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HomeMy WebLinkAboutPW Street Resurfacing 2016-2017 ContractorITEM 1. 2. 3. 4. City of San Rafael + California Fonn of Agreement for Street Resurfacing 2016-2017 This Agreement is made and entered into this ~ day of A(>cq 2018 by and between the City of San Rafael (hereinafter called City) and Team Ghilotti, Inc. (hereinafter called Contractor). Witnesseth, that the City and the Contractor, for the considerations hereinafter named, agree as follows: 1-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 described in the specifications for the project entitled: Street Resurfacing 2016-2017, City Project No. 11306, all in accordance with the requirements and provisions of the "Specifications and Contract Documents for Street Resurfacing 2016-2017" dated February 2018, which are hereby made a part of this Agreement. The liability insurance provided to City by Contractor under this contract shall be primary and excess of any other insurance available to the City. 11-Time of Completion (a) The work to be performed under this Contract shall be commenced within Five (5) Working Days after the date of written notice by the City to the Contractor to proceed. (b) All work shall be completed, including all punchlist work, within Sixty (60) Working Days and with such extensions of time as are provided for in the General Provisions. 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 $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. The total Contract amount shall not exceed $1,394,144.00; any additional units not specifically enumerated in this Contract, that are incoroporated in or made necessary by work covered by the Contract must be requested and approved in writing as an addendum to this Contract. DESCRIPTION ESTIMATED UNIT UNIT TOTAL QUANTITY PRICE PRICE Mobilization (3% Maximum of Base Bid) LS @ $30,000.00 $30,000.00 Signs and Traffic Control LS @ $45,000.00 $45,000.00 Clearing and Grubbing LS @ $112,000.00 $112,000.00 Minor Concrete AGREEMENT· 1 ORIGINAL ITEM DESCRIPTION ESTIMATED UNIT UNIT TOTAL QUANTITY PRICE PRICE a. Type 'A' Curb and Gutter 500 LF @ $56.00 $28,000.00 b. 4" PCC Sidewalk 1,400 SF @ $15.00 $21,000.00 c. Curb Ramp -Case C 5 EA @ $4,250.00 $21,250.00 d. Curb Ramp -Modified Case C 4 EA @ $4,600.00 $18,400.00 e. Curb Ramp -Case A 3 EA @ $4,550.00 $13,650.00 5. Full Width Grinding** 322,500 SF @ $0.40 $129,000.00 6. Cold Planning a. 6' Edge Grind 7,000 LF @ $3.25 $22,750.00 b. 20' Conform Grind 250 LF @ $25.00 $6,250.00 7. Hot Mix Asphalt a. Full Depth HMA at Curb Ramps 100 TON @ $450.00 $45,000.00 b. Deep Lift Patching 100 TON @ $450.00 $45,000.00 c. Hot Mix Asphalt Overlay 5,600 TON @ $117.77 $659,512.00 d. Asphalt Berm 40 LF @ $30.00 $1,200.00 8. Micro-Surfacing** 23,315 SY @ $2.80 $65,282.00 9. Adjust Existing Facility to Grade a. Adjust Manhole Castings 50 EA @ $605.00 $30,250.00 b. Adjust Water Valve Cover (Roadway Only) 110 EA @ $395.00 $43,450.00 c. Adjust Gas Valve Cover (Roadway Only) 15 EA @ $370.00 $5,550.00 d. Adjust Monument 45 EA @ $370.00 $16,650.00 e. Adjust Sewer Rodhole 20 EA @ $605.00 $12,100.00 10. Striping and Pavement Markings a. 4" White Stripe 100 LF @ $5.00 $500.00 b. Detail 22 700 LF @ $5.00 $3,500.00 c. Pavement Markings (Thermoplastic) 3,500 SF @ $5.00 $17,500.00 d. Red Curb 300 LF @ $2.00 $600.00 11. Roadside Signs EA @ $750.00 $750.00 GRAND TOTAL BID $1,394,144.00 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) As soon as possible after the preparation of the estimate, the City shall, after deducting previous payments made, pay to the Contractor 95% of the amount of the estimate as approved by the Public Works Department. (c) The Contractor may elect to receive 100% of payments due under the contract from time to time, without retention of any portion of the payment by the public agency, by depositing securities of equivalent value with the public agency in accordance with the provisions of Section 22300 of the Public Contract 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 City 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 City 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) 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 City Engineer so certifies, the City shall, upon certificate of the City 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. VII -Assignment of Warranties; Waiver of Subrogation (a) Contractor hereby assigns to City all warranties, guarantees, or similar benefits such as insurance, provided by or reasonably obtainable from the manufacturers or suppliers of equipment, material or fixtures that Contractor has installed or provided in connection with the work performed under this Agreement. (b) Contractor hereby agrees to waive and arrange by contract for its subcontractors to waive any subrogation rights which any insurer of Contractor or its subcontractors might otherwise acquire in connection with the insurer's payment to Contractor or its subcontractors of any insured loss with respect to work performed under this Agreement. Contractor further agrees to obtain and to arrange for its subcontractors to obtain for City's benefit any endorsements from insurers that may be necessary to effect such waiver of subrogation. Specifically, any worker's compensation insurance policies of the Contractor or its subcontractors shall be endorsed with a waiver of subrogation in favor of City for any work performed by Contractor or its subcontractors under this Agreement, and copies of such endorsements shall be provided to City. AGREEMENT' 3 IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the day and year first written above. CITY OF SAN RAFAEL: City er ATTEST: Lindsay Lara City Clerk APPROVED AS TO FORM: Robpa,,~ 1~ (l(£ City Attorney File No. 16.06.87 Team Ghilotti, Inc. By: ptit~~rtEU' Title: Vice President and, Title: Secretary AGREEMENT' 4 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 UmmEl III I i:111 II m m &:I EiJ mill II 0 00 IJ IJ II II II m m e!!mmmISml!E06 B B BOB B 0 [to 0 III II m as Ismco:rn8888 (] B 8 (] 0 OIl:EI D III 1:1 III II Cill CI CI 1:1 1:1 II) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of SOr\.()mo.... } On !}spill d-.'-I, ').018 Jennifer Lorraine Ghilotti, Notary Public before me, _____________________ _ Date Here Insert Nal7)...e af}Q Title of the Officer Robert E. Lee, Vice t'reSldent personally appeared _______________________________ _ N~e*~noB~AAac~Stecretary -----------------------------------------, who proved to me on the basis of satisfactory evidence to be the erson(s) whose name(S~~~Cribed to the within instrument and acknowledged ~e that A they ecuted the same in' heir authorized capacity(ies), and that b~~ signature(s) on e instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~~::,=~ OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ___________________________ _ Document Date: _____________________ NumberofPages: ____ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ____________ _ o Corporate Officer -Title(s): ______ _ o Corporate Officer -Title(s): ______ _ o Partner - 0 Limited 0 General o Partner -0 Limited 0 General o Individual o Attorney in Fact o Individual 0 Attorney in Fact o Trustee o Guardian of Conservator o Trustee 0 Guardian of Conservator o Other: o Other: Signer is Representing: _________ _ Signer is Representing: _________ _ 8B 0 0 0 (] 1(1 DlOiJ 11111011'1111111 Ba IIIJUDI!O:{BtJ8a 180:8ICII.,1 III (] liD D 1)fI1:I1@31:II' IllslllIJIJOOB 0:8881 CII:I £11:11:1 IIII mC88!11 ©2017 National Notary Association A312™ -2010 Performance Bond Bond No.: .;:.0~2-,-15~3::..:2::..:5,---__ _ Premium: $12,732.00 CONTRACTOR: (Name, legal status and address) Team Ghilotti, Inc. 2531 Petaluma Blvd ., South Petaluma, CA 94952 OWNER: (Name. legal status and address) City of San Rafael 1400 Fifth Avenue, Room 209 San Rafael, CA 94901 CONSTRUCTION CONTRACT Date: SURETY: Berkley Insurance Company 475 Steamboat Rd. Greenwich, CT 06830 This document has important legal consequences . Consultation with an attomey is encouraged with respect to its completion or modificalion. Any. singular reference to Contractor, Surety. Owner or other party shall be considered plural where applicable . This document combines two separate bonds, a Performance Bond and a Payment Bond. into one form. This is not a single combined Amount: Performance and Payment Bond. One Million Three Hundred Ninety Four Thousand One Hundred Forty Four & 00/1005-($1,394,144.00) Description: Street Resurfacing 2016-2017 City Project No. 11306 (Name and location) Santa Rafael, CA BOND Date: April 23, 2018 (Not earlier than Constn/ction Contract Dale) Amount: One Million Three Hundred Ninety Four Thousand One Hundred Forty Four & 00/1 00s-($1 ,394,144.00) Modifications to this Bond: ® None o Sec Section 16 CONTRACTOR AS PRINCIPAL SURETY Company: (Co/porale Seal) (Co/porate Seal) Team Ghilotti , Inc. Berkley Insurance Company 2531 Petaluma Blv d., South 475 Steamboat Rd. Petaluma, c~ ~~ ~Z-£'''' CT 06830 , Si.~_ ~ {Il1Jtt S'g~_ ~~ Name Steven B. Mack, Secretary Name Erm Bautt a and Title: and Title: Attorney-in-Fact (Any additional signatures appear on the last page of this Pe/formance Bond.) (FOR INFORMATION ONLY -Name. address and telephone) AGE.NT or BROKER: OWNER'S REPRESENTATIVE: ABO Insurance & Financial serviceiArchitect. Engineer or other party:) 5448 Thornwood Drive San Jose, CA 95123 Conforms to American Institute of Architects 2010 A312™ Performance Bond ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Santa Clara On April 23, 2018 before me, Jean L. Neu, Notary Public (insert name and title of the officer) ~~nal~awea~~E_r_in_B_a_u~ti_~_a ____ ~ _______ ~ ____ ~_~ __ who proved to me on the basis of satisfactory evidence to be the person~) whose name(s) is/me subscribed to the within instrument and acknowledged to me that ~e/she/~~ executed the same in ~herhtlm(Rauthorized capacity~~, and that by ~her/~k' signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~L / (Seal) Ie .......... ··f _. JEAN L. NEU :@·· .. i·,:;;NotarypUbIiC-California ~ § ~ .. ,f,. ,. Santa Clara County > 1 \:!