day notice would be sent on non payment.
JOB: East San Rafael Improvement Project, Phase III, GBI #04406, Proj #10755
30*XES98138(02/03)SPECIAL
CERTIFICATE HOLDER
City of San Rafael, its agents
officers & employees
Dept. of Public Works
P.O. Box 151560
San Rafael, CA 94915-1560
ACORD 25 (2001/08)
CANCELLATION
SANRAI3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL EN96WQR TF MAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, E:.T //LI►1.1111 T8-8959 So !Al!
AU'yHQ�EO RESE E, ���� �����
(\ �v1 Uk A*L.5RD CORPORATION 1988
Insured: Ghilotti Bros., Inc.
Policy: XGI034822001
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ASIC — ES 98 138 02 03
ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS
Non -Contributory
(MODIFIED FORM B)
This Endorsement shall not serve to increase our limits of insurance, as described in SECTION III —
LIMITS OF INSURANCE.
Name of Person or Organization: City of San Rafael, its agents, officers & employees
Name of Project: East San Rafael Improvements Project, Phase III, Project #10755,
GBI #04406
Effective Date: 05/19/04
In consideration of the payment of premiums, it is hereby agreed that the following changes are
incorporated into the policy:
WHO IS AN INSURED (SECTION II) is
amended to include as an insured the person or
organization shown in the Schedule, but only
with respect to liability arising out of "your
work" which is performed at the project
designated above. This Endorsement applies
only to ongoing operations performed by the
Named Insured on or after the effective date of
this Endorsement.
Coverage under this Endorsement applies only as
respects a legally enforceable written contract
with the Named Insured and only for liability
arising out of or relating to the
Named Insured and only for bodily injury or
property damage caused by an occurrence under
coverage A not otherwise excluded in the policy
to which this Endorsement applies.
It is further understood and agreed that
irrespective of the number of entities named as
insureds under this policy in no event shall the
Company's limits of liability exceed the limits of
liability designated in the Declarations.
All other, terms, conditions and exclusions under
the policy are applicable to this Endorsement and
remain unchanged
Copyright 2003 American Safety Indemnity Company
CERI rOLDER COPY
STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 05-19-2004 GROUP: 000315
POLICY NUMBER: 1293-2003
CERTIFICATE ID: 696
CERTIFICATE EXPIRES: 10-01-2004
10-01-2003/10-01-2004
CITY OF SAN RAFAEL
P.O. BOX 151560
SAN RAFAEL CA 94915-1560
JOB: JOB: EAST SAN RAFAEL IMPROVEMENT
PROJECT, PHASE III, GBI #04406,
PROJ. #10755
This is to certify that we have issued a valid Worker's 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
policies 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 may pertain, the insurance afforded by the policies
described herein is subject to all the terms, exclusions, and conditions, of such policies.
AUTHORIZED REPRESENTATIVE
A�� e - A,.
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - MICHAEL GHILOTTI, VP, S - EXCLUDED.
ENDORSEMENT #1600 - DANTE GHILLOTTI, T - EXCLUDED.
ENDORSEMENT #1700 - DANTE GHILOTTI - EXCLUDED.
ENDORSEMENT #1700 - MICHAEL GHILOTTI - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2000 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
GHILOTTI BROS, INC AND/OR GHILOTTI, DANTE PTN AND/OR
GHILOTTI, MICHAEL PTN
525 JACOBY ST
SAN RAFAEL CA 94901
PPRIQC4 ED:
4ED: 05-19-2004
SCIF 10262E Accept this certificate only if you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT" PAGE 1 OF 1