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HomeMy WebLinkAboutPW D St and Via Sessi Storm Drain ImprovementsCity of San Rafael. California
Form of Agreement for Informal Bids
D Street and Via Sessi Storm Drain Improvements
This Agreement is made and entered into this ~day of .. hAn ~ , 20 IS by and between the City of San Rafael
(hereinafter called City) and Ghilotti Bros, Inc. (hereinafter called Contractor). Witnesseth, that the City and the Contractor,
for the considerations hereinafter named, agree as follows:
1. Scope of the Work.
The Contractor hereby agrees to furnish all of the materials, equipment, and labor necessary to perform the work for the
project entitled "D Street and Via Sessi Storm Drain Improvements," all in accordance with the requirements and
provisions ofthe Construction Plans attached hereto as Attachment A.
2. Prevailing Wages.
Pursuant to the requirements of California Labor Code Section 1771, and San Rafael Municipal Code Section 11.50.1S0 (C), the
general prevailing wage in the locality in which the work is to be performed, for each craft or type of worker needed to execute
the contract, shall be followed.
3. Bonds.
The Contractor shall provide and maintain during the course of the project, a Labor and Materials Bond and a Faithful
Performance Bond issued by a surety admitted in California, to cover the work under this Agreement, both in the amount of
$174,735.00.
4. 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, including punchlist items, shall be completed within 20 Working Days, and with such reasonable
extensions oftime as may be requested by Contractor and approved by City.
5. 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 working day's delay in finishing
the work in excess of the number of working days prescribed above; and the Contractor agrees to pay said liquidated damages
herein provided for, and further agrees that the City may deduct the amount thereof from any moneys due or that may become
due the Contractor under the contract.
6. 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 untis for work in the following scheduled completed at the unit price stated. The number of units contained in this
schedule is approximately 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, provided that the total compensation under this Contract shall not
exceed $174,735.00 unless a written amendment is executed by the City and the Contractor.
ITEM DESCRIPTION
1. D Street and Via Sessi Storm Drain
BID ITEMS
ESTIMATED
QUANTITY
Agreement· 1
UNIT UNIT PRICE TOTAL PRICE
LS @ $174,735.00 = $174,735.00
GRAND TOTAL BID $174,735.00
ORIGINA
7. 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.
8. Acceptance and Final Payment.
(a) Upon receipt of written notice that the work is ready for final inspection and acceptance, the Engineer shall within 5
days make such inspection, and when he finds the work acceptable under the Contract and the Contract fully
performed, he will promptly issue a Notice of Completion, over his own signature, stating that the work required by
this Contract has been completed and is accepted by him under the terms and conditions thereof, and the entire
balance found to be due the Contractor, shall be paid to the Contractor by the City as soon as possible,
(b) Before final payment is due the Contractor shall submit evidence satisfactory to the Engineer that all payrolls,
material bills, and other indebtedness connected with work have been paid, except that in case of disputed
indebtedness or liens the Contractor may submit in lieu of evidence of payment a surety bond satisfactory to the City
guaranteeing payment of all such disputed amounts when adjudicated in cases where such payment has not already
been guaranteed by surety bond.
(c) The making and acceptance of the final payment shall constitute a waiver of all claims by the City, other than those
arising from any of the following: (1) unsettled liens; (2) faulty work appearing within 12 months after final payment;
(3) requirements of the specifications; or (4) manufacturers' guarantees. It shall also constitute a waiver of all claims
by the Contractor, except those previously made and still unsettled.
Such payment shall be made under the terms and conditions governing final payment, except that it shall not constitute a
waiver of claims.
9. Insurance.
(a). Scope of Coverage. During the term of this Agreement, Contractor shall maintain, at no expense to City, the following
insurance policies:
1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000)
per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property
damage.
2. An automobile liability (owned, non-owned, and hired vehicles) insurance policy in the minimum amount of
one million dollars ($1,000,000) dollars per occurrence.
3. Ifit employs any person, Contractor shall maintain worker's compensation insurance, as required by the State
of California, with statutory limits, and employer's liability insurance with limits of no less than one million
dollars ($1,000,000) per accident for bodily injury or disease.. Contractor's worker's compensation
insurance shall be specifically endorsed to waive any right of subrogation against City.
(b) Other Insurance Requirements. The insurance coverage required of the Contractor in subparagraph (a) of this section
above shall also meet the following requirements:
Agreement· 2
1. The insurance policies shall be specifically endorsed to include the City, its officers, agents, employees, and
volunteers, as additionally named insureds under the policies.
2. The additional insured coverage under Contractor's insurance policies shall be primary with respect to any
insurance or coverage maintained by City and shall not call upon City insurance or self-insurance coverage for
any contribution. The "primary and noncontributory" coverage in Contractor's policies shall be at least as
broad as ISO form CG20 01 0413.
3. The insurance policies shall include, in their text or by endorsement, coverage for contractual liability and
personal injury.
