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HomeMy WebLinkAboutPW Removal of Underground Storage TankCITY OF SAN RAFAE L 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 Golden Gate Tank Removal, Inc., ("Contractor"), a corporation authorized to do work in California, for work on the City's Removal of Underground Storage Tank ("Project"), and is effective on 2W( -Effective Date"). The parties agree as follows: 1. Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies, transportation, and any and all other items or services necessary to perform and complete the work required for the Project ("Work"), as specified in Exhibit A, Scope of Work, and according to the terms and conditions of this Contract, including all attachments to the Contract and any other documents and statutes incorporated by reference. To the extent that any attachment contains provisions that conflict or are inconsistent with the terms set forth in the body of this Contract, the Contract terms will control. This Project requires a valid California contractor's license for the following classification(s): A 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, City will pay Contractor $54,720 (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 3 below, and/or upon completion, for the Work performed during the preceding month, itemizing labor, materials, equipment and any incidental costs incurred. Contractor warrants that title to all work, materials and equipment incorporated into the Work will pass to City free of any claims, liens, or encumbrances upon payment to Contractor. 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, Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 1 Approved by City Attorney, dated 02/27/2020 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. 4. Time for Completion. Contractor will fully complete the Work within 30 days 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 from and against any and all liability, demands, loss, damage, claims, settlements, expenses, and costs (including, without limitation, attorney fees, expert witness fees, and costs and fees of litigation) (collectively, "Liability") of every nature arising out of or in connection with Contractor's acts or omissions with respect to this Contract, except such Liability caused by the active negligence, sole negligence, or willful misconduct of the City. This indemnification obligation is not limited by any limitation on the amount or type of damages or compensation payable under Workers' Compensation or other employee benefit acts, or by insurance coverage limits, and will survive the expiration or early termination of this Contract. City will notify Contractor of any third -party claim pursuant to Public Contract Code section 9201. 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.t)insadvantage.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 $2,000,000 per occurrence and $4,000,000 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. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 2 Approved by City Attorney, dated 02/27/2020 9.4 Pollution Liability. The pollution liability insurance policy must be issued on an occurrence basis, providing coverage of at least $2,000,000 for all loss arising out of claims for bodily injury, death, property damage, or environmental damage caused by pollution conditions resulting from the Work. 9.5 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. 9.6 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. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 3 Approved by City Attorney, dated 02/27/2020 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 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. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 4 Approved by City Attorney, dated 02/27/2020 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 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 Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 5 Approved by City Attorney, dated 02/27/2020 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. 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 parry must be given as follows: City: Address: 111 Morphew Street City/State/Zip: San Rafael, CA 94901 Phone: (415) 458-5347 Attn: Shawn Graf, Project Manager Email: shawn.graf@cityofsanrafael.org Contractor: Name: Golden Gate Tank Removal Inc. Address: 1480 Carroll Ave City/State/Zip: San Francisco, CA 94124 Phone: (415) 512-1555 Attn: Tim Hallen Email: tim@ggtr.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 Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 6 Approved by City Attorney, dated 02/27/2020 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 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.] Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Page 7 Approved by City Attorney, dated 02/27/2020 The parties agree to this Contract as witnessed by the signatures below: CITY: 1 s/ -- f Jim Sch ; City Manager Date: -�;- - 4 L L, Attest: S/ ,CJ p. Lindsay Lara, City Clerk Date: Approved as to form: sl L4.6. Robert F. Epstein, City Attorney Date: ,5 -u - CONTRACTOR: Golden Gate Tank Removal,Inc. Business Name t Seal: Tim Hallen , President Name/Title Date: 4/20/22 s/ Gina ee/Corporate Secretary Name/Title Date: 4/20/22 616521 2/28/2023 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 END OF CONTRACT Removal of Underground Storage Tank City Project #: 11357-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Page 8 Exhibit A SCOPE OF WORK Removal of Underground Storage Tank City Project #: 11357-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Scope of Work Exhibit A February 16, 2022 Proposal # 9693 Mr. Rich Souza CSW/Stuber-Stroeh Engineering Group, .Inc. RE: UNDERGROUND STORAGE TANK LOCATED ON IRWIN STREET AT 2ND STREET, SAN RAFAEL, CALIFORNIA Dear Mr. Souza: Thank you for the opportunity to remove one underground petroleum fuel tank located on Irwin Street at Second Street, San Rafael, California. I would like to submit this proposal for your consideration. Golden Gate Tank Removal, Inc. is a Licensed "A" General Engineering Contractor, Licensed Concrete Contractor, Licensed Hazardous Substance Removal and Remedial Actions Contractor. Our California contractor's license number is 616521. Golden Gate Tank Removal, Inc. carries Worker's Compensation Insurance and $4 million dollars of Liability and Pollution Insurance and Professional Errors and Omission Insurance. Insurance certificates can be provided upon request. Here .is our proposal for your review. Please sign and date one copy and return it to my attention. If you have any questions, please call me at (415) 512-1555 Sincerely, Tim Tian Hallen H a l l e n Golden Gate Tank Removal, Inc. Digitally signed byTim Hallen DN: cn=Tim Hallen, o=Golden Gate Tank Removal, Inc., cu=General Manager, email=tim@ggtr.com, c=US Date: 2022.02-16 12:31:02 -08,00, 1480 Carroll Avenue - San Francisco, CA 94124 - Tel.: 415.512.1555 Fax: 415.512.0964 General Engineering Contractors License No. 616521 Irwin St. and 2"' St, San Rafael California Proposal &&. Contract # 9693 February 16, 2022 SCOPE OF WORK Golden Gate Tank Removal, Inc. will perform the following tasks according to all applicable Federal, State and Local regulations. 1. We will notify Underground Services Alert (USA) that a tank removal is planned and obtain a USA number for permit application. USA will contact and instruct the utility companies to come out and mark the major utilities in the area of the tank. 2. Arrange for a Traffic Control vendor who will provide equipment and personnel to direct vehicle and pedestrian traffic around the work area and provide a metal safety fence or other barricade as needed, to protect pedestrians from the work area. 3_ Prepare and submit an Underground Storage Tank Modification Application to the .Marin County Department of Public Works Certified Unified Program Agency (Marin County DPW) and schedule for an on-site inspection of the tank removal and sampling procedures. 4. Prepare a site-specific Health and Safety Plan as required by OSHA 29 CFR 1910.120. A copy of this safety plan will be kept on-site, and one copy will be submitted to the Marin DPW. 5. Prepare and submit a letter to the State of California, Department of Industrial Relations, Division of Occupational Safety and Health (OSHA) for all excavations in excess of five feet in depth as required by Safety Order 3203. Golden Gate Tank Removal, Inc. maintains an annual permit for excavations. 6. Submit an application to the Bay Area Air Quality Management District, when required, with at least five days written notice before tank removal begins as per Regulation 8, Rule 40 of the BAAQMD. 7. Schedule all work to be performed only on weekends and during non -peak. hours. 8. Notify the San .Rafael .Fire Department Bureau of .Fire Prevention for an on-site inspection to witness proper displacement of combustible and/or flammable vapors and/or the cutting of any tank. 9. Standard trench shields may be used as needed for shoring or our Registered Engineer will provide shoring calculations showing the location and depth of the excavation and a copy of the shoring tables or calculations will be submitted to the County of Marin Department of Public Works. 10. Acquire all permits listed in this proposal and schedule all inspections listed in this proposal. 11. The excavation will be covered during off work periods with a steel traffic plate that is currently provided on site to protect the excavation area. 12. Confirm all underground utilities are clear of the excavation before excavating. 13. Begin to excavate the soil on top of and around the underground tank. 14. Arrange for overburden stockpile soil storage at a location adjacent to the worksite or arrange for the :Marin County DPW/CUPA to permit sampling the overburden soil in-situ prior to tank excavation and to permit the direct loading of the soil for transport and disposal to eliminate the need for local stockpile storage. 15. Arrange for acceptance of the overburden stockpile at a suitable facility according to applicable soil disposal guidelines if needed. Golden Gate Tank Removal, Inc. Page 2 San Francisco, California Irwin St. and 2"' St, San Rafael California Proposal & Contract # 9693 February 16, 2022 SCOPE OF WORK 16. The excavated soil will be appropriately disposed of offsite after laboratory analysis of the soil and approval of the Marin County DPIAT/CtiPA. 