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HomeMy WebLinkAboutCC Resolution 11270 (Bret Harte Park Impr.; Phase I)RESOLUTION NO. 11270 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING THE CONTRACT TO PAT NELSON CONSTRUCTION, INC. FOR BRET HARTE PARK PHASE I IMPROVEMENTS PROJECT IN THE AMOUNT OF $158,683.00 BE IT RESOLVED by the Council of the City of San Rafael as follows: WHEREAS, on the 18th day of February, 2003, pursuant to due and legal notice published in the manner provided by law, inviting sealed bids or 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: "BRET HARTE PARK PHASE I IMPROVEMENTS" PROJECT NO. 11004 in accordance with the plans and specifications therefore on file in the office of said City Clerk; and WHEREAS, the bid of Pat Nelson Construction, Inc. 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 Pat Nelson Construction, Inc. and the same is hereby accepted at said bid and that the contract for said work and improvements be and the same is hereby awarded to said Pat Nelson Construction, Inc. at the price mentioned in said bid. IT IS FURTHER ORDERED AND RESOLVED that the Mayor and the City Clerk of said City be authorized and directed to execute a contract with Pat Nelson Construction, Inc. for said work and to return the bidders bond upon the execution of said contract. IT IS FURTHER ORDERED AND RESOLVED that the Director of Public Works take any and all such actions and make changes as may be necessary to accomplish the purpose of this Resolution. I, JEANNE M. LEONCINI, 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 on the 3rd day of March, 2003, by the following vote, to wit: AYES: COUNCILMEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None ..,-`4 . JEANNE M. LEONCINI, City Clerk File No.: 22.04.34 O O O O O C 7 O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O Oi O O O O 1 Gi O O O O h � Vl O DD O O O O O O Q O O O 0o O O O O o 0 o nl r nl Q 00 �o 10 o Q o 0 0 o Q rn m o ,moi o o c� z v rn 1 c' lo Q rn In oo10 H _ N ^ - o = cui a Urn U � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ,fn O o O b vi O 0 V Q 10 O O O O m C m h 7 O m O O O vt m m Q o m Q o o rn m 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 nl 0 0 0 r 0 0 0 �o ni vi o 0 o r<i o o r vi vi o o vi o ri oo a ai ni o 0 o Iri Q O nl ^ 00 O Q O 1 N O Q N oa h N Q C m m Q Q 00 O r l7 I° V� m o VI N nl V �O Q m m °� O� G, N n F, E- W O U O O O O O O O O O O O O O O O O O O O O O O r O O O m 0 0 m m 0 0 o m �c v, 0 0 0- o0 oc �d h vi o h r oo Q 10 W Q o o _ 00 o m r o0 .- .- m oa Q o0 o m c m Q r w h � r N m r �D m N Q C, of O r U 0 a a F 0 z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 {.q O O O O Q o Q Vl o N vl o rl N O O O O O O o Q V' N o O O V r o m r oa m ao - oo m Q m rn r o 0 o r t% Vl O Q N 10 F � F m m '^ .n v rn o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 E uc, 0 0 o O� 0 0R 0 0 0 0 0 0 0 0 0q 0 0R o rr o 0 0 0 c n¢= 0 0 o Q .n o ni vi o ^ oo a c o vi o v vi o v oo a 0 0 0 ° '_� U F' L: o v o - o Q m Q nl N N- °� m e `" rl ^ rl n v rV Q 0 0 or _ N Q � � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o vi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 r, V' v1 O H r O Vl m m O of 1 r V1 m N vt - Oa N O rr N Q o0 00 O O Y nl h N Q D ` 00 � - V1 � Vl Q vt Q m N1 O O O N O m M O OIt N F 0 rl T nl Nl O nl rl Vl r b m Vl nl ^ f C N T [ Q .�° >¢ 0 0 0 0 0 0 2 N U Q o 0 0 o v v o 0 0o r v 0 0 0 oc v v �i o 00 0 ^ o ni .. 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(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: Bret Harte Park Phase I Improvements 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 five (5) calendar days after the date of written notice by the City to the Contractor to proceed. (b) The work shall be completed within thirtv (301 working days after the date of such notice and with such extensions of time as are provided for in the General Conditions. IIII - 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 Agency, and that it is and will be impracticable and extremely difficult to ascertain and determine the actual damage which the Agency will sustain in the event of and by reason of such