4. By execution of this Contract, Contractor hereby grants to City a waiver of any right to subrogation which
any insurer of Contractor may acquire against City by virtue of the payment of any loss under such
insurance. Contractor agrees to obtain any endorsement that may be necessary to effect this waiver of
subrogation, but this provision applies regardless of whether or not City has received a waiver of
subrogation endorsement from the insurer.
5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said
insurance coverage shall survive for a period of not less than five years.
6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of
this Agreement.
7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella
or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that
such coverage shall also apply on a primary and noncontributory basis for the benefit of City (if agreed to in a
written contract or agreement) before City's own insurance or self-insurance shall be called upon to protect it
as a named insured.
8. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess
of the specified minimum insurance coverage requirements and /or limits shall be available to City or any other
additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minimum
coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage
of any insurance policy or proceeds available to the named insured; whichever is greater.
(c) DeductibIes and SIR's. Any deductibles or self-insured retentions in Contractor's insurance policies must be declared
to and approved by the City, and shall not reduce the limits of liability. Policies containing any self-insured retention
(SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or City
or other additional insured party. At City's option, the deductibles or self-insured retentions with respect to City shall be
reduced or eliminated to City's satisfaction, or Contractor shall procure a bond guaranteeing payment of losses and
related investigations, claims administration, attorney's fees and defense expenses.
(d) Proof of Insurance. Contractor shall provide to the City all of the following: (1) Certificates of Insurance evidencing the
insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page
listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policy language or specific
endorsements evidencing the other insurance requirements set forth in this Agreement. City reserves the right to obtain a
full certified copy of any insurance policy and endorsements from Contractor. Failure to exercise this right shall not
constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by City.
10. Indemnification.
(a) Contractor shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by City,
and hold harmless City, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from
and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to
attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of
Contractor's perfonnance of its obligations or conduct of its operations under this Agreement. The Contractor's
Agreement· 3
obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive
negligence of the City Indemnitees. However, to the extent that liability is caused by the active negligence or willful
misconduct of the City Indemnitees, the Contractor's indemnification obligation shall be reduced in proportion to the
City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or
approval of the Contractor's work or work product by the City or any of its directors, officers or employees shall not
relieve or reduce the Contractor's indemnification obligations. In the event the City Indemnitees are made a party to
any action, lawsuit, or other adversarial proceeding arising from Contractor's performance of or operations under
this Agreement, Contractor shall provide a defense to the City Indemnitees or at City's option reimburse the City
Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims.
(b) The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any
way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or
completion of this Agreement for the full period of time allowed by law.
11. Nondiscrimination.
Contractor shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national
origin or disability in connection with or related to the performance of its duties and obligations under this Agreement.
12. Compliance with All Laws.
Contractor shall observe and comply with all applicable federal, state and local laws, ordinances, codes and regulations, in the
performance of its duties and obligations under this Agreement. Contractor shall perform all services under this Agreement in
accordance with these laws, ordinances, codes and regulations. Contractor shall release, defend, indemnifY and hold harmless
City, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any
noncompliance or violation of any laws, ordinances, codes or regulations.
13. No Third Party Beneficiaries.
City and Contractor do not intend, by any provision of this Agreement, to create in any third party, any benefit or right owed by
one party, under the terms and conditions of this Agreement, to the other party.
14. Notices.
All notices and other communications required or permitted to be given under this Agreement, including any notice of change of
address, shall be in writing and given by personal delivery, or deposited with the United States Postal Service, postage prepaid,
addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if mailed,
upon the date of deposit with the United States Postal Service. Notice shall be given as follows:
To City: Public Works Director
City of San Rafael
111 Morphew Street
San Rafael, CA 94901
To Contractor: Ghilotti Bros, Inc.
525 Jacoby Street
San Rafael, CA 94901
15. Independent Contractor.
For the purposes, and for the duration, of this Agreement, Contractor, its officers, agents and employees shall act in the capacity
of an Independent Contractor, and not as employees of the City. Contractor and City expressly intend and agree that the status of
Contractor, its officers, agents and employees be that ofan Independent Contractor and not that of an employee of City.
16. Entire Agreement; Amendments.
(a) The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by
reference, represent the entire Agreement of the parties with respect to the subject matter ofthis Agreement.
(b) This written Agreement shall supersede any and all prior agreements, oral or written, regarding the subject matter
between the Contractor and the City.
Agreement· 4
(c) No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid
or binding, except by way of a written amendment to this Agreement.
(d) The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this
Agreement signed by the Contractor and the City.
(e) If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions ofthe attached
exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control.
17. Waivers.
The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance,
law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of
any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent
acceptance by either party of any fee, performance, or other consideration which may become due or owing under this
Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other party of any term, condition,
covenant of this Agreement or any applicable law, ordinance or regulation.
18. City Business License; Other Taxes.
Contractor shall obtain and maintain during the duration of this Agreement, a City business license as required by the San Rafael
Municipal Code Contractor shall pay any and all state and federal taxes and any other applicable taxes. City shall not be required
to pay for any work performed under this Agreement, until Contractor has provided City with a completed Internal Revenue
Service Form W-9 (Request for Taxpayer Identification Number and Certification).