17. Empty and clean the underground tank using high pressure hot water and detergent and have a licensed hazardous waste hauler dispose of the fuel and the rinse water at a State Certified Treatment Facility for recycling. The cost of the disposal of the residual product and rinse is not included in the price of this contract. 18. To reduce the possibility of a fire, as needed, we will reduce the oxygen content of the tank by displacing the combustible vapors, if present, prior to removal of the tank. This will be completed by inserting a minimum of 3 pounds of solid carbon dioxide (dry ice.) for every 100 gallons of tank volume as required by the San Rafael .Fire Department. 19. Remove one - 2000 gal [on or less underground fuel oil tank from the excavation and provide for inspection by the .Marin County DPW. 20. Upon the approval of the San .Francisco Department of Public Health, we will certify the tank as non- hazardous, load the tank on a truck and transport it to a metal recycler 21. If the tank cannot be rendered non -hazardous, we will load the tank on a licensed hazardous waste truck, have the tank transported to a state certified treatment facility for final cleaning and disposal. The transport and disposal of hazardous material is not included in the contract. 22. At the direction of the Marin County DPW/CUPA, we will collect the required samples, observing correct sampling protocols. Normally two sample extractions two feet below the bottom of the fonner tank and composite samples of the overburden stockpile. 23. Provide for state certified laboratory analysis of the required samples with a Chain of Custody record. 24. As required by the Marin County DPW, the sample analysis will be for Total (Extractable) Petroleum Hydrocarbons (TPFT), Benzene, Toluene, Ethyl Benzene, & Xylene (BTEX), Naphthalene and 16 Poly Aromatic Hydrocarbons (PAH's) or other analytes as directed. 25. Upon approval of the Marin County DPW, we will backfill the excavation with three sack sand slurry tailgated to minus 12" from grade in preparation for a 12" HMA pavement section replacement or other site restoration to be done by others. 26. Provide a final report for the Marin County DPW/CUPA in written narrative form to establish that procedures and regulations for Marin County DPW have been observed and that outlines the guidelines, results, and conclusions of the tank removal process. 27. Provide a copy of the final report for the client. STATE LICENSE BOARD Contractors are required by law to be licensed and regulated by the Contractors State License Board. Any questions concerning a contractor may be referred to the Registrar, Contractors State License Board; 9835 Goethe Road Sacramento, California. The mailing address is: P.O. Box 26000, Sacramento, California 95826. Golden Gate Tank Removal, Inc. Page 3 San Francisco, California Irwin St. and 2"' St, San Rafael California Proposal & Contract # 9693 February 16, 2022 SPECIAL CONDITIONS The owner is to furnish Golden Gate Tank Removal, Inc. with a one-time California EPA ID Waste Generator Number. GGTR will assist in obtaining this number. The costs and schedules of this proposal are based on information provided by the owner and the assumption that soil and groundwater contamination has not occurred as a result of an unauthorized release of hydrocarbon products. PRODUCT INSIDE TANK Cost for the removal and disposal of residual fuel (liquid) and rinse water or any material from inside the tank is not included in the price of the contract. The cost of the removal and disposal of these items including vacuum truck will be billed at cost plus 15%. If needed a sample of the tank contents will be collected and submitted to a state certified laboratory to confirm information needed for acceptance of the material at a recycling and disposal facility. ITEMS NOT INCLUDED IN CONTRACT PRICE Additional charges may be billed in addition to the stated contract price. If any of the following need to be performed, a change order will be submitted for your approval. The price stated in this proposal does not include the following: A. Any remedial action, extra sampling, or tax assessment, or permits which may be required by the Federal, State, or Local agencies. B. The relocation, removal or repair of any utilities, concrete, piping or cutting of tank, if it becomes necessary. C. The cost for removal or replacement of soil that may be disturbed during the tank removal process. D. The cost for removal, transport, or disposal of any material, hazardous or non -.hazardous, (such as the tank, soil, residual product, rain, ground water, gasoline, solvent, oil, sludge, or chemicals, etc.) from the tank, any excavation or the site. GENERAL CONDITIONS TERMINATION This agreement may be terminated by either party upon five (5) days written notice. In the event of termination, Golden Gate Tank Removal, Inc. shall be paid for services performed prior to the termination notice date. This proposal may be withdrawn if not