~.~ •. , Commission # 2230024 i ~ '. -My (omm. Expires Mar 1. 2022 , § I The Contractor and Surety,jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner for the performance of the Construction Contract, which is incorporated herein by reference. § 2 If the Contractor performs the Construction Contract, the Surety and the Contractor shall have no obligation under this Bond, except when applicable to participate in a conference as provided in Section 3. § 3 Ifthere is no Owner Default under the Construction Contract, the Surety's obligation under this Bond shall arise after .1 the Owner first provides notice to the Contractor and the Surety that the Owner is considering declaring a Contractor Default. Such notice shall indicate whether the Owner is requesting a conference among the Owner, Contractor and Surety to discuss the Contractor's performance. If the Owner does not request a conference, the Surety may, within five (5) business days after receipt of the Owner's notice, request such a conference. If the Surety timely requests a conference, the Owner shall attend. Unless the Owner agrees otherwise, any conference requested under this Section 3.1 shall be held within ten (10) business days of the Surety's receipt of the Owner's notice. If the Owner, the Contractor and the Surety agree, the Contractor shall be allowed a reasonable time to perform the Construction Contract, but such an agreement shall not waive the Owner's right, if any, subsequently to declare a Contractor Default; .2 the Owner declares a Contractor Default, terminates the Construction Contract and notifies the Surety; and .3 the Owner has agreed to pay the Balance of the Contract Price in accordance with the terms of the Construction Contract to the Surety or to a contractor selected to perform the Construction Contract. § 4 Failure on the part of the Owner to comply with the notice requirement in Section 3.1 shall not constitute a failure to comply with a condition precedent to the Surety's obligations, or release the Surety from its obligations, except to the extent the Surety demonstrates actual prejudice. § 5 When the Owner has satisfied the conditions of Section 3,the Surety shall promptly and at the Surety's expense take one of the following actions : § 5.1 Arrange for the Contractor, with the Consent of the Owner, to perform and complete the Construction Contract; § 5.2 Undertake to perform and complete the Construction Contract itself, through its agents or in?ependent contractors; § 5.3 Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner for a contract for performance and completion of the Construction Contract, arrange for a contract to be prepared for execution by the Owner and a contractor selected with the Owner's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract, and pay to the Owner the amount of damages as described in Section 7 in excess of the Balance of the Contract Price incurred by the Owner as a result ofthe Contractor Default; or § 5.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances: .1 After investigation, determine the amount for which it may be liable to the Owner and, as soon as practicable after the amount is determined, make payment to the Owner; or .2 Deny liability in whole or in part and notify the Owner, citing the reasons for denial. § 6 If the Surety does not proceed as provided in Section 5 with reasonable promptness, the Surety shall be deemed to be in default on this Bond seven days after receipt of an additional written notice from the Owner to the Surety demanding that the Surety perform its obligations under this Bond, and the Owner shall be entitled to enforce any remedy available to the Owner. If the Surety proceeds as provided in Section 5.4, and the Owner refuses the payment or the Surety has denied liability, in whole or in part, without further notice the Owner shall be entitled to enforce any remedy available to the Owner. § 7 If the Surety elects to act under Section 5.l, 5.2 or 5 .3, then the responsibilities of the Surety to the Owner shall not be greater than those of the Contractor under the Construction Contract, and the responsibilities of the Owner to the Surety shall not be greater than those of the Owner under the Construction Contract. Subject to the commitment by the Owner to pay the Balance of the Contract Price, the Surety is obligated, without duplication, for Conforms to American Institute of Architects 2010 A312TII Performance Bond 2 .1 the responsibilities of the Contractor for correction of defective work and completion of the Construction Contract; .2 additional legal, design professional and delay costs resulting from the Contractor's Default, and resulting from the actions or failure to act of the Surety under Section 5; and .3 liquidated damages, or if no liquidated damages are specified in the Construction Contract, actual damages caused by delayed performance or non·performance of the Contractor. § 8 If the Surety elects to act under Section 5.1,5.3 or 5.4, the Surety's liability is limited to the amount of this Bond . § 9 The Surety shall not be liable to the Owner or others for obligations of the Contractor that are unrelated to the Construction Contract, and the Balance of the Contract Price shall not be reduced or set off on account of any such unrelated obligations . No right of action shall accrue on this Bond to any person or entity other than the Owner or its heirs, executors, administrators, successors and assigns. § 10 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. § II Any proceeding, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be instituted within two years after a declaration of Contractor Default or within two years after the Contractor ceased working or within two years after the Surety refuses or fails to perform its obligations under this Bond, whichever occurs first. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. § 12 Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears. § 13 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. § 14 Definitions § 14.1 Balance of the Contract Price. The total amount payable by the Owner to the Contractor under the Construction Contract after all proper adjustments have been made, including allowance to the Contractor of any amounts received or to be received by the Owner in settlement of insurance or other claims for damages to which the Contractor is entitled, reduced by all valid and proper payments made to or on behalf of the Contractor under the Construction Contract. § 14.2 Construction Contract. The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and changes made to the agreement and the Contract Documents. § 14.3 Contractor Default, Failure of the Contractor, which has not been remedied or waived, to perform or otherwise to comply with a material term of the Construction Contract. § 14.4 Owner Default. Failure of the Owner, which has not been remedied or waived, to pay the Contractor as required under the Construction Contract or to perform and complete or comply with the other material terms of the Construction Contract. § 14,5 Contract Documents. All the documents that comprise the agreement between the Owner and Contractor. § 15 If this Bond is issued for an agreement between a Contractor and subcontractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. Confonns to American InstItute of Architects 2010 A312 18 Perfonnance Bond 3 § 16 Modifications to this bond are as follows : (Space is provided belolll for additional signatllres of added parties. other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY (Corporate Seal) (Co/porate Seal) S;~.rure ~~ Name and Title: Steven B. Mack, Secr~i; I'\' Signature: Name and Title: Team GhifDlti, ~i~fS~l Petaluma Bwl. South Petaruma, CA 94952 Address: Conforms to American Institute of Architects 2010 A312TU Performance Bond 4 POWER OF ATTORNEY BERKLEY INSURANCE COMPANY WILMINGTON, DELAWARE No . .81-10192b NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly ~-r:l organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made, constituted ~ ~ and appointed, and does by these presents make, constitute and appoint: Bryall D. Martin,' Erill Bautista,' Jeall L. Neu; Stephen {l .:: E. Leverolli,' Debra AIlIl Perry; or Allgelilla A. Campallo of ABD Illsurallce & Fillallcial Services, Illc. of San Mateo, CA its -0 ~ ~ true and lawful Attorney-in-Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver 2 ~ any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall ~ .~ exceed Fifty Million and 00/100 U.S. Dollars (U.S.$50,000,000.00), to the same extent as if such bonds had been duly executed ] ~ and acknowledged by the regularly elected officers ofthe Company at its principal office in their own proper persons. <fl <fl <fl ::l ] ~ This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, § ~ without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following -0 ~ resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25, 2010: o IlJ .. ..... Vl § >-. '-' IlJ '" ::: c: 5 .:= ~ -~ ~ ~!: ..... '" IlJ c: ... -o § 0. ._ .~ ~ ..::: u f-o.: .. t: -0 <:.I IlJ > :E~ :..c a e ~ 0. .:: .~ E ~ r:l !:: ::: ~ ~" ::i .= 15 P.. -c E <fl .- :S] '-::l o e !:::: bJ) O..!.: .