Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutPW Grand Avenue Storm Drain Replacement ProjectCITY OF SAN RAFAEL
Department of Public Works
111 Morphew Avenue
San Rafael, CA 94901
Public Works Contract for Projects up to $175,000
Grand Avenue Storm Drain Replacement Project
This public works contract ("Contract") is entered into by and between the City of San Rafael ("City") and
Maggiora and Ghilotti, Inc. ("Contractor"), a corporation authorized to do business in California, for work
on the City's Grand Avenue Storm Drain Replacement Project ("Project"), and is effective on
CG't • 7.S-, 20A ("Effective Date").
The parties agree as follows:
1. Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies,
transportation, and any and all other items or services necessary to perform and complete the work
required for the Project ("Work"), as specified in Exhibit A, Scope of Work, and according to the terms
and conditions of this Contract, including all attachments to the Contract and any other documents and
statutes incorporated by reference. To the extent that any attachment contains provisions that conflict or
are inconsistent with the terms set forth in the body of this Contract, the Contract terms will control. This
Project requires a valid California contractor's license for the following classification(s): Classification A.
2. Contract Price. As full and complete compensation for Contractor's timely performance and
completion of the Work in strict accordance with the terms and conditions of the Contract, City will pay
Contractor $71,350 as detailed in Exhibit A attached and incorporated herein by reference (the "Contract
Price") for all of Contractor's direct and indirect costs to perform the Work, including all labor, materials,
supplies, equipment, taxes, insurance, bonds and all overhead costs, in accordance with the payment
provisions contained herein.
2.1 Payment. Contractor must submit an invoice on the first day of each month during the
Contract Time, defined in Section 3 below, and/or upon completion, for the Work performed during the
preceding month, itemizing labor, materials, equipment and any incidental costs incurred. Contractor
warrants that title to all work, materials and equipment incorporated into the Work will pass to City free of
any claims, liens, or encumbrances upon payment to Contractor.
2.2 Payment and Performance Bonds. If the Contract Price is over $25,000, then Contractor
must provide City with a payment bond and a performance bond using the bond forms included in this
Contract as Exhibit B, Bond Forms, and submit the bonds with the executed Contract. Each bond must
be issued by a surety admitted in California. If an issuing surety cancels a bond or becomes insolvent,
Contractor must provide a substitute bond from a surety acceptable to City within seven days after written
notice from City. If Contractor fails to substitute an acceptable surety within the specified time, City may,
in its sole discretion and without prior notice to Contractor, purchase such bond(s) at Contractor's
expense and deduct the cost from payments otherwise due to Contractor, or terminate the Contract.
3. Time for Completion. Contractor will fully complete the Work within 20 days from the date the
City authorizes Contractor to proceed with the Work ("Contract Time").
Grand Avenue Storm Drain Replacement Project
Contract
Up to $175,000
Page 1
Approved by City Attorney, dated 10/8/2019y f�
■[;���tlL�Ja�t4a
4. Liquidated Damages. If Contractor fails to complete the Work within the Contract Time,
Contractor must pay liquidated damages in the amount of $500 per day for each day of unexcused delay
in completion.
5. Standard of Care. All Work must be provided in a manner that meets or exceeds the standard of
care applicable to the same type of work in the State of California. Contractor must promptly correct, at
Contractor's sole expense, any Work that the City determines is deficient or defective.
6. Permits and Licenses. Contractor, at its sole expense, must obtain and maintain during the
term of this Contract, all appropriate permits, certificates and licenses including, but not limited to, the
required California contractor's license and a City business license.
7. Indemnification. Contractor will indemnify, defend with counsel acceptable to City, and hold
harmless to the full extent permitted by law, City, its governing body, officers, agents, employees, and
volunteers from and against any and all liability, demands, loss, damage, claims, settlements, expenses,
and costs (including, without limitation, attorney fees, expert witness fees, and costs and fees of litigation)
(collectively, "Liability") of every nature arising out of or in connection with Contractor's acts or omissions
with respect to this Contract, except such Liability caused by the active negligence, sole negligence, or
willful misconduct of the City. This indemnification obligation is not limited by any limitation on the amount
or type of damages or compensation payable under Workers' Compensation or other employee benefit
acts, or by insurance coverage limits, and will survive the expiration or early termination of this Contract.
City will notify Contractor of any third -party claim pursuant to Public Contract Code section 9201.
8. Insurance. Contractor will, at all times under this Contract, maintain the insurance coverage
required in this section to cover the activities of Contractor and any subcontractors relating to or arising
from performance of the Work. Each policy must be issued by a company licensed to do business in
California, and with a strength and size rating from A.M. Best Company of A -VIII or better. Contractor
must provide City with certificates of insurance and required endorsements as evidence of coverage with
the executed Contract, or through the PINSAdvantage website https://www.pinsadvantage.com/ upon
request by the City, and before the City authorizes Contractor to proceed with the Work.
8.1 Workers' Compensation. Statutory coverage is required by the California Workers'
Compensation Insurance and Safety Act. If Contractor is self-insured, it must provide its duly authorized
Certificate of Permission to Self -Insure. In addition, Contractor must provide employer's liability insurance
with limits of no less than one million dollars ($1,000,000) per accident for bodily injury or disease.
8.2 Liability. Commercial General Liability ("CGL") insurance issued on an occurrence basis,
including coverage for liability arising from Contractor's or its subcontractor's acts or omissions in
performing the Work, including Contractor's protected coverage, blanket contractual, products and
completed operations, broad form property damage, vehicular coverage, and employer's non -ownership
liability coverage, with limits of at least $2,000,000 per occurrence and $4,000,000 general aggregate.
8.3 Automotive. Commercial automotive liability coverage for owned, non -owned and hired
vehicles must provide coverage of at least $2,000,000 combined single limit per accident for bodily injury,
death, or property damage.
8.4 Subrogation Waiver. Each required policy must include an endorsement that the insurer
waives any right of subrogation it may have against the City or the City's insurers.
8.5 Required Endorsements. The CGL policy and the automotive liability policy must include
the following specific endorsements:
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 2
Approved by City Attorney, dated 10/8/2019
(1) The City, including its Council, officials, officers, employees, agents, volunteers and
consultants (collectively, "Additional Insured") must be named as an additional insured for
all liability arising out of the operations by or on behalf of the named insured, and the policy
must protect the Additional Insured against any and all liability for personal injury, death or
property damage or destruction arising directly or indirectly in the performance of the
Contract.
(2) The inclusion of more than one insured will not operate to impair the rights of one
insured against another, and the coverages afforded will apply as though separate policies
have been issued to each insured.
(3) The insurance provided is primary and no insurance held or owned by City may be
called upon to contribute to a loss ("primary and non-contributory").
(4) Any umbrella or excess insurance must contain or be endorsed to contain a provision
that such coverage will also apply on a primary or non-contributory basis for the benefit of
City before the City's own insurance or self-insurance will be called upon to protect it as a
named insured.
(5) This policy does not exclude explosion, collapse, underground excavation hazard, or
removal of lateral support.
9. Labor Code Compliance. Unless the Contract Price is $1,000 or less, the Contract is subject to
all applicable requirements of Chapter 1 of Part 7 of Division 2 of the Labor Code, beginning at section
1720, and the related regulations, including but not limited to requirements pertaining to wages, working
hours and workers' compensation insurance. Contractor must also post all job site notices required by
laws or regulations pursuant to Labor Code section 1771.4.
9.1 Prevailing Wages. Each worker performing Work under this Contract that is covered under
Labor Code section 1720 or 1720.9, must be paid at a rate not less than the prevailing wage as defined in
sections 1771 and 1774 of the Labor Code. The prevailing wage rates are on file with the City Engineer's
office and are available online at http://www.dir.ca.gov/DLSR. Pursuant to Labor Code section 1775,
Contractor and any subcontractor will forfeit to City as a penalty up to $200 for each calendar day, or
portion of a day, for each worker paid less than the applicable prevailing wage rate, in addition to paying
each worker the difference between the applicable wage rate and the amount actually paid.
9.2 Working Day. Pursuant to Labor Code section 1810, eight hours of labor consists of a legal
day's work. Pursuant to Labor Code section 1813, Contractor will forfeit to City as a penalty the sum of
$25 for each day during which a worker employed by Contractor or any subcontractor is required or
permitted to work more than eight hours during any one calendar day, or more than 40 hours per
calendar week, unless such workers are paid overtime wages under Labor Code section 1815. All Work
must be carried out during regular City working days and hours unless otherwise specified in Exhibit A or
authorized in writing by City.
9.3 Payroll Records. Contractor and its subcontractors must maintain certified payroll records
in compliance with Labor Code sections 1776 and 1812, and all implementing regulations promulgated by
the Department of Industrial Relations ("DIR"). For each payroll record, Contractor and its subcontractors
must certify under penalty of perjury that the information in the record is true and correct, and that it has
complied with the requirements of Labor Code sections 1771, 1811, and 1815. Unless the Contract Price
is under $25,000, Contractor must electronically submit certified payroll records to the Labor
Commissioner as required under California law and regulations.