19. Warranty.
(a) Except as otherwise expressly provided in the Agreement, and excepting only items of routine maintenance, ordinary
wear and tear and unusual abuse or neglect by City, Contractor warrants and guarantees all work executed and all
supplies, materials and devices of whatsoever nature incorporated in or attached to the work, or otherwise provided as a
part of the work pursuant to the Agreement, to be absolutely free of all defects of workmanship and materials for a
period of one year after final acceptance of the entire work by the City. Contractor shall repair or replace all work or
material, together with any other work or material that may be displaced or damaged in so doing, that may prove
defective in workmanship or material within this one year warranty period without expense or charge of any nature
whatsoever to City.
(b) In the event that Contractor shall fail to comply with the conditions of the foregoing warranty within ten (10) days after
being notified of the defect in writing, City shall have the right, but shall not be obligated, to repair, or obtain the repair
of, the defect and Contractor shall pay to City on demand all costs and expense of such repair. Notwithstanding
anything herein to the contrary, in the event that any defect in workmanship or material covered by the foregoing
warranty results in a condition that constitutes an immediate hazard to public health or safety, or any property interest, or
any person, City shall have the right to immediately repair, or cause to be repaired, such defect, and Contractor shall pay
to City on demand all costs and expense of such repair. The foregoing statement relating to hazards to health, safety or
property shall be deemed to include both temporary and permanent repairs that may be required as determined in the
sole discretion and judgment of City.
(c) In addition to the above, the Contractor shall make a written assignment of any applicable manufacturers' and other
product warranties to the City, prior to completion and final acceptance ofthe work by City.
IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this Agreement the
day and year first written above.
Agreement· 5
CITY OF SAN RAFAEL:
Jim Schutz
City Manager
ATTEST:
Lindsay Lara
City Clerk
APPROVED AS TO FORM:
L Q~ ... ~f?H:
Robert F. Epstein 1
City Attorney
File No.:OS.09.26
Ghilotti Bros, Inc.
By:
Printed Name: Michael M. Ghilotti
Title of Corporate Officer: President
Ghilotti Bros, Inc.
By:
Printed Name: nn n III atlr'\. Chlb' n~Yl( t<,,{ {) /ftc...f/
Title of Corporare"'t5fficer.
Agreement· 6
California All-Purpose Certificate of Acknowledgment
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which th is certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of __ M_a_r_in __________ _ 5.5.
On May 31 > 2018 before me, __ M_e_l_is_s_a..<...J ._R_li_S_S_O..:...,> N=o""ta""'ry+=P""'li::-;b""l;:;:ic::::-1':-=-_____ _
Name of Notary Public. Iitie
personally appeared ______ M_i_c_h_ae_l_M_,_G_h_i_lo_t_ti..:..> _P_re_s_id_e_n_t .... /T_re_a_Sli_r_e_r ______ _
Name of Signer (1)
Name of Signer (2)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is~ subscribed to the within instrument and acknowledged to me that he~ executed
the same in his~ authorized capacity~, and that by his~ signature(s) on the
instrument the person(:s), or the entity upon behalf of which the person~) 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.
\fYkAiR,d~
MELISSA
COMM. #2213840
Notary Public ' California
Marin
OPTIONAL INFORMA TlON ------------
Althougil tile information in this section is not required by law, it could prevent fraudulent removal and reattacilmel
this acknowledgment to an unauthorized document and may prove useful to persons relying on tile attached G umen!.
Description of Attached Document
The preceding Certificate of Acknowledgment is attached to a
document titled/for the purpose of _________ _
containing __ pages, and dated __________ '
The signer(s) capacity or authority is/are as:
D Individual(s)
D Attorney-in-fact
D Corporate Officer(s) ---------::;",.c--------
D Guardian lConservator
D Partner -Limited/Gen
D Trustee(s)
D Other: -7".::-----------------
rm(s) of identification 0 cred ible witness(es)
Notarial event is detailed in notary j ournal on :
Page # __ Entry # __
Notary contact: _________ _
Other
o Additional Signer 0 Signer(s) Thumbprints(s)
0 ___________ _
© 2009-2015 Notary Learning Center -All Rights Reserved You can purchase copies of this form from our web site at VNlw.TheNotarysStore.com
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CONSTRUCTION NOTES
CONSTRUCT T'l'PE 'A' MANHOLE PER MARIN
COUNTY SID. OWG. 205.
FURNISH AND INSTAll 12" PVC (C900) STORM
DRAIN PIPE. BEDDING AND INITIAL BACKFlLl TO
TOP OF PIPE SHALl CONSISTS OF 3/~"
CRUSHED DRAIN ROCK. AT CONTRACTOR'S
OPTION, INTERMEDIATE BACKFlLl SHALl BE
EITHER CLASS 2 BASE ROCK OR CDF TO WITHIN
S" OF FlNISHEO GRADE. INSTALl S" OF HOT MIX
ASPHALT (t AGG ., PG 64-16) WITH 2" T -CUT
ON FlNAL UFT. o FUTURE STORM DRAIN PIPE BY OTHERS. NOT
PART OF THIS CONTRACT.