-u E] RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and revoke any power of attorney previously granted; and further RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and further RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, the Company has c lsed thes~ presents to b~ )igncd and attested by its appropri!lte officers and its corporate seal hereunto affixed thisj2!day of...:::·~~~~~ ,..2rJ/1(_ . Attest:./ (J Berkle Insurance Com pan ~ IlJ (Seal) ~~ ./"i,.-J By -=-~~-:---.ir;e-...J"-_____ _ ..... o . ~ -0 (3 ~ Ira· . L~den an Executive Vice President & Secretary 'g 2 WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. -0 ;:: [ ~ ST ATE OF CONNECTICUT) ~ .;: ) ss: ] ~ COUNTY OF FAIRFIELD ) J.. (3.D Sworn to before me, a Notmy Public in the State of Connecticut, thisL'Z..: day of , by 1m S. Lederman ..::: IlJ "5 -5 and Jeffrey M. Haftcr who are sworn to me to be the Executive Vice Pro 'de t and Seeretm , n the Senior Vice President. S 'cj respectively, of Berkley Insurance Compa~ARIAC. RUNDBAI(EN A . . .I /J //-' / ;:, (tj NOTARY PUBLIC ' ..t.. A:.... L,. ../.A-....,.~f,r..I{1l ..< ~ MY COMMISSION EXPIRES otary Public, State of Con nee tic lit o APRIL 30, 2019 ~ .~ CERTIFICATE Z ~ I, the undersigned, Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct Z 'f: and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked or rescinded and that the authority of the 0:: t: Attorney-in-Fact set forth therein, who executed the bond or undertaking to which this Power of Attorney is attached, is in full force and effect as ~ -5 of this date. ~AP~ . Given under my hand and seal of the Company, this ___ day of __ ~""7'""~"<""=:'p----="'.4 .. '-=~ ~:I.-I. b-f----' (Seal) . ~------.... Vincent P. Forte ) Please verify the authenticity of the instrument attached to this Power by: Toll-Free Telephone: (800) 456-5486; or Electronic Mail: BSGlnquiry@berkleysurety.com Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com Please include with all communications the bond number and the name of the principal on the bond. Where a claim is being asserted, please set forth generally the basis of the claim. In the case of a payment or performance bond, please also identify the project to which the bond pertains. Berkley Surety is a member company of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. · . CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Iii IU II i I I1III1III IIIIII! II D IS III D IIII D 1111111111111. cOl &a I:Im81.:IBI III &:lell:111181 RIRlc.a mllllllOB 80:00:08 0000000 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of 5bf\..o m e,--} On I'VI ~ 'J: :10 \ B before me, ____ J_e_n_ni_fe_r L_o_IT_ai_ne_G_h_il_ot_ti,_N_otaryc..:..:c:..L....:....P-=.ub=li=c __ Date Here Insert Name and Title of the Officer personally appeared ____________ S_t_ev_e_n_B_,_M_a_ck_,_S_e_cr_e_ta_ry _______ _ Namef(lPof Signer~ who proved to me on the basis of satisfactory evidence to be the person(~hose name~ is subscribed to the within instrument and acknowledged to me that~lge/tl'ey executed the same i 15i'ffi€:ff~1r authorized capacity(h.5), and that .by A'IiS.lRerftlgeir signature~ on the instrument the person . or the entity upon behalf of which the person~a'tre'd, executed the instrument. Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature cfn,e;. , -a,nD ~"-~ Si~ture of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ___________________________ _ Document Date: _____________________ N umberofPages: ____ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ____________ _ o Corporate Officer -Title(s): ______ _ o Corporate Officer -Title(s): ______ _ o Partner -0 Limited 0 General o Partner -0 Limited 0 General o Individual 0 Attorney in Fact o Individual o Attorney in Fact o Trustee 0 Guardian of Conservator o Trustee o Guardian of Conservato r o Other: o Other: Signer is Representing: _________ _ Signer is Representing: _________ _ OOOO()lOlC E 0 [J oooooom 0 0 U 188111 lUll(] 11111111111 1111 0111111] 0 IJ IJ on] 88 BOHa B088 0 BOG HUOg (]I) BOBO IJ ooe ©2017 National Notary Association . , A312TM. 2010 Payment Bond CONTRACTOR: SURETY: (Name. legal status and address) Team Ghilotti, Inc. 2531 Petaluma Blvd., South Petaluma, CA 94952 Berkley Insurance Company 475 Steamboat Rd. Greenwich, CT 06830 OWNER: (Name. legal status and address) City of San Rafael 1400 Fifth Avenue, Room 209 San Rafael, CA 94901 CONSTRUCTION CONTRACT Date: Amount: One Million Three Hundred Ninety Four Thousand One Hundred Forty Four & 00/1005-($1.394.144.00) Description: Street Resurfacing 2016·2017 City Project No . 11306 (Name and location) San Rafael. CA BOND Date: April 23. 2018 (Not earlier thall Construction Contract Date) Amount: Modifications to this Bond: ® None o Sec Section 18 CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company : Team Ghilotti, Inc. Bcrkley Insurancc Company 2531 Petalu Blvd., South 475 Steamboat Rd. 4952 Greenwich, CT 06830 S;, .. w • ' ~ 'on . 1iJW.td2z~ Steven B. Mack, SecretarV ame Erin Bautista and Title: and Title : Attorney-in-Fact Name (Any additional signatllres appear on the last page of this Payment Bond.) (FOR INFORMATION ONLY -Name. address and lelepllOne) AGENT or BROKER: OWNER'S REPRESENTATIVE: . . I S (Architect. Engineer or other party:) ABD Insurance and Fmancla ervlces 5448 Thornwood Drive San Jose, CA 95123 Conforms to the American Institute of Architects 2010 A312™ Payment Bond Bond #0215325 Premium: Inc!. in Performance Bond Th 's document has important lega l consequences . Consultation with an attorney is encouraged with respect to its completion or modification. Any singu lar reference to Contractor, Surety. Owner or other party shall be considered plural where applicable. This document combines two separate bonds. a Performance Bond and a Payment Bond. Into one form . This is not a single combined Performance and Payment Bond. (Co/porate Seal) 5 ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Santa Clara On April 23, 2018 before me, Jean L. Neu, Notary Public (insert name and title of the officer) personally appeared _E_r_in_B_a_u_ti_st_a _____________________ _ who proved to me on the basis of satisfactory evidence to be the person~) whose name(s) is/m:e subscribed to the within instrument and acknowledged to me that "'e/she/~y executed the same in m/her~Rauthorized capacity~, and that by ~her/~k' signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. J············f _ JEAN LNEU _@': .... f1;.NotarypUbIiC-California ~ ~ ~~ I~" _ Santa Clara County ~ !fie Commission # 2230024 , My Comm. Expires Mar 1. 2022 Signatu ~~L / (Seal) § 1 The Contractor and Surety, jointly and severally bind themselves, their heirs, executors, administrators, successors and assigns to the Owner to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which is incorporated herein by reference, subject to the following tcrms. § 2 If the Contractor promptly makes payment of all sums due to Claimants, and defends, indemnifies and holds harmless the Owner from claims, demands, liens or suits by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Construction Contract, then the Surety and the Contractor shall have no obligation under this Bond. § 3 If there is no Owner Default under the Construction Contract, the Surety's obligation to the Owner under this Bond shall arise after the Owner has promptly notified the Contractor and the Surety (at the address described in Section 13) of claims, demands, liens or suits against the Owner or the Owner's property by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Construction Contract and tendered defense of such claims, demands, liens or suits to the Contractor and the Surety. § 4 When the Owner has satisfied the conditions in Section 3, the Surety shall promptly and at the Surety's expense defend, indemnify and hold harmless the Owner against a duly tendered claim, demand, lien or suit. § 5 The Surety's obligations to a Claimant under this Bond shall arise after the following: . § 5.1 Claimants, who do not have a direct contract with the Contractor, .1 have furnished a written notice of non-payment to the Contractor, stating with substantial accuracy the amount claimed and the name of the party to whom the materials were, or equipment was, furnished or supplied or for whom the labor was done or performed, within ninety (90) days after having last performed labor or last furnished materials or equipment included in the Claim; and .2 have sent a Claim to the Surety (at the address described in Section 13). § 5.2 Claimants, who are employed by or have a direct contract with the Contractor, have sent a Claim to the Surety (at the address described in Section 13). § 6 If a notice of non-payment required by Section 5.1.1 is given by the Owner to the Contractor, that is sufficient to satisfy a Claimant's obligation to furnish a written notice of non-payment under Section 5.1.1 § 7 When a Claimant has satisfied the conditions of Sections 5.1 or 5.2, whichever is applicable, the Surety shall promptly and at the Surety's expense take the following actions: § 7.1 Send an answer to the Claimant, with a copy to the Owner, within sixty (60) days after receipt of the Claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed; and § 7.2 Payor arrange for payment of any undisputed amounts. § 7.3 The Surety's failure to discharge its obligations under Section 7.1 or Section 7.2 shall not be deemed to constitute a waiver of defenses the Surety or Contractor may have or acquire as to a Claim, except as to undisputed amounts for which the Surety and Claimant have reached agreement. If, however, the Surety fails to discharge its obl.igations under Section 7.1 or Section 7.2, the Surety shall