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 3
Approved by City Attorney, dated 10/8/2019
9.4 Apprentices. If the Contract Price is $30,000 or more, Contractor must comply with the
apprenticeship requirements in Labor Code section 1777.5.
9.5 DIR Monitoring, Enforcement, and Registration. This Project is subject to compliance
monitoring and enforcement by the DIR pursuant to Labor Code section 1725.5, and, subject to the
exception set forth below, Contractor and any subcontractors must be registered with the DIR to perform
public works projects. The registration requirements of Labor Code section 1725.5 do not apply if the
Contract Price is for under $25,000.
10. Workers' Compensation Certification. Under Labor Code section 1861, by signing this
Contract, Contractor certifies as follows: "I am aware of the provisions of Labor Code section 3700 which
require every employer to be insured against liability for workers' compensation or to undertake self-
insurance in accordance with the provisions of that code, and I will comply with such provisions before
commencing the performance of the Work on this Contract."
11. Termination.
11.1 Termination for Convenience. City reserves the right to terminate all or part of the
Contract for convenience upon written notice to Contractor. Upon receipt of such notice, Contractor must:
immediately stop the Work, including under any terms or conditions that may be specified in the notice;
comply with City's instructions to protect the completed Work and materials; and use its best efforts to
minimize further costs. In the event of City's termination for convenience, Contractor waives any claim for
damages, including for loss of anticipated profits from the Project. If City terminates the Contract for
convenience, City will only owe Contractor payment for the Work satisfactorily performed before Contract
termination, as well as five percent of the total value of the Work performed as of the date of notice of
termination or five percent of the value of the Work yet to be completed, whichever is less, which is
deemed to cover all overhead and profit to date.
11.2 Termination for Default. The City may terminate this Contract for cause for any material
default. Contractor may be deemed in default for a material breach of or inability to perform the Contract,
including Contractor's refusal or failure to supply sufficient skilled workers, proper materials, or equipment
to perform the Work within the Contract Time; refusal or failure to make prompt payment to its employees,
subcontractors, or suppliers or to correct rejected work; disregard of laws, regulations, ordinances, rules,
or orders of any public agency with jurisdiction over the Project; lack of financial capacity to complete the
Work within the Contract Time; or responsibility for any other material breach of the Contract
requirements. If City terminates the Contract for cause, City will only owe Contractor payment for the
Work satisfactorily performed before Contract termination.
12. Dispute Resolution. Any dispute arising under or related to this Contract is subject to the
dispute resolution procedures of Public Contract Code sections 9401 and 20104 et. seq., which are
incorporated by reference.
13. Waiver. A waiver by City of any breach of any term, covenant, or condition in this Contract will
not be deemed a waiver of any subsequent breach of the same or any other term, covenant, or condition
contained herein, regardless of the character of any such breach.
14. Warranty. Contractor guarantees and warrants the Work and the materials used or provided for
the Project for a period of one year, beginning upon City's acceptance of the Work for the Project as
complete ("Warranty Period"). During the Warranty Period, upon notice from the City of any defect in the
Work or the materials, Contractor must, at its sole expense, promptly repair or replace the defective Work
or materials, including repair or replacement of any other Work or materials that is or are displaced or
damaged during the warranty work, excepting any damage resulting from ordinary wear and tear.
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 4
Approved by City Attorney, dated 10/8/2019
15. Worksite Conditions.
15.1 Clean and Safe. Contractor must maintain the Work site and staging and storage areas in
a clean and neat condition and must ensure it is safe and secure. On a daily basis the Contractor must
remove and properly dispose of debris and waste materials from the Work site.
15.2 Inspection. Contractor will make the Work accessible at all times for inspection by the City.
15.3 Hazardous Materials. Unless otherwise specified in the Contract documents, this Contract
does not include the removal, handling, or disturbance of any asbestos or other hazardous materials, as
identified by any federal, state, or local law or regulation. If Contractor encounters materials on the
Project site that Contractor reasonably believes to be asbestos or other hazardous materials, and the
asbestos or other hazardous materials have not been rendered harmless, Contractor may continue Work
in unaffected areas reasonably believed to be safe, but must immediately cease Work on the area
affected and report the condition to City. No asbestos, asbestos -containing products or other hazardous
materials may be used in performance of the Work.
15.4 Utilities, Trenching and Excavation. As required by Government Code section 4215, if,
during the performance of the Work, Contractor discovers utility facilities not identified by City in the
Contract documents, Contractor must immediately provide written notice to City and the utility. In
performing any excavations or trenching work, Contractor must comply with all applicable operator
requirements in Government Code sections 4216 through 4216.5. If the trenching or excavation extends
deeper than four feet below the surface, then it must also comply with Public Contract Code section 7104.
16. Records. Unless otherwise specified in Exhibit A, Contractor must maintain and update a
separate set of as -built drawings while the Work is being performed, showing changes from the Work as
planned in Exhibit A, or any drawings incorporated into this Contract. The as -built drawings must be
updated as changes occur, on a daily basis if necessary.
17. Conflicts of Interest. Contractor, its employees, subcontractors and agents, may not have,
maintain or acquire a conflict of interest in relation to this Contract in violation of any City ordinance or
policy or in violation of any California law, including under Government Code section 1090 et seq. and
under the Political Reform Act as set forth in Government Code section 81000 et seq. and its
accompanying regulations. Any violation of this Section constitutes a material breach of the Contract.
18. Non -Discrimination. No discrimination will be made in the employment of persons under this
Contract because of the race, color, national origin, ancestry, religion, gender or sexual orientation of
such person.
19. Independent Contractor. City and Contractor intend that Contractor will perform the Work under
this Contract as an independent contractor. Contractor is solely responsible for its means and methods in
performing the Work. Contractor is not an employee of City and is not entitled to participate in health,
retirement or any other employee benefits from City.
20. Assignment of Unfair Business Practice Claims. Under Public Contract Code section 7103.5,
Contractor and its subcontractors agree to assign to City all rights, title, and interest in and to all causes
of action it may have under section 4 of the Clayton Act (15 U.S.C. section 15) or under the Cartwright
Act (Chapter 2 (commencing with section 16700) of Part 2 of Division 7 of the Business and Professions
Code), arising from purchases of goods, services, or materials pursuant to the Contract or any
subcontract. This assignment will be effective at the time City tenders final payment to Contractor,
without further acknowledgement by the parties.
Grand Avenue Storm Drain Replacement Project
Contract
Approved by City Attorney, dated 10/8/2019
Up to $175,000
Page 5
21. Notice. Any notice, billing, or payment required by or pursuant to the Contract documents must
be made in writing, signed, dated and sent to the other party by personal delivery, U.S. Mail, a reliable
overnight delivery service, or by email as a PDF (or comparable) file. Notice is deemed effective upon
delivery unless otherwise specified. Notice for each party must be given as follows:
City:
Address: 111 Morphew St
City/State/Zip: San Rafael, CA 94901
Phone: 415-485-3373
Attn: Mark Wright
Email: mark.wright@cityofsanrafael.org
Copy to: iman.kayani@cityofsanrafael.org
Contractor:
Name: Maggiora and Ghilotti, Inc.
Address: 555 Dubois Street
City/State/Zip: San Rafael, CA 94901
Phone: 415-459-8640
Attn: Scott Ghilotti
Email: ghilotti@gmail.com
Copy to:
22. General Provisions.
22.1 Compliance with All Laws. Contractor will comply with all applicable federal, state, and
local laws and regulations including, but not limited to, unemployment insurance benefits, FICA laws,
conflict of interest laws, and local ordinances. Work may only be performed by qualified and experienced
workers who are not employed by the City and who do not have any contractual relationship with City,
with the exception of this Contract.
22.2 Provisions Deemed Inserted. Every provision of law required to be inserted in the
Contract is deemed to be inserted, and the Contract will be construed and enforced as though such
provision has been included. If it is discovered that through mistake or otherwise that any required
provision was not inserted, or not correctly inserted, the Contract will be deemed amended accordingly.
22.3 Assignment and Successors. Contractor may not assign its rights or obligations under
this Contract, in part or in whole, without City's written consent. This Contract is binding on Contractor's
and City's lawful heirs, successors and permitted assigns.
22.4 Third Party Beneficiaries. There are no intended third party beneficiaries to this Contract.
22.5 Governing Law and Venue. This Contract will be governed by California law and venue
will be in the Superior Court of Marin County, and no other place.
22.6 Amendment. No amendment or modification of this Contract will be binding unless it is in a
writing duly authorized and signed by the parties to this Contract.
