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HomeMy WebLinkAboutPW Mission Avenue Sidewalk ProjectCITY OF SAN RAFAEL
Department of Public Works
111 Morphew Avenue
San Rafael, CA 94901
Public Works Contract for Projects up to $175,000
This public works contract ("Contract") is entered into by and between the City of San Rafael ("City") and
Ghiiotti Bros, Inc. ("Contractor"), a C Iifornia corporation, for work on the City's Mission Ave Sidewalk
("Project"), and is effective on �, 2Effective 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): C-8
2. Contract Documents. The Contract Documents incorporated into this Contract include and are
comprised of all of the documents listed below:
2.1 Notice Inviting Bids;
2.2 Contract;
2.3 Addenda, if any;
2.4 Exhibit A — Scope of Work;
2.5 Exhibit B — Payment, Performance, and Bid Bonds;
2.6 Exhibit C — Noncollusion Declaration;
2.7 Exhibit D — Bid Schedule;
2.8 Exhibit E — Subcontractor List.
3. 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 Documents, City
will pay Contractor $151,046 (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.
3.1 Payment. Contractor must submit an invoice on the first day of each month during the
Contract Time, defined in Section 4 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.
3.2 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.
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 1
Approved by City Attorney, dated 03/28/2022
4. Time for Completion. Contractor will fully complete the Work within one year from the date the
City authorizes Contractor to proceed with the Work ("Contract Time").
5. 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.
6. 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 City of San Rafael. Contractor must promptly correct, at
Contractor's sole expense, any Work that the City determines is deficient or defective.
7. 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.
8. 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 (the "Indemnitees") 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 the
acts or omissions of Contractor, its employees, subcontractors, representatives, or agents in performing
the Work of failing to comply with any obligation of Contractor under this Contract, except such Liability
caused by the active negligence, sole negligence, or willful misconduct of an Indemnitee. 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.
9. 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.
9.1 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.
9.2 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 $1,000,000 per occurrence and $2,000,000 general aggregate.
9.3 Automotive. Commercial automotive liability coverage for owned, non -owned and hired
vehicles must provide coverage of at least $1,000,000 combined single limit per accident for bodily injury,
death, or property damage.
9.4 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.
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 2
Approved by City Attorney, dated 03/28/2022
9.5 Required Endorsements. The CGL policy and the automotive liability policy must include
the following specific endorsements:
(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.
10. 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.
10.1 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.
10.2 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.
10.3 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
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 3
Approved by City Attorney, dated 03/28/2022
is under $25,000, Contractor must electronically submit certified payroll records to the Labor
Commissioner as required under California law and regulations.
10.4 Apprentices. If the Contract Price is $30,000 or more, Contractor must comply with the
apprenticeship requirements in Labor Code section 1777.5.
10.5 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.
11. 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."
12. Termination.
12.1 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.
12.2 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.
13. 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.
14. 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.
15. 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
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 4
Approved by City Attorney, dated 03/28/2022
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.
16. Worksite Conditions.
16.1 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.
16.2 Inspection. Contractor will make the Work accessible at all times for inspection by the City
16.3 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.
16.4 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.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 5
Approved by City Attorney, dated 03/28/2022
22. 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 Street
City/State/Zip: San Rafael, CA 94901
Phone: (415) 725-1166
Attn: JC Agcaoili
Email: john.agcaoili@cityofsanrafael.org
Contractor:
Name:
Ghilotti Bros Inc.
Address:
525 Jacoby St
City/State/Zip:
San Rafael, CA 94901
Phone:
(415) 760-0289
Attn:
Ryan Strong
Email:
ryans@ghilottibros.com
23. General Provisions.
23.1 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.
23.2 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
23.3 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.
23.4 Third Party Beneficiaries. There are no intended third -party beneficiaries to this Contract.
23.5 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.
23.6 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.
23.7 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
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.
23.8 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
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Page 6
Approved by City Attorney, dated 03/28/2022
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.]
Mission Ave Sidewalk
City Project #: 11414-02
Approved by City Attorney, dated 03/28/2022
Up to $175,000 Contract
Page 7
The parties agree to this Contract as witnessed by the signatures below:
C
sl
0
Attest:
51.te . /V
LINDSAY LARA City Jerk
11! Date:
CONTRACTOR: Ghilotti Bros., Inc.
Approv las to form:
1
s/ /
ROBEW F. EPSTEIN, C# Attorney
1)%Date: v 0 W 27i
Business Name
s/ Seal:
Michael M. Ghilotti, President
Name/Title
Date: -1
'%OY\A,a5 61. Irrl v b
Name/Title
Date: 2 $ 12?
132128, 12/31/23
Contractor's California License Number(s) and Expiration Date(s)
Exhibit A: Scope of Work
Exhibit B: Bond Forms
Exhibit C: Noncollusion Declaration
Exhibit D: Bid Schedule
Exhibit E: Subcontractor List
Mission Ave Sidewalk
City Project #: 11414-02
END OF CONTRACT
Approved by City Attorney, dated 03/28/2022
Up to $175,000 Contract
Page 8
Mission Ave Sidewalk
City Project #: 11414-02
Exhibit A
SCOPE OF WORK
Approved by City Attorney, dated 03/28/2022
Up to $175,000 Contract
Scope of Work
Exhibit A
Revised Bid Proposal -- Mission Sidewalk
�: t aI I �
t,.ta 9 A FA �.0
Ghilotti Bros., Inc.