indemnify the Claimant for the reasonable attorney's fees the Claimant incurs thereafter to recover any sums found to be due and owing to the Claimant. § 8 The Surety's total obligation shall not exceed the amount of this Bond, plus the amount of reasonable attorney's fees provided under Section 7.3, and the amount of this Bond shall be credited for any payments made in good faith by the Surety. § 9 Amounts owed by the Owner to the Contractor under the Construction Contract shall be used for the performance of the Construction Contract and to satisfy claims, if any, under any construction performance bond. By the Contractor furnishing and the Owner accepting this Bond, they agree that all funds earned by the Contractor in the performance of the Construction Contract are dedicated to satisfy obligations of the Contractor and Surety under this Bond, subject to the Owner's priority to use the funds for the completion of the work. Conforms to the American Institute of Architects 2010 A3121101 Payment Bond 6 .' § 10 The Surety shall not be liable to the Owner, Claimants or others for obligations of the Contractor that are unrelated to the Construction Contract. The Owner shall not be liable for the payment of any costs or expenses of any Claimant under this Bond, and shall have under this Bond no obligation to make payments to, or give notice on behalf of, Claimants or otherwise have any obligations to Claimants under this Bond. § 11 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. § 12 No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the state in which the project that is the subject of the Construction Contract is located or after the expiration of one year from the date (I) on which the Claimant sent a Claim to the Surety pursuant to Section 5.1.2 or 5.2, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Construction Contract, whichever of (I) or (2) first occurs. If the provisions of,this Paragraph are void or prohibited by law, the minimum period oflimitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. § 13 Notice and Claims to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears. Actual receipt of notice or Claims, however accomplished, shall be sufficient compliance as of the date received. § 14 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. § 15 Upon request by any person or entity appearing to be a potential beneficiary of this Bond, the Contractor and Owner shall promptly furnish a copy of this Bond or shall permit a copy to be made . § 16 Definitions § 16.1 Claim. A written statement by the Claimant including at a minimum: .1 the name of the Claimant; .2 the name of the person for whom the labor was done, or materials or equipment furnished; .3 a copy of the agreement or purchase order pursuant to which labor, materials or equipment was furnished for use in the performance of the Construction Contract; .4 a brief description of the labor, materials or equipment furnished; .5 the date of which the Claimant last performed labor or last furnished materials or equipment for use in the performance of the Construction Contract; .6 the total amount earned by the Claimant for labor, materials or equipment furnished as of the date of the Claim, .7 the total amount of previous payments received by the Claimant; and .8 the total amount due and unpaid to the Claimant for labor, materials or equipment furnished as of the date of the Claim § 16.2 Claimant. An individual or entity having a direct contract with the Contractor or with a subcontractor of the Contractor to furnish labor, materials or equipment for use in the performance of the Construction Contract. The term Claimant also includes any individual or entity that has rightfully asserted a claim under an applicable mechanic's lien or similar statute against the real property upon which the Project is located. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the work of the Contractor and the Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment were furnished . § 16.3 Construction Contract. The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and all changes made to the agreement and the Contract Documents. § 16.4 Owner Default. Failure of the Owner, which has not been remedied or waived, to pay the Contractor as required under the Construction Contract or to perform and complete or comply with the other material terms of the Construction Contract. § 16.5 Contract Documents. All the documents thnt comprise the agreement between the Owner and Contractor. Conforms to the American Institute of Architects 2010 A312111 Payment Bond 7 § 17 If this Bond is issued for an agreement between a Contractor and subcontractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. § 18 Modifications to this bond are as follows: (Space is provided below for additional signatures of added parties. other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Co,.porate Seal) Signature: __ --=-:--_-'-_________ Signature: Name and Title: Address: Address: T. Ghilotti.lnc. 2531 Petaluma Blvd. South Petaluma, CA 94952 Conforms to the American 'nsUtute of Architects 2010 A312li1 Payment Bond 8 POWER OF ATTORNEY BERKLEY INSURANCE COMPANY WILMINGTON, DELA WARE No. BI-IOI92b NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully. KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the "Company"), a corporation duly ~-Cj organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made, constituted .S:! . and appointed, and does by these presents make, constitute and appoint: Bryall D. Martill; Erill Bautista; Jeall L. Neu; Stephell :g :5 E. Leverolli; Debra AIIII Perry; or Allgelilla A. Campallo of ABD Insurallce & Fillancial Services, Illc. of Sail Mateo, CA its ~ g true and lawful Attorney-in-Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver ~ :::0 any and all bonds and undertakings, with the exception of Financial Guaranty Insurance, providing that no single obligation shall ~ .~ exceed Fifty Million and 00/100 U.S. Dollars (U.S.$SO,OOO,OOO.OO), to the same extent as if such bonds had been duly executed 1i :: and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. ~ ~ ~ ..§.. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware, § ~ without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following -0 ~ resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010: o <lJ > ... C/J § >-. ~ <lJ '" C c 6 .=: --~ ~ ~!: t; ~ > .-o § 0.. ._ .~ ~ ,... u f=..: . -c -0 <:J <lJ ;.. :E~ :E a o bIl ... ,... 0.. .:: .~ E ~ Cj c: ::: ~ .: :3 .= g P- -a E if) .- .--0 -5 c <;.... :: o 0 c 5b o~ °C (J ~~ RESOLVED, that, with respect to the Surety business written by Berkley Surety, the Chairman of the Board, Chief Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such attorney-in-fact and revoke any power of attorney previously granted; and further RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances, or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the manner and to the extent therein stated; and further RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and further RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, the Company has c lsed these presents to b~e ;igncd and attcsted by its appropri!lte officers and its corporate seal hereunto affixed thisjZ!'day of..!:·~~~~-~ ,.2D!¥_ . Attest:./ (J Berkle ' Insllrance Com pan ~ ~ (Seal) '-f-o . ,...-0 . ./'L/ I BY~~~~~(,~L-_____ ___ o ~ '~.8 WARNING: THIS POWER INVALID IF NOT PRINTED ON BLUE "BERKLEY" SECURITY PAPER. -0 ~ o -P-~ ST ATE OF CONNECTICUT) 2 .;: ) ss: ] ~ COUNTY OF FAIRFIELD ) J. 5.J::J Sworn to before me, II Notmy Public in the Stulc of Connecticut, thjs~ day of , by Ira S. Lederman ..c <lJ ::; -5 and Jeffrey M. Hafter who are sworn to mc to be the Executive Vicc Pres:'del t and Secretal , n the Senior Vice President, S ~ respectively, of Berkle)1 Insurance Compa~ARIAC. RUNDBAI<EN A . . ,/ fl // / ;:, C;; NOTARY PUBLIC '/ ,(.IL t...". ~~f;,r..I((l c ~ MY COMMISSION EXPIRES otary Public, State of Connecticut <C § APRIL30.2019 'c CERTIFICATE ~ ~ I, the undersigned, Assistant Secretary of BERKLEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a true, correct Z .€ and complete copy of the original Power of Attorney; that said Power of Attorney has not been revoked or rescinded and that the authority of the 0::: ~ Attorney-in-Fact set forth therein, who executed the bond or undertaking to which this Power of Attorney is attached, is in full force and effect as ~ ~ of this date. ~P ~ ~ Given under my hand and seal of the Company, this ___ d,y of = _ 3 bl----. (Seal) _ ~ VincentP. Forte ~ Please verify the authenticity of the instrument attached to this Power by: Toll-Free Telephone: (800) 456-5486; or Electronic Mail: BSGlnquiry@berkleysurety.com Any written notices, inquiries, claims or demands to the Surety on the bond attached to this Power should be directed to: Berkley Surety 412 Mount Kemble Ave. Suite 310N Morristown, NJ 07960 Attention: Surety Claims Department Or Email: BSGClaim@berkleysurety.com Please include with all communications the bond number and the name of the principal on the bond. Where a claim is being asserted, please set forth generally the basis of the claim. In the case of a payment or performance bond, please also identify the project to which the bond pertains. Berkley Surety is a member company of W. R. Berkley Corporation that underwrites surety business on behalf of Berkley Insurance Company, Berkley Regional Insurance Company and Carolina Casualty Insurance Company. · . ., " t ,. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 a a:61J 8 8 gOO 00 0 0 B H H 8 e 886UJlIs m m RI m B:J 1:1 m B!I B Ii] IIII ill i I mil' I &:a & ! I] m a:l a ! 