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HomeMy WebLinkAboutPW City Hall Switchgear Replacement and PG&E UpgradesCity of San Rafael ♦ California
Form of Agreement
for
City Hall Switchgear Replacement and PG&E Upgrades
This Agreement is made and entered into this _1Q_ day of A\AS\.l~t 2018 by and between the City of San Rafael
(hereinafter called City) and CES Corp. DBA Cal Elite Builders (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: City Hall Switchgear Replacement
and PG&E Upgrades all in accordance with the requirements and provisions of the Contract Documents as defined
in the General Conditions which are hereby made a part of this Agreement. The required additional insured coverage
for City under contractor's liability insurance policy shall be primary with respect to any insurance or coverage
maintained by city and shall not call upon city's insurance or self-insurance for any contribution.
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.
Ill -Liquidated Damages
It is agreed that, if all the work required by the contract is not finished or completed within the number of working
days as set forth in the contract, damage will be sustained by the City, and that it is and will be impracticable and
extremely difficult to ascertain and determine the actual damage which the City will sustain in the event of and by
reason of such delay; and it is therefore agreed that the Contractor will pay to the City, the sum of $1,900 for each and
every calendar day's delay in finishing the work in excess of the number of working days prescribed above; and the
Contractor agrees to pay said liquidated damages herein provided for, and further agrees that the City may deduct the
amount thereof from any moneys due or that may become due the Contractor under the contract.
IV -The Contract Sum
The City shall pay to the Contractor for the performance of the Contract the amounts determined for the total number
of each of the units of work in the following schedule completed at the unit price stated. The number of units contained
in this schedule is approximate only, and the final payment shall be made for the actual number of units that are
incorporated in or made necessary by the work covered by the Contract; .
ITEM DESCRIPTION ESTIMATEI
UNIT UNIT TOTAL
QUANTITY PRICE PRICE
1. Mobilization (3% Maximum of Base 1 LS @ Bid) 17,000.00 17,000.00
2. Clearing and Grubbing 1 LS @ 20,000.00 20,000.00
3. Excavation and Backfill 275 CY @ 160.00 44,000.00
5. Minor Concrete
a. Concrete Paving 380 SF @ 60.00 22,800.00
b. Concrete Pad 640 SF @ 75.00 48,000.00
0 INAl
ITEM DESCRIPTION ESTIMATE! UNIT UNIT TOTAL
QUANTITY PRICE PRICE
5. Concrete Retaining Wall 50 CY @ 980.00 49,000.00
7. Black Clad Chain Link Fence 70 LF @ 150.00 10,500.00
8. Electrical 1 LS @ 278,690.00 278,690.00
BASE BID$ $489,990.00
Four hundred Eighty Nine Thousand Nine hundred Ninety dollars and 0/100
(BASE BID WRITTEN IN WORDS)
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) Final payment of all moneys due shall be made within 15 days after the expiration of 35 days following the filing
of the notice of completion and acceptance of the work by the Public W arks Department.
(d) The Contractor may elect to receive 100% of payments due under the contract from time to time, without
retention of any portion of the payment by the public agency, by depositing securities of equivalent value with
the public agency in accordance with the provision s 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 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 of35 days following the date ofrecordation of said Notice of Completion.
(b) Before final payment is due the Contractor shall submit evidence satisfactory to the Engineer that all payrolls,
material bills, and other indebtedness connected with work have been paid, except that in case of disputed
indebtedness or liens the Contractor may submit in lieu of evidence of payment a surety bond satisfactory to the
City guaranteeing payment of all such disputed amounts when adjudicated in cases where such payment has not
already been guaranteed by surety bond.
( c) 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. lt shall also constitute a
waiver of all claims by the Contractor, except those previously made and still unsettled.
(e) If after the work has been substantially completed, full completion thereof is materially delayed through no fault
of the Contractor, and the Engineer so certifies, the City shall, upon certificate of the Engineer, and without
terminating the Contract, make payment of the balance due for that portion of the work fully completed and
accepted.
Such payment shall be made under the terms and conditions governing final payment, except that it shall not constitute
a waiver of claims.
IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute this
Agreement the day and year first written above.
CITY OF SAN RAFAEL:
ATTEST:
Lindsay Lara
City Clerk
APPROVED AS TO FORM:
Robeke~ _t~h-, f'-t:J=c
City Attorney
File No.: 18.06.59
CES Corp. DBA Cal Elite Builders
By:
e:C lie A. Lapurga
e Officer: President
CES Corp. DBA Cal Elite Builders
By:
meEvangeline P. Lapurga
fCo rate Officer: Secretary
PHILADELPHIA
INSURANCE COMPANIES
A Member of the Tokio l\larine Group
Executed in Triplicate
Bond Number: CE 11510701359
Premium: $34,299.00
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS, That, CESCORP dba Cal Elite Builders as Principal, hereinafter called
Principal, and PHILADELPHIA INDEMNITY INSURANCE COMPANY, as Surety, hereinafter called Surety, are held and
firmly bound unto City of San Rafael as Obligee, hereinafter called Owner, in the amount of Four Hundred Eighty-nine
Thousand. Nine Hundred Ninety and no cents DOLLARS ($489,990.00), for the payment whereof Principal and Surety bind
themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS. Principal has by written agreement dated ________ entered into a contract with Owner for
City Hall Switchgear Replacement and PG&E Upgrades
NOW THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall promptly and faithfully
perform said contract, then this obligation shall be null and void, otherwise it shall remain in full force and effect.
THE Surety hereby waives notice of any alteration or extension ohime made by the Owner.
WHENEVER, Principal shall be, and declared by Owner to be in default under the contract, the Owner having performed
Owner's Obligations thereunder, the Surety may promptly remedy the default, or shall promptly:
1. Complete the contract in accordance with its terms and conditions or
2. Obtain a bid or bids for completing the contract in accordance with its terms and conditions, and upon determination
by Surety of the lowest responsible bidder, or if the Owner elects, upon determination by the Owner and the Surety
joint(v of the lowest responsible bidder arrange for a contract between such bidder and Owner, and make available as
work progresses (even though there should be a default or a succession of defaults under the contract or contracts of
completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the
contract price; including other costs and da111ages for which the Surety may be liable hereunder, but not exceeding the
amount set forth in the first paragraph hereof The term "balance of the contract price " as used in the paragraph,
shall mean the total a111011nt payable by the Owner to the Contractor under the Contract and any amendments thereto,
less the amount proper(v paid by Owner to Contractor.
Any suit under this bond must be instituted before the expiration of Two (2) years from the date on which final payment under
the contract falls due. No right of action shall accrue on this bond to or for the use of any person or corporation other th an the
Owner named herein or the heirs, executors, administrators or successors of Owner.
SIGNED, SEALED, DATED: September 18, 2018
By:
Performance Bond -11-09
CESCORP dba Cal Elite Buiidel's
(Principai)
By:
Steven A. Swartz, Attorney In Fact
DIRECT CORRESPONDENCE TO:
Philadelphia Indemnity Insurance Company -One Bala Plaza, Suite 100, Bala Cynwyd, PA 19004
PHONE (626) 639-1321
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
County of _.,.,O""'ra=n~g;µe.__ _________ _ S.S.
On September 1 B, 201 B before me, ---'B=e=t .... h=a ...... nyr-=J=o=hn'"'"'s,..,,o'"'"n,.._, _,_N,.,.o,.,,,ta.,_,_ry+-'-P_.u..,,b=li=c _______ ,
Name of Notary Public, Trtle
personally appeared -----=S=te=v=e,.,_,n_,_A_,_,_.--=S=w=a=rtz=-----------------
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)
isl}ti,e subscribed to the within instrument and acknowledged to me that he/sMOO'~¥ executed
the same in his/K~M.t( authorized capacity(~). and that by his~~~~ signature(!.) on the
instrument the person(K), or the entity upon behalf of which the person(X) acted, executed the
instrument.