NOTES
1. ALl TRAFFlC CONTROL, IF NElEDED, SHAll
BE IN ACCORDANCE WITH THE 2015 CA
MUTCD.
2. THE CONTRACTOR IS RESPONSIBLE FOR
CONSTRUCTION STAKING.
3. THE CONTRACTOR SHAll COMPLETE ALl
WORK WITHIN 20 WORKING DAYS.
~. THE CONTRACTOR SHAll INCLUDE
SHORING PROTECTION PER All CAL OSHA
STANDARDS.
5. THE LUMP SUM PRICE FOR THIS JOB
SHALl INCLUDE All THE LABOR,
MATERIALS, TOOLS, EOUIPMENT,
OVERHEAD, PROFlT AND INCIDENTALS,
AND FOR DOING ALl THE WORK INVOLVED
IN CONSTRUCTING All ITEMS OF WORK
ON THIS PLAN SHEJET AND NO SEPARATE
PAYMENT WIll BE ALlOWIED THEREFORE .
UTILITY NOTES
1. THE CONTRACTOR SHAll PRESERVE AND
PROTECT All EXISTING UTIUTIES IN PLACE
WHICH ARE NOT IDENTIFlED FOR
REIMOVAL/RELOC"TION.
2. EXISTING UTIUTY DEPTHS ON PROFlLE ARE
BASED ON POTHOUNG BY GHILOTTI BROS.,
INC. PERFORMED ON ~/23/1S.
SURVEY NOTES
BENCHMARK: SCRIBED 'X', LOCATION SHOWIN
HEREON , ELEVATION 43.IS (DATUM NAIIIl SS BY
GPS OBSERVATION UTIUZING THE CALIFORNIA
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FlELD SURVEY DATE : MARCH 12, 201 S.
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=38 LF L=77 LF --;;sr '
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-..
2+25 2+50 2+75 3+00 3+25 3+50 3+75 4+00 4+25
GRAPHIC SCALE
'~..J ':' i -
OJ
o
o
CONSTRUCTION NOTES
CONSTRUCT TYPE 'A' MANHOLE PER MARIN COUNTY STD. DWG .
205.
FURNISH AND INSTALL 12" PVC (C900) STORM DRAIN PIPE.
BEDDING AND INITIAL BACKFILL TO TOP OF PIPE SHALL
CONSISTS OF 3/4" CRUSHED DRAIN ROCK . AT CONTRACTOR'S
OPTION, INTER MEDIA TE BACKFILL SHALL BE EITHER CLASS 2
BASE ROCK OR CDF TO IIlTHIN 8" OF FINISHED GRADE. INSTALL
8" OF HOT MIX ASPHALT (j" AGG., PG 64-16 IIlTH 2" T-CUT
ON FINAL UFT.
FUTURE STORM DRAIN PIPE BY OTHERS . NOT PART OF THIS
CONTRACT.
VIA SESSI SO PIPE PROFILE
H: 1"='0' V: '''=2'
UTILITY NOTES
1. THE CONTRACTOR SHALL PRESERVE AND PROTECT ALL
EXISTING UTlUTlES IN PLACE WHICH ARE NOT IDENTIFIED
FOR REMOVAL/RELOCATION.
2. EXISTING UTIUTY DEPTHS ON PROFlUE ARE BASIED ON
POTHOUNG BY GHILOTn BROS ., INC . PERFORMED ON
4/23/18.
CONTROL POINT N3
ElEVATION = 50.05
MAG
\
\
1312 4lH ST /
APN: 011-205-10 \
1"
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1"
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o :g I D.4yS-BEFORE YOU Ole; ( [If FEET )
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SCALE : 1"=10'
DAllE: MAY 2018
CITY PROJECT NO .: --
SHEET NO.:
SD-02
DRAWING: 2 OF 2
Bond No. . 5.7I?CSH ,y'v376~.
Contract Bond
Public Work -California TH E HARTFORD. Premium Charge $1.239.00
HarHard Plaza, Hartford, Connecticut 06115
Bond Executed in Triplicate
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS :
That we.
Ghil0l!! ~.ro~., Inc. , ... ,as Principa I,
and Ihe Hartford Fire Insurance Company , a Corporation organized and existing under Ihe laws of the State of Connecticut
and authorized to transact surety business in the State of California , as Surety, are held and firmly bound unto
City of sa[1 R.<!f<Jel
in the sum of One Hundred Seventy Four Thousand Seve~ HundredThirty Five & 0.0/100. -'-:-. Dollars ($1~4 ~?35.0o. . ),
lawful money of the United Stales of America, for the payment whereof, well and truly to be made, we hereby bind ourselves, our heirs, e.ec'
utors, administrators, successors and assigns , joinlly and severa lly, firm ly by these presents.
SIGNED, sealed with our seals, and dated this 30th day of .. .... ..., ._1!l-~018 .•
The cond ition of the foregoing obligation is such that, whereas the above bounden Principal has entered Into a contract dated ..