525 Jacoby Street
San Rafael, CA 94901
GBI Contact: Ryan Strong
Phone/Mobile: 415-760-0289
Email: ryans@ghilottibros.com
Mote To,• City of San Rafael Job Name:
Name: JC Agcaoili
Email: john.agcaoili@cityofsanrafael.org Bid Number:
Proposal Date:
Bond Added
Based on field walk and site measurements
Mission Sidewalk
MR22133
5/20/2022
5/20/2022 8:57:07AM
I1'I?M
DESCRIPTION
QUANTITY
UNIT
UNITPRICE
AMOUNT
I
Mobilization & Pothole + Bond
1.00
LS
9,107.00
9,107.00
2
Daily Detour TC
I 1.001
LS
7,000.00
7,000.00
3
Demo, Excavate, Subgrade Prep
I 1.001
LS
35,167.00
35,167.00
4
Handicap Ramps
2.001
EA
4,700.00
9,400.00
5
New Glue Down Domes
1.001
EA
1,000.00
1,000.00
6
New 4' Sidewalk w/Retaining Curb
877.001
LF
76.00
66,652.00
7
Fine Grade Slope & Backfill Sidewalk
1.001
LS
2,500.00
2,500.00
8
Plug Paving
1.001
LS
5,500.00
5,500.00
Base Bid Total
1
1
136,326.00
9
New 8" Concrete Driveways
640.001
SF
23.00
14,720.00
GRAND TOTAL $151,046.00
NOTES:
GBI will mobilize, pothole, provide daily lane closure detours, excavate/demo, leave du -t onsite, off haul broken concrete and
asphalt, prepare subgrade, place recycled rock over tree root locations, pour new sidewalk wh'etaining curb (no handrails
included), pour two new handicap ramps, and provide one glue down dome, plug pave, and fine grade new area between
roadway and sidewalk.
GBI excludes handrail, utility relocation, tree removal, arborist, CMS boards, striping, or bond.
****Added Bond Cost = $1,107
Work to be started in the next 20 days
Thank you for the opportunity,
ti
Ryan Strong
Page 1 of 1
Bond Executed in Triplicate
Bond No: 57BCSIW2235
Performance Bond Premium: $1,071
City of 5 n afael ("City), and Ghilotti Bros Inc. ("Contractor") have entered into a contract, dated
.2 'Contract") for work on the Mission Ave Sidewalk ("Project"). The
Contract 4incorporated by reference into this Performance Bond ("Bond").
1. General. Under this Bond, Contractor as Principal and Hartford Fire Insurance Company , its
surety ("Surety"), are bound to City as obligee for an amount not less than $ 151.046.00'
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 for completion of the
Work prior to acceptance of the Project, 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:
`One Hundred Fifty One Thousand Forty Six & 00/100 --
Mission Ave Sidewalk Up to $175,000 Contract
City Project #: 11414-02 Performance Bond
Approved by City Attorney, dated 03/28/2022
Attn:
Keith Lovitt
Address:
One Pointe Drive, 6th Floor
City/State/Zip:
Brea. CA 92821
Phone:
(469) 287-1022
Fax:
(866) 780-9956
Email:
Keith. Lovitt(cDthehartford.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 .July 26th
20 22 . Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: Hartford Fire Insurance Company
Business Name
s/ L' L_
Kelly Holtemann, Attomey-In-Fact
Name/Title [print]
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRACTOR: Ghilotti Bros., Inc.
Busines Name
sl
Michael M. Ghilotti, President/ Treasurer
Name/Titie
s/ Xrwti 0�f.
Lance A. Bushnell, Vice President, Estimating
Namerritle
APPRO •ED BY CITY:
s/ h � U ( ��� 41-
ROBEFT F. EPSTEIN, City Attorney
Mission Ave Sidewalk
City Project* 11414-02
END OF PERFORMANCE BOND
Approved by City Attorney, dated 03/28/2022
Date
Up to $175,000 Contract
Performance Bond
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Marin
On 7/27/22 before me, Natalia Kataoka, Notary Public
(insert name and title of the officer)
personally appeared Lance A. Bushnell
who proved to me on the basis of satis actory evidence to be the persons whose names 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.
Signature
(Seal)
•` ' •a HATANUA KAINIK 1
Hatary Public • CaII[oral a
r^ y Y. " Alarin County 3:
Commission k 2309562 I
n,o. My Comm. EXPlres qct 20, 702
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 Marin
On 7/27/22
before me, Natalia Kataoka, Notary Public
(insert name and title of the officer)
personally appeared Michael M. Ghilotti
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.