delay; and it is therefore agreed that the Contractor will pay to the Agency, the sum of 500 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 NO. ITEM i QTY PRICE, $ TOTAL, $ 1 Demolition, Site Cleaning, 1 LS 25,000.00 25,000.00 Grubbing, Mobilization, and Traffic Control la Relocation of Backflow Preventer 1 EA 1,000.00 1,000.00 2 Earthwork 2a Excavation, loading, 1 LS 5,000.00 5,000.00 hauling, disposal at disposal area. Construction of tree well. 3 Concrete Work 3a IConcrete Sidewalk 45 SF 4.00 180.00 3b IConcrete sub -base slab for pavers 365 SF 4.00 1,460.00 3c (ADA ramp 1 EA 350.00 350.00 3d IConcrete Retaining seat wall 42 LF 100.00 4,200.00 3e (Seat Wall 243 LF 45.00 10,935.00 3f IConcrete sign wall 22 LF 150.00 3,300.00 3g IConcrete header 22 LF 25.00 550.00 4 (Drainage/Water System 4a 14" PVC drain line 65 LF 30.00 1,950.00 4b IFrench Drain line 150 LF 30.00 4,500.00 4c 12" PVC drain line 38 LF 30.00 1,140.00 4d (Catch Basins/DI's 7 EA 500.00 3,500.00 4e (Connection to (E) catch basin/DI. I 1 LS 1,000.00 1,000.00 Adjust catch basin/DI. to grade 4f (Connection to (E) PVC storm drain I 1 LS 500.00 500.00 line 4g 6" SCH 40 sleeves (includes saw 28 LF 20.00 560.00 cutting and patching road @ sleeves) 4h (Gate valve and valve box I 1 I EA 800.00 800.00 4i I1" SCH 40 PVC 20 LF 20.00 400.00 5 IAC Pavement 34 TON 200.00 6,800.00 6 (Fences 6a ISingle Gates - inclusive I 2 I EA 742.50 1,485.00 6b IDouble Gate 1 I EA 1,430.00 1,430.00 6c 142" Chain Link Fence 80 LF 27.22 2,177.60 6d 16' Chain Link Fence 28 LF 47.30 1,324.40 S-7 (Playground Equipment, Safety Surface and Benches 7a (Play Equipment I 1 I LS 63,997.00 63,997.00 7b ISafety Surface including geo fabric I 1 I LS 12,314.00 12,314.00 7c (Benches I 2 I EA 1,415.00 2,830.00 Grand Total 158,683.00 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 Contractor, shall be valued by the City's Finance Director, whose decision on valuation of the securities shall be final. VI - Acceptance and Final Payment (a) Upon receipt of written notice that the work is ready for final inspection and acceptance, the Engineer shall within 5 days make such inspection, and when he finds the work acceptable under the Contract and the Contract fully performed, he will promptly issue a Notice of Completion, over his own signature, stating that the work required by this Contract has been completed and is accepted by him under the terms and conditions thereof, and the entire balance found to be due the Contractor, including the retained percentage, shall be paid to the Contractor by the Agency 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 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. (d) If after the work has been substantially completed, full completion thereof is materially delayed through no fault of the Contractor, and the Engineer so certifies, the City shall, upon certificate of the Engineer, and without terminating the Contract, make payment of the balance due for that portion of the work fully completed and accepted. Such payment shall be made under the terms and conditions governing final payment, except that it shall not constitute a waiver of claims. AGREEMENT • 3 IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the day and year first written above. ATTEST: �on — , Je ne M. Leoncini CITY OF N RAF L: A e or Mayor CONTRACTOR: for File No. 22.04.34 AGREEMENT • 4 H Gulf Insurance Group BOND EXECUTED IN DUPLICATE BOND NUMBER: B34231044 PREMIUM: $4,056.00 KNOWN ALL MEN BY THESE PRESENTS: THAT PAT NELSON CONSTRUCTION. INC. (hereinafter called principal), as Principal, and the Gulf Insurance Company, a corporation of the State of Connecticut with its principal Office in San Diego, Ca ( hereinafter called Surety), as Surety, are held and firmly bound unto CITY OF SAN RAFAEL .