22.7 Integration; Severability. This Contract and the Contract documents incorporated herein,
including authorized amendments or change orders thereto. constitute the final, complete, and exclusive
terms of the agreement between City and Contractor. If any provision of the Contract documents, or
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 6
Approved by City Attorney, dated 10/8/2019
portion of a provision, is determined to be illegal, invalid, or unenforceable, the remaining provisions of
the Contract documents will remain in full force and effect.
22.8 Authorization. Each individual signing below warrants that he or she is authorized to do so
by the party that he or she represents, and that this Contract is legally binding on that party. If Contractor
is a corporation, signatures from two officers of the corporation are required pursuant to California
Corporation Code section 313.
[Signatures are on the following page.]
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 7
Approved by City Attorney, dated 10/8/2019
The parties agree to this Contract as witnessed by the signatures below:
CITY: Approved as to form:
t
s/ s/ J , kiii
Jim Sc utz, City Manager F. Epstein, City Attorney
Date: it) — -L] T �� Date: /at/let ( C)
Attest-
s/
Lindsay Lara, City Clerk
Date: 10
CONTRACTOR:
Maggiora and Ghilotti, I c.
s/ Seal:
Scott Ghilotti, Vice President/Owner
Date:
� �► Lr
�l
Uan
-W-
Date: \ Ck
2Zc.?1C.-I ;S{3t(2k
Contractor's California License Number(s) and Expiration Date(s)
Exhibit A: Scope of Work
Exhibit B: Bond Forms
END OF CONTRACT
Grand Avenue Storm Drain Replacement Project Up to $175,000
Contract
Page 8
Approved by City Attorney, dated 10/8/2019
Exhibit A
SCOPE OF WORK
., LNGCON
'lO.0p
ENCTORSY
555 DUBOIS STREET PHONE (415) 459-8640
SAN RAFAEL, CA 94901 FAX (415) 459-1475
Grand Ave Storm Drain Replacement
Biditetn Description
ouantih,
Units
Unit Price
Bid Total
1 Mobilization
1.000
LS
6,800.00
6,800.00
2 15" HDPE
215.000
LF
210.00
45,150.00
3 Type B Manhole Turn Structures
2.000
EA
9,700.00
19,400.00
Bid Total
>
$71,350.00
#1 - Post No Parking, Layout, Mobilize EQ, Locate SD Alignment and Pothole Utilities
#2 - Dig, Lay & Backfill, removing existing SD and replacing with new 15" HDPE. Back -fill
with 3/4 clean 1 ft above and then AB2 to 6" from surface. 6" AC plug, with 1ft T -cut over
trench. M&G will restripe centerline with yellow paint.
#3 - Pour 2 Type B Manhole Turn Structures for access and cleaning per County Std Plans.
Exclude testing, survey, hazmat, unsuitable soils, AC placement thicker than 6", resident
notification, permits, and any work not specifically included above.
<Project Title>
<Project Number>
Approved by City Attorney, dated <insert date>
Up to $60,000 Contract
Payment Bond
Bond Number: 070208477
Premium: $482.00
Performance Bond
City of San Rafael ("City") and Maciaiiora and Ghilotti, Inc. ("Contractor") have entered into a contract,
dated ' , 20("Contract") for work on the Grand Avenue Storm Drain
Replacement Projec ("Project" ), he Contract is incorporated by reference into this Performance Bond
("Bond").
The Ohio Casualty
1. General. Under this Bond, Contractor as Principal and Insurance Company its
surety ("Surety"), are bound to City as obligee for an amount not less than $71,350. By executing
this Bond, Contractor and Surety bind themselves and their respective heirs, executors,
administrators, successors and assigns, jointly and severally, to the provisions of this Bond.
2. Surety's Obligations; Waiver. If Contractor fully performs its obligations under the Contract,
including its warranty obligations under the Contract, Surety's obligations under this Bond will
become null and void upon City's acceptance of the Project, provided Contractor has timely
provided a warranty bond as required under the Contract. Otherwise Surety's obligations will
remain in full force and effect until expiration of the one year warranty period under the Contract.
Surety waives any requirement to be notified of and further consents to any alterations to the
Contract made under the applicable provisions of the Contract documents, including changes to the
scope of Work or extensions of time for performance of Work under the Contract. Surety waives
the provisions of Civil Code sections 2819 and 2845.
3. Application of Contract Balance. Upon making a demand on this Bond, City will make the
Contract Balance available to Surety for completion of the Work under the Contract. For purposes
of this provision, the Contract Balance is defined as the total amount payable by City to Contractor
as the Compensation minus amounts already paid to Contractor, and minus any liquidated
damages, credits, or backcharges to which City is entitled under the terms of the Contract.
4. Contractor Default. Upon written notification from City that Contractor is in default under the
Contract, time being of the essence, Surety must act within seven calendar days of receipt of the
notice to remedy the default through one of the following courses of action:
4.1 Arrange for completion of the Work under the Contract by Contractor, with City's consent,
but only if Contractor is in default solely due to its financial inability to complete the Work;
4.2 Arrange for completion of the Work under the Contract by a qualified contractor
acceptable to City, and secured by performance and payment bonds issued by an admitted
surety as required by the Contract documents, at Surety's expense; or
4.3 Waive its right to complete the Work under the Contract and reimburse City the amount
of City's costs to have the remaining services completed.
5. Surety Default. If Surety defaults on its obligations under the Bond, City will be entitled to recover
all costs it incurs due to Surety's default, including legal, design professional, or delay costs.
6. Notice. Notice to Surety must be given or made in writing and sent to the Surety via personal
delivery, U.S. Mail, or a reliable overnight delivery service, or by email as a PDF (or comparable)
file. Notice is deemed effective upon delivery unless otherwise specified. Notice for the Surety
must be given as follows:
Attn: Liberty Mutual Surety Claims
Address: 1001 4th Avenue Suite 1300
City/State/Zip: Seattle WA 98154
[Project Title] Up to $60,000 Contract
[Project Number] Performance Bond
Approved by City Attorney, dated <insert date>
Phone: 206-473-6200
Fax: 866-548-7321
Email: HOSCL(a-libertymutual.com
7. Law and Venue. This Bond will be governed by California law, and any dispute pursuant to this
Bond will be venued in the Superior Court of < Marin > County, and no other place. Surety will
be responsible for City's attorneys' fees and costs in any action to enforce the provisions of this
Bond.
8. Effective Date; Execution. This Bond is entered into and effective on October 09
2019 . Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: The Ohio Casualty Insurance Company
Business Name
s/
Seymour, Att6rney-in-Fact
Name/Title [print]
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRACTOR: Maggiora & Ghilotti, Inc.
Maggiora and Ghilotti, Inc. /
s/
er
s/
Name/Title
END OF PERFORMANCE BOND
[Project Title] Up to $60,000 Contract
[Project Number] Performance Bond
Approved by City Attorney, dated <insert date>
r �
i�
i>
ica
--0
cn
I �
10
1a)
t0
iN
n(1)
f `
n(1)
i.c
im
CU >�
O`
ZU
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutual The Ohio Casualty Insurance Company Certificate No: 8200335-976005
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint Sandra J.
Dunaway, Tom Griffith, Jenny Hagemann, Paul Ramatici, Jill Seymour
all of the city of Petaluma state of Califomia each individually if there be more than one named, its true and lawful attorney-in-fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 22nd day of January , 2019
Liberty Mutual Insurance Company
P� 1NSUR4 P1Z1 INS& \NSUb The Ohio Casualty Insurance Company
xx �uP°oaP040 West American Insurance Company
J3 om T on a 3 oAt
1912 a o 1919 1991
dJ1�95CHUS��.dD yO� MAMPS�'`�,aD YS �N°IANr' aa3 � r /
i7
B y'
David M. Carey, Assistant Secretary
State of PENNSYLVANIA
County of MONTGOMERY ss
W
N
N
C
.y
On this 22nd day of January , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual insurance I o
Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes = -
therein contained by signing on behalf of the corporations by himself as a duly authorized officer. u LLI
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
St, PAST
Q'�u°Uwe q�FC� COMMONWEALTH OF PENNSYLVANIA
!Q ? y Notarial Seal
�Q��
OF Teresa PastelnTwp.ia, Notary Public
Upper Marion Twp., Montgomery County By:
My Commission Expires March 28, 2021
.y nSyLVP a Teresa Pastella, Notary Public
OJq� PUMember. PennsylvanlaAssocletlonorNotaries
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV— OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe.
shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this q1* day of .
1NSUR �SY INSU a \NSuz
�Jp 40NP3
rtgr qyc+ yJp a°NP°�T egy .GP a°NP°"tgr 9yC+
a3 Fof° vQ� Fo m Q3 °otN
1912 o -k1919 o a 1991
rd�9Ss7CHUSF�da SO NAMP`'�` as By.
�W �y°IANP as Renee C. Llewellyn, Assistant Secretary
LMS -12873 LMIC OCIC WAIC Multi Co 062018
00
2�
O�
C
N
OW
3-
0
0 aa)
D d
m�
>o
�C?