May 29th, 2018 I with said City of San Rafael
to do and perform the following work, to·wit:
D Street and Via Sessi Storm Drain Improvements
NOW, THEREFORE. if the above·bounden P,,"cipal shall well and truly perform, or cause to be performed, each and all of the requirements
and obligations of said contract to be performed by said Principal, as in said contrad set forth, then this bond shall be null and void; other'
wise It shall remain in fu II force and effect.
G~ilotti Bros.,J~c ...
. ... (SEAL)
Michael M. Ghilotti, President 1 Treasurer
Hartford Fire Insurance Company :r""~".;~:'~Hljd!-··· -: . (SEAL)
Form 5-3665-1 (HFI Printed In U.S.A.
California All-Purpose Certificate of 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
Countyof ____ ~ __ a_r_ill ____________________ __ 5.5.
On ~ay 31,2018 before me, ___ ~ __ el_is_s_a~J_. R_u_s_s_o..:.., "'N"""o,,-;:t -=ary..fr:::,P""u"'b""l""ic:::-;o:-;r::-__________ _
Name of Notary Pub li c, ri ll e
person ally a ppeared __________ .::.:~.::.:i:..::c.:.:h.::.ae.:.:lc..::~=..: • ....:G=..:h:.::i:::.clo::...:t:..::;ti"_, .=..P.=..re=..:s:.:.id.::.e=.:ll.:..:t::.../T=-r:...:e:..::a:::.su=r:...:e:.:.r ____________ _
Name of Signer (1)
Name of Signer (2)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is~ subscribed to the within instrument and acknowledged to me that he~ executed
the same in his~ authorized capacity~, and that by his~ signature(s) on the
instrument the person (:s:) , or the entity upon behalf of which the person~) 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.
Ignatur ',f Notary Public
OPTIONAL INFORMA TlON --------------
Althougil tile information in this section is not required by law, it could prevent fraudulent removal and reattacilme
this aclmowledgment to an unauthorized document and may prove useful to persons relying all tile attached
Description of Attached Document
The preceding Certificate of Acknowledgment is attached to a
document titled/for the purpose of _________ _
containing __ pages, and dated __________ '
The signer(s) capacity or authority is/are as:
D Ind ividual (s)
D Attorney-In-fact
D Corporate Officer(s) _______ .,..,::-. _____ _
D Guardian/Conservator
D Partner -Lirnited/Gener V
D Trustee(s)
D Other: -r------------------
Name: 5) of Person~s) Ent IY(105) Signer 5 Representing
Notarial event is detail ed in notary journal on :
Page # __ Entry # __
Notarycontact _________ _
Other
D Additional Signer D Signer(s) Thumbprints(s )
D ____________________ _
.1"t .... ..", u.. '.. ., ...... J , • '. II;. .\" ....... '. II. .\(" ... II ... " II. .\.(' ... II .. ,", II., .\.t ... t J ... ', It.. .\.t. ... II .... II..' .,to. ... II , .. II.. ., .... C) , •.. H;. ..
© 2009·2015 Notary Learning Center -All Rights Reserved You can purchase caples of thiS form from our web site at VJIN\V. TheNotarysStore.com
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CMl CODE § 1189
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
Countyof _________ M_a_ri_n ____________ __
On _....!M!-"a"'y'-'3::..:0::..:t!.!Jh,c..:2::..::O'-'-1.=.8 _____ before me, ________ J,_D_e_L_u_ca_,_N_o_ta_ry~P_u_bl_ic __________________ _
Date Here Insert Name and TItle of the Officer
personally appeared ___________________ Ke_' .... 'y_H_o_lt_e_m_a_nn ________________________ _
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islar-e-
subscribed to the within instrument and acknowledged to me that Aelshe/tAey executed the same in
Rislher/tAeir authorized capacity(ies), and that by Rislher/tfleif signature(s) on the instrument the person~,
or the entity upon behalf of which the person(.s) acted, executed the instrument.
Place Notary Seal Above
I certify under PENAL TV OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
~JL~ Signature ______________________ __
Signature of Notary Public
-----------------------------OPTIONAL-----------------------------
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: _________________ _
Number of Pages : Signer(s) Other Than Named Above: __ ""------------
Capacity(ies) Claimed by Signer(s)
Signer's Name: ________________ ~
o Corporate Officer -Title(s): _____ ---,=-"''--_
I , Partner -n Limited II General
o Individual 0 Attorne · act
~ Trustee
o Other:
Signer I
gner's Name: _____________ _
n Corporate Officer -Title(s): _______ _
Ii Partner -n Limited n General
~ Individual LJ Attorney in Fact
o Trustee 0 Guardian or Conservator o Other: ________________________ _
Signer Is Representing: ________ _
©2014 National Notary Association' www.NationaINotary .org • 1-800-US NOTARY (1-800-876-6827) Item #5907
· . Direct Inquiries/Claims to:
THE HARTFORD
BOND, T-12
One Hartford Plaza POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF
Agency Code: 57-554795
Hartford, Connecticut 06155
Bond.Claims@thehartford.com
call: 888-266-3488 or fax : 860-757-5835
SAWYER & COMPANY
~ Hartford Fire Insurance Company. a corporation duly organized under the laws of the State of Connecticut
~ Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana
~ Hartford Accident and Indemnity Company. a corporation duly organized under the laws of the State of Connecticut o Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut o Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana o Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois o Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana o Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make , constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Alicia Dass, Joan DeLuca, Roger C. Dickinson, Patrick R
Diebel, Nancy L. Hamilton, Kelly Holtemann, Thomas E. Hughes, Stanley D. Loar, Mark
M. Munekawa, Yvonne Roncagliolo, Charles R. Shoemaker of SAN FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by t8J, and to execute, seal and acknowledge any and all bonds , undertakings. contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have
caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attqrney.
