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PW 20 Meyer Road Slide Repair
CITY 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 James A Piazza Sr. DBA Piazza Construction ("Contractor"), a sole proprietor authorized to w rk in California, for work on the City's 20 Meyer Rd. Slide Repair ("Project"), and is effective on 20Effective Date"). 0117 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 Documents, City will pay Contractor $99,650 (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, 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project* 11388-02 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 90 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 (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 or 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.tainsadvantage.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. 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Page 2 Approved by City Attorney, dated 02/27/2020 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. 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 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Page 3 Approved by City Attorney, dated 02/27/2020 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. 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 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Page 4 Approved by City Attorney, dated 02/27/2020 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. 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Page 5 Approved by City Attorney, dated 02/27/2020 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: (626) 290-3424 Attn: JC Agcaoili, project manager Email: john.agcaoili@cityofsanrafael.org Contractor: Name: Piazza Construction Address: 5200 Carroll Rd City/State/Zip: Petaluma, CA 94952 Phone: (707) 876-3410 Attn: James Piazza Email: piazzapc02@gmaii.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 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Page 6 Approved by City Attorney, dated 02/27/2020 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.] 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Page 7 �K The parties agree to this Contract as witnessed by the signatures below: CITY: s/ \ Jim hutz, ity Manager \ Date: Attest: 1( Lindsay Lara, City Ci k Date: �� Approved as to form: s/ OL Robert F. Epstein, City Attorney Date: fh,* 1 ZUZ2 CONTRACTOR: James A. Piazza, dba Piazza Construction Business Na s/ )" Seal: James A. Piazza, Owner Name/Title Date: 04/28/2022 s/ Name/Title Date: A-406456 Expiration Date: 06/30/23 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 20 Meyer Rd. Slide Repair City Project #: 11388-02 END OF CONTRACT Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Page 8 20 Meyer Rd. Slide Repair City Project #: 11388-02 Exhibit A SCOPE OF WORK Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Scope of Work General Info Total: $99,650.00 Number Description 20 Meyer Rd. Slide Repair The project is located along 20 Meyer Rd. and consists of the installation of a soldier Deadline pile retaining wall, guardrail, water lateral replacement, and hillside stabilization. 03/02/2022 09:30 PM UTC Engineer's Estimate: $145,000.00 Vendor Public Works is inviting you to a scheduled Zoom meeting. Piazza Construction Topic: 20 Meyer Rd. Slide Repair -Bid Opening Submitted Time: Mar 2, 2022 01:30 PM Pacific Time (US and Canada) 03/02/2022 09:06 PM UTC Join Zoom Meeting Signed by https://us06web.zoom.us/j/82743588274 James A. Piazza Meeting ID: 827 4358 8274 Account Holder James Piazza One tap mobile +16699006833„82743588274# US (San Jose) Opened +12532158782„82743588274# US (Tacoma) 03/02/2022 09:32 PM UTC By Dial by your location john.agcaoili@cityofsanrafael.org +1 669 900 6833 US (San Jose) +1 253 215 8782 US (Tacoma) +1 346 248 7799 US (Houston) +1 929 205 6099 US (New York) +1 301 715 8592 US (Washington DC) +1 312 626 6799 US (Chicago) Meeting ID: 827 4358 8274 Find your local number: https://us06web.zoom.us/u/kL33IZsOY Allows zero unit prices and labor No Allows negative unit prices and labor No ATTACHMENT LIST 20 Meyer Rd. Slide Repair - 100% Plans.pdf (11.5 MB) Specifications for 20 Meyer Rd. Slide Repair - Final.pdf (1.26 MB) 20 Meyer Rd. - Addendum #1.pdf (240 KB) BID PROPOSAL Page 1 of 7 03/02/2022 ("Bidder") * Piazza Construction hereby submits this Bid Proposal to the City of San Rafael ("City") for the above -referenced project ("Project") in response to the Notice Inviting Bids and in accordance with the Contract Documents referenced in the Notice. 1. Base Bid. Bidder proposes to perform and fully complete the Work for the Project as specified in the Contract Documents, within the time required for full completion of the Work, including all labor, materials, supplies, and equipment and all other direct or indirect costs including, but not limited to, taxes, insurance and all overhead for the following price ("Base Bid"): $98,600.00 2. 