M
C °O
0 C
U —
O CD
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 Sonoma
WO -70" I HO
personally appeared Jill Seymour
Jenny Anne Hagemann - Notary Public
(insert name and title of the officer)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their 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.
JENNY ANNE HAGEMA�aN
-F COMM. #2156191 Z
Notary Public • California O
WITNESS my hand and official seal.
0-1
=Sonoma county
M comm. Expues June 11, 2020
Signatwec (Seal)
Exhibit B
BONDFORMS
Required for contracts over $25, 000.
Payment Bond
Bond Number: 070208477
Premium Included in Performance Bond
City of San Rafael ("Ci y") an Maggiora and Ghilotti, Inc. ("Contractor") have entered into a
contract, dated ' 11 204 ("Contract") for work on the Grand Avenue Storm
Drain Replacement Project ("Project"). The Contract is incorporated by reference into this
Payment Bond ("Bond").
The Ohio Casualty
1. General. Under this Bond, Contractor as principal and Insurance Company
its surety ("Surety"), are bound to City as obligee in an amount not less than $71,350,
under California Civil Code sections 9550, et seq.
2. Surety's Obligation. If Contractor or any of its subcontractors fails to pay any of the
persons named in California Civil Code section 9100 amounts due under the
Unemployment Insurance Code with respect to work or labor performed under the
Contract, or for any amounts required to be deducted, withheld, and paid over to the
Employment Development Department from the wages of employees of Contractor and its
subcontractors, under California Unemployment Insurance Code section 13020, with
respect to the work and labor, then Surety will pay for the same.
3. Beneficiaries. This Bond inures to the benefit of any of the persons named in California
Civil Code section 9100, so as to give a right of action to those persons or their assigns in
any suit brought upon this Bond. Contractor must promptly provide a copy of this Bond
upon request by any person with legal rights under this Bond.
4. Duration. If Contractor promptly makes payment of all sums for all labor, materials, and
equipment furnished for use in the performance of the Work required by the Contract, in
conformance with the time requirements set forth in the Contract and as required by
California law, Surety's obligations under this Bond will be null and void. Otherwise,
Surety's obligations will remain in full force and effect.
Waivers. Surety waives any requirement to be notified of alterations to the Contract or
extensions of time for performance of the Work under the Contract. Surety waives the
provisions of Civil Code sections 2819 and 2845. City waives requirement of a new bond
for any supplemental contract under Civil Code section 9550. Any notice to Surety may be
given in the manner specified in the Contract and delivered or transmitted to Surety as
follows:
Attn: Liberty Mutual Surety Claims
Address: 1001 4th Ave.. Suite 1300
City/State/Zip:
Phone: Seattle WA 98154
Fax: 866-548-7321
Email: HOSCLalihPrtynnit ual conn
6. Law and Venue. This Bond will be governed by California law, and any dispute pursuant
to this Bond will be venued in the Superior Court of Marin County, and no other place.
Surety will be responsible for City's attorneys' fees and costs in any action to enforce the
provisions of this Bond.
<Project Title>
<Project Number>
Approved by City Attorney, dated <insert date>
Up to $60,000 Contract
Payment Bond
7. Effective Date; Execution. This Bond is entered into and is effective on October 09
2019. Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: The Ohio Casualty Insurance Company
Business Name
s/1,14
Jill Seymour, Attorney -in -Fact
Name/Title
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRACTOR: Maggiora & Ghilotti, Inc.
Maggiora and Ghilotti, Inc.
s/
Name/Title
APPROVED BY CITY:
s/ L.'W
Name/Title
END OF PAYMENT BOND
<Project Title> Up to $60,000 Contract
<Project Number> Payment Bond
Approved by City Attorney, dated <Insert date>
Liberty
Mutual
SURETY
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8200335-976005
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Sandra J
Dunaway, Tom Griffith, Jenny Hagemann, Paul Ramatici, Jill Seymour
all of the city of Petaluma state of California each individually if there be more than one named, its true and lawful attorney-in-fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 22nd day of January , 2019 .
a)
lv
61
C l
State of PENNSYLVANIA
5 County of MONTGOMERY ss
Liberty Mutual Insurance Company
P� INSU&Pity INS& INsub The Ohio Casualty Insurance Company
�� aoat o�rFyC� yJ `oNro,�r eyy `VPooµroy� WestAmerican Insurance Company
Lu
m 3
1912 0 0 1919 o f 19910
d�9�9ACHUS,da yONA MPSa '( rNOIAN)'
ej7 * *� �y1 * ��,a s�M * )�a By:
nn.id M Carcv Accicf.nf Senmf—
lv I On this 22nd day of January , 2019 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
> therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
5t, PAST
Q��rroNwF COMMONWEALTH OF PENNSYLVANIA
9< < Notarial seal����c�-A/
ti v i 9
OF Teresa Paslella, Notary Public
Upper MerionTwp., Montgomery County By:
My Commission Expires March 2e, 2021
Z ti5vWP ��G Member, Pennsylvenla Association of Notaries eresa Pastella, Notary Public
°TgRY Pve ,
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV– OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII – Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation – The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attomeys-in-
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization – By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 94 day o , 20 1q
P� 1NS11� P�ZY INS& � %NSURq
J =`oNro�roy�to Q 3°oaror4", 14, `VF.?Olt 0�r� y�
;1912ga o 1919 1991
: �o s
rd�'�`S4CHU5� da %NA MPS`"` a Y �NOIAN)' aim By:
Renee C. Llewellyn, Assistant Secretary
LMS -12673 LMIC OCIC WAIL Multi Co 062018
_ t—
v LU
aE
a) Q
E
00
0
C
d) fa
Ocu
3- C=)
Wo
C CO
o N
D d
m -Q
>o
m�
Y N
M
c °O
00
U —
OC9
T
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 Sonoma
On(-)�' 2 ?-012 before me,
personally appeared Jill Seymour
Jenny Anne Hagemann - Notary Public
(insert name and title of the officer)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their 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.
�—''� •,,,,, JENNY ANNE MAGMA
COMM. #2156191 ZM
w Notary Public California o
d r Sonoma County 1
My Comm Expires June 11, 2020
MAGGIA
OP ID- SD
�� CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
10/09/2019
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(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 707-782-9200
Don Ramatici Insurance, Inc.
731A Southpoint Blvd
Petaluma, CA 94954
Paul Ramatici
COA E:NTACT Paul Ramatici
PHONE 707-782-9200 FAX707-782-9300
(AIC, No, Ext): (A/C, No):
ADD IESS:
DT22CO9J210471TCT19
10/01/2019
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: TravelerslndemCo ofConnecticut 25682
DAMAGE TO RENTED 300,000
aoccu a ce $
INSURED
Ma�gggglora & Ghilotti, Inc.
555Du Bois Street
San Rafael, CA 94901
INSURER B: Travelers Pro p.CasualtyCo Amer. 25674
INSURER C:
INSURER D
INSURER E
PRODUCTS - COMP/OP AGG $ 4'000'000
INSURER F
A
COVERAGES CERTIFICATE NUMBER: 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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
POLICY EXPLTR
LIMITS
B
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
X PD Ded $10k-Occ
X
X
DT22CO9J210471TCT19
10/01/2019
10/01/2020
EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED 300,000
aoccu a ce $
MED EXP (Any oneperson) $ 5,000
X XCU & Cntrtl Incl
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 1 JECT FI LOC
OTHER:
GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMP/OP AGG $ 4'000'000
Emp Ben. $ 1,000,000
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
H RED X NON -OWNED
ATOSONLY AUTOS ONLY
X
X
8106N3379181926G
10/01/2019
10/01/2020
COMBINED
e aBINED SINGLE LIMIT $ 2,000,000
BODILY INJURY Perperson) $
BODILY INJURY Per accident $
PROPERTY DAMAGE
Per accident $
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
I CLAIMS -MADE
CUP9J6834101926
10/01/2019
10/01/2020
EACH OCCURRENCE 5 4,000,000
AGGREGATE $ 4,000,000
DED I X I RETENTION$ 10,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
X
UB9J2104711926G
10/01/2019
10/01/2020
X PERTLIT, OTH-
ER
E.L. EACH ACCIDENT S 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1'000'000
E.L. DISEASE - POLICY LIMIT 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
**The City, including its Council, officials, officers, employees, agents,
volunteers & consultants as additional insureds, when required by contract,
including primary noncontributory & waiver of subrogation per CGD246,CGD316,
CAT353, CA0001 & WC990376 attached.
Job: Grand Avenue Storm Drain Replacement Project / M&G #4585
City of San Rafael**
Dept. of Public Works
111 Morphew Street
San Rafael, CA 94915
ACORD 25 (2016/03)
SANRA19
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
110A OUB
©1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Named Insured: Maggiora & Ghilotti, Inc.