1:111 m i:1 i;1 m m m m Rs m m m m Ell E:I m III U):J m el m I (;0:0:8:3 m m DEB (JOD A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of .sol'\..o'fY'D..... } On \YI~ "-l ( ~ \ CO before me, ____ J_en_n_ife_r_L_oIT_8_in_e_G_h_ilo_tt_i,_N_ota_ry_P_u_bl_ic __ U Date Here Insert Name and Title of the Officer personally appeared ___________ -----;-_S_te_v_e_n.=B..:.... :.:.:M=8C=k.:.!...I-=S-=-ec=r-=-eta=.:...iry~ _____ _ Name~f Signerf!i who proved to me on the basis of satisfactory evidence to be the person~ whose name~~scribed to the within instrument and aCknow~d to me tha~Slleltlley-executed the same in ~erftheir authorized capacity(ih), and that b~ i eri-tAcir sign 'ure~n the instrument the person~ or the entity upon behalf of which the person~cted, executed the instrument. Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature &j]Il;~ in!] ~~Q..,.--:tt:;- S n ture of Notary Pub IC OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: ___________________________ _ Document Date: _____________________ Number of Pages: ____ _ Signer(s) Other Than Named Above: _______________________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ Signer's Name: ____________ _ o Corporate Officer -Title(s): ______ _ o Corporate Officer -Title(s): ______ _ o Partner - 0 Limited 0 General o Partner -0 Limited 0 General o Individual 0 Attorney in Fact o Individual o Attorney in Fact o Trustee 0 Guardian of Conservator o Trustee o Guardian of Conservator o Other: o Other: _____________ ___ Signer is Representing: _________ _ Signer is Representing: _________ _ »«3 mEl 11m 1:1&:1 1:1 EaEI is m Is elm m IlmmRI Rill &:1 m m m 18:8am mal m ElelElllm 1:88:0:0:88:0:0:00:0 BOO 0) 0 0 [) 0 8 8 Ej:8s;ms:g:sE:lI:i III II II II I!I I:tCsEli ! I B II ©2017 National Notary Association ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/yyyy) ~ 4/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER ABO Insurance & Financial Services CONTACT Construction Certs NAME: Attn: Construction De~artment rllgN';o. Ext!: 650-488-8565 I FAX 650-488-8566 3 Waters Park Drive, uilding 3, Suite 100 iAlc Nol: E-MAIL ConstructionCertReQuest(Qltheabdteam.com San Mateo, CA 94403 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# www.theabdteam.com OH55918 INSURER A : Executive Risk Indemnity Inc 35181 INSURED INSURERB: Federal Insurance Company 20281 Team Ghilotti, Inc. INSURERC: Navigators Specialty Insurance Company 36056 Kevin Ghilotti 2531 Petaluma Blvd., South INSURERD: Indian Harbor Insurance Company 36940 Petaluma CA 94952 INSURER E : Travelers Indemnity Company of CT 25682 INSURER F: COVERAGES CERTIFICATE NUMBER: 41489837 REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ~~~ ~~ (~3Mg~1 1(~3~~g~1 LIMITS LTR POLICY NUMBER A rL COMMERCIAL GENERAL LIABILITY I 54309508 10/1/2017 10/1/2018 EACH OCCURRENCE $1000000 I-.::::J CLAIMS-MADE [LJ OCCUR ~~~~~~~9E~~~~~encel $ 100000 rL X , C , U Included MED EXP (Anyone person) $5000 I-PERSONAL & ADV INJURY $1000000 R'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY [2] ~~g: 0 LOC PRODUCTS -COMP/OP AGG 52000000 OTHER: Deductible $10000 B AUTOMOBILE LIABILITY 54309507 10/1/2017 1011/2018 PE~~~b~d~~I~INGLE LIMIT $ 1000000 I- L ANY AUTO BODILY INJURY (Per person) $ -OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ --HIRED NON-OWNED rp~~~;"~J.,';,WAMAGE L AUTOS ONLY ....L AUTOS ONLY $ I Deductible $1 000 Como.lCollision $ C UMBRELLA LIAB H OCCUR SF17EXC8852791C 10/1/2017 10/1/2018 EACH OCCURRENCE $ 10000000 - I EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10000000 OED I I RETENTION sO S B WORKERS COMPENSATION I 54309509 10/1/2017 10/1/2018 II ~~~TUTE I 10TH- AND EMPLOYERS' LIABILITY ER YIN ANYPROPRIETORIPARTNERlEXECUTIVE cr:J N/A E.L. EACH ACCIDENT 51000000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 1000.000 If yes. describe under 51 000000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT D Professional Liability PEC004833101 10/1/2017 10/1/2018 $1,000,000 Occ 1 $2,000,000 Aggregate D Pollution Liability PEC004833101 10/1/2017 10/1/2018 $1,000,000 Occ 1 $2,000,000 Aggregate E Railroad Liabilitv SPS7H65766ATCT 5/14/2018 5/14/2019 $5000 000 Occ 1 $10000000 Aaareaate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddItIonal Remarks Schedule, may be attached If more space Is requIred) Street Resurfacing 2016-2017/City Project No. 11306. The City of San Rafael, its elective and appointive Boards, Commisions, Officers, Agents, and Employees are named as additional insured in respects to general liability, on a primary and non-contributory basis, as required by written contract. Waiver of subrogation applies to workers compensation as required by written contract. 30 days notice of cancellation applies -10 days notice of cancellation for non-payment of premium applies. Endorsements attached. CERTIFICATE HOLDER CANCELLATION Street Resurfacing 2016-2017/City Project No. 11306 Ci~ of San Rafael SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 14 0 Fifth Avenue, Room 209 ACCORDANCE WITH THE POLICY PROVISIONS. San Rafael CA 94901 AUTHORIZED REPRESENTATIVE ~./ I Scott Gaddy © 1988-2015 ACORD CORPORATION. All rIghts reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 41489837 I 17 18,GL-AL -XS -WC PR -RRPL -Job #8206 I Laura Berry I 4 /23 /2 0 1 8 3,20,41 PM (PDTI I Page 1 of 7 This certificate cancels and supersedes ALL previously issued certific a tes. COMMERCIAL GENERAL LIABILITY 10·02·2508 (Ed. 7.15) 54309508 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: \ COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION II -WHO IS AN INSURED is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the insured by this endorsement is limited as follows: a. In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. b. The insurance provided to the insured does not apply to damages, loss, cost or expense arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (2) Supervisory, inspection , architectural or engineering activities. C. The insurance provided to the insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that insured, and then the insurance provided to the insured applies only to such "bodily injury" or "property damage" that occurs before: (1) The end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage; or (2) The end of the policy period; whichever is earlier. 3. The insurance provided to the insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance . But the insurance provided to the insured by this endorsement still is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when that person or organization is an additional insured under such other insurance. 4. As a condition of coverage provided to the insured by this endorsement: a. The insured must give us written notice as soon as practicable of an "occurrence" or an 10·02·2508 (Ed. 7.15) Includes copyrighted material of Insurance Services Office , Inc., with its permission. Page 1 of 2 41489837 I 17 18.GL-AL xs we PR RRPL -Job #8206 I Laura Berry I 4 /2 3/2018 3,20,41 PM (PDT ] I Page 2 of 7 This certificate cancels and supersedes ALL previously i s sued certi f i c a t es. offense which may result in a claim . To the extent possible, such notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against the insured, the insured must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. The insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d. The insured must tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover the insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the insured by this endorsement is primary to other insurance available to the insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V -DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you ; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., 10·02·2508 (Ed. 7·15) with its permission . 41489837 I 17 -18.GL-AL -XS -WC PR RRPL -Job #8206 I Laura Berry I 4/23/2018 3,20,41 PI1 (PDT) I Page 3 of 7 This certificate cancels and supersedes ALL previously issued certificates. 54309508 COMMERCIAL GENERAL LIABILITY Form 10-02-2052 (Ed. 12-09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUAL LIABILITY -RAILROADS This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: ALL RAILROADS ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract" in the Definitions section is replaced by the following: 12."lnsured contract" means: a. A contract for a lease of premises. However , that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization . Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. Form 10-02-2052 (Ed. 12-09) Includes copyrighted material of ISO Properties, Inc ., Page 1 of 1 41489837 I 17 1B.GL AL xs we PR RRPL ~Job #B206 I .Laura Berry I 4/23 /20183,20,41 pt.l (PO'I'I I Page 4 of 7 This certificate cancels and supersedes ALL prevlously l ssued certificates . POLICY NUMBER: 54309508 COMMERCIAL GENERAL LIABILITY 10-02-2494 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following : COMMON POLICY CONDITIONS SCHEDULE Name(s) and Address(es): ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US. The following Condition Is added : Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule Thirty (30) days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or Organization(s) shown in the Schedule Ten (10) days prior to the effective date of cancellation. 3. If notice is mailed, proof of mailing will be sufficient proof of notice . 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). 10-02-2494 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., with its permiss ion. 41499931 I 11 19.GL l\L XS -WC PR -RRPL -Job n9206 I Laura ~erry I 4/23/2019 3,20,41 FM (PDT) I Page 5 of 1 This certificate cancels and supersedes ALL prevl0usly Issued certIficates. Page 1 of 1 Team GhiJotti, Inc. POLICY NUMBER: 54309507 COMMERCIAL AUTO 16-02-0322 (Ed. 11-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following: COMMON POLICY CONDITIONS SCHEDULE Name(s) and Address(es): City of San Rafael 1400 Fifth Avenue, Room 209 San Rafael CA 94901 The following Condition is added : Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule ~ days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or Organization(s) shown in the Schedule ~ days prior to the effective date of cancellation. 3. If notice is mailed , proof of mailing will be sufficient proof of notice . 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). 16-02-0322 (Ed. 11-15) Includes copyrighted material of Insurance Serv ices Office , Inc., w ith its permission. 41489837 I 17 ·18.GL·AL ·XS -wc PR RRPL·Job #8206 I Laura Berry I 4/23/20183 ,20,41 PM (PDT) I Page 6 of 7 This certificate cancels and supersedes ALL previously issued certificates . Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY we 99 06 62 NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZA TIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . This endorsement effective on at 12:01 A. M. standard time, forms a part of Policy No . 54309509 Issued to As required by written contract (DATE) of the The following Condition is added to PART SIX -CONDITIONS: (NAME OF INSURANCE COMPANY) Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule THIRTY 30 days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or Organization(s) shown in the Schedule TEN 10 days prior to the effective date of cancellation. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). Name (s) and Address (es): ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US SCHEDULE we 9906 62(Ed. 01-16) 414B9B37 I 17 1B.GL ~AL ·XS -WC PR RRPL Job #B206 I Laura Berry I 4/23/201B 3,20,41 PH (PDT) I Page 7 of 7 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 1 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 4/23/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ABD Insurance & Financial Services CONTACT Construction Certs NAME: Attn: Construction Degartment 3 Waters Park Drive, uilding 3, Suite 100 fllgN:o. Exll: 650-488-8565 I FAX iAic No}: 650-488-8566 E-MAIL ConstructionCertRequest@theabdteam.com San Mateo, CA 94403 ADDRESS : INSURER(S) AFFORDING COVERAGE NAlC# www.theabdteam .com OH55918 INSURERA : Executive Risk Indemnity Inc 35181 INSURED INSURERB: Federal Insurance Company 20281 Team Ghilotti, Inc. INSURERC: Navigators Specially Insurance Company 36056 Kevin Ghilotti 2531 Petaluma Blvd., South INSURER 0: Indian Harbor Insurance Company 36940 Petaluma CA 94952 INSURER E: Travelers Indemnity Company of CT 25682 INSURER F: COVERAGES CERTIFICATE NUMBER' 41490067 REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE I~~~~ I~~ (~3M%~) 1(~3~~%~} LIMITS LTR POLICY NUMBER A f-L COMMERCIAL GENERAL UABILITY I 54309508 10/1/2017 10/1/2018 EACH OCCURRENCE $ 1000000 I-~ CLAIMS-MADE W OCCUR ~~~~~H?E~~~i~ence} $ 100000 rL X , C , U Included MED EXP (Anyone person) $5000 I-PERSONAL & ADV INJURY $1000000 R'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $2,000,000 POLICY [{] ~rg: D LOC PRODUCTS -COMP/OP AGG $2000000 OTHER: Deductible $ 10 000 B AUTOMOBILE LIABILITY I 54309507 10/1/2017 10/1/2018 1i:~~~~~d~~lfINGLE LIMIT $1000000 7 ANYAUTO BODILY INJURY (Per person) $ I-'-OWNED -SCHEDULED BODILY INJURY (Per eccident) $ AUTOS ONLY AUTOS I-HIRED r-NON·OWNED rp~~~;:[.';,RAMAGE rL AUTOS ONLY rL AUTOS ONLY $ I Deductible 1$1 000 Comp.lColiision $ C UMBRELLA L1AB H OCCUR SF17EXC8852791C 10/1/2017 10/1/201 B EACH OCCURRENCE $10000000 7 EXCESS LIAB CLAIMS·MADE AGGREGATE $ 10000000 OED I I RETENTION$O $ B WORKERS COMPENSATION I 54309509 10/1/2017 10/1/201 B II ~f~UTE I 1 0TH • AND EMPLOYERS' LIABILITY ER YIN ANYPROPRIETORIPARTNERlEXECUTIVE ~ N/A E.L. EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1.000.000 g~~~~~~f~~ ~n~~PERATIONS below E.L. DISEASE -POLICY LIMIT $ 1000000 D Professional Liability I PEC004833101 10/1/2017 10/1/2018 $1,000,000 Occ 1 $2,000,000 Aggregate D Pollution Liability PEC004833101 10/1/2017 10/1/2018 $1,000,000 Occ 1 $2,000,000 Aggregate E Railroad Liabilitv SPS7H65766ATCT 5/14/2018 5/14/2019 $5000000 Occ 1 $10 000 000 Aaareaate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may ba attachad If mora space I. required) Street Resurfacing 2016-2017/City Project No. 11306. Sonoma Marin Area Rail Transit (SMART), its officers, and employees, as well as the North Coast Railroad Authority are named as additional insured in respects to general, auto, pollution, and railroad liability, on a primary and non-contributory basis, as required by written contract. Waiver of subrogation applies to workers compensation as required by written contract. 30 days notice of cancellation applies -10 days notice of cancellation for non-payment applies. Endorsements attached. CERTIFICATE HOLDER CANCELLATION Street Resurfacing 2016-2017/City Project No . 11306 Sonoma Marin Area Rail Transit SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 5401 Old Redwood Highway, Suite 200 ACCORDANCE WITH THE POLICY PROVISIONS. Petaluma CA 94954 AUTHORIZED REPRESENTATIVE ~./ I Scott Gaddy © 1988·2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 41490067 I 17 -1B,GL AL xs we PR RRPL Job #B206 I Laura Berry I 4/23/20183,32,53 PM (PDT) I Page 1 of 12 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY 10-02-2508 (Ed. 7-15) 54309508 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: \ COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. SECTION II -WHO IS AN INSURED is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the insured by this endorsement is limited as follows: a. In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. b. The insurance provided to the insured does not apply to damages, loss, cost or expense arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (2) Supervisory, inspection, architectural or engineering activities . c. The insurance provided to the insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that insured, and then the insurance provided to the insured applies only to such "bodily injury" or "property damage" that occurs before: (1) The end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage; or (2) The end of the policy period; whichever is earlier. 3. The insurance provided to the insured by this endorsement is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the insured which covers that person or organization as a named insured for such loss, and we will not share with that other insurance. But the insurance provided to the insured by this endorsement still is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when that person or organization is an additional insured under such other insurance. 4. As a condition of coverage provided to the insured by this endorsement: a. The insured must give us written notice as soon as practicable of an "occurrence" or an 10-02-2508 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of2 41490067 I 17 1B.GL AL xs we PR RRPL -Job #B206 I Laura Berry I 4/23/201B 3,32,53 PI1 (PDT) I Page 2 of 12 This certificate cancels and supersedes ALL previously issued certificates. offense which may result in a claim. To the extent possible, such notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. If a claim is made or "suit" is brought against the insured, the insured must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. The insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d. The insured must tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover the insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the insured by this endorsement is primary to other insurance available to the insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V -DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., 10-02-2508 (Ed. 7-15) with its permission . 41490067 I 17 18.GL AL -XS -WC -PR -RRPL -Job #8206 I Laura Berry I 4/23/2018 3,32,53 PM (PDT) I Page 3 of 12 This certificate cancels and supersedes ALL previously issued certificates. 54309508 COMMERCIAL GENERAL LIABILITY Form 10-02-2052 (Ed. 12-09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUAL LIABILITY -RAILROADS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: ALL RAILROADS ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Scheduled Railroad at a Designated Job Site, the definition of "insured contract" in the Definitions section is replaced by the following : 12."lnsured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization . Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect , engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions , or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. Form 10-02-2052 (Ed. 12-09) Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 41490067 I 17 18,GL AL xs we PR RRPL ·Job #8206 I ,Laura Berry I 4/23/2018 3,]2,53 PI4 (POT) I page 4 o f 12 This certificate cancels and supersedes ALL prevl.ously issued c:ertifl.cates. POLICY NUMBER: 54309508 COMMERCIAL GENERAL LIABILITY 10-02-2494 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following : COMMON POLICY CONDITIONS SCHEDULE Name(s) and Address(es): ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US. The following Condition Is added: Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment . we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule Thirty (30) days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver not ice of the cancellation to any Person(s) or Organization(s) shown in the Schedule Ten (10) days prior to the effective date of cancellation . 