(hereinafter called Obligee), in the full and just sum of ONE HUNDRED FIFTY EIGHT THOUSAND SIX HUNDRED EIGHTY THREE & 00: 100-- ($158,683.00). To the payment of which sum, well and truly to be made, the Principal and surety bind themselves, their and each of their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Signed, sealed and dated this 3TH day of MARCH 2003 WHEREAS, the Principal has entered into a certain written contract, dated the 3RD day of MARCH 2003 with the Obligee for BRET HARTE PARK PHASE I IMPROVEMENTS, PROJECT NO: 11004 NOW ,THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the Principal shall indemnify the Obligee against any and all loss or damage directly arising by reason of the failure of the Principal to faithfully perform said contract, then this obligation shall be void; otherwise to remain in full force and effect. This bond is executed and accepted upon the following express conditions precedent: 1. That the Obligee shall faithfully and punctually perform all the terms and conditions of said contract to be performed by the Obligee. 2. That if the Principal shall abandon said contract or be lawfully compelled by reason of a default to cease operations thereunder, the Surety shall have the right at its option to complete said contract or to sublet the completion thereof. 3. That the Obligee shall notify the Surety by registered letter, addressed and mailed to it at its Principal Office, of any breach of said contract within a reasonable time after such breach shall have come to the knowledge of the Obligee, or the Architect, or Engineer. 4. That the Surety shall not be liable for any provisions of the contract or specifications respecting guarantees of efficiency or wearing qualities, of for the maintenance of repairs, nor is the Surety obligated to furnish any other bond covering such provisions of the contract specifications 5. All suits at law or proceedings in equity to recover on this bond must be instituted within twelve months after the completion of said contract, and in any event within twelve months form the date fixed in said contract for its completion. PAT NELSON CONSTRUCTION, INC. cipal Witness O; �, Witness GULF -PERF (7/02) Gulf Insurance Company i 9 By /j i zu �_ e(-9) ��ilurz_ LAWRENCE J'COY E, Attorney-in-fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No. 59G7 lr'c:�1 State of CALIFORNIA � County of SONOMA L On 3/3/03 before me, K. HOLTEMANN DATE NAME, TITLE OF OFFICER • E.G., 'JANE DOE, NOTARY PUBLIC personally appeared LAWRENCE J. COYNE, ATTORNEY-IN-FACT NAME(S) OF SIGNER(S) -- CX personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be the per-son(s) whose name(* ism subscribed to the within instrument and ac- knowledged to me that he/m� executed the same in hisbhwahsck authorized -capacity(); and that by his/*N&jAbsk signature(s) on the instrument the person(.), or. the entity upon behalf of which the CFF ;L .l ;EAL-1364054 1fl person(2)acted executed the instrument. K HOLTEMANN n r IN',[ -,'Y PUBLIC - CALIF � GOUr4'1 Y OF SONOMA '. W r1} "u; ro Exp Jjly 6, 2066 I WITNESS my hand and official seal. SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law, It may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER ❑ 114DIVIDUAL ❑ CORPORATE OFFICER TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL DESCRIPTION OF ATTACHED DOCUMENT PERFORMANCE BOND TITLE OR TYPE OF DOCUMEMT ONE 0 ATTORNEY-IN-FACT NUMBER OF PAGES j ❑ -TRUSTEE(S) >t ❑ GUARDIAN/CONSERVATOR ❑ OTHER: 3/3/03 t t DATE OF DOCUMENT t t i t SIGNER IS REPRESENTING: t t t NAME OF PERSON(S) OR ENTITY(IES) n/a E GULF INSURANCE COMPANY SIGNER(S) OTHER THAN NAMED ABOVE t �� r -„•'+HT1 fT, r r r i r i� .. ,1i•�JJ/� 01993 NATIONA_ NOTARY ASSOCIATION- 6236 Remmei Ave., P.O. Bon 71 B4 • Canoga Park, CA 91309.71 B4 71 - Insurance Group 110 West "A" Street Suite 1805 San Diego, CA 92101 BOND EXECUTED rN DUPLICATE Payment Bond Number: B34231044 Premium: Included in Performance Bond BY THIS BOND, We, PAT NELSON CONSTRUCTION. INC. as Principal, and Gulf Insurance Company, with principal offices in San Diego CA, a Connecticut corporation , as Surety are bound unto CITY OF SAN RAFAEL herein called Owner, in the sum of ONE HUNRED FIFTY EIGHT THOUSAND SIX HUNDRED EIGHTY THREE & 00/100 --(S 158.683.00) for the payment of which we bind ourselves, our heirs, personal representatives, successors and assigns, jointly and severally. THE CONDITION OF THIS BOND is that if principal: 1. Promptly makes payments to all lienors supplying labor, material, and