Policy Number: DT22CO93210471TCT19
COMMERCIAL GENERAL LIABILITY
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. WHO IS AN INSURED — (Section II) is amended
c) The insurance provided to the additional In-
to include any person or organization that you
sured does not apply to "bodily injury" or
agree in a "written contract requiring insurance"
"properly damage" caused by "your work"
to include as an additional insured on this Cover-
and Included in the "products -completed op -
age Part, but:
erations hazard" unless the "written contract
a) Only with respect to liability for "bodily Injury",
requiring Insurance" specifically requires you
"properly damage" or "personal Injury"; and
to provide such coverage for that additional
Insured, and then the Insurance provided to
b) If, and only to the extent that, the Injury or
the additional insured applies only to such
damage is caused by acts or omissions of
"bodily Injury" or "properly damage" that oc-
you or your subcontractor in the performance
curs before the end of the period of time for
of "your work" to which the "written contract
which the "written contract requiring Insur-
requiring insurance" applies. The person or
ance" requires you to provide such coverage
organization does not qualify as an additional
or the end of the policy period, whichever is
insured with respect to the Independent acts
earlier.
or omissions of such person or organization.
3. The Insurance provided to the additional insured
2. The insurance provided to the additional Insured
by this endorsement Is excess over any valid and
by this endorsement is limited as follows:
collectible "other Insurance", whether primary,
a) In the event that the Limits of Insurance of
excess, contingent or on any other basis, that Is
this Coverage Part shown in the Declarations
available to the additional insured for a loss we
exceed the limits of liability required by the
cover under this endorsement. However, if the
"written contract requiring insurance", the In-
"written contract requiring Insurance" specifically
surance provided to the additional insured
requires that this Insurance apply on a primary
shall be limited to the limits of liability re-
basis or a primary and non-contributory basis,
qulred by that "written contract requiring in-
this Insurance Is primary to "other Insurance"
surance". This endorsement shall not In-
available to the additional Insured which covers
crease the limits of Insurance described In
that person or organization as a named Insured
Section III — Limits Of Insurance,
for such loss, and we will not share with that
"other Insurance". But the Insurance provided to
b) The Insurance provided to the additional In-
the additional insured by this endorsement still Is
sured does not apply to "bodily injury", prop-
excess over any valid and collectible "other in-
erly damage" or "personal Injury" arising out
surance", whether primary, excess, contingent or
of the rendering of, or failure to render, any
on any other basis, that is available to the addi-
professional architectural, engineering or sur-
tional Insured when that person or organization Is
veying services, Including:
an additional Insured under such "other insur-
I. The preparing, approving, or failing to
ance".
prepare or approve, maps, shop draw-
4. As a condition of coverage provided to the
Ings, opinions, reports, surveys, field or-
additional Insured by this endorsement:
ders or change orders, or the preparing,
approving, or falling to prepare or ap-
a) The additional Insured must give us written
prove, drawings and specifications; and
notice as soon as practicable of an "occur -
rence" or an offense which may result in a
ii. Supervisory, inspection, architectural or
claim, To the extent possible, such notice
engineering activities,
should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 11 of 2
COMMERCIAL GENERAL LIABILITY
1. How, when and where the 'occurrence"
or offense took place;
If. The names and addresses of any injured
persons and witnesses; and
III. 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 additional insured, the additional insured
must:
I. Immediately record the specifics of the
claim or "suit" and the date received; and
if. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
soon as practicable.
c) The additional 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 additional insured must tender the de-
fense and indemnity of any claim or "suit" to
any provider of 'other insurance" which would
cover the additional Insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to 'other Insur-
ance" available to the additional 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 in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs 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 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
Named Insured: Maggiora & Ghilotti, Inc.
Policy Number: DT22CO9J210471TCT19
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. Aircraft Chartered With Pilot
B. Damage To Premises Rented To You
C. Increased Supplementary Payments
D. Incidental Medical Malpractice
E. Who Is An Insured — Newly Acquired Or Formed
Organizations
F. Who Is An Insured — Broadened Named Insured
— Unnamed Subsidiaries
G. Blanket Additional Insured — Owners, Managers
Or Lessors Of Premises
PROVISIONS
A. AIRCRAFT CHARTERED WITH PILOT
The following is added to Exclusion g., Aircraft,
Auto Or Watercraft, in Paragraph 2. of SECTION
I — COVERAGES — COVERAGE A BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY:
This exclusion does not apply to an aircraft that
is:
(a) Chartered with a pilot to any insured;
(b) Not owned by any insured; and
(c) Not being used to carry any person or prop-
erty for a charge.
B. DAMAGE TO PREMISES RENTED TO YOU
1. The first paragraph of the exceptions in Ex-
clusion j., Damage To Property, in Para-
graph 2. of SECTION I — COVERAGES —
COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY is deleted.
2. The following replaces the last paragraph of
Paragraph 2., Exclusions, of SECTION I —
COVERAGES — COVERAGE A. BODILY
H. Blanket Additional Insured — Lessors Of Leased
Equipment
I. Blanket Additional Insured — States Or Political
Subdivisions — Permits
J. Knowledge And Notice Of Occurrence Or Offense
K. Unintentional Omission
L. Blanket Waiver Of Subrogation
M. Amended Bodily Injury Definition
N. Contractual Liability — Railroads
INJURY AND PROPERTY DAMAGE LI-
ABILITY:
Exclusions c. and g. through n. do not apply
to "premises damage". Exclusion f.(1)(a)
does not apply to "premises damage" caused
by:
a. Fire;
b. Explosion;
c. Lightning;
d. Smoke resulting from such fire, explosion,
or lightning; or
e. Water;
unless Exclusion f. of Section I — Coverage A
— Bodily Injury And Property Damage Liability
is replaced by another endorsement to this
Coverage Part that has Exclusion — All Pollu-
tion Injury Or Damage or Total Pollution Ex-
clusion in its title.
A separate limit of insurance applies to
'Premises damage" as described in Para-
graph 6. of SECTION III — LIMITS OF IN-
SURANCE.
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 1 of 6
COMMERCIAL GENERAL LIABILITY
3. The following replaces Paragraph 6. of SEC-
TION III — LIMITS OF INSURANCE:
Subject to 5. above, the Damage To Prem-
ises Rented To You Limit is the most we will
pay under Coverage A for damages because
of "premises damage" to any one premises.
The Damage To Premises Rented To You
Limit will apply to all "property damage"
proximately caused by the same "occur-
rence", whether such damage results from:
fire; explosion; lightning; smoke resulting from
such fire, explosion, or lightning; or water; or
any combination of any of these causes.
The Damage To Premises Rented To You
Limit will be:
a. The amount shown for the Damage To
Premises Rented To You Limit on the
Declarations of this Coverage Part; or
b. $300,000 if no amount is shown for the
Damage To Premises Rented To You
Limit on the Declarations of this Coverage
Part.
4. The following replaces Paragraph a. of the
definition of "insured contract" in the DEFINI-
TIONS Section:
a. A contract for a lease of premises. How-
ever, that portion of the contract for a
lease of premises that indemnifies any
person or organization for "premises
damage" is not an "insured contract";
5. The following is added to the DEFINITIONS
Section:
"Premises damage" means "property dam-
age" to:
a. Any premises while rented to you or tem-
porarily occupied by you with permission
of the owner; or
b. The contents of any premises while such
premises is rented to you, if you rent such
premises for a period of seven or fewer
consecutive days.
6. The following replaces Paragraph 4.b.(1)(b)
of SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS:
(b) That is insurance for "premises damage";
or
7. Paragraph 4.b.(1)(c) of SECTION IV —
COMMERCIAL GENERAL LIABILITY CON-
DITIONS is deleted.
C. INCREASED SUPPLEMENTARY PAYMENTS
1. The following replaces Paragraph 1.b. of
SUPPLEMENTARY PAYMENTS — COVER-
AGES A AND B of SECTION I — COVER-
AGE:
b. Up to $2,500 for the cost of bail bonds
required because of accidents or traffic
law violations arising out of the use of any
vehicle to which the Bodily Injury Liability
Coverage applies. We do not have to fur-
nish these bonds.
2. The following replaces Paragraph 1.d. of
SUPPLEMENTARY PAYMENTS — COVER-
AGES A AND B of SECTION I — COVER-
AGES:
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit", including actual loss of earnings up
to $500 a day because of time off from
work.
D. INCIDENTAL MEDICAL MALPRACTICE
1. The following is added to the definition of "oc-
currence" in the DEFINITIONS Section:
"Occurrence" also means an act or omission
committed in providing or failing to provide
"incidental medical services", first aid or
"Good Samaritan services" to a person.