Signature
�l�
(Seal)
` `, .,'rya' NATALIA KATAOKA
Notary Public - California
`. c = Atar€n County
' , ° Commission k 230456,
'���*" ray Comm. Expires Oct 201 7023
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Marin
On 13%�-� before me,
Date
personally appeared
J. DeLuca, Notary Public
Here Insert Name and Title of the Officer
Kelly Holtemann
Name(s) of Signer(s)
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/" executed the same in
hWher/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.
amy
J, DELUCA
Notary Public . CaliforniaAlarmCounty
Commission M x338744
Comm, Uplres NOV 27, 2014
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages: Signer(s)
_ Document
Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: _
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorne ' act
❑ Trustee ❑ ian or Conservator
❑ Other:
Signer I presenting.
miner's Name:
❑ Corporate Officer — Title(s): _
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing: __
s`i.�eG�..'b`Sf�r�(.'�'iD�"�i�'4`C;b'$�.75eC`S(.^�v'eSUS!F7T,'eC.YwC:`5105scr`S.'r(.`SOUS:�4�.C`4;L..`S%i.`G't�::<.�Se:t7S:'f.`S:L"4�'�t'�e✓�.�S'�3ri:`isC•^4�GYiS.'�.."4C'SSC,2�[+�."�
02014 National Notary Association • www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907
Direct Inquiries/Claims to:
THE HARTFORD
POWER OF ATTORNEY BOND, ctic
One Hartford Plaza
Hartford, Connecticut 06155
Hand,Ci aims{mthehartford.com
call. • 888-2663488 or fax: 860-7575835
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
_ Agency Code: 57-554795
0 Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized underthe laws ofthe State of Indiana
Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized underthe laws ofthe State of Illinois
Hartford Insurance Company ofthe Midwest, a corporation duly organized underthe laws ofthe State of Indiana
Q Hartford Insurance Company ofthe Southeast, a corporation duly organized underthe laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Alicia Dass, Joan DeLuca, Patrick R Diebel, Andrew S.
Holloway, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V_ Overbay,
Christina Parsons, Karen Rhodes, Yvonne Roncagliolo, Charles R. Shoemaker, Valerie
Takeuchi , Peter Tam of SAN FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
�sYi • •����•- +err_ , ee rely ..v":.,r �'�+-•"d�,
�,�t +�� �� �� ''Na 6s,+y ' *eerM• $ E` I879�c= •r7� *0
y YrF . 'qtr ,�1 .. �� = •l,�i, •• - -
♦ L �a • t� � � �14a1 i�? i
Shelby Wiggins, Assistant Secretary
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOL€
v'
Joelle L. LaPierre, Assistant Vice President
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly swom, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
t.
Jessica Ciccone
- My Commission HH 122280
Expires June 20, 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of July 26th, 2022
Signed and sealed in Lake Mary, Florida.
X19$': ., � �S p•
�� 're,rr:r.• 4a:�y� 1' i}1970 a' k&f p94e
rn.�+
Z"
Keith D. Dozois, Assistant Vice President
Bond Executed in Triplicate
Bond No: 57BCSIW2235
Payment Bond Premium: Included
Cityof Sana
I (" ity") and Ghilotti Bros Inc. ("Contractor") have entered into a contract,
dated 20{"Contract') for work on the Mission Ave Sidewalk
("Project"). C ntract is incorporated by reference into this Payment Bond ("Bond").
C General. Under this Bond, Contractor as principal and Hartford_ Fire_ Insurance_ Company
its surety ("Surety"), are bound to City as obligee in an amount not less than
$ 151.046.00" , 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.
5. 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:
Keith Lovitt
Address:
One Pointe Drive. 6th Floor
City/State/Zip:
Brea, CA 92821
Phone:
(0287-1022
Fax:
(86 6) 780-9956
Email:
Keith.Lovitt@thehartford.com
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_
'One Hundred Fifty One Thousand Forty Six & 00/100 —
Mission Ave Sidewalk
City Project #: 11414-02
Approved by City Attorney, dated 03/28/2022
Up to $175,000 Contract
Payment Bond
7. Effective Date; Execution. This Bond is entered into and is effective on July 26th
2022. Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: Hartford Fire Insurance Company
Business Name
Kelly Holtemann, Attomey-In-Fact
Name/Title
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRACTOR: Ghilotti Bros., Inc.
Business Name
Z
�iAi /IIG`"Ir
Michael M. Ghilotti, President / Treasurer
Name/Title
V
s/ .
�1 0..-;�-
Lance A. Bushnell Vice President Estimating
Name/Title
APPROVED BY CITY:
s/
ROB F. EPSTEIN, City A orney Date
Mission Ave Sidewalk
City Project #: 11414-02
END OF PAYMENT BOND
Approved by City Attorney, dated 03/28/2022
Up to $175,000 Contract
Payment Bond
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validitv of that document.
State of California
County of Marin
On 7/27/22
before me, Natalia Kataoka, Notary Public
(insert name and title of the officer)
personally appeared Lance A. Bushnell
who proved to me on the basis of sates actory evidence to be the person(s) whose names 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.
Signature
(Seal)
NATAt.ia ItArnoKn
*MY
Rotary Nblk - California
hSarin CountyCommissionk 230956z { Comm. Expires Dc 20, 2023 17
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 Marin
On 7/27/22 before me, _ Natalia Kataoka, Notary Public
(insert name and title of the officer)
personally appeared Michael M. Ghilotti
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.