3. If notice is mailed, proof of mailing will be sufficient proof of notice . 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). 10-02-2494 (Ed. 7-15) Includes copyrighted material of Insurance Services Office . Inc., with its permission. 41490067 I 17 18,GL AL xs we PR RRPL Job #8206 I.Laura ~erry I 4/23/2018 ),32 ,53 PI4 (PDTl I Page 5 of 12 This certificate cancels and supersedes ALL prevl.ously l.sGued certificates. Page 1 of 1 54309507 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM \ This endorsement modifies the Business Auto Coverage Form . borrow in your business or your personal affairs . 1. EXTENDED CANCELLATION CONDITION C. Lessors as Insureds Paragraph A.2.b. -CANCELLATION -of the COMMON POLICY CONDITIONS form IL 0017 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership . However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation . Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A .1. -WHO IS AN INSURED -of SECTION II -LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or \ Paragraph A.1. -WHO IS AN INSURED -of SECTION II -LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee" or agent of the lessor, operating an "auto" with the permission of any of 1. and/or 2. above. D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 -WHO IS AN INSURED -of SECTION II -LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed under an express provision in a written "insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: Form: 16-02-0292 (Rev. 4-11) Page 1 of3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" 41490067 I 17 -18.GL AL -xs ·wc PR RRPL -Job #8206 I Laura Berry I 4/23/20183,32,53 PM (PDT) I Page 6 of 12 This certificate cancels and supersedes ALL previously issued certificates. (1) with respect to the operation, maintenance or use of a covered "auto"; and (2) for "bodily injury" or "property damage" caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) The permit has been issued to you. 3. FELLOW EMPLOYEE COVERAGE EXCLUSION B.5 . -FELLOW EMPLOYEE -of SECTION II -LIABILITY COVERAGE does not apply. 4. PHYSICAL DAMAGE -ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. -TRANSPORTATION EXPENSES -of SECTION 111-PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1 ,000. 5. AUTO LOAN/LEASE GAP COVERAGE Paragraph A. 4. -COVERAGE EXTENSIONS -of SECTION 111-PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the loan or lease for a covered "auto" minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c . Security deposits not returned by the lessor: d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto"; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered "auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. -COVERAGE EXTENSIONS -of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: d . Rental Expense We will pay the following expenses that you or any of your "employees" are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or "loss" of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2 ,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered "loss"; and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3. combined. 7. EXTRA EXPENSE -BROADENED COVERAGE Paragraph A.4. -COVERAGE EXTENSIONS -of SECTION III -PHYSICAL DAMAGE COVERAGE is amended to add the following: e . Recovery Expense We will pay for the expense of returning a stolen covered "auto" to you. 8. AIRBAG COVERAGE Paragraph B.3.a . -EXCLUSIONS -of SECTION III -PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT -BROADENED COVERAGE Paragraph C.2. -LIMIT OF INSURACE -of SECTION 111-PHYSICAL DAMAGE is deleted and replaced with the following: 2 . $2,000 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: a. Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; b. Removable from a permanently installed housing unit as described in Paragraph 2 .a. above or is an integral part of that equipment; or c. An integral part of such equipment. Fonn: 16-02-0292 (Rev. 4-11) Page 2 of 3 "Includes copyrighted material of Insurance Servi ces Office, Inc. with its permission" 41490067 I 11 18,GL·AL -XS -WC -PR-RRPL -Job #8206 I Laura Berry I 4/23/2018 3 ,32,53 PM (PDT) Page 7 of 12 This certificate cancels and supersedes ALL previously issued certificates . 10. GLASS REPAIR -WAIVER OF DEDUCTIBLE Under Paragraph D. -DEDUCTIBLE -of SECTION III -PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph 0.-DEDUCTIBLE -of SECTION 111- PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us that is not an automobile policy or Coverage Form applies to the same "accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. -DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV -BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when the "accident" is known to: (1) You or your authorized representative, if you are an individual; (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an "accident", claim, "suit" or "loss" by other persons does not imply that the persons listed above have such knowledge. Notice to us should include: (1) How, when and where the "accident" or \ "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.5. -TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV -BUSINESS AUTO CONDITIONS is deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for "loss" to wh"ich this insurance applies, provided the "insured" has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such "loss". To the extent that the "insured's" rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. -CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV -BUSINESS AUTO CONDITIONS -is deleted and replaced with the following: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph B.5. -OTHER INSURANCE of SECTION IV -BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's" personal insurance. 16. HIRED AUTO -COVERAGE TERRITORY Paragraph B.7.b.(5).(a) -POLICY PERIOD, COVERAGE TERRITORY of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (a) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17. RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of -SECTION V -DEFINITIONS is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the "bodily injury" sustained by that person. Fonn: 16-02-0292 (Rev. 4-11) Page 3 of3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" 41490067 I 17 -18.GL AL -XS -WC -PR -RRPL -Jab #8206 I Laura Berry I 4 /23/2018 3,32,53 PM (PDT) I Page 8 af 12 This certificate cancels and supersedes ALL previously issued certificates. Team Ghilotti, Inc. POLICY NUMBER: 54309507 COMMERCIAL AUTO 16-02-0322 (Ed. 11-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZATIONS This endorsement modifies the following: COMMON POLICY CONDITIONS SCHEDULE Sonoma Marin Area Rail Transit Name(s) and Address(es): 5401 Old Redwood Highway, Suite 200 Petaluma CA 94954 The following Condition is added: Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment, we will deliver notice of the cancellation or non -renewal to any Person(s) or Organization(s) shown in the Schedule ~ days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or Organization(s) shown in the Schedule ~ days prior to the effective date of cancellation . 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). 16-02-0322 (Ed. 11-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. 41490067 I 17 1B .GL AL XS WC -PR -RRPL Job #B206 I Laura Berry I 4/23/201B 3,32,53 PM (POT) I Page 9 of 12 This certificate cancels and supersedes ALL previously issued certificaees. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY we 990662 NOTICE OF CANCELLATION OR NON-RENEWAL TO SPECIFIED PERSONS OR ORGANIZA TIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated . This endorsement effective on at 12:01 A. M. standard time, forms a part of Policy No . 54309509 Issued to As required by w ritten contract (DATE) of the The following Condition is added to PART SIX -CONDITIONS: (NAME OF INSURANCE CO MPANY) Notice Of Cancellation Or Non-Renewal To Specified Persons Or Organizations 1. If we cancel or non-renew this policy for any reason other than non-payment , we will deliver notice of the cancellation or non-renewal to any Person(s) or Organization(s) shown in the Schedule THIRTY 30 days prior to the effective date of cancellation or non-renewal. 2. If we cancel this policy for non-payment, we will deliver notice of the cancellation to any Person(s) or Organization(s) shown in the Schedule TEN 10 days prior to the effective date of cancellation. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4. Any failure by us to notify such person(s) or organization(s) will not invalidate such cancellation or non-renewal with respect to any other person(s) or organization(s). Name (s) and Address (es): ALL PERSONS OR ORGANIZATIONS AS ON FILE WITH US. SCHEDULE we 990662 (Ed . 