~."...... .'-':~ ~~~~ _.:~~~~, !t!~u, ... 't.\~\ :J~'~ \';'~" I;; ra.ln \~~i" .li·7{jJ -"j' '{ 19~~ ~-(.' .......... ~ ....... ~~ .. '-'O~ ~.~
-'.,'lll1;I'\ I •• tao ... • ~.~ • .... -..
John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President
STATE OF CONNECTICUT}
SS.
COU NlY OF HARTFO RD
Hartford
On this 5th day of January, 2018, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and
say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations
described in and which executed the above instrument; that he knows the seals of the said corporations ; that the seals affixed to the said
instrument are such corporate seals ; that they were so affixed by authority of the Boards of Directors of said corporations a nd that he signed his
name thereto by like authority.
CERTIFICATE
1'01\ :!U IK
frC1:_JuJ., .. >,--:/--h 1(1 t'.· .... r..."-.Il..
"athleen T Maynard
Notary PlIbhc
My (on1l",551011 Expires July 31. 2021
Contract Bond
Public Work -California
KNOW ALL MEN BY THESE PRESENTS:
That we •
LTHE HARTFORD
Bond Executed in Triplicate
LABOR AND MATERIAL PAYMENT BOND
Bond No ••• !il~.g§l:tw.??§.~ ................... .
Premium Charga Included In Premium
Charged for Performance Bond
........................................................................... ~.~!!~~! .. B.~.'?~:.,.1~.9: ............................................................................................................... as Principal,
and ......... t:I.?r'!.~9.rg .. f.!r~.!n~~r.?n~~ .. G.9.mP.!ilnY. ...................................................... , a Corporation organized and eX isting under the laws of the State
o! Connecticut and authorized to !ransact surety business In !he Slate of Calilornia, as Surety. are held and rlrmly bound unto the
Stale of California for Ihe use and banelit of tha State Treasurer as ex officio treasurer and custodian of the Unemployment Fund and any and all
materialman, persons, companies or corporalions furnishing malerlals, provisions, provender or other supplies used In, upon . for or about Ihe perlorm.
ance of Iha work contracted to be executed or performed under the contract hereinaltar mantioned, and all persons, companies or corporations
renling or hiring learns, or Implemenls Or machinery, for or conlrlbuling to said work to be done. and all persons perform ing work or labor upon the
88me and all persons supplying bolh work and malerials as aforesaid, in Ihe sum of .................................................................................... ..
................................. g~~ .. Ij .':l.~~r.e~.~.~)!~.I).ty .. F!?~r.I~!?~.s.a.~~ .. ~~.~.I!'.':1.!:l~~.9.~~!! .. !bir.tY..F.!~e .. ~ .. QQ!.~g.g .= .. Dollars ($ .... 1.!.~.,?~~:g.o. ....................... 1.
lawful money of the United States 01 America, for the payment whereof well and Iruly to be made . we hereby bind ourselves, our heirs. executors ,
administrators, successors and assigns, jointly and severally, firmly by Ihese presenls .
StGNED, sealed with our seals and daled this ........................ ~~.t.~ ..................... day of ..................... ~.~y. ......................... .. 2018
.. ........... ,,·,ge ...... ..
The condition ot the foregoing obll gallon is such thai . whereas Ihe above· bounden Principal has entered inlo a conlracl, dated .............................. .
...... M!!y .. ?~m .... ?Q.1.~ ............. 49"' ....... , wilh .................... g.i.t~.9.U:!~I) .. ~.a.f~!:l.l.. ........................ ' ...................................................................................... .