2. The following is added to Paragraph 2.a.(1) of
SECTION II — WHO IS AN INSURED:
Paragraph (1)(d) above does not apply to
"bodily injury" arising out of providing or fail-
ing to provide:
(i) "Incidental medical services" by any of
your "employees" who is a nurse practi-
tioner, registered nurse, licensed practical
nurse, nurse assistant, emergency medi-
cal technician or paramedic; or
(ii) First aid or "Good Samaritan services" by
any of your "employees" or "volunteer
workers", other than an employed or vol-
unteer doctor. Any such "employees" or
"volunteer workers" providing or failing to
provide first aid or "Good Samaritan ser-
vices" during their work hours for you will
be deemed to be acting within the scope
of their employment by you or performing
duties related to the conduct of your busi-
ness.
Page 2 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11
3. The following is added to Paragraph 5. of
SECTION III — LIMITS OF INSURANCE:
For the purposes of determining the applica-
ble Each Occurrence Limit, all related acts or
omissions committed in providing or failing to
provide "incidental medical services", first aid
or "Good Samaritan services" to any one per-
son will be deemed to be one 'occurrence".
4. The following exclusion is added to Para-
graph 2., Exclusions, of SECTION I — COV-
ERAGES — COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE LIABILITY:
Sale Of Pharmaceuticals
"Bodily injury" or "property damage" arising
out of the willful violation of a penal statute or
ordinance relating to the sale of pharmaceuti-
cals committed by, or with the knowledge or
consent of, the insured.
5. The following is added to the DEFINITIONS
Section:
"Incidental medical services" means:
a. Medical, surgical, dental, laboratory, x-ray
or nursing service or treatment, advice or
instruction, or the related furnishing of
food or beverages; or
b. The furnishing or dispensing of drugs or
medical, dental, or surgical supplies or
appliances.
"Good Samaritan services" means any emer-
gency medical services for which no compen-
sation is demanded or received.
6. The following is added to Paragraph 4.b., Ex-
cess Insurance, of SECTION IV — COM-
MERCIAL GENERAL LIABILITY CONDI-
TIONS:
The insurance is excess over any valid and
collectible other insurance available to the in-
sured, whether primary, excess, contingent or
on any other basis, that is available to any of
your "employees" or "volunteer workers" for
"bodily injury" that arises out of providing or
failing to provide "incidental medical ser-
vices", first aid or "Good Samaritan services"
to any person to the extent not subject to
Paragraph 2.a.(1) of Section II — Who Is An
Insured.
E. WHO IS AN INSURED — NEWLY ACQUIRED
OR FORMED ORGANIZATIONS
The following replaces Paragraph 4. of SECTION
II — WHO IS AN INSURED:
COMMERCIAL GENERAL LIABILITY
4. Any organization you newly acquire or form,
other than a partnership, joint venture or lim-
ited liability company, of which you are the
sole owner or in which you maintain the ma-
jority ownership interest, will qualify as a
Named Insured if there is no other insurance
which provides similar coverage to that or-
ganization. However:
a. Coverage under this provision is afforded
only:
(1) Until the 180th day after you acquire or
form the organization or the end of the
policy period, whichever is earlier, if you
do not report such organization in writing
to us within 180 days after you acquire or
form it; or
(2) Until the end of the policy period, when
that date is later than 180 days after you
acquire or form such organization, if you
report such organization in writing to us
within 180 days after you acquire or form
it, and we agree in writing that it will con-
tinue to be a Named Insured until the end
of the policy period;
b. Coverage A does not apply to "bodily injury"
or "property damage" that occurred before
you acquired or formed the organization; and
c. Coverage B does not apply to "personal in-
jury" or "advertising injury" arising out of an
offense committed before you acquired or
formed the organization.
F. WHO IS AN INSURED — BROADENED NAMED
INSURED — UNNAMED SUBSIDIARIES
The following is added to SECTION II — WHO IS
AN INSURED:
Any of your subsidiaries, other than a partnership,
joint venture or limited liability company, that is
not shown as a Named Insured in the Declara-
tions is a Named Insured if you maintain an own-
ership interest of more than 50% in such subsidi-
ary on the first day of the policy period.
No such subsidiary is an insured for "bodily injury"
or "property damage" that occurred, or "personal
injury" or "advertising injury" caused by an of-
fense committed after the date, if any, during the
policy period, that you no longer maintain an
ownership interest of more than 50% in such sub-
sidiary.
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6
COMMERCIAL GENERAL LIABILITY
G. BLANKET ADDITIONAL INSURED — OWNERS,
MANAGERS OR LESSORS OF PREMISES
The following is added to SECTION II — WHO IS
AN INSURED:
H. BLANKET ADDITIONAL INSURED — LESSORS
OF LEASED EQUIPMENT
The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that is a premises Any person or organization that is an equipment
owner, manager or lessor and that you have lessor and that you have agreed in a written con -
agreed in a written contract or agreement to in- tract or agreement to include as an insured on
clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re -
Part is an insured, but only with respect to liability spect to liability for "bodily injury", "property dam -
for "bodily injury", "property damage", "personal
injury" or "advertising injury" that: age", "personal injury" or "advertising injury" that:
a. Is "bodily injury" or "property damage" that
occurs, or is "personal injury" or "advertising
injury" caused by an offense that is commit-
ted, subsequent to the execution of that con-
tract or agreement; and
b. Arises out of the ownership, maintenance or
use of that part of any premises leased to
you.
The insurance provided to such premises owner,
manager or lessor is subject to the following pro-
visions:
a. The limits of insurance provided to such
premises owner, manager or lessor will be
the minimum limits which you agreed to pro-
vide in the written contract or agreement, or
the limits shown on the Declarations, which-
ever are less.
b. The insurance provided to such premises
owner, manager or lessor does not apply to:
(1) Any "bodily injury" or "property damage"
that occurs, or "personal injury" or "adver-
tising injury" caused by an offense that is
committed, after you cease to be a tenant
in that premises; or
(2) Structural alterations, new construction or
demolition operations performed by or on
behalf of such premises owner, lessor or
manager.
c. The insurance provided to such premises
owner, manager or lessor is excess over any
valid and collectible other insurance available
to such premises owner, manager or lessor,
whether primary, excess, contingent or on
any other basis, unless you have agreed in
the written contract or agreement that this in-
surance must be primary to, or non-
contributory with, such other insurance, in
which case this insurance will be primary to,
and non-contributory with, such other insur-
ance.
a. Is "bodily injury" or "property damage" that
occurs, or is "personal injury" or "advertising
injury" caused by an offense that is commit-
ted, subsequent to the execution of that con-
tract or agreement; and
b. Is caused, in whole or in part, by your acts or
omissions in the maintenance, operation or
use of equipment leased to you by such
equipment lessor.
The insurance provided to such equipment lessor
is subject to the following provisions:
a. The limits of insurance provided to such
equipment lessor will be the minimum limits
which you agreed to provide in the written
contract or agreement, or the limits shown on
the Declarations, whichever are less.
b. The insurance provided to such equipment
lessor does not apply to any "bodily injury" or
"property damage" that occurs, or "personal
injury" or "advertising injury" caused by an of-
fense that is committed, after the equipment
lease expires.
c. The insurance provided to such equipment
lessor is excess over any valid and collectible
other insurance available to such equipment
lessor, whether primary, excess, contingent
or on any other basis, unless you have
agreed in the written contract or agreement
that this insurance must be primary to, or
non-contributory with, such other insurance,
in which case this insurance will be primary
to, and non-contributory with, such other in-
surance.
I. BLANKET ADDITIONAL INSURED — STATES
OR POLITICAL SUBDIVISIONS — PERMITS
The following is added to SECTION II — WHO IS
AN INSURED:
Any state or political subdivision that has issued a
permit in connection with operations performed by
you or on your behalf and that you are required
Page 4 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11
by any ordinance, law or building code to include
as an additional insured on this Coverage Part is
an insured, but only with respect to liability for
"bodily injury", "property damage", "personal in-
jury" or "advertising injury" arising out of such op-
erations.
The insurance provided to such state or political
subdivision does not apply to:
a. Any "bodily injury," "property damage," "per-
sonal injury" or "advertising injury" arising out
of operations performed for that state or po-
litical subdivision; or
b. Any "bodily injury" or "property damage" in-
cluded in the "products -completed operations
hazard".
J. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
The following is added to Paragraph 2., Duties In
The Event of Occurrence, Offense, Claim or
Suit, of SECTION IV — COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS:
e. The following provisions apply to Paragraph
a. above, but only for the purposes of the in-
surance provided under this Coverage Part to
you or any insured listed in Paragraph 1. or 2.
of Section II — Who Is An Insured:
(1) Notice to us of such "occurrence" or of-
fense must be given as soon as practica-
ble only after the "occurrence" or offense
is known by you (if you are an individual),
any of your partners or members who is
an individual (if you are a partnership or
joint venture), any of your managers who
is an individual (if you are a limited liability
company), any of your "executive offi-
cers" or directors (if you are an organiza-
tion other than a partnership, joint venture
or limited liability company) or any "em-
ployee" authorized by you to give notice
of an "occurrence" or offense.