accepted within 30 days. DISPUTES & COLLECTIONS Failure to remit any payment in the time otherwise agreed in this contract shall constitute default of contract. Tn the event of default, Golden Gate Tank Removal, Inc. shall be entitled to receive its costs in pursuing collections, including interest and reasonable attorneys' fees. Should it become necessary for either party to this contract to obtain its enforcement or interpretation in a court of law, then the prevailing party in court shall be entitled, in addition to any other relief it receives, to its costs and reasonable attorneys' fees. Golden Gate Tank Removal, Inc.. Page 4 San Francisco, California Irwin St. and 2'd St, San Rafael California Proposal & Contract # 9693 February 16, 2022 COMPENSATION The cost of (lie above-described work at Irwin Street and Second Street in San Rafael, shall be in the amount of: Tank Removal Permits (Estimate $3,000.00) Traffic Control (Estimate $2100/day for 3 days) Laboratory Analysis (Estimate $2,160.00) Tank Contents -Transport & Disposal (Est. $10/Gal) Overburden Soil Stockpile Transport & Disposal Tank Transport & Disposal as Hazardous (if required) Surface Restoration $54,720.00 Cost+15% Cost+15% Cost+15% Cost+15% Cost+15% Cost+15 % Cost+15% $ 27,360.00 (50%) is due upon start of project. The balance is due upon completion of the work. A service charge of 1'/2% per month is charged on all delinquent accounts. The final report will be submitted to the owner and regulatory agencies upon receipt of final payment. Date: February 16, 2022 Date: Acceptance Print Name & Title PhoneTim DN: only signed by en, o=G olden DN: cn=Tim Hallen, o=Golden Gate Tank Removal, Inc., ou=General Manager, Hallen email=tim@ggt.co US Date: 2022.0.166 12:31:52 SlWO I im Hallen Golden Gate Tank Removal, Inc. Golden Gate Tank Removal, Inc. Page 5 San Francisco, California Exhibit B BONDFORMS Required for contracts over $25, 000. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Bond Forms Approved by City Attomey, dated 02/27/2020 Bond #100649990 Premium: $1,094.00 Performance Bond Golden Gate Tank City of San Rafael ("City") and Removal , Inc . ("Contractor") have entered into a contract, dated , 20 ("Contract") for work on the City's Removal of UST ("Project"). The Contract is incorporated by reference into this Performance Bond ("Bond"). American Contractors Indemnity Company 1. General. Under this Bond, Contractor as Principal andits surety ("Surety"), are bound to City as obligee for an amount not less than $ 0 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: Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Performance Bond Approved by City Attorney, dated 02/27/2020 Attn: American Contractors Indemnity Company Address: 801 S. Figueroa Street, Suite 700 City/State/Zip: Los Angeles, CA 90017 P hone: 310-649-0990 Fax: Email: 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 April 20. 20 22 Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. Name/ I Itle [pnntj (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: Golden Gate Tank Removal,Inc. Business Name Tim Hallen/President Name/Title s/ Gina F Name/Title APPROVED BY CITY: orate Secret END OF PERFORMANCE BOND Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Performance Bond Approved by City Attorney, dated 02/27/2020 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 '" �Cf'iG'fC-�•�:-c't-�1`.cN.cCry`,cx�c:•('.rf'.cY"rr< 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 j County of Sacramento ) 1 I)o= i J. Swalley, notary public On jf' __ before me, Date Here Insert Name and Title of the Officer personally appeared Shirley Baugh 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/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. w WITNESS my hand and official seal. J. SWALLEY 9mmisslan # 226NWAFy Public - California g iT� §�Er�mentnCounty s SI nature T €5603 MY Wnm, Expires Nov 30, zozz Signature of Notary Publ' 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing, 02016 National Notary Association • www.NationaiNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907 TOKIO MARI N E HCC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, SHIRLEY BAUGH its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100649990 issued in the course of its business and to bind the Company thereby, in an amount not to Three million and 00/100 ( S3,000,000.00 exceed This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 1s' day of September. 2011. "Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company President on this 15' day of June, 2018..&1111 k"Ijl oft ,, ... .... ••. fir, State of California = � � riGAR►pRAtfp y County of Los Angeles has caused its seal to be affixed hereto and executed by its AMERICAN CONT CTO S INDEMNITY COMPANY By: AdaiPn S. Pessin, President 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. On this Is' day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature J06* 4,?� (seal) I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of April 2022 `,pur 11 urury�� Bond No. 100649990 Agency No- 2011 '"P°R`TE 0 =y= Kio Lo, Asksant Secretary " '"itis"'- HCCSZZPOAACIC06/2018 visit tmhcc.com/surety for more information Bond #100649990 Premium included in performance bond Payment Bond Golden Gate City of San Rafael ("City") and Tank Removal, Inc .