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HomeMy WebLinkAboutCC Resolution 11423 (Gerstle Park Tot Lot & Restroom Impr.)RESOLUTION NO. 11423 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING CONTRACT FOR GERSTLE PARK TOT LOT & RESTROOM IMPROVEMENTS TO PAT NELSON CONSTRUCTION, INC. IN THE AMOUNT OF $187,384.43. WHEREAS, on the 30th day of September, 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: "GERSTLE PARK TOT LOT & RESTROOM IMPROVEMENTS" PROJECT NO. 10717 in accordance with the plans and specifications therefor on file in the office of said City Clerk; and WHEREAS, the bid of Pat Nelson Construction, 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, BE IT RESOLVED that the bid of Pat Nelson Construction, 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 Pat Nelson Construction, Inc. at the unit prices mentioned in said bid. BE IT FURTHER 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. 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, 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 Monday, the 6th day of October, 2003, by the following vote, to wit: AYES: COUNCILMEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None JE E M. LEONCINI, City Clerk File No.: 22.04.35 City of San Rafael • California Form of Contract Agreement For GERSTLE PARK TOT LOT & RESTROOM IMPROVEMENTS PROJECT NO. 10717 This Agreement is made and entered into this 6th day of October, 2003 by and between the City of San Rafael (hereinafter called City) and Pat Nelson Construction, 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: Gerstle Park Tot Lot & Restroom Improvements, Project No. 10717, 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 ninety (90) 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 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 $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 OPY 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 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: CITY OF SAN RAFAEL: JearYe M. Leoncini Abert oro i1 City Clerk Mayor APPRd/7 A CONTRACTOR: i Gary T. Ragg a City Attorney 6f AGREEMENT • 4 gulf Insurance Group BOND NUMBER B34231067 PREMIUM: $ 4, 573.00 KNOWN ALL MEN BY THESE PRESENTS: "BOND EXECUTED IN TRIPLICATE" 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 Obli eell,, in the full and just sum of ONE riuNOt>r�U ELUjf uy. �tvta-rnuubluvL THREE HUNDRED GHTY FOUR*(5 87, 384.43). 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. * AND 43/100ths-------- Signed, sealed and dated this 6th day of OCTOBER 20 03 WHEREAS, the Principal has entered into a certain written contract, dated the 6th day of OCTOBER 20 03 with the Obligee for GERSTLE PARK TOT LOT AND RESTROOM IMPROVEMENTS, PROJECT NO. 10717 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. P . ipal Witness B i /��- Gulf //Insura%nce Co pany Witness By� KELLY H0 TEN1 Attorney-in-fact GULF -PERF (7/02) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California SS. County of SONOMA On 10-6-03 before me, BONNIE K. FRYMIRE NOTARY PUBLIC Date Name and Title of Officer je.g., Jane Doe, Notary Public") personally appeared KELLY HOLTEMANN OFFICIAL SEAL - 1412172 I BONNIE K. FRYMIRE z U NOTARY PUBLIC - CALIF. Z COUNTY OF SONOMA �) My Comm. Exp. April 28, 2007 Name(s) of Signer(s) M personally known to me ❑ proved to me on the basis of satisfactory evidence to be the person(4) whose name(&) is7Wi5 subscribed to the within instrument and acknowledged to me that MsheNWexecuted the same in WheMBEEX authorized capacity(JW, and that by N4Jfiffier/ElOtf signature(K) on the instrument the person(M), or the entity upon behalf of which the person(R) acted, executed the instrument. WI ESS my hand,an�fficial seal. Place Notary Seal Above Signature of Notary PubN1: 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: PIIIFIORMANCE BOND Document Date: OCTOBER 6th, 2003 Number of Pages: Signer(s) Other Than Named Above: NIS Capacity(ies) Claimed by Signer Signer's Name: KELLY HOLTEMANN ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General IN Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: GULF INSURANCE COMPANY Top of thumb here 0 1999 National Notary Association • 9350 Oe Soto Ave., P.C. Box 2402 • Chatsworth, CA 91313-2402 • www.nalionalnolary.org Prod. No. 5907 Reorder. Call Tal' -Free 1-800-876.6827 ' Gulf Insurance Group 110 West "A" Street Suite 1805 San Diego, CA 92101 Payment Bond Number: B34231067 Premium: Included in Performance Bond itBOND EXECUTED IN TRIPLICATE" BY THIS BOND, We, PAT NELSON