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 (click "+" to add addenda. Type "N/A" if no addenda have been issued): Addendum M 01 Addendum Date: 2/25/2022 3. Bidder's Certifications and Warranties. By signing and submitting this Bid Proposal, Bidder certifies and warrants the following: 3.1 Examination of Contract Documents. Bidder has thoroughly examined the Contract Documents and represents that, to the best of Bidder's knowledge, there are no errors, omissions, or discrepancies in the Contract Documents, subject to the limitations of Public Contract Code§ 1104. 3.2 Examination of Project Site. Bidder has had the opportunity to examine the Project site and local conditions at the Project location. 3.3 Bidder Responsibility. Bidder is a responsible bidder, with the necessary ability, capacity, experience, skill, qualifications, workforce, equipment, and resources to perform or cause the Work to be performed in accordance with the Contract Documents and within the Contract Time. 3.4 Responsibility for Bid. Bidder has carefully reviewed this Bid Proposal and is solely responsible for any errors or Page 2 of 7 03/02/2022 omissions contained in its completed Bid. All statements and information provided in this Bid Proposal and enclosures are true and correct to the best of Bidder's knowledge. 3.5 Nondiscrimination. In preparing this Bid, the Bidder has not engaged in discrimination against any prospective or present employee or Subcontractor on grounds of race, color, ancestry, national origin, ethnicity, religion, sex, sexual orientation, age, disability, or marital status. 3.6 Iran Contracting Act. If the Contract Price exceeds $1,000,000, Bidder is not identified on a list created under the Iran Contracting Act, Public Contract Code § 2200 et seq. (the "Act"), as a person engaging in investment activities in Iran, as defined in the Act, or is otherwise expressly exempt under the Act. 4. Award of Contract. By signing and submitting this Bid Proposal, Bidder agrees that if Bidder is awarded the Contract for the Project, within ten days following issuance of the Notice of Award to Bidder, Bidder will do all of the following: 4.1 Execute Contract. Enter into the Contract with City in accordance with the terms of this Bid Proposal, by signing and submitting to City the Contract prepared by City using the form included with the Contract Documents; 4.2 Submit Required Bonds. Submit to City a payment bond and a performance bond, each for 100% of the Contract Price, using the bond forms provided and in accordance with the requirements of the Contract Documents; and 4.3 Insurance Requirements. Submit to City the insurance certificate(s) and endorsement(s) as required by the Contract Documents. This Bid Proposal is hereby submitted on [Date] * 3/02/2022 s/ * James A. Piazza Name and Title James A. Piazza, owner s/ * n/a Name and Title n/a Page 3 of 7 03/02/2022 Company Name * Piazza Construction License #, Expiration Date, and Class 406456, 6/30/2023, A Address * PO Box 573, Penngrove, CA 94951 DIR Registration # 1000008021 City, State, Zip * Penngrove, CA, 94951 Phone * (707) 876-3410 Contact Name * James Piazza Contact Email piazzapc02@gmail.com END OF BID PROPOSAL BID SCHEDULE - DIRECTIONS 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 LF = Linear Foot CF = Cubic Feet LS = Lump Sum CY = Cubic Yard SF = Square Feet EA = Each TON = Ton (2000lbs) LB = Pounds BID SCHEDULE Page 4 of 7 03/02/2022 $99,650.00 Bid Item No. Item Description Est Qty. Unit Unit Cost Extension -1 Mobilization/Demobilization 1.00 LS $9,750.00 $9,750.00 2 Clearing and Grubbing 1.00 LS $5,400.00 $5,400.00 3 Bench Excavation 12.00 CY $590.00 $7,080.00 4 Soldier Pile Wall 250.00 SF $160.00 $40,000.00 5 Water Laterals 100.00 LF $57.00 $5,700.00 6 Compacted Fill (Import) 80.00 CY $200.00 $16,000.00 7 Erosion Control 1,200.00 SF $3.50 $4,200.00 8 Guard Rail System 45.00 LF $256.00 $11,520.00 Total: $99,650.00 SUBCONTRACTOR LIST - INSTRUCTIONS 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,[1] 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. [1] For street or highway construction this requirement applies to any subcontract of $10,000 or more. SUBCONTRACTOR LIST Description Subcontractor of Work Name Erosion control Nitta Erosion Control Tully Water pollution California Contractor Location of DIR Reg Percent of License Number Business No. Work 401640 Loomis, CA 1000000478 100 n/a Dixon, CA 1000024960 100 Page 5 of 7 03/02/2022 Description Subcontractor of Work Name Estimating control plan Group California Contractor Location of DIR