...................... .... .... .................................................................... _ ............................................................... to do and perform the following work . to wit:
D Street and Via Sessi Storm Drain Improvements
NOW THEREFORE. If the above· bounden Princlpat. or ........................... ~b!.I~.~U~.r~~:.' .. I.~~: ....................................................................................... ..
sub-contractor, tails 10 pay for any malarials . provisio ns, provender or othar supplies or teams, used In, upon . tor or aboul the parformance of the
work contracted to be done under said contract. or for any work or labor done thereon of any kind, or for amounls due under the Unemptoyment
Insurance Act wllh res pact to such work. the Surety on th is bond will pay the seme, in an amount not exceeding the sum specified /n this bond, and,
also, fn case suit is brought upon Ihis bond, a reasonable attorney's fee to be fixad by the Court and to be taxed as costs and to be included in the
judgment therein rendered : PROVIDED Ihat this bond is flied by the Princ/pal 10 comply with the provisions 01 Chapter 7, Title XV of the Civil Code of
Callfomia and othar appllcabte provisions of so ld Title" XV relating to Public Work and liability hereunder Is subject to the provisions of said section
and acts amendatory Ihereof, and sact ons of other code& of the Siale of California referred to therein and acts amendatory theroof .
............... '3.~~I~~.i .. S.r.O'~:.!':l~: ....................................................... .
Principal Michael M. Ghilotti, President I Treasurer
...... H?r:tl9.rQ . .f !r~ .. !t!~!lf.a.n~~ .. ~9.mP.~!.'Y. ........................ .
~~~i~_"E'"
i'n,m S·3674·~ Pr intAd in U.S.A
.\{ ·'''SI ,\,'1 .1:1 11.:\11 ::-;,...\{ ., .. S ( ,\,".1 :11( .:\11 ::-;',' \1 ·hSII\'·I .I ·IU •. \II ::-':T .\1 ·h:-;I'\'·'.F I U •. \1 1 ::-;'I'.\.l " .. :-'-1 1\,'1.1-:11( .:\11 ::"00"'1' .\1 ·I .. :"oo"( '\,·I .FII( al l :S ',' .\I ·h:"oo"1 '\'·I .t-: H ;:\11-::-';'" .\( '1 .. :"'0"1 J\n .EII( •. \lI :S'I" .\(' .. :-'-1 'WI .I :I II .:\II-:S·I ·
California All-Purpose Certificate of Acknowledgment
A notary public o r othe r officer co m pletin g this certificate verifi es only the identity of the individua l who s igned t he
document to wh ich this certif icate is attached, and not the truthfulness , accuracy, or validity of that d o c ument.
State of California
County of __ M_a_ri_TI _________ _ r 5.5.
On May 31,2018 before me, __ M_el_is_s_a ..!...J _. R_u_s_s_o..:...., "'N:::-;:o::-:::ta-::<ryrf=P::-;u"'b.",l"'ic,."...".,...-;:-_____ _
Name of Notary PubliC, Title
personally appeared _____ .::..:M.::..:i:..::.c:.::h .::.ae:.::lc..::M=..: • ....:G::..:h:=:i.::.lo:.,:t:=:ti:!.." .::..P.::..re=.::s.::.id.::.e:.::TI=.::t~/T::..:r:...:e:.::a=-SU=I:...:·e:.::.r ______ _
Name of Signer (1)
Name of Signer (2)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is~ subscribed to the within instrument and acknowledged to me that he~ executed
the same in his~ authorized capacity~, and that by his~ 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.
-~~;~
OPTIONAL INFORMA TlON ------------
Although the information in this section IS not required by law, It could prevent fraudulent removal and reattachmen
this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached d ~ ment
Description of Attached Document ...
The preceding Certificate of Acknowledgment is attached to a
document titled/for the purpose of _________ _
(5) of identifi cation 0 credib le wi t ness (es )
containing __ pages , and dated ________ _ Notaria l event is detail ed in notary journal on :
The signer(s) capacity or authority is/are as: Page # __ Ent ry # __
o Individ ual (s) Notary con ta ct: _________ _
o Atto rn ey-in-fa ct
D Corporate Offi cer (s) --------7"':::.....------Other
o Additional Signer 0 Signer(s) Thurnbprints(s)
0 __________ _
D Gu ardian /Cons ervator o Part ner -Lirni ted/G ener o Trus tee(s)
D Ot her: -r----------------
r'Jame\s) of Person(sl Ent,ty IC5) Signer is Representing
\1 ... I '.'. II.. .\t· .... (., ,'. It .. \1 .... II, •• It . .\t · .... II ,. It •. ' .\.1" .... 10 , .'. It.. .\t" ,. I., .'. It.. .\t .... II , .'. It •. ' .\ ..... II , •• II .. .\ ..... tJ ~ .'. I ;.
© 2009-2015 Notary Learning Center -All Rights Reserved You can purchase copies of this forrn from our web site at \VVoI\V TheNotarysStore.com
, .
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of _____ M_a_ri_n ______ _
On _--,M.!.!.a",-VL.:3"-,O,,-,-t!.!Jh'c.!:2:-,,O,-,-1 ::<,.8 ____ before me, _____ J._D_e_L_u_ca....:,_N_o_ta_ry'--P_u_bl_ic _________ _
Date Here Insert Name and Title of the Officer
personally appeared _____________ K_el..:;ly_H_o_lt_e_m_a_n_n ____________ _
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islar-e-
subscribed to the within instrument and acknowledged to me that helshe/tfley executed the same in
hislher/their authorized capacity(ies), and that by hislher/-tt-leiF signature(s) on the instrument the person(s),
or the entity upo n behalf of which the person($) acted, executed the instrument.