supplies used directly of indirectly by Principal in the prosecution of the work provided in the contract dated the day of MARCH 3RD. 2003 between Principal and Owner for construction of BRET HARTE PARK PHASE I IMPROVEMENTS. PROJECT NO: 11004 the contract being made a part of this bond by reference; and 2. Pays Owner all loss, damage, expenses, costs, and attorney's fees, including appellate proceedings that Owner sustains because of default by Principal under paragraph 1. Of this bond; then this bond is void; otherwise, it remains in full force. Any changes in or under the contract documents and compliance or noncompliance with formalities connected with the contract or with the changes do not affect Surety's obligation under this bond. Dated on 3RD day of MARCH 2003 PAT NELSON CONSTRUCTION. INC. Principal GULF INSURANCE COMPANY By: /1,2— LAWRENCE J. COWE Attorney-in-fact CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT No.s9a7 1 1 State of CALIFORNIA County of SONOMA On 3/3/03 before me, K. HOLTEMANN ; DATE NAME, TITLE OF OFFICER - E.G., 'JANE DOE, NOTARY PUBLIC - personally appeared LAWRENCE J. COYNE, ATTORNEY-IN-FACT - NAMEISIOFSIGNER(Sl CX personally known to me - OR - ❑ proved to me on the basis of satisfactory evidence to be the person(z) whose name(* is6 subscribed to the within instrument and ac- knowledged to me that he/Bbaft&y executed the 'same in hiskl=$bl authorized -capacity(A-%), and that by his/tmuWbeia- signature(s) on the instrument the person(s), or.the entity upon behalf of which the dl person() acted, executed the instrument. k HOLTI- ANN z n NO ARY PUBLIC - CALIF � COUN FY OF solaoMA WITNESS my hand and official seal. L un �i Exp J-iIy 6, 2006 SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law, It may prove valuable to persons relying on the document and could prevent . fraudulent -reattachment of this form. ,CAPACITY CLAIMED BY SIGNER ❑ INDIVIDUAL ❑ CORPORATE OFFICER MLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR ❑ OTHER: DESCRIPTION OF ATTACHED DOCUMENT ZINQW11 1.11 TITLE OR TYPE OF DOCUME1`fT ONE NUMBER OF PAGES 3/3/03 DATE OF DOCUMENT SIGNER IS REPRESENTING: ` NAME OF PERSON(S) OR ENTITY(IES) n/a 1 GULF INSURANCE COMPANY l � SIGNER(S) OTHER THAN NAMED X BOVE l , 01993 NATIONAL NOTARY ASSOCIATION - 8236 Remmel Ave., P.O. Box 7164 - Canoge Park, CA 913019-7184 GULF INSURANCE COMPANY DARTFORD, CONNECTICUT ]POWER OF ATTORNEY ORIGINALS OF THIS POWER OF ATTORNEY ARE PRINTED ON BLUE SAFETY PAPER WITH TEAL INK. KNOW ALL MEN BY THESE PRESENTS: That the Gulf Insurance Company, a corporation duly organized under the laws of the State of Connecticut, having its principal office in the city of Irving, Texas, pursuant to the following resolution, adopted by the Finance & Executive Committee of the Board of Directors of the said Company on the 10th day of August, 1993, to wit: "RESOLVED, that the President, Executive Vice President or any Senior Vice President of the Company shall have authority to make, execute and deliver a Power of Attorney constituting as Attorney -in -Fact, such persons, firms, or corporations as may be selected from time to time; and any such Attorney -in -Fact may be removed and the authority granted him revoked by the President, or any Executive Vice President, or any Senior Vice President, or by the Board of Directors or by the Finance and Executive Committee of the Board of Directors. RESOLVED, that nothing in this Power of Attorney shall be construed as a grant of authority to the attorney(s)-in-fact to sign, execute, acknowledge, deliver or otherwise issue a policy or policies of insurance on behalf of Gulf Insurance Company. RESOLVED, that the signature of the President, Executive Vice President or any Senior Vice President, and the Seal of the Company may be affixed to any such Power of Attorney or any certificate relating thereto by facsimile, and any such powers so executed and certified by facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bond and documents relating to such bonds to which they are attached." Gulf Insurance Company does hereby make, constitute and appoint RODERICK T. TAYLER LAWRENCE J. COYNE GORAN