I certify under PENAL TY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
The preceding Certificate of ~nowledgment i
document titled/for the purpose of _CE11 0701359
Performance Bond -CESCORP dba Cal Elite -City of San Rafael
containing _1_ pagel,l, and dated September 18, 2018
The signer(s) capacity or authority is/are as:
D lndividual(s)
~ Attorney-in-fact
D Corporate Officer(s) ______________ _
D Guardian /Conservator
□ Partner -Limited /General
D Trustee(s)
Trtle(s)
D Other: ________________ _
representing: Philadelphia Indemnity Insurance Company
Name(s) of Person(s) Ent1ty(ies) Signer 1s Represent ng
BETHANY JOHNSON
Notary Public -California
Orange County
Commission # 2207129
My Comm. Expires Jul 27, 2021
Seal
1MIDffl.] i ti flnifl.] ••• f: rnm:r
Method of Signer Identification
Proved to me on the basis of satisfactory evidence :
D form(s) of identificat ion D cred ible witness (es)
Notarial event is detailed in notary journal on:
Page# __ Entry# __
Notary contact:
Other
D Add itional Signer D Signer (s) Thumbprints(s )
□
© 2009-201 5 Notary Learning Center -All Rights Reserved You can purchase copies of this form from our web site at www.TheNotarysStore.com
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite I 00
Bala Cynwyd, PA 19004-0950
Power of Attorney
11767
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint Steven A. Swartz, Kelly Specht, Nicki Swartz, Michael Herranen
and Thomas C. Buckner of South Coast Surety its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds, undertakings, recognizances
and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to
exceed $25,000,000.00.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14 th ofNovember, 2016.
RESOLVED:
FURTHER
RESOLVED:
That the Board of Directors hereby authorizes the President or any Vice President of the
Company: (I) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney-in-Fact and revoke the
authority given. And, be it
That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS
CORPORATE SEAL TO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 2?1 11 DAY OF OCTOBER, 2017.
(Seal)
Robert D. O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27"' day of October, 2017, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed .
(Notary Seal)
Notary Public:
residing at:
My commission expires:
Bala Cynw:yd PA
September 25, 2021
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of
Directors and the Power of Attorney issued pursuant thereto on the 27tl' day of October, 2017 are true and correct and are still in full force and effect. I do further certify
that Robert D. O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President
of PHILADELPHIA INDEMNITY INSURANCE COMPANY. fi
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this /.X_ day of '::;t f l],,1113 zL ' 20 ~
........ ~:. ... ;·;·• .... ~ .. i/ . _···.\
[.. 19?.7 · ',J
"::., . . ::
Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY .. , .....
·•·,,.:,,.,, ~'"'":.:~:.>··
PHILADELPHIA
INSURANCE COMPANIES Bond Executed in Triplicate
\ \l,•mh,•r of the Toki" \larim• Group
MAINTENANCE BOND
Bond Number: cE11s101013ss -------------
KNOW ALL MEN BY THESE PRESENTS:
THAT, CESCORP dba Cal Elite Builders as Principal and Philadelphia Indemnity Insurance Company a Corporation
duly, authorized to transact general surety business in the State of _____ as Surety, are held and firmly bound unto ~-----
City of San Rafael for the sum of Two Hundred Forty-four Thousand, Nine Hundred Ninety-five and no cents
Dollars ($244,995.00 ),lawful money of the United States, for the payment of which, well and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT:
WHEREAS, the Principal entered into a written contract dated _______ with the Obligee for City Hall Switchgear Replacement
and PG&E Upgrades and; WHEREAS, the said Principal is required to post a bond to protect the said Obligee
against the result of faulty material or workmanship for a period of one year from and after the date of acceptance of said work;
NOW, THEREFORE, if the said Principal shall for a period ofone year from and after the date of acceptance of said work, replace any and all
defects arising in said work; whether resulting from defective materials or defective workmanship, then the above obligation to be void;
otherwise, to remain in full force and effect.
SIGNED, SEALED AND DATED this _1_8t_h ___ day of September
CESCORP dba Cal Elite Builders
Principal
Philadelphia Indemnity Insurance Company
Surety
2018
Califomia 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
County of _...,O'"'"r=an...,g...,e...._ _________ _ S.S.