Signature i �
(Seal)
NATALIA KATAOKA
Notary Public - California
Marin Caunly s;
£ Cammfssion k 2344562 r
My Comm. Expires Oct 20, 2023 y
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
;t S �`[ G c3t5S c C Gf cCisLd f r is Ccs Gi7LC cC7Gsti{ CY c f �Y7 (.iN ,<X C t X1 +ESt [,�] C2 t>[Y7GCCf C, C cC EY c P[� Y,s fti f AOi
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Marin _ )
On -2—t. before me,
Date
personally appeared _ _
J. DeLuca, Notary Public
Here Insert Name and Title of the Officer
Kelly Holtemann
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/ar�
subscribed to the within instrument and acknowledged to me that he/she/" executed the same in
hWher/fheir authorized capacity(ies), and that by Ns/her/theif signature(e) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
*my
J. DELUCA
Notary Public - California
Marin County
Commission 8 233874Comm. Expires Nov 27, 2024
Place Notary Seal Above
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature--)
Signature of Notary Public
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages:
Document
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorne ' ac
❑ Trustee ❑ ian or Conservator
❑ Other:
Signer [ presenting:
miner's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
Direct inquirfeslClaims to:
THE HARTFORD
POWER OF ATTORNEY BOND,ctic One Hartford Plaza
Hartford, Connecticut 06155
Bond-Claint s@tliehat'iforcl.com
cal/. -888-2663488 or fax 860-7575835
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
Agency Code: 57-554795
0 Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized under the laws of the State of Indiana
Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
0 Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois
Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana
0 Hartford Insurance Company of the Southeast, a corporation duly organized under the laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Alicia Dass, Joan DeLuca, Patrick R Diebel, Andrew S.
Holloway, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V. Overbay,
Christina Parsons, Karen Rhodes, Yvonne Roncagliolo, Charles R. Shoemaker, Valerie
Takeuchi , Peter Tam of SAN FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
���� � I {. r„ K... f�A1.M■� -. r87� � �i�aio t :�i'T
Shelby Wiggins, Assistant Secretary
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOLE
I
Joelle L. LaPierre, Assistant Vice President
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly swom, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
JL
Plr-�'.sicaCicrone
-
My Commission HH 122280
Expires June 20, 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of July 26th, 2022
Signed and sealed in Lake Mary, Florida.
7!
1'7 *■MMs� � -. ✓.i..,..,�� � a ; 4 a T �" :.�� � �:3,.��""a,e :.^t ! F,rcvn•ur,�
i tela y ■ �f� �-+ ;� ,i
■ri1 �CEyp '`•. R -.t ..rt.�le,a...^ M■I�k■ �.,�1f�1'4 S rF7� rriy 1979 `=
s \ �. - ' �,,. > ` r >>•� • �'w,'•<� �iyte' 'aria.. .�._��,� 1
Keith D. Dozois, Assistant Vice President
AC"J?"a CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
7/25/2022
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
CONTACT Chris Kell@
Woodruff -Sawyer & Co.
50 California Street, Floor 12
PHONE FAX
. 415-402-6521 1AIC. No: 415-989-9923
ADDRESS: ckelle woodruffsa er.com
San Francisco CA 94111
INSURERS AFFORDING COVERAGE NAIC #
10/1/2022
INSURFRA; Zurich American Insurance Company 16535
INSURED GHILBRO-01
INSURER B: Illinois Union Insurance Company 27960
Ghilotti Bros, Inc.
525 Jacoby Street
INSURERC:
PREMISES Ea u $ 300,000
San Rafael, CA 94901
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1158369569 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.
7N3R
LTtt
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICYEFF
MM/DD/YYYY
MMIDD� LIMITS
U" Z*
A
X COMMERCIAL GENERAL LIABILITY
Y
Y
GLOO92422001
10/1/2021
10/1/2022
EACH OCCURRENCE $2,000,000
CLAIMS -MADE FIOCCUR
PREMISES Ea u $ 300,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $2,000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $4,000,000
POLICY EflPRO- JECT F7LOC
PRODUCTS - COMP/OP AGG 1 $4,000,000
$
OTHER.:
A
AUTOMOBILE LIABILITY
Y
Y
BAP092421701
10/1/2021
10/1/2022
CDMBINED SINGLE LIMIT $2,000,000
Ea acdden
BODILY INJURY (Per person) $
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) $
PROPERTYOAMAGE $
Per acederd
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DEE) RETENTIONS
r $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE
Y
WC056260101
10/1/2021
10/1/2022
X PER OTH
STATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBEREXCLUDED? ❑
NIA
(Mandatoryin NH)
E.L. DISEASE- EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000.000
B
Pollution Liability
Y
Y
COOG71830627002
10/1/2021
10/1/2022
Each Occurrence $2,000,000
Aggregate $2,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: GBI Job # 22414 - Project Number: 11414-02 - Mission Ave Sidewalk - The City its Council, officials, officers, employees, agents, volunteers and
consultants are additional insured, on a primary, non-contributory basis, per the attached endorsements. Waiver of Subrogation is applicable with respect to
General Liability, Workers Compensation, Business Automobile, and Pollution Liability, per the attached endorsements.