Reg Percent of License Number Business No. Work NON -COLLUSION DECLARATION TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID The undersigned declares: I am the owner of: * Piazza Construction 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], * [city] * [state] 3/01/2022 Petaluma CA Page 6 of 7 03/02/2022 v I agree that my digital or electronic signature applies to this form Name * James A. Piazza Bid Security As a guarantee that, if awarded the Contract, Bidder will perform its obligations under Section 4 above, Bidder is enclosing bid security in the amount of ten percent of its maximum bid amount in one of the following forms (select one). Upload a scan of the paper bid security. Within ten calendar days following City's issuance of the Notice of Award to the apparent low bidder, the bidder must submit original hardcopies of the payment and performance bonds to City as specified in the Contract Documents using the bond forms included in the Contract Documents. Guarantee Method * Paper Bid Security, Cashier's Check, or Certified Check: Paper Bid Security, Cashier's Check, or Certified Check: Confirmation: * A bid security, using the Bid Security form included with the Contract Documents, payable to City and executed by a surety licensed to do business in the State of California. REQUIRED DOCUMENTS LIST Name Omission Terms Scan of Bond Forms Within 10 calendar days following City's issuance of the Notice of Potential Award to the apparent I am verifying my bid security electronically low bidder, the bidder must submit original hardcopies to the City. 1 Required Document Page 7 of 7 Submitted File Meyers Rd Slide Repair bid bond.pdf 03/02/2022 ACKNOWLEDGMENT A notary public or other officer completing this f certificate verifies only the identity of the individual who signed the document to which this certificate is f attached, and not the truthfulness, accuracy, or validity of that document. State of California County of. Sacramento } On February 28, 2022 before me, Kathleen Le, Notary Public (insert name and title of the officer) personally appeared Mary Collins who proved to me on the basis of satisfactory evidence to be the person(&) whose name(s) ist> subscribed to the within instrument and acknowledged to me that imp/she/tw executed the same in ibWher/tbeixauthorized capacity(ia3), and that by JaWherlftilr, signature(s) on the instrument the person(s), or the entity upon behalf of which the person(g) 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. I " KATHLEEN LE If WITNESS my hand and official seal. COMM, # 2380925 a ' p NOTARY PUBLIC CALIFORNIA COUNTY OF SACRAMENTO w Comm. Expires OCT 31, 2025 Signature (Seal) POWER OF ATTORNEY Bond # NIA HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh, North Carolina 27605 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint ELIZABETH COLLODI, JOSEPH H WEBER, JASON BRYAN MARCH, SARA WALLISER, STEPHANIE AGAPOFF, MARISSA ROBINSON, DEANNA QUINTERO, K. COREY WARD, SAMANTHA WATKINS, MARY COLLINS, RENEE RAMSEY, TONY CLARK, WILLIAM RAPP, JOHN HOPKINS, JENNIFER LAKMANN, CLAUDINE GORDON, KRISTIE PHILLIPS, MINDY WHITEHOUSE, JOHN J. WEBER, PHIL WATKINS, STEVEN L. WILLIAMS, MICHAEL FEENEY, MATT FOSTER Chico, CA their true and lawful attomey(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporatlan; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31st day of December, 2021 .....,,, ."''Pop "'P R�s X, SEAL O'; 1044 $ = �c�DEuf r l %(� STATE OF NEW JERSEY STATE OF ILLINOIS q�40�r9y County of Essex County of Cook 4 IO0 1884. o yIER�L� Kenneth Chapman Executive Vice President, Harco National Insurance Company and International Fidelity Insurance Company On this 31st day of December, 2021 , before me came the individual who executed the preceding Instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. ., IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, `•��,V A. Oar New Jersey the day and year first above written. dh..,L� a r•,,fily' j RS ,•` Shirelle A. Outley a Notary Public of New Jersey +�F , I I My Commission Expires April 4, 2023 CERTIFICATION I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Pmver of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on tile- In the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Pow, .,r of Attc)n-roy •hias not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto sett iffy hand on this day, February28, 2022 A00447 InterWest Insurance Services, Irene Martins, Assistant Secretary 20 Meyer Rd. Slide Repair City Project #: 11388-02 Exhibit B BONDFORMS Required for contracts over $25, 000. Approved by City Attomey, dated 02/27/2020 Up to $175,000 Contract Bond Forms Payment Bond City of San Rafael ("City") and ("Contractor") have entered into a contract, dated , 20_ ("Contract") for work on the ("Project"). The Contract is incorporated by reference into this Payment Bond ("Bond"). General. Under this Bond, Contractor as principal and its surety ("Surety"), are bound to City as obligee in an amount not less than $ , 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 Address: _ City/State/Zip: Phone: Fax. Email: 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. 