('Contractor") have entered into a contract, dated , 20_ ("Contract") for work on the City' s Removal of UST ("Project"). The Contract is incorporated by reference into this Payment Bond ("Bond"). 1. General. Under this Bond, Contractor as principal and American Contractors indemnity Company its surety ("Surety"), are bound to City as obligee in an amount not less than $ 54, 720.00 , 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: American Contractors Indemnity Company Address: 801 S. Figueroa Street, Suite 700 City/State/Zip: Los Angeles, CA 90017 Phone: 310-649-0990 Fax - Email 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. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Payment Bond Approved by City Attorney, dated 02/27/2020 7. Effective Date; Execution. This Bond is entered into and is effective on April 20 20 22. Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. SURETY: American Contractors Indemnity Company Business Name s/ A h11/1 L�JA J Shirley Baugh, Attorn -in-Fact Name/Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR:Golden Gate Tank Removal,Inc_ Bus`f inees�ss Name Tim Hallen/President Name/Title s/ —kwv��. Gina Wee/Corporate Secretary Name/Title APPROVED BY CITY: s/ L:2�-a a Name/Title END OF PAYMENT BOND Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Payment Bond Approved by City Attorney, dated 02/27/2020 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 "Fx�'s"sc�.LY't-t'<r�-r•�-rr-�•�r�-rrr<e•<-c�ti:,=.__',r�^c«-crK^rcx�rr�c:trr6_��C,c.S�C>�a:�,c-r�t:rrrrc.^��.r<-n-.rrr<r 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 Sacramento On !t'�---a ' _ before me, , Date personally appeared J. Swalley, notary public Shirley Baugh Here Insert Name and Title of the Officer 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/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 QF.J, SWAT I EY is true and correct. Na[Ary P011C - California tMFl;imvnsn County WITNESS my hand and official seal. C"IbMIWOM H ESQ 5603 My C.u.'AitiEkOUi!s N6v 30, 2oaz Signature Signature of Notary Pu 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: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: '34."+.'tU..`uv�G:Cv+%"t�%vr7S:4.C1�"4x:`tf7 rX +SP?Y.r�L`.' fY+�I>'L�C.S�ieJ �L?G�CSGY+C7G%<•�L7L^C-:,t."1{.tYv"-2.Y-rv=`v'°-' x:{v`L" vXIV YY . x 02016 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907 Q 0 TOKIO MARI NE HCC POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company of the State of California, a California corporation, does hereby appoint, SHIRLEY BAUGH its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100649990 issued in the course of its business and to bind the Company thereby, in an amount not to exceed Three million and 00/100 [ S3.000.000.00 } This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the Board of Directors of AMERICAN CONTRACTORS INDEMNITY COMPANY at a meeting duly called and held on the 15' day of September, 2011. "Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary. Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company. IN WITNESS WHEREOF, American Contractors Indemnity Company has caused its seal to be affixed hereto and executed by its President on this 1 sI day of June, 2018. "'Acro'"' ........... State of California ,� AMERICAN CONT CTD S INDEMNITY COMPANY _� � nsoeroaRrer :� _ County of Los Angeles w; sePr n-"'° By: •�., �..._•_,..,.• Pessin, President •.,,-0LrFOAN�,a 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. On this 1st day of June, 2018, before me, Sonia O. Carrejo, a notary public, personally appeared Adam S. Pessin, President of American Contractors Indemnity Company, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature 5041A C (seal)c^ llsa 121394", Aly CamMEIP"A0, 22, 20i2 I, Kio Lo, Assistant Secretary of American Contractors Indemnity Company, do hereby certify that the Power of Attorney and the resolution adopted by the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of Attorney nor the resolution have been revoked and they are now in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of Bond No. 100649990 Agency No. 2011 Ez=_ wcoRPowaEo SEPT. 25, 1990 t C5 visit tmhcc.com/surety for more information April 2022 44z� Kio Lo, As n€ Secretary H C C SZ Z P OAAC I C 06/2018 Bid Bond ("Bidder") has submitted a bid, dated 20 ("Bid"), to the City of San Rafael ("City") for work on the ("Project'). Under this duly executed bid bond ("Bid Bond"), Bidder as Principal and its surety ("Surety"), are bound to City as obligee in the penal sum of ten percent of the maximum amount of the Bid (the "Bond Sum"). Bidder and Surety bind themselves and their respective heirs, executors, administrators, successors and assigns, jointly and severally, as follows: General. If Bidder is awarded the Contract for the Project, Bidder will enter into the Contract with City in accordance with the terms of the Bid. 2. Submittals. Within ten days following issuance of the Notice of Award to Bidder, Bidder must submit to City the following: 2.1 Contract. The executed Contract, using the form provided by City in the Project contract documents ("Contract Documents"); 2.2 Payment Bond. A payment bond for 100% of the maximum Contract Price, executed by a surety licensed to do business in the State of California using the Payment Bond form included with the Contract Documents; 2.3 Performance Bond. A performance bond for 100% of the maximum Contract Price, executed by a surety licensed to do business in the State of California using the Performance Bond form included with the Contract Documents; and 2.4 Insurance. The insurance certificate(s) and endorsement(s) required by the Contract Documents, and any other documents required by the Instructions to Bidders or Notice of Award. 