CERTIFICATE HOLDER CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of San Rafael
ACCORDANCE WITH THE POLICY PROVISIONS.
Department of Public Works
AUTHORIZED REPRESENTATIVE
111 Morphew Avenue
San Rafael CA 94901
U" Z*
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Coverage Extension Endorsement
ZURICH
Policy No. Eff. Date of Pol.
Exp. Date of Pol.
Eff. Date of End. Producer No. I AWL Prem
Return Prem.
BAP092421701 10/01/2021
10/01/2022
10/01/2021 INCL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II — Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment — Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II — Covered Autos Liability
Coverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an
"accident" we cover. We do not have to furnish these bonds.
(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.
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C. Fellow Employee Coverage
The Fellow Employee Exclusion contained in Section II — Covered Autos Liability Coverage does not apply.
D. Driver Safety Program Liability and Physical Damage Coverage
1. The following is added to the Racing Exclusion in Section II — Covered Autos Liability Coverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the
Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage
Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E. Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered
"auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and
b. Any:
(1) Overdue lease or loan payments at the time of the "loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous leases or loans.
F. Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We will pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is
disabled. However, the labor must be performed at the place of disablement.
G. Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and
is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass
repaired rather than replaced.
H. Hired Auto Physical Damage — Increased Loss of Use Expenses
The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the
following:
Loss Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for
loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We
will pay for loss of use expenses if caused by:
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(1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered
"auto";
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided
for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000.
I. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We will pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) In or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered
"auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of
the following:
(1) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other
documents of value.
(2) Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches,
precious or semi-precious stones.
(3) Paintings, statuary and other works of art.
(4) Contraband or property in the course of illegal transportation or trade.
(5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph B.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage
Form and the Exclusion in Paragraph 13.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier
Coverage Form does not apply.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the
Physical Damage Coverage Section:
We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic
equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the time of "loss".
The most we will pay for such 'loss" to tapes, records, discs or other similar devices is $500. The Physical
Damage Coverage Deductible Provision does not apply to such 'loss".
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K. Airbag Coverage
The Exclusion in Paragraph B.3.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form
and the Exclusion in Paragraph B.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage
Form does not apply to the accidental discharge of an airbag.
L. Two or More Deductibles
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you
by us, the following applies for each covered "auto" on a per vehicle basis:
1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or
2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by
the amount of the smaller (or smallest) deductible.
M. Physical Damage — Comprehensive Coverage — Deductible
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to
Comprehensive Coverage for all "loss" from any one cause is $5,000 or the deductible shown in the Declarations,
whichever is greater.
N. Temporary Substitute Autos — Physical Damage
1. The following is added to Section I — Covered Autos:
Temporary Substitute Autos — Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following
types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered
"auto" you do own but is out of service because of its -
1 .
ts1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos — Physical Damage
We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or
omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any other
party.
The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" it
replaces.
O. Amended Duties In The Event Of Accident, Claim, Suit Or Loss
Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following
a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice
of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or
"loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited
liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any
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agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit";
(2) The "insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos — Physical Damage
Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow, and
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or
elected or appointed official with your permission while being operated within the course and scope of that
"employee's" employment by you or that elected or appointed official's duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto — World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
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U. Expected Or Intended Injury
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II — Covered Auto Liability
Coverage is replaced by the following:
Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does
not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or
property.
V. Physical Damage — Additional Temporary Transportation Expense Coverage
Paragraph AA.a. of Section III — Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you
because of the total theft of a covered "auto" of the private passenger type. We will pay only for those
covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will
pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and
ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its
"loss".
W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto
The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or
"auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost
of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a
maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative
fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease
agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of
propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,
either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be
powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by
biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay
only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage.
All other terms, conditions, provisions and exclusions of this policy remain the same
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Additional Insured — Owners, Lessees Or Contractors
— Scheduled person Or Organization ZURICH
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy No. GL0092422001 Effective Date: 10/01/2021
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s) Location(s) Of Covered Operations
Or Organization(s):
BUT ONLY IF YOU ARE REQUIRED TO PROVIDE
ADDITIONAL INSURED STATUS IN A WRITTEN
CONTRACT OR WRITTEN AGREEMENT EXECUTED
PRIOR TO LOSS AND WHERE THAT CONTRACT
SPECIFICALLY REQUIRES THE ISO CG2010
072004 EDITION FORM OR THE EQUIVALENT
OF SAME
ANY LOCATION OR PROJECT, OTHER THAN A
WRAP-UP OR OTHER CONSOLIDATED INSURANCE
PROGRAM LOCATION OR PROJECT FOR WHICH
INSURANCE IS OTHERWISE SEPARATELY
PROVIDED TO YOU BY A WRAP -JP OR OTHER
CONSOLIDATED INSURANCE PROGRAM
U -GL -2169-A CVV (02/19)
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A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown
in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property damage" or "personal
and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated in such
Schedule.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than
service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person
or organization other than another contractor or subcontractor engaged in performing operations for a principal as
a part of the same project.