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Payment Bond 7. Effective Date; Execution. This Bond is entered into and is effective on 20_. Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. SURETY. Business Name s/ Name/Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: Business Name s/ Name/Title s/ Name/Title APPROVED BY CITY: s/ Name/Title 20 Meyer Rd. Slide Repair City Project #: 11388-02 END OF PAYMENT BOND Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Payment Bond Performance Bond City of San Rafael ("City") and ("Contractor") have entered into a contract, dated , 20 ("Contract") for work on the ("Project"). The Contract is incorporated by reference into this Performance Bond ("Bond"). 1. General. Under this Bond, Contractor as Principal and , its surety ("Surety"), are bound to City as obligee for an amount not less than S 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. 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: 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Performance Bond Attn: Address: City/State/Zip: Phone: 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 20_ Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. SURETY Business Name s/ Name/Title [print] (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: Business Name s/ Name/Title s/ Name/Title APPROVED BY CITY: s/ Name/Title 20 Meyer Rd. Slide Repair City Project #: 11388-02 END OF PERFORMANCE BOND Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Performance Bond Bid Bond Piazza Construction ("Bidder') has submitted a bid, dated March 2 12022 ("Bid"), to the City of San Rafael ("City") for work on the 20 Meyer Rd. Slide Repair Project ("Project'). Under this duly executed bid bond ("Bid Bond"), Bidder as Principal and Hawn Nailonal Insurance Company . 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: 1, 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 Potential 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 Potential 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: Nancy L. Wallis Address: 702 Oberlin Road City/State/Zip: Raleigh- NC 27605.0800 Phone: 919-833-1600 Fax: N/A Email: Nancy. Wallisniatinsurance.com 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.] 20 Meyer Rd. Slide Repair 2021 Form BID BOND City Project No. 11388 Page 14 This Bid Bond is entered into and effective on February 28 , 2022 SURETY: Harco National Insurance Company Business Name s/ Marr Collins, Attorney -in -Fa_ ct Name, Title February 28, 2022. Date (Attach Acknowledgment with Notary Seal and Power of Attorney) BIDDER: ❑in77� rtnnelnirfinn i James A. Piazza, Owner Name, Title 3/01/2022 Date END OF BID BOND 20 Meyer Rd. Slide Repair 2021 Form BID BOND City Project No. 11388 Page 15 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 UNIT EXTENDED NO. ITEM DESCRIPTION EST. QTY. UNIT COST 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. 20 Meyer Rd. Slide Repair Up to $175,000 Contract City Project #: 11388-02 Bid Schedule Approved by City Attorney, dated 2/27/2020 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 20 Meyer Rd. Slide Repair City Project* 11388-02 END OF BID SCHEDULE 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. DESCRIPTION SUBCONTRACTOR CALIFORNIA LOCATION OF DIR REG. NO. PERCENT OF WORK NAME CONTRACTOR BUSINESS OF LICENSE NO. WORK END OF SUBCONTRACTOR LIST 1 For street or highway construction this requirement applies to any subcontract of $10,000 or more. 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 2/27/2020 Up to $175,000 Contract Subcontractor List Bond No. 0806620 Executed in Triplicate Premium: $1,090.00 Performance Bond Premium is for contract term and is subject to adjustments based on final contract price. City of San Rafael ("City") and Piazza Construction ("Contractor") have entered into a contract, dated , 20 ("Contract") for work on the 20 Meyer Rd. Slide Repair ("Project"). The Contract is incorporated by reference into this Performance Bond ("Bond"). 1. General. Under this Bond, Contractor as Principal and Harco National Insurance Company , its surety ("Surety"), are bound to City as obligee for an amount not less than $ 99.650.00* 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. 