G.E. RYN KELLY HOLTEMANN BONNIE K. FRYMIRE its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred in its name, place and stead, to sign, execute, acknowledge and deliver in its behalf, as surety, any and all bonds and undertakings of suretyship, and to bind Gulf Insurance Company thereby as fully and to the same extent as if any bonds, undertakings and documents relating to such bonds and/or undertakings were signed by the duly authorized officer of the Gulf Insurance Company and all the acts of said attorneys) -in -fact, pursuant to the authority herein given, are hereby ratified and confirmed. The obligation of the Company shall not exceed five million (5,000,000) dollars. IN WITNESS WHEREOF, the Gulf Insurance Company has caused these presents to be signed by any officer of the Company and its Corporate Seal to be hereto affixed. \�SURANCE co; mJ G�P40RN4 �Z SEAL STATE OF NEW YORK SS 'yNEcl COUNTY OF NEW YORK / GULF INSURANCE COMPANY Lawrence P. Miniter Executive Vice President On this list day of October, AD 2001, before me came Lawrence P. Miniter, known to me personally who being by me duly sworn, did depose and say: that he resides in the County of Bergen, State of New Jersey; that he is the Executive Vice President of the Gulf Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instruments is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name, thereto by like order. $ ?OT,q,9� to Y STATE OF NEW YORK SS 7AVBI\G COUNTY OF NEW YORK J of Nt 4i,; -4k-4 ANGIE MAHABIR-BEGAZO Notary Public, State of New York No. OIMA6019988 Qualified in Kings County Commission Expires February 16, 2003 I, the undersigned, Senior Vice President of the Gulf Insurance Company, a Connecticut Corporation, DO HEREBY CERTIFY that the foregoing and attached POWER OF ATTORNEY remains in full force. SURANCEC Dated the 3RD day of MARCH 20 03 Signed and Sealed at the City of New York. ��N ok, cJ v�Pp �lF �t SEAQ. EC`�Gv George Biancardi Senior Vice President Corr3nany Profile Company Profile Page 1 of 2 MA ft Insurance� GULF INSURANCE COMPANY 125 BROAD STREET, 8TH FLOOR NEW YORK, NY 10004 800-360-8399 Agent for Service of Process JERE KEPRIOS, C/O CT CORPORATION SYSTEM 818 WEST SEVENTH STREET, 2ND FLOOR LOS ANGELES, CA 90017 Unable to Locate the Agent for Service of Process? Reference Information NAIC #: NAIC Group #: California Company ID #: Date authorized in California: License Status: Company Type: State of Domicile: 22217 3321 0938-1 December 07, 1942 UNLIMITED -NORMAL Property & Casualty CONNECTICUT Lines of Insurance Authorized to Transact The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY DISABILITY FIRE LIABILITY MARINE MISCELLANEOUS http://160.88.209.44/pls/wu_co_prof/idb_co_prof utl.get_co_prof?p_EID 3063 03/12/2003 0 any Profile PLATE GLASS SPRINKLER SURETY TEAM AND VEHICLE WORKERS' COMPENSATION Company Complaint Information Company Enforcement Action Documents Company_Performance & Comparison Data Composite Complaint Studies Want More? Help Me Find a Company Representative_in My Area Financial Rating Organizations Last Revised - January 08, 2003 06:21 PM Copyright © California Department of Insurance Disclaimer Page 2 of 2 http://160.88.209.44/pls/wu_co_prof/idb_co_prof utl.get_coproVp_EID=3063 nn� ACORD CERTIFICAT-' OF LIABILITY INSUR/a NCE DATE (MM/ *M 03/07/220000 3 PRODUCER (707)687-2200 FAX (707)687-2021 THIS CERTIFICATE IS IS,30ED AS A MATTER OF I FORMATION Rogers & Young Insurance Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9101 Los Amigos Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1738 Windsor, CA 95492 INSURED Pat Nelson Construction, Inc. 75 Magnolia Ave Petaluma, CA 94952 INSURERS AFFORDING COVERAGE INSURER A North American Capacity Ins Co INSURER B: Golden Eagle Insurance INSURER C: TOPA Insurance Company INSURER D. I I INSURER E: 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. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYI DAT (MMI D/YYI LIMITS GENERAL LIABILITY PNG000066100 12/31/2002 12/31/2003 1 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100,000 CLAIMS MADE FKOCCUR I MED EXP (Any one person) $ S,000 A I PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. I PRODUCTS - COMP/OP AGG $ 1,000,000 il POLICYF—] JE 0 n LOC AUTOMOBILE LIABILITY CBP9660665 12/31/2002 12/31/2003 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ I SCHEDULED AUTOS B (Per person) HIRED AUTOS BODILY INJURY $ I NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS LIABILITY TBD 03/07/2003 12/31/2003 EACH OCCURRENCE $ 4,000,000 OCCUR CLAIMS MADE I AGGREGATE $ 4,000,000 C I $ DEDUCTIBLE I $ RETENTION $ $ WORKERS COMPENSATION AND WC OTH- I I TORY LII ITS I I ER EMPLOYERS, LIABILITY I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS IT IS HEREBY UNDERSTOOD AND AGREED THAT THE CITY OF SAN RAFAEL, ITS OFFICERS, AGENTS AND EMPLOYEES, 4RE ADDITIONAL INSUREDS HEREUNDER BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF THE LAND &/OR PROPERTY &/OR WORK DESCRIBED IN THE PUBLIC WORKS CONTRACT FOR THE PR03ECT ENTITLED "BRET HARTE PARK PHASE I IMPROVEMENTS" BETWEEN THE CITY OF SAN RAFAEL AND THE NAMED INSURED FOR THE WORK AND THE IMPROVEMENTS DESCRIBED THERIN. SEE ATTACHED ENDORSEMENT. *CANCELLATION IS 10 DAYS FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: A City of San Rafael Dept. of Public Works P.O. Box 151560 San Rafael, CA 94915-1560 ACORD 25-S (7/97) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL 0k)(00M MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, THORIZED R RES E-N TA(TIV ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7/97) CG 20 10 1185 INSURED: PAT NELSON CONSTRUCTION, INC. POLICY NUMBER: PNG000066100 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS ( FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of person or organization: THE CITY OF SAN RAFAEL IT'S OFFICERS, AGENTS AND EMPLOYEES DEPT. OF PUBLIC WORKS P.O. BOX 151560 SAN RAFAEL, CA 94915-1560 RE: BRET HARTE PARK PHASE I IMPROVEMENTS (If no entry appears above, information required to complete this endorsement will be shown in the declarations as applicable to the endorsement.) WHO IS AN INSURED ( Section 11) 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" for that insured by or for you. CG 20 10 1185 RO0ERS Y INS U RAN C E S 3/7/2003 City of San Rafael Dept. of Public Works P.O. Box 151560 San Rafael, CA 94915-1560 OUNG E R V I C E S Re: Pat Nelson Construction, Inc. CGL Policy No: PNG000066100 (Term: 12/31/2002 to 12/31/2003) Auto Policy No.: CBP9660665 (Term: 12/31/02 to 12/31/03) Umbrella Policy No.: TBD (Term: 3/07/03 to 12/31/02) To Whom it May Concern: Certificate holders for certain job performed by the above captioned Insured require the cancellation wording for their certificate of insurance be amended to exclude the "endeavor to...but failure to..." wording contained in the cancellation clause. It is agreed and understood that in the event of cancellation or non -renewal, Rogers & Young Insurance Services will advise Certificate Holder of said change and will not be the responsibility of the insurance companies shown on the certificate of insurance. Sincerely, uthorized Sig4�nare Rogers & Young Insurance Services LLC • 2455 Bennett Valley Road, Suite A-200, Santa Rosa, California 95404-5648 707 579-5200 - 800 562-1716 • fax: 707 546-8021 • www.rogers-young.com • License # OB18090 FOLIC. .JLDER COPY STATE P -O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CQMoENSAT-QN INSURANCL FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE MARCH 7, 2003 CITY OF SAN RAFAEL BLDG INSPECTION DEPT P 0 BOX 151560 SAN RAFAEL CA 94915 GROUP: 000046 POLICY NUMBER: 10010-2003 CERTIFICATE ID: 29 CERTIFICATE EXPIRES: 01-01-2004 01-01-2003/01-01.2004 BRETHARTE PARK PHASE ONE IMPROVEMEENTS This is to certify that we have issued a valid Workers Compensation Insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to:ts normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or atter the coverage afforded by the policies fisted 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 PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS! $1,000,000 PER OCCURRENCE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER PAT NELSON CONSTRUCTION INC NELSON, PAT NELSON, THERESA DBA: NELSON CONSTRUCTION 75 MAGNOLIA AVE PETAWMA CA 94952 ciiQ'^°`O= rEPF-UI- JH I