All other terms, conditions, provisions and exclusions of this policy remain the same.
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Policy No. GL0092422001
4. Other Insurance
If other valid and collectible insurance is available
to the insured for a loss we cover under Coverages
A or B of this Coverage Part, our obligations are
limited as follows:
a. Primary Insurance
(3) When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the
sum of:
This insurance is primary except when
Paragraph b. below applies. If this insurance is
primary, our obligations are not affected unless
any of the other insurance is also primary. Then, (4)
we will share with all that other insurance by the
method described in Paragraph c. below.
b. Excess Insurance
(1) This insurance is excess over:
(a) Any of the other insurance, whether
primary, excess, contingent or on any
other basis:
(i) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for 'your work';
(ii) That is Fire insurance for premises
rented to you or temporarily occupied
by you with permission of the owner;
(iii) That is insurance purchased by you to
cover your liability as a tenant for
"property damage" to premises rented
to you or temporarily occupied by you
with permission of the owner; or
(iv) If the loss arises out of the
maintenance or use of aircraft, "autos"
or watercraft to the extent not subject
to Exclusion g. of Section I —
Coverage A — Bodily Injury And
Property Damage Liability.
(b) Any other primary insurance available to
you covering liability for damages arising
out of the premises or operations, or the
products and completed operations, for
which you have been added as an
additional insured.
(2) When this insurance is excess, we will have
no duty under Coverages A or B to defend
the insured against any "suit" if any other
insurer has a duty to defend the insured
against that "suit". If no other insurer defends,
we will undertake to do so, but we will be
entitled to the insured's rights
against all those other insurers.
(a) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(b) The total of all deductible and self-insured
amounts under all that other insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the Declarations
of this Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method also.
Under this approach each insurer contributes
equal amounts until it has paid its applicable limit
of insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this method, each insurer's
share is based on the ratio of its applicable limit
of insurance to the total applicable limits of
insurance of all insurers.
5. Premium Audit
a. We will compute all premiums for this Coverage
Part in accordance with our rules and rates.
b. Premium shown in this Coverage Part as
advance premium is a deposit premium only. At
the close of each audit period we will compute
the earned premium for that period and send
notice to the first Named Insured. The due date
for audit and retrospective premiums is the date
shown as the due date on the bill. If the sum of
the advance and audit premiums paid for the
policy period is greater than the earned premium,
we will return the excess to the first Named
Insured.
c. The first Named Insured must keep records of
the information we need for premium
computation, and send us copies at such times
as we may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are
accurate and complete;
Page 12 of 16 0 Insurance Services Office, Inc., 2012 CG 00 0104 13
POLICY NUMBER:GL0092422001
COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
ANY PERSON OR ORGANIZATION THAT REQUIRES YOU TO WAIVE YOUR RIGHTS OF
RECOVERY, IN A WRITTEN CONTRACT OR AGREEMENT WITH THE NAMED INSURED
THAT IS EXECUTED PRIOR TO THE ACCIDENT OR LOSS.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of Section
IV — Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
'Your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0
Nollcy No. UUU(3(16MUNU1
In the event the "insured" is entitled by law to select independent counsel to defend itself at the Insurer's expense,
the attorney fees and all other litigation expenses the Insurer shall pay to that counsel are limited to the rates the
Insurer actually pays to counsel that the Insurer normally retains in the ordinary course of business when
defending "claims" or lawsuits of similar complexity in the jurisdiction where the "claim" arose or is being
defended. In addition, the "insured" and the Insurer agree that the Insurer may exercise the right to require that
such counsel: 1) have certain minimum qualifications with respect to their competency, including experience in
defending "claims" similar to those being asserted against the "insured"; 2) maintain suitable errors and omissions
insurance coverage; 3) be located within a reasonable proximity to the jurisdiction of the "claim"; and 4) agree in
writing to respond in a timely manner to the Insurer's requests for information regarding the "claim". The "insured"
may at any time, by its signed consent, freely and fully waive its right to select independent counsel.
C. The "insured" shall have the right and the duty to retain a qualified environmental consultant or "catastrophe
management firm" to: 1) perform any investigation and/or remediation of any "pollution condition" or "site
environmental condition" covered pursuant to this Policy; or 2) perform "catastrophe management services"
covered pursuant to this Policy, respectively. The "insured" must receive the consent of the Insurer prior to the
selection and retention of any such environmental consultant or "catastrophe management firm", except in the
event of an "emergency claim" that results in "emergency response costs".
D. "Legal defense expenses" reduce the Limits of Liability identified in the Declarations to this Policy, and, unless
specifically stated otherwise herein, any applicable Limits or Sublimits of Liability identified in any endorsement
hereto. "Legal defense expenses" shall also be applied to the "self-insured retention".
E. The Insurer shall present all settlement offers to the "insured". If the Insurer recommends a settlement which is
acceptable to a claimant, exceeds any applicable "self-insured retention", is within the Limits of Liability, and does
not impose any additional unreasonable burdens on the "insured", and the "insured" refuses to consent to such
settlement offer, then the Insurer's duty to defend shall end. Thereafter, the "insured" shall defend such "claim"
independently and at the "insured's" own expense. The Insurer's liability shall not exceed the amount for which
the "claim" could have been settled if the Insurer's recommendation had been accepted, exclusive of the "self-
insured retention".