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: *Ninety Nine Thousand Six Hundred Fifty and 00/100 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Performance Bond Attn: _Nancy L. Wallis Address: 4200 Six Forks Road City/State/Zip: Raleigh, North Carolina 57609 Phone: 919-833-1600 Fax: N/A Email: Nancy.Wailis@iabnsurance.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 April 29 20 22 . Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. SUR , Marco Natigra insurance Company /h Business VaA6 _ s/ Claudine Gordon, Attomey-in-Fact Narne/Title [print] (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: Pizza Construction Bu iness Name 1 ,_' R OWV04L Name/Title s/ Name/Title APPROVED BY CITY' s/ L.�yName/Title 20 Meyer Rd. Slide Repair City Project #: 11388-02 END OF PERFORMANCE BOND Approved by City Attorney, dated 02/27/2020 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 Sonoma On 41g:� before me, Kristie Lyn Phillips, Notary Public (insert name and title of the officer) personally appeared Claudine Gordon who proved to me on the basis of satisfactory evidence to be the person(&) whose name(s) is/MW subscribed to the within instrument and acknowledged to me that he/she/executed the same in )bWher/theiKauthorized capacity**, and that by JSsiher/ft*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) KRISTIE LYN PHILLIPS m P COMM. # 2242973 D Z NOTARY PUBLIC CALIFORNIA 0) COUNTY OF SONOMA w �- Comm. Expires MAY 18, 2022 p ii kF'1 19 POWER OF ATTORNEY Bond # 0806620 HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 4200 Six Forks Rd, Suite 1400, Raleigh, NC 27609 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint ELIZABETH COLLODI, JOSEPH H WEBER, JASON MARCH, SARA WALLISER, BREANNA BOATRIGHT, MARISSA ROBINSON, DEANNA QUINTERO, K COREY WARD, SAMANTHA WATKINS, MARY COLLINS, KATHLEEN LE, RENEE RAMSEY, TONY CLARK, BILL RAPP, JOHN HOPKINS, JENNIFER LAKMANN, CLAUDINE GORDON, KRISTIE PHILLIPS, MINDY WHITEHOUSE, JOHN J WEBER, PHIL WATKINS, STEVEN L. WILLIAMS. MICHAEL FEENEY, MATT FOSTER Chico, CA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31st day of December, 2021 '•�•tHSfjA'' �\/ STATE OF NEW JERSEY STATE OF ILLINOIS O�*p p40A �• ,' z vp�9F�� O County of Essex County of Cook - �; GSEAL SEAL 1904 Q V. Ilk Kenneth Chapman Hj " �`� Executive Vice President, Harco National Insurance Company •• •''' •• and International Fidelity Insurance Company On this 31st day of December, 2021 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, A •0Uj:: New Jersey the day and year first above written. SER Shirelle A. Outley a Notary Public of New Jersey � My Commission Expires April 4, 2023 CERTIFICATION I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, April 29, 2022 A00447 InterWest Insurance Services, a-, e 41 ;_,:� Irono RA— inc AcciQfnnt Cor•rotnni Bond No. 0806620 Executed in Triplicate Premium is included in the performance bond subject to Payment Bond adjustments based on final contract price. City of San Rafael ("City") and Piazza Construction ("Contractor") have entered into a contract, dated , 20_ ("Contract") for work on the 20 Meyer Rd. Slide Repair ("Project"). The Contract is incorporated by reference into this Payment Bond ("Bond") General. Under this Bond, Contractor as principal and Haroo National Insurance Company its surety ("Surety"), are bound to City as obligee in an amount not less than $ 99.650.00* under California Civil Code sections 9550, et seq 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. 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: Nancy L. Wallis Address: 4200 Six Forks Road City/State/Zip: Raleigh, North Carolina 57609 Phone: 919-833-1600 Fax: N/A Email: Nancy.Wallis@iabnsurance.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. *Ninety Nine Thousand Six Hundred Fifty and 00/100 20 Meyer Rd. Slide Repair City Project #: 11388-02 Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Payment Bond 7. Effective Date; Execution. This Bond is entered into and is effective on AP6129 2022. Three identical counterparts of this Bond, each of which is deemed an original for all purposes, are hereby executed and submitted. Sl s/ Claudine Gordon, Attomey-in-Fact Name/Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: I Piazza Construction ,$usiness Na d s/ Name/Title s/ Name/Title APPROVED BY CITY: s/ 5Z2 A-. C761d Name/Title 20 Meyer Rd. Slide Repair City Project #: 11388-02 END OF PAYMENT BOND Approved by City Attorney, dated 02/27/2020 Up to $175,000 Contract Payment Bond ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of Sonoma On Vcl� Z before me, Kristie Lyn Phillips, Notary Public (insert name and title of the officer) personally appeared Claudine Gordon who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/;W subscribed to the within instrument and acknowledged to me that IIS/she/texecuted the same in Asher/i:beiKauthorized capacity(*, and that by kdsiher/*eW signature(s) on the instrument the person(s), or the entity upon behalf of which the person(.$) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) KRISTIE LYN PHILLIPS c"n COMM. # 2242973 D Q = NOTARY PUBLIC CALIFORNIA C COUNTY OF SONOMA w Comm. Expires MAY 18, 2022 if POWER OF ATTORNEY Bond# 0806620 HARCO NATIONAL INSURANCE COMPANY INTERNATIONAL FIDELITY INSURANCE COMPANY Member companies of IAT Insurance Group, Headquartered: 4200 Six Forks Rd, Suite 1400, Raleigh, NC 27609 KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and appoint ELIZABETH COLLODI, JOSEPH H. WEBER, JASON MARCH, SARA WALLISER, BREANNA BOATRIGHT, MARISSA ROBINSON, DEANNA QUINTERO, K. COREY WARD, SAMANTHA WATKINS, MARY COLLINS, KATHLEEN LE, RENEE RAMSEY, TONY CLARK, BILL RAPP, JOHN HOPKINS, JENNIFER LAKMANN, CLAUDINE GORDON, KRISTIE PHILLIPS, MINDY WHITEHOUSE, JOHN J. WEBER, PHIL WATKINS, STEVEN L. WILLIAMS, MICHAEL FEENEY, MATT FOSTER Chico, CA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018. "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY have each executed and attested these presents on this 31 st day of December, 2021 F SEAL \L)`'— 's6: STATE OF NEW JERSEY STATE OF ILLINOIS r 0R4��!s County of Essex County of Cook SEAL 1904 o lfaR� Kenneth Chapman` ~ �7 * �`� Executive Vice President, Harco National Insurance Company and International Fidelity Insurance Company On this 31 st day of December, 2021 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies •'�' `� � 0'r"IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, 4fi�L A New Jersey the day and year first above written. s Ook d �� S00799tir� FAY JERK', Shirelle A.Outley a Notary Public of New Jersey CERTIFICATION My Commission Expires April 4, 2023 I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, April 29, 2022 A00447 InterWest Insurance Services, bona RAmrHnm Accic4�nt Ccrrot�n, �1 .�eo�co0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/2/2022 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 N'A", Claudine Gordon InterWest Insurance Serv., LLC PHONE 707-657-4499 FAX Nq; 707-239 7874 3645 Westwind Blvd., Suite A LALC Santa Rosa CA 95403 ADDRESS: cgordon@wins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED Piazza Construction P.O. Box 573 Penngrove CA 94951 e # B01094 PIAZZA INSURERA: Travelers Indemnity Co of CT 25682 INSURER B: Travelers Property & Casualty Co of America 25674 INSURER C: Homeland Ins Co of NY 34452 INSURER D: Everest Premier Insurance Company 16045 INSURER E.; INSURER F: X COMMERCIALGENERAL LIABILITY COVERAGES CERTIFICATE Nl1MRER- 1n3453Rd91 RFVI31r]N NIIMRFR- 4/1/2022 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDQSU R POLICY NUMBER POLICY EFF IMEDPayyyJ POLICY EXP IMWDWYYY)LIMITS A X COMMERCIALGENERAL LIABILITY Y Y DT22CO7B313458TCT22 4/1/2022 4/1/2023 EACH OCCURRENCE $1,000,000 PREMISES fEa occurrence $ 300,000 CLAIMS -MADE ii OCCUR MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY U JEST 7 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY Y Y BA7N0255392026G 10/15/2021 10/1/2022 COMBlNEDSINGLE LIMIT $1,000,000 Ea d nt X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ JPden IAUTOS XI HIRED X NON -OWNED ONLY AUTOS ONLY B UMBRELLALIAB X OCCUR Y Y CUP8K7056852226 4/1/2022 4/1/2023 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS MADE DED I X RETENTION $ 1n $ D WORKERS COMPENSATIONY AND EMPLOYERS'LIABILITY YIN 7600019584211 10/1/2021 10/1/2022 X T PATUTE EOR E.L EACH ACCIDENT $ 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED9 N/A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 C Contractors Pollution Liab 7930047150006 4/1/2022 4/1/2023 Each Poll Condition $3,000,000 Aggregate Limit $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Liability Policy CUP81<7056852226 extends over the GL, AL and EL Policies and is following form and provides additional insured, Primary & Non -Contributory wording and Waiver of Subrogation per underlying coverages Re: City Project #11388-02, City's 20 Meyer Rd. Slide Repair. City of San Rafael, including its Council, officials, officers, employees, agents, volunteers and consultants. CERTIFICATE HOLDER CANCELLATION 30 City of San Rafael Public Works Departments 111 Morphew Avenue San Rafael CA 94901 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT DRlZED REPRESEN TIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: DT22CO7B313458TCT22 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership, joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION II — WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDMONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORQATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury' or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II —Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury', "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury' or "property damage" included in the "products -completed operations hazard". CG D316 0219 © 2017 The Travelers Indemnity Company All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number: DT22CO7B313458TCT22 COMMERCIAL GENERAL LIABILITY C.I NCIDENTAL MEDICAL MALPRACTICE 1.T he following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technidan or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINMONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. E. CONTRACTUAL LIABILITY— RAILROADS 1. The following replaces Paragraph C. of the definition of "insured contract" in the DEFINMONS Section: c. Any easement or license agreement; Page 2 of 3 © 2017 The Travelers Indemnity Company All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission 2. Paragraph f.(1) of the definition of "insured contract' in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: Policy Number: DT22CO7B313458TCT22 COMMERCIAL GENERAL LIABILITY a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D316 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc , with its permission POLICY NUMBER: DT22-CO-7B313458-TCT-22 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 04-1-2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED IN A GENERAL AGGREGATE WRITTEN CONTRACT THAT IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS. GENERAL AGGREGATE L=T, PROVIDED THAT THE CONTRACT IS SIGNED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION Q, and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A., except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or C. Persons or organizations malting claims or bringing "suits". 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION Q, and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D2 1101 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit. C. Part 2. of SECTION III — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Damages under Coverage B; and b. Damages from 'occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 0104 Policy Number: DT22CO7B313458TCT22 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury" or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 04 19 © 2018 The Travelers Indemnity Company All rights reserved Page 1 of 2 Policy Number: DT22CO7B313458TCT22 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. Page 2 of 2 © 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 tSHf NUZOOJ:JLUZOU COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2. The following is added to Paragraph B.S., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part S. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is a named insured when a written contract or agreement with you, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non- contributory. CA T4 99 02 16 G 2016 The Travelers Indemnity Company All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission BA7N0255392026G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is hot covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is 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 busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission, COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or 'loss" ap- plies only when the "accident" or 'loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How - N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2021 Insured: Policy No. 7600019584211 Endorsement No. 001 Piazza, James dba: Piazza Construction Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. RAP 5- y0 1 T H 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: Piazza Construction Contractor's Contact: James Piazza Contact's Email: piazzapc02@gmaii.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 3/16/2022 Attorney c/o Laraine.Gittens@cityofsanrafael.org ©AD 2 City Attorney [aTRReview, revise, and comment on draft agreement 4/25/2022 0 L and return to Project Manager 4/25/2022 © 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 Click or tap ❑X BG contractor to enter a Project Manager Forward three (3) originals of final agreement to date. 4 4/27/2022 contractor for their signature Project Manager When necessary, contractor -signed agreement 5 ® 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 5/6/2022 AD Attorney with printed copy of this routing form 7 City Attorney Review and approve hard copy of signed S�/120 agreement 8 City Attorney Review and approve insurance in PINS , and bonds jell� d IA Arm (for Public Works Contracts) City Manager/ Mayor Agreement executed by City Council authorized 9 City Clerk official Attest signatures, retains original agreement and 10 forwards copies to Project Manager 6 do A