CONSTRUCITON, 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 QNF HUNT)RFn F,T(TRTY SM1Fw TH01Tfi�ND THREE HUNDRED EIGHTY FOUR` 187,384.43 for the payment of which we bind ourselves, our heirs, personal representatives, successors and assigns, jointly and severally. * AND 43/100ths-------- 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 OCTOBER 6th. 20 03 between Principal and Owner for construction of GERSTLE PARK TOT LOT AND RESTROOM IMPROVEMENTS, PROJECT NO. 10717 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 6th day of OMBER 2003 PAT NELSON CONSTRUCTION, INC. Principal By//�2._ V -- GULF INSURANCE COMPANY By: l��. f J,(_•1 i)""�. lug �� KELLY HOLTEMAO , Attorney-in-fact SGulf Insurance Group Gulf Insurance Group 125 Broad Street, 8th Floor New York, NY 10004 Phone: 2 12.291 .3000 IMPORTANT DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE On November 26, 2002, President Bush signed into law the Terrorism Risk Insurance Act of 2002 (the "Act"). The Act establishes a short-term program under which the Federal Government will share in the payment of covered losses caused by certain acts of international terrorism. We are providing you with this notice to inform you of the key features of the Act, and to let you know what effect, if any, the Act will have on your premium. Under the Act, insurers are required to provide coverage for certain losses caused by international acts of terrorism as defined in the Act. The Act further provides that the Federal Government will pay a share of such losses. Specifically, the Federal Government will pay 90% of the amount of covered losses caused by certain acts of terrorism that is in excess of Gulf Insurance Group's statutorily established deductible for that year. The Act also caps the amount of terrorism -related losses for which the Federal Government or an insurer can be responsible at $100,000,000,000.00, provided that the insurer has met its deductible. Please note that passage of the Act does not result in any change in coverage under the attached policy or bond (or the policy or bond being quoted). Please also note that no separate additional premium charge has been made for the terrorism coverage required by the Act. The premium charge that is allocable to such coverage is inseparable from and imbedded in your overall premium, and is no more than one percent of your premium. �. �.:7'��i�� 971�.�!!`rl.�i`t".f^;i�7�l�r; :�,�1�7�F�il�,l,•�;1��c'���� Lfy r. 1.-pCTICI I ,r, IN -...T r..E R OF 'V• vT; Z ri i 7 ORIGINAU13 OF THM POWER OF AT'rDRi1F( 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 iavrs of the State, of Connecticut, havin its principal office in the Pity of Irving, 'Texas, pursuant to the following resolution, adopted by the Finance & ExecutnVe Committee of the hoard of Directol 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 Power of Attorney constituting as Attorney -in -Fact, such persons, firms, or cprporations as may be selected from time to time, and any such Attorney -in -Fac 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 c 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, delrve or otherwise issue a policy or policies of Insurance on behalf of Gulf Insurance Company. RESOLVED, that the signature of the President, Executive Vire President or any Senior Vice President, and the Seal of the Company may be affixed to an such Power of Attorney or any certificate relating thereto by facsimile, anti any such powers so executed and certified by facsimile signature and facsimil seal shall be valid and binding upon the Company in the future with respect to any boner and documents relating to such boners to which they are attached. Gulf Insurance Company does hereby make, constitute and appoint LAWRENCE J. COYNE GORAN G.E. RYN KELLY HOLTEMANN BONNIE K. FRYMIRE its true and lawful attorneys) -in - fact, with full power and authority hereby conferred in its name, place. and stead, to sign, ezeF:nte, acknowledge and deliv+ 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 P.xtent i, any bonds, undertakings and documents relating to such bonds and/or undertakingswere signed by the duly authorized officer of the Gulf Insurance Connl),,n and all the acts of said attorneys) -in -fact, pursuant to the authority herein given, are hereby ratified and confirmed. *rho 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 Cornpany and its Corporate: Seal I he hereto affixed. -- �— e;ULF INSURAhICI? (T)I •IPANY 4,taSUt•Aurf,� � `, Go�Yoit�l� of^ SEAL S'FATE OF NEW -YO12K !t SS �°vNEr'S�vJ COUN'I"Y OF NEIX'Y6RK ~`--'' L::«rence t A'tiniter I/ Executive Vice President On this 1st day of October, AD 2001, before me game Lawrence P. Miniler, knovrn to me personally who being fly me duty sworn, did depnsr• and sa+ that he resides in the County of Bergen, State of New Jersey; that he is the Executive Vice President of the Guff Insurance: Company, the corporation deserihe 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 sea that it was so affixed by order of the Board of Directors of said corporation and that he signed his mime, thereto by like order. T•� :c � S'FATE OF NEW'IORiC SS COUNTY OF NEW 17 r f (J I APiC1I_ -MAll MI11-11FCAZO ✓ Notary Public, State or New burl: No. 01 M A 6019988 Qualified in kinl�s County Commission fapire: February lei, 2007 I, the undersigned, Senior Vice President of the Gulf Insurance Company, a Connecticut Corporation, DO HEREBY CERTIFY Ihut the foregoing and attache POWER OF ATTORNEY remains fn full force. �--- „�RAWr,E Uuted tile 6th day of OCTOBER 2r`03 Signed and Sealed at the City of N(!%Y'iorl<. \!�� \ 1 SE ex- s=r' '� .•��.rr' . -°tea George Biaucardi _- Senior Vice President DATE SRA CERTIFICATL OF LIABILITY INSURAh%:EI 10/16/2003) PRODUCER (707)687-2200 FAX (707)687-2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers & Young Insurance Services LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9101 Los Amigos Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1738 Windsor, CA 95492 I INSURERS AFFORDING COVERAGE I NAIC # INSURED Pat Nelson Construction, Inc. IINSURERA: North American Capacity Ins Co 75 Magnolia Ave IINSURERB: Golden Eagle Insurance Petaluma, CA 94952 INSURERc: TOPA Insurance Company INSURER D: 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. WSR 410131 LTR ,MSR[ TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER nATE (MM/DD/YYI DATE (MM/DD/YYI LIMITS GENERAL LIABILITY PNG000066100 12/31/2002 12/31/2003 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 1 $ 100,00( CLAIMS MADE M OCCUR MED EXP (Any one person) $ 5,00( A X X $2500 Ded Per C 1 m I PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMP/OP AGG I $ 1,000,00( POLICY n JEC f LOC AUTOMOBILE LIABILITY CBP9660665 12/31/2002 12/31/2003 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) I $ 1,000,00( ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS B (Per person) HIRED AUTOS I BODILY INJURY I $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT I $ ANY AUTO OTHER THAN EA ACC I $ AUTO ONLY AGG I $ EXCESS/UMBRELLA LIABILITY XL15664 03/07/2003 12/31/2003 EACH OCCURRENCE Is 4,000,000 OCCUR ❑ CLAIMS MADE I AGGREGATE Is C Is DEDUCTIBLE I I $ RETENTION $ I I $ WORKERS COMPENSATION AND WC STATU- I I OTH-is EMPLOYERS' LIABILITY IMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? I E.L DISEASE - EA EMPLO YEEI $ If yes, describe under SPECIAL PROVISIONS below I E L. DISEASE - POLICY LIMIT I $ OTHER I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ET IS HEREBY UNDERSTOOD AND AGREED THAT THE CITY OF SAN RAFAEL, ITS OFFICERS, AGENTS AND EMPLOYEES, ARE ADDITIONAL INSUREDS HEREUNDER BUT ONLY AS RESPECTS LIABILITY ARISING OUT OF THE LAND AND/OR PROPERTY .AND/OR WORK DESCRIBED IN THE PUBLIC WORKS CONTRACT FOR THE PROJECT ENTITLED, GERSTLE PART TOT LOT & RESTROOM IMPROVEMENTS, PROJECT # 10717 BETWEEN THE CITY OF SAN RAFAEL AND PAT NELSON CONSTRUCTION, INC. *CANCELLATION IS 10 DAYS FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CITY OF SAN RAFAEL DEPARTMENT OF PUBLIC WORKS P.O. BOX 151560 SAN RAFAEL, CA 94915-1560 ACORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL WM00M MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, E()(K)(&Y&UXXXdifU)CXac)!QLXdCnt)%X)kxmI(Il(I)f1(XXXX W"XcXD4)(#xdYXmr,YsXrxmx)txxmxx)iKXKAXX IWID6d6MXXXXXXXXXX AUrTHORI� REPRESENTATIVE;s /` ©ACORD CORPORATION 198E IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001/08) POLICY NUMBER: PNG0000661-00 COMMERCIAL GENERAL LIABILITY CG 201011 85 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: Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to (1) occurrence s taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section ll) 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. Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insured(s) shall be excess and non-contributory, but only as respects any claim or liability determined to be the result of the sole negligence or responsibility of the Named Insured and only if required of the Named Insured by written contract. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1