IV. COVERAGE TERRITORY
The coverage afforded pursuant to this Policy shall only apply to "covered operations" and "transportation" performed,
and "claims" made, within the United States of America.
V. DEFINITIONS
A. "Additional insured" means:
1. Any person or entity specifically endorsed onto this Policy as an "additional insured", if any. Such "additional
insured" shall maintain only those rights that are specified by endorsement to this Policy; and
2. All clients, or other persons or entities, which a "named insured" is required by written contract or agreement
with its client to secure such coverage, but solely with respect to "covered operations" or "transportation"
performed for that client (hereinafter Client Additional Insureds). Such Client Additional Insureds are covered
solely with respect to their vicarious liability for a monetary judgment, award or settlement of compensatory
damages to which this insurance applies.
B. "Adverse media coverage" means national or regional news exposure in television, radio, print or internet
media that is reasonably likely to have a negative impact on the "insured" with respect to its income, reputation,
community relations, public confidence or good will.
C. "Bodily injury" means physical injury, illness, disease, mental anguish, emotional distress, or shock, sustained
by any person, including death resulting therefrom, and any prospective medical monitoring costs that are
intended to confirm any such physical injury, illness or disease.
D. "Catastrophe management costs" means reasonable and necessary expenses approved by the Insurer, in
writing, except for those expenses incurred during the same seven (7) day period associated with "emergency
response costs", which have been incurred by the "insured" for the following:
PF -46969 (04/15) Page 3 of 14
Policy #C00G7183o627009
basis over the remainder of the "policy period". Notwithstanding the foregoing, in the event a "claim"
is first made against an "insured", or a "wrongful act", "pollution condition" or "site environmental
condition" is first discovered by an "insured", during the "policy period", to which this insurance may
apply, in whole or in part, then any remaining unearned premium, if any, shall be deemed
immediately earned upon such event. Any unearned premium amounts due the "first named insured"
upon cancellation of this Policy shall be calculated on a pro rata basis and refunded within thirty (30)
days of the effective date of cancellation.
B. Inspection and Audit
To the extent of the "insured's" ability to provide such access, and with reasonable notice to the "insured",
the Insurer shall be permitted, but not obligated, to inspect the "insured's" property and/or operations.
Neither the Insurer's right to make inspections, the making of said inspections, nor any report thereon
shall constitute an undertaking, on behalf of or for the benefit of the "insured" or others, to determine or
warrant that such property or operations are safe or in compliance with applicable law.
The Insurer may examine and audit the "insuredW' books and records during this "policy period" and
extensions thereof and within three (3) years after the final termination of this Policy.
C. Legal Action Against the Insurer
No person or organization other than an "insured" has a right pursuant to this Policy:
i. To join the Insurer as a party or otherwise bring the Insurer into a suit against any "insured"; or
2. To sue the Insurer in connection with this insurance unless all of the Policy terms have been fully
complied with.
A person or organization may sue the Insurer to recover after an agreed settlement or on a final judgment
against an "insured". However, the Insurer shall not be liable for amounts that are not payable pursuant
to the terms of this Policy or that are in excess of the applicable Limit of Liability. An agreed settlement
means a settlement and release of liability signed by the Insurer, the "insured", and the claimant or the
claimant's legal representative.
CoVera a E.
Notwithstanding the foregoing, and solely with respect to coverage afforded pursuant to Coverage E. of
this Policy, no action shall lie against the Insurer unless, as a condition precedent thereto, there has been
full compliance with all of the terms and conditions of this Policy, and both the "responsible
professionals" liability and the amount of the "responsible professionals"' obligations to pay have been
finally determined either by final judgment against the "responsible professionals" after an actual
contested "affirmative claim" or by the "named insured's" written settlement with the "responsible
professionals" to which the Insurer has given its prior written approval.
D. Bankruptcy
The insolvency or bankruptcy of any "insured", or any "insured's" estate, shall not relieve the Insurer of its
obligations pursuant to this Policy. However, any such insolvency or bankruptcy of the "insured", or the
"insured's" estate, shall not relieve the "insured" of its "self-insured retention" obligations pursuant to this
Policy. This insurance shall not replace any other insurance to which this Policy is excess, nor shall this
Policy drop down to be primary, in the event of the insolvency or bankruptcy of any underlying insurer.
E. Subrogation
In the event of any payment pursuant to this Policy by the Insurer, the Insurer shall be subrogated to all of
the rights of recovery against any person or organization, and the "insured" shall execute and deliver
instruments and papers and do whatever else is necessary to secure such rights. All "insureds" shall do
nothing to prejudice such rights. Any recovery as a result of subrogation proceedings arising pursuant to
this Policy shall accrue first to the "insureds" to the extent of any payments in excess of the limit of
coverage; then to the Insurer to the extent of its payment pursuant to the Policy; and then to the "insured"
to the extent of the "self-insured retention". Expenses incurred in such subrogation proceedings shall be
apportioned among the interested parties in the recovery in the proportion that each interested party's
share in the recovery bears to the total recovery.