On September 18 2018 before me, ~B=e=t~h=a~nyr-=J=o=hn~s=o~n'-'-, ~N=o=ta=ry+--'-P~u=b=li=c ______ _
t-Jame of Notary Public, Title
personally appeared ------=S=te,,_,v=e~n~A~-~S~w=a=rtz=-----------------
Name of Signer (1)
~lame of Signer (2)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s)
is~J!e subscribed to the within instrument and acknowledged to me that he/sMta'l~ executed
the same in his/k.~M.l( authorized capacity(te's), and that by his~~~~ signature()() on the
instrument the person(K), or the entity upon behalf of which the person(X) acted, executed the
instrument.
I certify under PENAL TY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
d official seal. ~
Seal
d by w, it could prevent fraudulent removal and reattachment of
cl 1m y prove useful to persons relying on the attached document.
Maintenance Bond -CESCORP dba Cal Elite -City of San Rafael
containing _1_ page~. and dated September 18, 2018
The signer(s) capacity or authority is/are as:
D lndividual(s)
IZl Attorney-in-fact
D Corporate 0fficer(s) ______________ _
D Guardian /Conservator
D Partner -Lim ited /General
D Trustee(s)
T1tle(s)
□ Other: _________________ _
representing: Philadelphia Indemnity Insurance Company
Name SJ of Pcrson{s) Entity{ies) Signer 1s Represenl!ng
Method of Signer Identification
Proved to me on the bas is of satisfactory evidence:
D form(s) of identification D cred ible witness(es)
Notarial event is detailed in notary journal on:
Page#__ Entry# __
Notary contact: _________ _
Other
D Additional Signer D Signer(s) Thumbprints(s)
□-------------
© 2009-2015 Notary Learning Center -All Rights Reserved You can purchase copies of this form from our web site at www.TheNotarysStore.com
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite I 00
Bala Cynwyd, PA 19004-0950
Power of Attorney
11771
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint Steven A. Swartz. Kelly Specht, Nicki Swartz. Michael Herranen
and Thomas C. Buckner of South Coast Surety its true and lawful Attorney-in-fact with full authority to execute on its behalf bonds, undertakings, recognizances
and other contracts of indemnity and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to
exceed $25,000 1000.00.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14 th ofNovember, 2016 .
RESOLVED:
FURTHER
RESOLVED:
That the Board of Directors hereby authorizes the President or any Vice President of the
Company : (I) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney-in-Fact and revoke the
authority given. And, be it
That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS
CORPORATE SEAL TO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 27111 DAY OF OCTOBER, 2017 .
• r '!
(Seal)
= · 1927 · "= tu,.. E
~ t • • .. '/
\.: .. :.:: .... ~ ............. >··
Robert D. O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27,;, day of October, 2017, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY ; that the seal affixed to said instrument is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed.
(Notary Seal)
Notary Public:
residing at:
My commission expires:
Bala Cynwyd, PA
September 25 2021
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of
Directors and the Power of Attorney issued pursuant thereto on the 27,;, day of October, 2017 are true and correct and arc still in full force and effect. I do further certify
that Robert D. O'Leary Jr., who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected President
of PHILADELPHIA INDEMNITY INSURANCE COMPANY. t l
In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company th isl g day of
Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
PHILADELPHIA
INSURANCE COMPANIES
Bond Number :
CE11510701359
BOND RIDER
·1 o be a11ad1cd 10 and fonn a pan ol l':n-numl Unnd . issued hy lhc unders igned compan). as Surct) on hchulf or CESCOIU' dhu
<:al Elitr HuiWrn as Principal. in farnr ofC'in· orS:m Rafarl a~ Ohligcc.
Hlc~l1\c Srplrmbrr IH, ?OIH . lhc Principal and thc Surcl}' hereby agree 111 amend the nlluchcd hund as follm1 ~·
Phi111drlphi11 Indemnity Insurance Agency, ns surely w11ives notice of modiliculions of the contract.