(2) If you are a partnership, joint venture or
limited liability company, and none of your
partners, joint venture members or man-
agers are individuals, notice to us of such
"occurrence" or offense must be given as
soon as practicable only after the "occur-
rence" or offense is known by:
COMMERCIAL GENERAL LIABILITY
(Ii) A manager of any limited liability
company; or
(Iii) An executive officer or director of
any other organization;
that is your partner, joint venture
member or manager; or
(b) Any "employee" authorized by such
partnership, joint venture, limited li-
ability company or other organization
to give notice of an "occurrence" or
offense.
(3) Notice to us of such "occurrence" or of an
offense will be deemed to be given as
soon as practicable if it is given in good
faith as soon as practicable to your work-
ers' compensation insurer. This applies
only if you subsequently give notice to us
of the "occurrence" or offense as soon as
practicable after any of the persons de-
scribed in Paragraphs e. (1) or (2) above
discovers that the "occurrence" or offense
may result in sums to which the insurance
provided under this Coverage Part may
apply.
However, if this Coverage Part includes an en-
dorsement that provides limited coverage for
"bodily injury" or "property damage" or pollution
costs arising out of a discharge, release or es-
cape of "pollutants" which contains a requirement
that the discharge, release or escape of "pollut-
ants" must be reported to us within a specific
number of days after its abrupt commencement,
this Paragraph e. does not affect that require-
ment.
K. UNINTENTIONAL OMISSION
The following is added to Paragraph 6., Repre-
sentations, of SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS:
The unintentional omission of, or unintentional
error in, any information provided by you which
we relied upon in issuing this policy will not preju-
dice your rights under this insurance. However,
this provision does not affect our right to collect
additional premium or to exercise our rights of
cancellation or nonrenewal in accordance with
applicable insurance laws or regulations.
L. BLANKET WAIVER OF SUBROGATION
(a) Any individual who is: The following is added to Paragraph 8., Transfer
(i) A partner or member of any part- Of Rights Of Recovery Against Others To Us,
nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI-
ABILITY CONDITIONS:
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6
COMMERCIAL GENERAL LIABILITY
If the insured has agreed in a contract or agree-
ment to waive that insured's right of recovery
against any person or organization, we waive our
right of recovery against such person or organiza-
tion, but only for payments we make because of:
a. "Bodily injury" or "property damage" that oc-
curs; or
b. "Personal injury" or "advertising injury"
caused by an offense that is committed;
subsequent to the execution of that contract or
agreement.
M. AMENDED BODILY INJURY DEFINITION
The following replaces the definition of "bodily
injury" in the DEFINITIONS Section:
3. "Bodily injury" means bodily injury, mental
anguish, mental injury, shock, fright, disability,
humiliation, sickness or disease sustained by
a person, including death resulting from any
of these at any time.
N. CONTRACTUAL LIABILITY — RAILROADS
1. The following replaces Paragraph c. of the
definition of "insured contract" in the DEFINI-
TIONS Section:
c. Any easement or license agreement;
2. Paragraph f.(1) of the definition of "insured
contract" in the DEFINITIONS Section is de-
leted.
Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11
Named Insured: Maggiora & Ghilotti, Inc.
Policy Number: 8106N3379181926G
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage Is excluded or limited by such an endorsement. The following listing Is a general
coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of
this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED
B. BLANKET ADDITIONAL INSURED
C. EMPLOYEE HIRED AUTO
D. EMPLOYEES AS INSURED
E. SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
F, HIRED AUTO — LIMITED WORLDWIDE
COVERAGE — INDEMNITY BASIS
G, WAIVER OF DEDUCTIBLE — GLASS
PROVISIONS
A. BROAD FORM NAMED INSURED
The following is added to Paragraph A,1., Who Is
An Insured, of SECTION II — LIABILITY
COVERAGE:
Any organization you newly acquire or form
during the policy period over which you maintain
50% or more ownership Interest and that Is not
separately Insured for Business Auto Coverage.
Coverage under this provision Is afforded only
until the 180th day after you acquire or form the
organization or the end of the policy period,
whichever is earlier.
B, BLANKET ADDITIONAL INSURED
The following Is added to Paragraph c, in A.1,,
Who Is An Insured, of SECTION II — LIABILITY
COVERAGE:
This Includes any person or organization who you
are required under a written contract or
agreement between you and that person or
organization, that is signed by you before the
"bodily Injury" or "property damage" occurs and
that is in effect during the policy period, to name
H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF
USE — INCREASED LIMIT
I, PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES — INCREASED LIMIT
J. PERSONAL EFFECTS
K. AIRBAGS
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
M. BLANKET WAIVER OF SUBROGATION
N. UNINTENTIONAL ERRORS OR OMISSIONS
as an additional Insured for Liability Coverage,
but only for damages to which this Insurance
applies and only to the extent of that person's or
organization's liability for the conduct of another
"Insured",
C. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A,1„
Who Is An Insured, of SECTION II —
LIABILITY COVERAGE:
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
contract or agreement in that "employee's"
name, with your permission, while performing
duties related to the conduct of your
business.
2. The following replaces Paragraph b, in B,6„
Other Insurance, of SECTION IV —
BUSINESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage
Coverage, the following are deemed to be
covered "autos" you own:
CA T3 63 08 17 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 4
Includes copyrighted material of Insurance Services Office, Inc. with its permission
COMMERCIAL AUTO
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's" name,
with your permission, while
performing duties related to the
conduct of your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
D. EMPLOYEES AS INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II — LIABILITY
COVERAGE:
Any "employee" of yours is an "insured" while
using a covered "auto" you don't own, hire or
borrow in your business or your personal affairs.
E. SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
1. The following replaces Paragraph A.2,a,(2),
of SECTION II — LIABILITY COVERAGE:
(2) Up to $3,000 for cost of ball bonds
(including bonds for related traffic law
violations) required because of an
"accident" we cover. We do not have to
furnish these bonds.
2, The following replaces Paragraph A,2.a.(4),
of SECTION II — LIABILITY COVERAGE:
(4) All reasonable expenses Incurred by the
"Insured" at our request, including actual
loss of earnings up to $500 a day
because of time off from work.
HIRED AUTO — LIMITED WORLDWIDE
COVERAGE — INDEMNITY BASIS
The following replaces Subparagraph e, in
Paragraph B.7., Policy Term, Coverage
Territory, of SECTION IV — BUSINESS AUTO
CONDITIONS:
e, Anywhere in the world, except any country or
jurisdiction while any trade sanction,
embargo, or similar regulation imposed by the
United States of America applies to and
prohibits the transaction of business with or
within such country orjurisdiction, for Liability
Coverage for any covered "auto" that you
lease, hire, rent or borrow without a driver for
a period of 30 days or less and that is not an
"auto" you lease, hire, rent or borrow from
any of your "employees", partners (if you are
a partnersh p), members (if you are a limited
liability company) or members of their
households.
(1) With respect to any claim made or "suit"
brought outside the United States of
America, the territories and possessions
of the United States of America, Puerto
Rico and Canada:
(a) You must arrange to defend the
"Insured" against, and Investigate or
settle any such claim or "suit" and
keep us advised of all proceedings
and actions.
(b) Neither you nor any other Involved
"Insured" will make any settlement
without our consent.
(c) We may, at our discretion, participate
in defending the "insured" against, or
in the settlement of, any claim or
"suit
(d) We will reimburse the "insured":
(1) For sums that the "insured"
legally must pay as damages
because of "bodily injury" or
"property damage" to which this
insurance applies, that the
"Insured" pays with our consent,
but only up to the limit described
in Paragraph C., Limit Of
Insurance, of SECTION II —
LIABILITY COVERAGE;
(11) For the reasonable expenses
incurred with our consent for your
investigation of such claims and
your defense of the "Insured"
against any such "suit", but only
up to and Included within the limit
described in Paragraph C., Limit
Of Insurance, of SECTION it —
LIABILITY COVERAGE, and not
in addition to such limit. Our duty
to make such payments ends
when we have used up the
applicable limit of insurance in
payments for damages,
settlements or defense expenses.
(2) This insurance is excess over any valid
and collectible other insurance available
to the "insured" whether primary, excess
contingent or on any other basis.
(3) This insurance is not a substitute for
required or compulsory insurance in any
country outside the United States, its
Page 2 of 4 © 2016 The Travelers Indemnity company. All rights reserved CA T3 53 08 17
Includes copyrighted material of Insurance Services Office, Inc. with Its permission
territories and possessions, Puerto Rico
and Canada.
You agree to maintain all required or
compulsory insurance in any such
country up to the minimum limits required
by local law. Your failure to comply with
compulsory insurance requirements will
not invalidate the coverage afforded by
this policy, but we will only be liable to the
same extent we would have been liable
had you complied with the compulsory
insurance requirements.
(4) It Is understood that we are not an
admitted or authorized insurer outside the
United States of America, its territories
and possessions, Puerto Rico and
Canada. We assume no responsibility for
the furnishing of certificates of Insurance,
or for compliance in any way with the
laws of other countries relating to
insurance.