PF -49723 (10/17) Page 19 of 22
Notwithstanding the foregoing, the Insurer hereby waives its rights to subrogate against all clients of a
"named insured" where such waiver is required by written contract or agreement executed between a
"named insured" and such client prior to the relevant "claim" or discovery of a "wrongful act", "pollution
condition" or "site environmental condition" to which this insurance applies.
Coverage E.
Notwithstanding the foregoing, and solely with respect to coverage afforded pursuant to Coverage E. of
this Policy„ the "named insured" agrees to provide a written transfer to the Insurer any rights against
other "responsible professionals" that the "named insured" obtains pursuant to Section VII., NOTICE
AND COOPERATION, Subsection F., of this Policy if the "named insured" has reasonably elected not to
pursue same in furtherance of its "affirmative claim". The "named insureds" agree not to do anything to
prejudice those rights.
F. Representations
By accepting this Policy, the "first named insured" agrees that:
i. The statements in the Declarations, schedules and endorsements to, and Application for, this Policy
are accurate and complete;
2. Those statements and representations constitute warranties that the "first named insured" made to
the Insurer; and
3. This Policy has been issued in reliance upon the "first named insured's" warranties.
G. Separation of Insureds
Except with respect to the Limits of Liability, Cancellation condition 2.a., and any applicable exclusions,
this Policy applies:
i. As if each "named insured" were the only "insured"; and
2. Separately to each "named insured" against whom a "claim" is made,
and any fraud, misrepresentation, breach of a condition or violation of any duty (hereinafter Breach) by
an "insured" shall not prejudice coverage for any "named insured" pursuant to this Policy, provided that:
i) such "named insured' did not participate in, know of or assist in such Breach; and 2) such "named
insured" is not a parent, subsidiary, partner, member, director, officer of, employer of or otherwise
affiliated with, the "insured" that committed such Breach.
H. Other Insurance
Coverage A-
i. If other valid and collectible insurance is available to any "insured" covering a "loss" also covered by
this Policy, other than a policy that is specifically written to apply in excess of this Policy, the
insurance afforded by this Policy shall apply in excess of and shall not contribute with such other
insurance.
Coverages B. and C.
2. If other valid and collectible insurance is available to any "insured" covering "loss" also covered by
this Policy, this insurance shall apply as primary insurance. The Insurer's obligations are not affected
unless any other applicable, unaffiliated insurance is also determined to be primary. In that event, the
Insurer shall share with the insurer underwriting such other insurance by the method described in
Paragraph 2., below.
3. Method of Sharing
If all of the other insurance permits contribution by equal shares, the Insurer shall follow this method
also. Pursuant to this approach each insurer contributes equal amounts until it has paid its applicable
limit of insurance or none of the loss remains, whichever comes first.
If any of the other insurance does not permit contribution by equal shares, the Insurer shall
PF -49723 (10/17) Page 20 of 22
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
WC 04 03 06 (Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -
CALIFORNIA
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a
different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on 10/01/2021 at 12:01 A.M. standard time, forms a part of
(DATE)
Policy No. WC056260101 Endorsement No.
ZURICH AMERICAN INSURANCE COMPANY
(NAME OF INSURANCE COMPANY)
issued to Ghilotti Bros., Inc.
Premium (if any) $
Authorized Representative
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. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in
the work described in the Schedule.
The additional premium for this endorsement shall be
mium otherwise due on such remuneration.
Schedule
Person or Organization
All Persons and/or Organizations that are required by
written contract or agreement with the insured, executed
prior to the accident or loss, that waiver of subrogation
be provided under this policy for the work performed by
you for that person and/or organization.
WC 252 (4-84)
WC 04 03 06 (Ed. 4-84)
0.00% of the California workers' compensation pre -
Job Description
All CA Operations
Page 1 of 1
CPN RAP�4�C
2
WITH P
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: Ashley Dohrmann (for JC) Extension: 3352
Contractor Name: Ghilotti Bros, Inc.
Contractor's Contact: Ryan Strong Contact's Email: ryans@ghilottibros.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 date.
b. Email contract (in Word) and attachments to City
6/16/2022
Attorney c/o Laraine.Gittens@cityofsanrafael.org
❑X AD
2
City Attorney
a. Review, revise, and comment on draft agreement
7/11/2022
and return to Project Manager
7/11/2022
❑X GC
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
❑X GC
3
Department Director
Approval of final agreement form to send to
7/14/2022
❑X AM
contractor
4
Project Manager
Forward three (3) originals of final agreement to
7/21/2022
Z
contractor for their signature
5
Project Manager
When necessary, contractor -signed agreement
® N/A
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
8/2/2022
AD
Attorney with printed copy of this routing form
Review and approve hard copy of signed
I �Z
?,1 I
7
City Attorney
/�
agreement
Review and approve insurance in PINS, and bonds
{
V C
8
City Attorney
City Manager/ Mayor
(for Public Works Contracts)
Agreement executed by City Council authorized
9 `
f� '1
2. Z_
City Clerk
official
Attest signatures, retains original agreement and
10
b
�fj
forwards copies to Project Manager
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