Thr puymcnl bond to include the followinit lnnguaec:
(b) The payment bond shall provide that if the direct contractor or a subcontractor fail,; to pay any or the
folio\\ ing. the surety will pay the obligation and, if an action is brought to enforce the liability on the
bond, a reasonable anomey s fee. to be fixed by the cm111:
(I) A person authorv.cd under Section 9l00 to assert a claim against a payment bond.
(2) Amounts due under the Unemployment Insurance Code with respect to work or labor performed
pursuant to the public works contract.
(3) /\mounts required to be deducted. withheld. and paid over to the Employment Development
Dcpanmcnt from the wages of employees of the contrnctor and subco111ractors under Section 130:!0 of the
Unemployment Insurance Code with respect to the work and labor.
(cHhcpayment bond shall be conditioned for the payment in full ofthe claims of all claimants and by its
1cm1s inure to the b.:nclit of any person authorized under Section 9100 to assen a claim against a payment
bond so as to give a right of action to that person or that person s assigrn; in an action to enforce the
liabilit) on the bond .
All else 11:111.iins lhc same .
l'ru\'ided that the liabilil)' under lhis cndorscmcnl shall be pan of'. and nol in addition 10. thi.: liability under the auachcd Bond .
and in no C\Cnl shall be cumulalhc.
Nothing hcrem contained ~hall \Ill). ahcr or cxlcnd Jn} oflhc prm is iuns. conditions. or nlhcr lcnns of 1hi~ hond c:-.ccpt us .ihn\'c
stated.
SHiNI I>. Sl·AI.EI>. DATFI>: Oclobcr 9. 2018
<:ii\· or Sun Rafel
(Ohligcc)
DIRECT CORRESPONDENCE TO
Philadelphia Indemnity Insurance Companies , 251 S Lake Avenue, 3'" FL Pasadena CA 91101
PHONE (626) 639-1321
"• '" • • u oU I • • • 01 ••••• I I l•I •~If • I )• I .... I , IO• 'Ii "
California All-Purpose Certificate of Acknowledgment
A notary publi c 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 __ o_ra_n,._ge __________ _ S.S.
On October 9, 2018 before me, Bethany Johnson, Notary Public
personally appeared ___________ s_t_ev_e_n_A_Sw_a_rtz __________ _
who proved to me on the basis of satisfactory evidence to be the person(s:) whose name(s:)
is/.erecsubscribed to the within instrument and acknowledged to me that he/~)' executed
the same in his>mJ"6tlcroo: authorized capacity(ies), and that by hishb&~ 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 PENAL TY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
~~ss my hand and offi~
'-
1•eeoncoeeoee
:'.:.;!!.-. IJ[Tt1ANY JOHNSUfi • 'Jl,-1'°1/,:· tlo1,11y l'utJ hc -C.ilirur rn ,, t ~ • ..,.,: .,: I:, 0tdl1CJ C Cuunly \'.
• 1-e ,.~.,1_ Cumrn 1~1 icm, 220/1 n ·
My Co mm. (ipi,c~ Jul 2 I, 2021
''·• I
\
\
-TION ------------
\ 1 1 I ,0 .l'::rH r~, l.J,· ,I ,fl(! ,c1 :-·1..sf'1l t~nr nf
\ 71]. ptt·~::. d 1' !•,,' ·o Jf f $1.1rJS ;(-:J~•J,i(J ·r ~,. ~,. ..... ,,. . •''ii: .f
Descri tion of Attached Docu
The preceding Certificate of Acknowledgment is attached to a
' document titled/for the purpose of ________ _
Rider#CE11510701359
containing _1_ pages, and dated October 9. 2018
The signer(s) capacity or authority is /are as :
0 lndividual(s)
31 Attorney-in-fact
D Corporate Officer(s) _____________ _
0 Guardian/Conservator
0 Partner • Limited/General
0 Trustee (s)
0 Other ________________ _
representing: Philadelphia Indemnity Insurance Company
Method of Signer Identification
Proved to me on the basis of satisfactory evidence·
D form(s) of identification D credible witness(es)
Nolarral event is detail ed In notary Journal on
Page#__ Entry# __
Notary contact : _________ _
Other
D Additional Signer D S1gner(s) Thumbpnnts(s )
□-------------
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Pllll,ADELPIIIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suilc 100
BalaCynwyd, PA 19004-0950
Power or Attorney
11814
KNOW ALL PERSONS BY 1liESE PRESBITS : Thal PHILADELPHL\ INDEMNIT\' INSURANCE COMPANY (the Company), a corporation organiud and
existina under the laws oflhe Commonwealth of Pennsylvania, docs hereby constitllle and appoinl Strvco A, Swartz. Kstly socs••· Nklci Swartz. M"ochacJ Htrragcn
and ThomH c, Rytlmer or Soatb Co11t Sugty its lnlC and lawful Attorney-in-fact with lull alllhority lo execute on its behalf bonds., undenakinss, rccognir.ances
and other contracts of indemnity and writings obligatory in DIC natwe lhereof, issued in the course of its business and 10 bind the Company thm:by, in an amount not to
exceed 525,noo.000,00.