G. WAIVER OF DEDUCTIBLE — GLASS
The following is added to Paragraph D.,
Deductible, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
No deductible for a covered "auto" will apply to
glass damage if the glass is repaired rather than
replaced.
H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF
USE — INCREASED LIMIT
The following replaces the last sentence of
Paragraph AA.b., Loss Of Use Expenses, of
SECTION III — PHYSICAL DAMAGE
COVERAGE:
However, the most we will pay for any expenses
for loss of use is $65 per day, to a maximum of
$750 for any one "accident".
i. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES — INCREASED LIMIT
The following replaces the first sentence In
Paragraph A.4,a., Transportation Expenses, of
SECTION III — PHYSICAL DAMAGE
COVERAGE:
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense
Incurred by you because of the total theft of a
covered "auto" of the private passenger type.
J. PERSONAL EFFECTS
The following is added to Paragraph AA,
Coverage Extensions, of SECTION III —
PHYSICAL DAMAGE COVERAGE:
COMMERCIAL AUTO
Personal Effects
We will pay up to $400 for "loss" to wearing
apparel and other personal effects which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto".
This coverage applies only in the event of a total
theft of your covered "auto".
No deductibles apply to this Personal Effects
coverage.
K. AIRBAGS
The following is added to Paragraph B.3.,
Exclusions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Exclusion 3.a. does not apply to 'loss" to one or
more airbags in a covered "auto" you own that
inflate due to a cause other than a cause of "loss"
set forth in Paragraphs A.1.b. and A.1.c., but
only:
a. If that "auto" is a covered "auto" for
Comprehensive Coverage under this policy;
b. The airbags are not covered under any
warranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one "loss".
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
The following Is added to Paragraph A.2.a., of
SECTION IV— BUSINESS AUTO CONDITIONS:
Your duty to give us or our authorized
representative prompt notice of the "accident" or
"loss" applies only when the "accident" or "loss" is
known to:
(a) You (if you are an individual);
(b) A partner (if you are a partnership);
(c) A member (if you are a limited liability
company);
(d) An executive officer, director or insurance
manager (if you are a corporation or other
organization); or
(e) Any "employee" authorized by you to give
notice of the "accident" or "loss".
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — BUSINESS AUTO
CONDITIONS:
CA T3 53 08 17 © 2016 The Travelers Indemnity Company. All rights reserved. Page 3 of 4
Includes copyrighted material of Insurance Services Office, Inc. with Its permission
COMMERCIAL AUTO
Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the
extent required of you by a written contract
signed and executed prior to any "accident"
or "loss", provided that the "accident' or "loss"
arises out of operations contemplated by
such contract. The waiver applies only to the
person or organization designated in such
contract.
N. UNINTENTIONAL ERRORS OR OMISSIONS
The following Is added to Paragraph B.2.,
Concealment, Misrepresentation, Or Fraud, of
SECTION IV — BUSINESS AUTO CONDITIONS:
The unintentional omission of, or unintentional
error in, any information given by you shall not
prejudice your rights under this insurance.
However this provision does not affect our right to
collect additional premium or exercise our right of
cancellation or non -renewal,
Page 4 of 4 © 2016 The Travelers Indemnity Company. All rights reserved. CA T3 53 08 17
Includes copyrighted material of Insurance Services Office, Inc. with Its permission
Named Insured: Maggiora & Ghilotti, Inc.
Policy Number: 8106N3379181926G
4. Loss Payment —Physical Damage
Coverages
At our option, we may:
a. Pay for, repair or replace damaged or
stolen property;
b. Return the stolen property, at our expense.
We will pay for any damage that results to
the "auto" from the theft; or
c. Take all or any part of the damaged or
stolen property at an agreed or appraised
value.
If we pay for the "loss", our payment will
Include the applicable sales tax for the
damaged or stolen property.
5. Transfer Of Rights Of Recovery Against
Others To Us
If any person or organization to or for whom we
make payment under this Coverage Form has
rights to recover damages from another, 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.
B. General Conditions
1. Bankruptcy
Bankruptcy or insolvency of the "insured" or the
"insured's" estate will not relieve us of any
obligations under this Coverage Form.
2. Concealment, Misrepresentation Or Fraud
This Coverage Form is void In any case of
fraud by you at any time as it relates to this
Coverage Form. It is also void if you or any
other "insured", at any time, intentionally
conceals or misrepresents a material fact
concerning:
a. This Coverage Form;
b. The covered "auto";
c, Your Interest in the covered "auto"; or
d. A claim under this Coverage Form,
3. Liberalization
If we revise this Coverage Form to provide
more coverage without additional premium
charge, your policy will automatically provide
the additional coverage as of the day the
revision is effective in your state,
4. No Benefit To Ballee — Physical Damage
Coverages
We will not recognize any assignment or grant
any coverage for the benefit of any person or
organization holding, storing or transporting
property for a fee regardless of any other
provision of this Coverage Form.
5. Other Insurance
a. For any covered "auto" you own, this
Coverage Form provides primary
insurance. For any covered "auto" you don't
own, the insurance provided by this
Coverage Form is excess over any other
collectible insurance.. However, while a
covered "auto" which is a "trailer" is
connected to another vehicle, the Covered
Autos Liability Coverage this Coverage
Form provides for the "trailer" is:
(1) Excess while it is connected to a motor
vehicle you do not own; or
(2) Primary while it is connected to a
covered "auto" you own.
b. For Hired Auto Physical Damage Coverage,
any covered "auto" you lease, hire, rent or
borrow is deemed to be a covered "auto"
you own. However, any "auto" that is
leased, hired, rented or borrowed with a
driver is not a covered "auto".
c. Regardless of the provisions of Paragraph
a. above, this Coverage Form's Covered
Autos Liability Coverage is primary for any
liability assumed under an "insured
contract",
d, When this Coverage Form and any other
Coverage Form or policy covers on the
same basis, either excess or primary, we
will pay only our share. Our share is the
proportion that the Limit of Insurance of our
Coverage Form bears to the total of the
limits of all the Coverage Forms and
policies covering on the same basis.
6. Premium Audit
a. The estimated premium for this Coverage
Form is based on the exposures you told us
you would have when this policy began. We
will compute the final premium due when
we determine your actual exposures. The
estimated total premium will be credited
against the final premium due and the first
Named Insured will be billed for the
balance, if any. The due date for the final
premium or retrospective premium is the
date shown as the due date on the bill. If
the estimated total premium exceeds the
final premium due, the first Named Insured
will get a refund.
b. If this policy Is Issued for more than one
year, the premium for this Coverage Form
will be computed annually based on our
rates or premiums in effect at the beginning
of each year of the policy,
CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 9 of 12
TRAVELERST
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 ( A) —
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not
enforce our right against the person or organization named in the Schedule.
The additional premium for this endorsement shal be 2 % of the California workers' compensation premium
Schedule
Person or Organization Job Description
ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED
HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR
TO LOSS TO FURNISH THIS WAIVER.
This endorsement changes the policy to which it is attached and is effective on the dale Issued unless otherwise
stated.
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of
the policy.)
Endorsement Effective: 10/01/19 Pol'cy No, UB9J2104711926G Endorsement No,
Named Insured: Maggtora & Ghilold, Inc Premium
Travelers Properly Casualty Insurance Cc Countersigned by ____.________________ —
Page 1 of 1
-XA RA f
^� 2
yo
/Tr WITH P`%y
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: Mark Wright Extension: 3373
Contractor Name: Maggiora and Ghilotti, Inc.
Contractor's Contact: Scott Ghilotti Contact's Email: ghilotti@gmail.com
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
DATE
Check/Initial
1
Project Manager
a. Email PINS Introductory Notice to Contractor
Click. here to
❑
enter a elate.
b. Email contract (in Word) and attachments to City
10/3/2019
Attorney c/o Laraine.Gittens@cityofsanrafael.org
2
City Attorney
a. Review, revise, and comment on draft agreement
10/8/2019
M LG
and return to Project Manager
10/8/2019
M LG
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
3
Department Director
Approval of final agreement form to send to
10/8/2019
® BG
contractor
4
Project Manager
Forward three (3) originals of final agreement to
10/8/2019
contractor for their signature
j
5
Project Manager
When necessary, contractor -signed agreement
❑ N/A
1
agendized for City Council approval *
*City Council approval required for Professional Services
❑
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
Click here to
Date of City Council approval
enter a date.
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
Project Manager
Forward signed original agreements to City
10/17/2019
IK
Attorney with printed copy of this routing form
7
City Attorney
Review and approve hard copy of signed
1gl o /�
16�l
0—
agreement
8
City Attorney
Review and approve insurance in PINS, and bonds
1 D gllq
(for Public Works Contracts)
f
9
City Manager/ Mayor
Agreement executed by City Council authorized
p 1
official
10
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager
to Z��