01-16) 41490067 I 17 18,GL-AL xs we PR -RRPL -Job #8206 I Laura Berry I 4/23/2018 3,)2,53 PI-! (PDT) I Page 10 of 12 This certificate cancels and supersedes ALL previously issued certificates. Page 1 of 1 PEC004833101 5 . CAT L IN with regard to Coverage C -Contractor's Pollution Liability only, any client of the Named Insured, or any entity or person, that the Named Insured is obligated to name as an additional insured on this Policy in a written contract, agreement, or permit , executed prior to when the Claim was first made, and solely as respects covered Pollution Loss caused by the Named Insured's Contractor Activities; or 6. any entity which is specifically identified as an Insured in the Declarations or by endorsement to this Policy; or 7. the estate, heirs, executors, shareholders, administrators or legal representatives of an Insured in the event of such Insured's death, incapacity, or bankruptcy, or the spouse or legal domestic partner of any Insured, but only to the extent such Insured would otherwise be provided coverage under this Policy while acting solely on behalf of the Named Insured; or 8. any prior entity that has been reported to the Insurer prior to when the Claim was first made and whose assets, partners, principals, or shareholders were acquired by the Named Insured, and for which the Named Insured is required to provide liability insurance under a written contract or agreement executed before the Claim was first made; or 9. any entity newly formed or acquired by the Named Insured during the Policy Period in which the Named Insured has more than 50% legal or beneficial interest and over which the Named Insured exercises management or financial control and has agreed to provide insurance for such entity prior to the Claim being made. However: a. Coverage will only be provided for Claims arising out of Professional Services or Contractor Activities performed on or after the date of formation, acquisition, or exercised financial or management control; and b. This coverage will expire within 90 days for such entity, or the end of the Policy Period, whichever is earlier, unless the Named Insured provides written details of such newly acquired entity to the Insurer and pays the additional premium requested by the Insurer, if any . K. Insured Contract means: 1. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to the Insured or temporarily occupied by the Insured with permission of the owner is not an Insured Contract; or 2. a sidetrack agreement; or 3. any easement or license agreement; or 4. an obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality ; or 5. an elevator maintenance agreement ; or 41490067 I RRC;;kQ§QJJ~1~ RRPL Job #8206 I Laura Berry I 4/23/20l8 3,)2,53 EM (POT) I Page II of l2 This certi ficate cance l s a n d supersedes ALL previously issued certi ficaces . Page 7 of 19 C AT I ... I N C. Subrogation In the event of any payment under this Policy , the Insurer shall be subrogated to all the Insured's rights of recovery thereof. The Insured shall execute and deliver all requested instruments and papers in furtherance of such rights to the Insurer and do whatever else is reasonably necessary to secure such rights . The Insured shall do nothing to waive or prejudice such rights. The Insurer shall have priority over the Insured in allocation of any recovery, and any amounts recovered in excess of the Insurer's total payment and the cost to the Insurer of recovery shall be paid to the Insureds. The Limit of Liability shall be reinstated by the amount recovered by the Insurer, less the cost to the Insurer of recovery. However, the Insurer waives its rights of subrogation under this Policy against clients of the Named Insured to the extent such a waiver is required by a written contract with the Named Insured executed prior to the Claim. O. Changes None of the provIsions of this Policy will be waived, changed, or modified except by written endorsement issued by the Insurer to form a part of this Policy . Notice to any agent of the Insurer or knowledge possessed by any such agent or any other person will not act as a waiver or change in any part of this Policy and will not prevent the Insurer from asserting any rights under the provisions of this Policy. E. Assignment It is agreed that the insurance provided herein and the interests of the Insured hereunder cannot be transferred or aSSigned to another party without the express written consent of the Insurer. F Cancellation and Termination 1. This policy may only be cancelled by the Insurer for one or more of the following reasons : (i) non-payment of premium; or (ii) a material misrepresentation or concealment of facts; or (iii) a breach of any material provision of this Policy. If this Policy is cancelled by the Insurer, notice of cancellation will be sent in writing to the Named Insured, at the address indicated on the Declarations. The Insurer will provide such written notice at least ninety (90) days prior to the date such cancellation is to take effect; except that, in the event of cancellation for non-payment of premium, the Insurer only will provide fifteen (15) days written notice. If the premium is paid by a premium financing company and the premium financing company, acting under a valid premium finance agreement with the Insured, requests cancellation of the policy due to non-payment of premium from the Insured, the earned premium shall be computed short-rate of the policy term premium and returned to the premium finance company. The effective date and hour of cancellation will be stated in such notice. Cancellation by the Insurer also cancels the additional 60 days for reporting Claims, and any Optional Extended Reporting Period ; the Policy Period, the additional 60 days for reporting Claims, and any Optional Extended Reporting Period will end on that date. If the Insurer cancels for the reason specified in subparagraph (il, there shall be no return premium. If the Insurer cancels for reasons stated in subparagraphs (ii) or (iii), the earned premium shall be computed pro- rata of the policy term premium . Payment of any return premium shall not be a condition of cancellation . 41490067 I RR~kQ@QJ);k1~ RRPL Job #8206 I Laura Berry I 4/23/2018 3,]2,53 PI·\ (POTi I page 12 of 12 This certificate can ce l s and sup ersedes ALL previously issued certificates. Page170f19 CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Public Works Project Manager: Shawn Graf Extension: 5347 Contractor Name: Team Ghilotti Inc. Contractor's Contact: TBD Contact's Email: TBD D FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION DEPARTMENT 1 Project Manager a. Email PINS Introductory Notice to Contractor b. Email contract (in Word) & attachments to City Atty c/o Laraine.Gittens@cityofsanrafael.org 2 City Attorney a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 3 Project Manager Forward at least two originals of final agreement to contractor for their signature 4 Project Manager When necessary, * contractor-signed agreement agendized for Council approval *PSA > $20,000; or Purchase> $35,000; or Public Works Contract> $125,000 Date of Council approval PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 5 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 6 City Attorney Review and approve hard copy of signed agreement 7 City Attorney Review and approve insurance in PINS and, and bonds (for Public Works Contracts) 8 City Manager / Mayor Agreement executed by Council authorized official 9 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager COMPLETED DATE Click here to enter a date. Click here to enter a date. Click here to enter a date. Click here to enter a date. Click here to enter a date. 0 N/A Or 4/16/2018 4/24/2018 S-J7/1'6 s1il,~ ~l lrl(f 5'hlP/\B REVIEWER Check/Initial 0 ~ ~ ~ ~ 4Y ~ ~ SG tl1-- IJ¥ J _"7 lll( ~~ ?-Record Without Fee ~ Per GC 27383 and ' 1 /l,,{--t When recorded mail to\(Vhen recorded mail to: 1111111 lllll lllil 1111111/IIIHII 1111! 11111 !111111111111111111111111111 ·,r,1 ° -Q111i '1rs. Ah ,:._ _J_(:> 1'L,--tl,.:'.1'-1!"•...; City of San Rafael Lindsay Lara, City Clerk 1400 Fifth Avenue P. 0. Box 151560 San Rafael, CA 94915-1560 fi·ecc,rded Gfficiol li:ecc,rcl,; cour1tvc,r M~nr, fiKHAli"D t,J. BENSON A~2~sc:1r·Recc1rder Count'/ Clerf.: 1j :oe.til\,t ?-D-1'-Jov-W:! e ! REC FEE Cr.GO I cr«Foeaeo COPY o.oo ! I ftiH f Page 1 a-f :;: SPACE ABOVE THIS LINE FOR RECORDER'S USE CITY OF SAN RAFAEL NOTICE OF COMPLETION OF IMPROVEMENT TO ALL PERSONS WHOM IT MAY CONCERN: NOTICE IS HEREBY GIVEN for and on behalf of the City of San Rafael, County of Marin, State of California, that there has been a cessation of labor upon the work or improvement and that said work or improvement was completed upon the 5th day of September, 2018 and accepted the 5th day of November, 2018; that the name, address and nature of the title of the party giving this notice is as follows: The City of San Rafael, 1400 Fifth Avenue, San Rafael, California, 94901, a municipal corporation, in the County of Marin, State of California, within the boundaries of which said work or improvement was made upon land owned by said City and/or over which said City has an easement; that said work or improvement is described as follows: 2016 -2017 STREET RESURFACING PROJECT CITY PROJECT #11306 and reference is hereby made for a further description thereof to the plans and specifications approved for said work or improvements now on file in the Department of Public Works of said City, and said plans and specifications are hereby incorporated herein by reference thereto; and that the name of the Contractor who contracted to perform said work and make such improvement is Team Ghilotti, Inc. I declare under penalty of perjury that the foregoing is true and correct. J-t-\-12 2 Executed at San Rafael, California, on t-lt>v€t"\f'!,\£<1.. 'J-C\ , 20\ ~. CITY OF SAN RAFAEL A Municipal Corporation By !Juk BILL GUERIN Director of Public Works . ' .. A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. STATE OF CALIFORNIA COUNTY OF MARIN Subscribed a~d s~?r~_ tp. f P~ _affirmed) before me ~n this . 1..C\ . day of tJo" c..Mb-ev- 20 \'o, by Bill Q(!~m;-:i=n:b,v-e~ to me on the basis of satisfactory evidence to be the person(s) who appeared befo{e~·-·, e.':!::::..': ";:, '·,!,,:. · /--;· ,·i .~ ,•:,•' '.'/; ··\ ~.. ·_r. fr', -:,;(~• ..... r.~_-),, __ 1· • 1 WITNESS n £ t\\"l§I'.l~?f~~la r s eal. . C ''.\•~ .,··_---_ J•~t '·/ .. \ ·,,'1 ';-\ ... ·~ / .... , ,,-\" . . .. ~~-=-·: ,/.~, .. .,,,,. .... ' Signature , 1 ·; • --~ Lindsay Lara · ---· San Rafael City Clerk File: 16.06.87