This Power of Allomcy is gninlcd and is signed llnd sealed by facsimile under and by the authority of the followins Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMN11Y INSURANCE COMPANY on the 14"' of November, 2016_
RESOLVED:
FURTHER
RESOLVED:
That DIC Board of Din:ctors hereby authorizes the President or any Vice President of the
Company: (I) Appoint Attomey(s) in Fact and authorize the Auomey(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
Olher writings oblip1ory in the nature thmof and to auach lhe seal of the Company
thereto; 1111d (2) to remove, at any time, any such Allomcy-in-Fact and revoke the
authority given . And, be it
That the signawres of such officers and the seal of the Company m11y be affixed to 11f1Y
such Power of Attorney or certifiwe relatina thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon DIC Company in the future willt respect to any bond or
undc:naking 10 which it is attached .
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO DE SIGNED AND ITS
CORPORATE SEALTO DE AFFIXED BY ITS AUTiiORIZED OFFICE nus 77m DAY OF OCTOBER, 2017.
(Seal)
Robert D. O'Leary Jr., Praidcnt ct CEO
Philadelphia Indemnity lnsllfllnCe Comp11ny
On this 21" day of October, 2017, before me wne the individual \\ho executed lhc: precedins instrument, to me personally lcncJml, and beins by me duly 5'\1Jm said
that he is the therein dcscnllcd and alllhorizcd officer of die PHILADELPHIA INDEl'tlNIT\' INSURANCE COMPANY; Iha& the seal affixed to said insuwnent is
the Corporate seal of said Company; thDt the said Corpofllte Seal and his signatu~ were duly affixed .
{Notary Seal)
Notary Public :
residins at:
My commission expires:
Raia Cynwyd, PA
scntembcr 2s 2021
I, Edward Sayqo, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify lltat the foregoins resolution of the Board of
Directors and the Power of Attorney issued pursuant thereto on the 21" day ofOc1obcr, 2017 arc true and correct and arc still in full fon:c and cfTecL I do further certify
that Roben D. O'Leary Jr., who executed the Power of Attorney as President, Wl1! on Ille date of execution of the attached Power of Allomcy the duly elected President
of PHILADELPHIA INDEMNllY INSURANCE COMPANY.
In Testimony Whereorl have subscribed my name and affixed the fmimile seal of each Company this 911\-day of Ocldbc..,.--,201'6.
Edward Sayqo, Corporate Secretary
PIIILADELPIIIA INDF.MNITY INSURANCE COMPANY
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: DPW
Project Manager: Kevin McGowan
Extension: 3389
Contractor Name: CES Corp. DBA Cal Elite Builders
Contractor's Contact: Evangeline Laphrga
Contact's Email: Brea@calelitebuilders.net
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 three (3) 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 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.
8/10/2018
8/13/2018
8/15/2018
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enter a date.
□ N/A
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8/20/2018
8/28/18
9/17/J'J"
9/J 7J y~
1{!/r1 111f
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REVIEWER
Check/Initial
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