3. Enforcement. If Bidder fails to execute the Contract and to submit the bonds and insurance certificates as required by the Contract Documents, Surety guarantees that Bidder forfeits the Bond Sum to City. Any notice to Surety may be given in the manner specified in the Contract and delivered or transmitted to Surety as follows: Attn: Address. City/State/Zip: Phone: Fax: Email. 4. Duration and Waiver. If Bidder fulfills its obligations under Section 2, above, then this obligation will be null and void; otherwise it will remain in full force and effect for 60 days following the bid opening or until this Bid Bond is returned to Bidder, whichever occurs first. Surety waives the provisions of Civil Code §§ 2819 and 2845. [Signatures are on the following page.] Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Bid Bond Approved by City Attorney, dated 2/27/2020 This Bid Bond is entered into and effective on , 20 SURETY: Business Name s/ Name, Title Date (Attach Acknowledgment with Notary Seal and Power of Attorney) BIDDER: Business Name s/ Name, Title Date END OF BID BOND Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Bid Bond Approved by City Attorney, dated 2/27/2020 Exhibit C NONCOLLUSION DECLARATION TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID The undersigned declares: I am the [title] of _ [business name], the party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid and will not pay, any person or entity for such purpose. This declaration is intended to comply with California Public Contract Code § 7106 and Title 23 U.S.0 § 112. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on [date], at [city], [state]. s/ Name [print] END OF NONCOLLUSION DECLARATION Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Noncollusion Declaration Approved by City Attorney, dated 2/27/2020 Exhibit D BID SCHEDULE This Bid Schedule must be completed in ink and included with the sealed Bid Proposal. Pricing must be provided for each Bid Item as indicated. Items marked "(SW)" are Specialty Work that must be performed by a qualified Subcontractor. The lump sum or unit cost for each item must be inclusive of all costs, whether direct or indirect, including profit and overhead. The sum of all amounts entered in the "Extended Total Amount' column must be identical to the Base Bid price entered in Section 1 of the Bid Proposal form. AL = Allowance CF = Cubic Feet CY = Cubic Yard EA = Each LB = Pounds LF = Linear Foot LS = Lump Sum SF = Square Feet TON = Ton (2000 lbs.) BID ITEM NO. ITEM DESCRIPTION EST. QTY. UNIT UNIT COST EXTENDED TOTAL AMOUNT TOTAL BASE BID: Items 1 through inclusive Note: The amount entered as the "Total Base Bid" should be identical to the Base Bid amount entered in Section 1 of the Bid Proposal form. Removal of Underground Storage Tank City Project #: 11357-02 Approved by City Attorney, dated 2/27/2020 Up to $175,000 Contract Bid Schedule This Bid Proposal is hereby submitted on s/ s/ Company Name Address City, State, Zip Contact Name 20_ Name and Title Name and Title License #, Expiration Date, and Classification DIR Registration # Phone Contact Email Addenda. Bidder agrees that it has confirmed receipt of or access to, and reviewed, all addenda issued for this Bid. Bidder waives any claims it might have against the City based on its failure to receive, access, or review any addenda for any reason. Bidder specifically acknowledges receipt of the following addenda: Addendum- Date Received: Addendum: Date Received: #01 #05 #02 #06 #03 #07 #04 #08 END OF BID SCHEDULE Removal of Underground Storage Tank City Project #: 11357-02 Approved by City Attorney, dated 2/27/2020 Up to $175,000 Contract Bid Schedule Exhibit E SUBCONTRACTOR LIST For each Subcontractor that will perform a portion of the Work in an amount in excess of one-half of 1 % of the bidder's total Contract Price,' the bidder must list a description of the Work, the name of the Subcontractor, its California contractor license number, the location of its place of business, its DIR registration number, and the portion of the Work that the Subcontractor is performing based on a percentage of the Base Bid price. END OF SUBCONTRACTOR LIST For street or highway construction this requirement applies to any subcontract of $10,000 or more. Removal of Underground Storage Tank Up to $175,000 Contract City Project #: 11357-02 Subcontractor List Approved by City