Place Notary Seal Above
I certify under PENAL TV OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official sea l.
, ~ n -~~ Signature _______________ _
Signature of Notary Public
-----------------------------opnONAL-----------------------------
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: ____________ _
Number of Pages : Signer(s) Other Than Named Above:--"=--__________ _
Capacity(ies) Claimed by Signer(s)
Signer's Name: ____________ ~
o Corporate Officer -Title(s): ____ ,,,,.....,,==----_
gner's Name: ____________ _
n Corporate Officer -Title(s): _____ _
n Partner -n Limited Ll General n Partner -n Limited n General
o Individual I 1 Attorne' act o Individual LJ Attorney in Fact
o Trustee o Trustee 0 Guardian or Conservator o Other: _-::;00-""=-__________ _ o Other: _____________ _
Signer I Signer Is Representing: _________ _
,K,~~'g;~'«<,~~'C(..'C(..'Q(..~~~'C(..~'G<.~'g,'c.(,~'G<,~~-a:,.<.;:( ... ~x.~~~~~'g(,~"Q(,~'(;.(,~~~~~~~
©2014 National Notary Association' www.Nationa INotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907
Direct Inquiries/Claims to:
THE HARTFORD
BOND, T-12
One Hartford Plaza POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF
Agency Code : 57-554795
Hartford, Connecticut 06155
Bond.Claims@thehartford.com
call: 888-266-3488 or fax : 860-757-5835
SAWYER & COMPANY
DC:] Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut
~ Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana
~ Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut o Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut o Twin City Fire Insurance Company, a corporation duly organized under the laws of the State oflndiana o Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State oflilinois o Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State ofindiana o Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make. constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Alicia Dass, Joan DeLuca, Roger C. Dickinson, Patrick R
Diebel, Nancy L . Hamilton, Kelly Holtemann, Thomas E . Hughes, Stanley D. Loar, Mark
M. Munekawa, Yvonne Roncagliolo, Charles R. Shoemaker of SAN FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above . to sign its name as surety(ies) only as
delineated above by [81 , and to execute, seal and acknowledge any and aI/ bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons , guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law .
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have
caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies , the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
John Gray, Assistant Secretary M. Ross Fisher, Senior Vice President
STATE OF CONNECTICUT}
SS.
COU NlY OF HARTFO RO
Hartford
On this 5th day of January, 2018, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and
say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations
described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said
instrument are such corporate seals ; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his
name thereto by like authority .
CERTIFICATE
I'OA2fJ IX
+,.!""_'1:;.k u: .. "--r 11/" :r'-ltA.&'
Kathleen T Maynard
Notary Public
My COmll1lSSIOn Exp ires July 31. 2021
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: Hunter Young
Extension: 3408
Contractor Name: Ghilotti Bros., Inc.
Contractor's Contact: Debbie Petersen
Contact's Email: debbiep@ghilottibros.com
o 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
*P5A > $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
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enter a date.
5/25/2018
5/29/2018
5/29/2018
5/29/2018
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6/4/2018
6/4/2018
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REVIEWER
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'yfl-~ . Per GC 27383 and ' I llllll lllll lll!l 11111111111111111111 Hiil lltll lllllllll! 1111111111111
11. \ When recorded ma1VVtten reco d d . ,vn r e mail to: 2018-0040944
City of San Rafael
Lindsay Lara, City Clerk
1400 Fifth Avenue
P. 0. Box 151560
San Rafael, CA 94915-1560
Offici~l necc,rd~
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li:ICHAfi'D N. BENE.ON
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County CJert
11:01:'AM 30-Nov·ZO:JS
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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 19th day of July, 2018 and accepted the 6th day of August, 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:
D STREET AND VIA SESSI STORM DRAIN IMPROVEMENTS PROJECT
CITY PROJECT #11347
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 office of the City Clerk 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
Ghilotti Bros., Inc.
I declare under penalty of perjury that the foregoing is true and correct.
tt-~-10S
Executed at San Rafael, California, on ~ov~'(!:)~ '2-C:., , 20 \ &.
CITY OF SAN RAFAEL
A Municipal Corporation
By f& /1------.,
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.
ST A TE OF CALIFORNIA
COUNTY OF MARIN
Subscribed and sworn to ( or affirmed) before me on this '? '\ day of )4 ov e.M b,c,v ,
20--1..B_, by Bill Guerin, proved to me on the basis of satisfactory evidence to be the person(s) who
appeared before ~~i·---~-· i J. 1 •-::•/;I•• /'• • r.)
WITNESS ~Y/~f~d·.~~c\6fpciiq~. seal.
. -I ·.-:-·.:.:,,;.:.·, ·,· -·.1 --::-), ,w.·,.::· .. ,·:. •, --:. .·
Signature ~ ~-···~-~.
LiJd~a f ig@ : . ~---.
·I ·• .. : ':\ San Rafael ·City Clerk
File: 08.09.26