Attorney, dated 2/27/2020 CERTIFICATE OF LIABILITY INSURANCE DATE (MM Y) i�ARJ 04,01,2022/2022 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 Maria Ricafort NAME: Calender -Robinson Company, Inc. PAHONN (415) 978-3800 (415) 978-3825 AI No E-MADDAREss: IL mricafort@calrob.com 0267063 1 ,000,000 EACH OCCURRENCE $ INSURER(S) AFFORDING COVERAGE NAIC # 233 Sansome St. Ste 508 INSURERA: Evanston Insurance Company 35378 San Francisco CA 94104 INSURED INSURER B: United Financial Casualty Co. 11770 INSURER C: Golden Gate Tank Removal, Inc INSURER D: 1480 CARROLLAVENUE INSURER E: INSURER F: SAN FRANCISCO CA 94124 COVERAGES CERTIFICATE NUMBER: CL2212731724 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IL7A TYPE OF INSURANCE JNSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMfDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY 1 ,000,000 EACH OCCURRENCE $ �/ CLAIMS -MADE OCCUR A A N 50,000 PREMISES Ea occutranco S MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY s 1,000,000 A Y Y MKLV5ENV103429 01123/2022 01/23/2023 GEN'LAOUREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY 171 @COT' r7 LOC PRODUCTS - COMP/OP AGG S 2.000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 JEa acrldenl BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS 06484167-4 01/23/2022 01/23/2023 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Geraalden! HIRED NON -OWNED AUTOS ONLY AUTOS ONLY P S UMBRELLA LIABX OCCUR EACH OCCURRENCE S 4,000,000 AGGREGATE $ 4'000'000 A x EXCESS LIAB CLAIMS -MADE MKLV5EFX100697 01/23/2022 01/23/2023 DED I I RETENTION S S WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY �, / N OTH- STAT 7E ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA EL EACH ACGIDENT $ EJ_ DISEASE -EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I E L DISEASE - POLICY LIMIT S A Pollution Liability Professional Liability MKLV5ENV103429 01/23/2022 01/23/2023 Pollution Condition Llmit $1,000,000 Each Claim Limit $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City Of San Rafael, including its Council, officials, officers, employees, agents, volunteers and consultants are included as additional insured per the attached endorsement. Liability is Primary and Non -Contributory. Wavier of Subrogation applies to general liability "10 -Day notice of cancellaton applies for non-payment of premium. 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. 111 Morphew Avenue AUTHORIZED REPRESENTATIVE Department of Public Work San Rafael CA 94901—��- @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD GOLDGAT-15 DGIRONj ACaR� — DATE(MMIDOlYYYY) —I CERTIFICATE OF LIABILITY INSURANCE 4/4/2022 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 CNAONTACT CAL Insurance & Associates, Inc. i'HONE FAX 2311 Taraval Street (AIc.No,Ext: 415) 661-6500 WC,w)J415) 661-2254 San Francisco, CA 94116noR;s info@myCALteam.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: State Compensation Ins. Fund 35076 INSURED INSURER B Golden Gate Tank Removal, Inc. INSURERC: 1480 Carroll Ave INSURER D : San Francisco, CA 94124 1 NSU RER E INSURER F: /`AVFRA2CC f CDTICf[`ATC MIIRARCIS• GCVICIA1J AIIfMRCD• 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, INSRTypE OF INSURANCE �ADDL RM SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR EACH OCCURRENCE 5 G TO RENTERe S occurm MED EXP iAny oneperson) S PERSONAL 8 ADV UL1JRY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ m9i F-1 LOC OTHER GENERAL AGGREGATE $ PRODUCTS- COMP/OPAGG S $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINEO SINGLE LIMIT $ BODILY INJURY Perperson) $ BODILY INJURY (Per accident 5 PROPERTY DAMAGE Per accident $ S UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE '1947693-2021 1011/2021 EACH OCCURRENCE S AGGREGATE $ DED I I RETENTION $ S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETO RIPARTNER/EXECUTIVE YIN W.1A ER/MEMBER EXCLUDED? 7 atory in NH) If yes, describe under DESCRIPTION OF OPERATJONS below X 10/112022 X PER I OTH- STATUTE FIR 1,000,000 E.L. EACH ACCIDENT 5 1,000,000 E.L DISEASE- EA EMPLOYE S 1,000,000 E.L. DISEASE- POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Waiver of Subrogation in favor of City Of San Rafael. rE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Of San Rafael THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. Department of Public Works 111 Morphew Avenue San Rafael, CA 94901 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 1 2021 AT 12 01 A.M. AND EXPIRING OCTOBER 1 2021 AT 12 Cl A.M. ALL EFFECTIVE DATES ARE AT 12:C1 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME GOLDEN GATE TANK REMOVAL INC 1480 CARROLL AVE SAN FRANCISCO CA 94124 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 THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2 CC$ OF THE TOTAL POLICY PREMIUM :CN:101 mlll i101 PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 1947693-21 RENEWAL NA 4-33-71-35 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT IVE SCIF FORME '02'7 IREV.4-20'81 SEPTEMBER 10 2021 1 PRES DENT AND CEO 2572 OLO DP 2'7 COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: MKLV5ENV103429 BVI IRKEL- EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM A. Section II — Who Is An insured is amended to include as an additional insured any person(s) or organization(s) to whom the insured agrees to provide additional insured status in a written contract, provided such written contract is signed by both parties and executed prior to the commencement of operations, 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" occurring after: All work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the location of the covered operations, including materials, parts or equipment furnished in connection with such work, 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement will not increase the applicable Limits Of Insurance shown in the Declarations. All other terms and conditions remain unchanged. MEGL 1542 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission_ COMMERCIAL GENERAL LIABILITY POLICY NUMBER: MKLV5ENV103429 l�I IRKEV EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s) or organization(s) with whom the Named Insured agrees, in a written contract executed prior to the 'occurrence", to waive rights of recovery The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule of this endorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEGL 0241-01 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. COMMERCIAL GENERAL LIABILITY III POLICY NUMBER: MKLV5ENV103429 M IRKEL EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. The following is added to Paragraph 2. Exclusions under Bodily Injury And Property Damage Liability coverage: This insurance does not apply to: Wrap-up Operations "Bodily injury" or "property damage" arising out of your ongoing operations or your operations included within the "products -completed operations hazard" at any location where a consolidated (wrap-up) insurance program has been provided by the prime contractor, project manager or owner of the construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap-up) insurance program: (1) Provides coverage identical to that provided by this Coverage Form; (2) Has limits adequate to cover all claims or "suits"; or (3) Remains in effect. For the purposes of this endorsement, consolidated (wrap-up) insurance program includes an owner -controlled insurance program and any otherjob or project specific insurance program. All other terms and conditions remain unchanged. MEGL 1331 11 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. ENVIRONMENTAL POLICY NUMBER: MKLV5ENV103429 NUIRKEU EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following, where indicated by an "X" in the checkbox below: ®COMMERCIAL GENERAL LIABILITY COVERAGE FORM ® CONTRACTOR'S POLLUTION LIABILITY COVERAGE FORM ❑ OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM ❑ PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Person Or Organization: Any additional insured with whom you agree in a written contract signed by both parties and executed prior to the commencement of operations to provide Primary and Non -Contributory status under this insurance. With respect to the coverage provided by this endorsement, the following is added to the Other Insurance condition of the Coverage Form(s) indicated above: Primary And Non -Contributory This insurance is primary to, and will not seek contribution from, any other insurance available to the Person Or Organization shown in the Schedule of this endorsement. However, this does not apply to any "claim", "suit" or "pollution condition" resulting from the sole negligence of the Person Or Organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. MEEI 2274 05 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. RAP 7 y 2 yo fT`wi-rH P`�y CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Public Works Project Manager: Ashley Dohrmann for Shawn Extension: 3352 Contractor Name: Golden Gate Tank Removal Inc. Contractor's Contact: Tim Hallen Contact's Email: tim@ggtr.com ❑ FPPC: Check if Contractor/Consultant must file Form 700 Step RESPONSIBLE DESCRIPTION COMPLETED REVIEWER DEPARTMENT a. Email PINS Introductory Notice to Contractor DATE Check/Initial 1 Project Manager Click here to ❑ enter a date. b. Email contract (in Word) and attachments to City 3/12/2022 Attorney c/o Laraine.Gittens@cityofsanrafael.org X❑AD 2 City Attorney a. Review, revise, and comment on draft agreement 3/24/2022 ® LG and return to Project Manager 3/24/2022 ® LG b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 3 Department Director _ Approval of final agreement form to send to 3/29/2022 ❑x BG Project Manager contractor Forward three (3) originals of final agreement to 4 3/30/2022 0 Project Manager contractor for their signature 5 When necessary, contractor -signed agreement ❑X 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 4/27/2022 AD Attorney with printed copy of this routing form 7 City Attorney Review and approve hard copy of signed K•�- agreement Review and approve insurance in PINS , and bonds 8 City Attorney (for Public Works Contracts) 9 City Manager/ Mayor Agreement executed by City Council authorized official ' 10 City Clerk Attest signatures, retains original agreement ander forwards copies to Project Manager