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HomeMy WebLinkAboutPW Use of City-Owned Parcel for Construction Operationsr1 RAF September 7, 2021 a z W[TH r' Miksis Services, Inc. Attn: Gary Miksis PO Box 591-1 Healdsburg, CA 95448 RE: Agreement for Use of City-Owned Parcel, APN 009-280-11, for Construction Operations Dear Mr. Miksis: The City of San Rafael (City) offers Miksis Services, Inc. (Miksis), at no charge, temporary use of a portion of its City -Owned parcel, APN 009-280-11 on Windward Way, San Rafael (Parcel). The specific location for Miksis's use on the site will be determined jointly by the Operations and Maintenance Manager of DPW and representatives of Miksis. Use of the Parcel shall comprise construction materials staging and equipment storage for the duration of the Francisco Blvd East Sidewalk Widening Project. The project duration is expected to be from September 9, 2021 to October 15, 2021. The term of this agreement will commence upon execution of this agreement by all parties, and will terminate on October 16, 2021; however, the parties may agree in writing to an extension of the term. While using the Parcel, Miksis agrees to release, indemnify, and hold harmless the City and its officers, officials, employees, agents, and volunteers from any liabilities for injuries to persons or damages to or loss of property caused by or arising out of Miksis's use of the Parcel, except such liability caused by the sole negligence or willful misconduct of the City and/or their officers, officials employees, agents and volunteers. The City maintains full rights to terminate this , Agreement at any time with or without cause. Additionally, the City reserves the right to continue use of the Parcel for its own purposes for the duration of this Agreement. During the term of this agreement and any extension thereof, Miksis will maintain the following insurance, at no cost to the City of San Rafael: 1) a general commercial liability insurance policy in the minimum amount of one million dollars 01,000,0007 peroccurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage; 2) an automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) dollars, per occurrence; and 3) if it employs any person, a worker's compensation insurance, as required by the State of California, with statutory limits, and employer's liability insurance with limits of no Kate Colin, Mayor • Maribetn Bushey, Vice Mayor • Rachel Kert, Councilmember • Maike Llorens Gulati. Councilmember • Eli Hill, Councilmember less than one million dollars$1,000 Opo ( )per accident for bodily injury or disease, specifically endorsed to waive any right of subrogation against the City. Except for worker's compensation insurance, the insurance policies shall be specifically endorsed to include the City, its officers, officials, agents, employees, and volunteers, as additional insureds under the policies, on a primary and noncontributory basis. By execution of this agreement, Miksis hereby grants to the City a waiver of any right to subrogation which any insurer Miksis may acquire against the City by virtue of the payment of any loss under such insurance. Miksis agrees to obtain any endorsement that may be necessary to effect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. Miksis will provide City with proof of the required insurance prior to the effective date of this agreement. Miksis further agrees to keep all stored material and equipment neatly organized so as not to interfere with City staff or other City Contractors concurrently using the Parcel. Additionally, Miksis agrees to not create undue noise or extended idling of motorized equipment so as to be a nuisance to neighboring properties. This includes not accessing the site before lam or after Spm. There will be no fueling of any kind within the lot or adjacent street. The City will provide Miksis with a lock to the main gate. Miksis agrees to keep all gates locked at all times when personnel are not present. Signature of both City and Miksis's authorized agents below hereby certifies mutual agreement of the aforesaid conditions. � 9/7/2021 Bill Gud Gary , ruDiic works Director Miksi��Serviic;� ,c. Authorized Agent Date 1-7--6�l Date Kate Colin. Mayor • Maribeth Bushey. Vice Mayor • Rachel Kertz, Councilmember - Maika Llorens Gulati. Councilmember • Eli Hill, councilmember .4C�RD� CERTIFICATE OF LIABILITY INSURANCE PRODUCER 61=202 A. E SCHIEFFER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION . & SON INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. P.O. BOX 515 THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HEALDSBURG CA 95448- INSURERS AFFORDING COVERAGE INSURED MIKSIS SERVICES INC_ INSURER A ADMIRAL INSURANCE COMPAI3Y DBA: RAPID ROOTER INSUR✓=RS:BURLINGTON INSURANCE COMPANY P.O. Sox 591 I INc: STATE COMPENSATxQN INSURANCE FUND HealCisbu� CA 95448- INSURERD TOKIO MARINE SPECIALTY INS CO COVERAGES INE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER THE INSURANCE TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY DOCUMENT WITH RESPECT TO WHICH AFFORDED BY THE POLICIES DESCRIBED HEREIN AGGREGATE THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION A GENERAL LIAMUTY DATE MMfDD1YY DATE MMIDOfYY LIMITS }{ COMMERCIAL GENERAL LIABILITY FACOCCURRENCE S 1, 000, 00C CLAIMS MADE X OCCUR CA000014196-13 FIRE DAMAGE (Any one fire) 5 50, 0 0 0 06/10/2021 06/10/2022 X XCU MEDEXP{An onepersort 5 5 OOC r X $2500 DEDUCTIBLE PERSONAL &ADV INJURY S 1,000,00C GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,OOC POLICY X J P>;CT RO• LOC PRODUCTS - CGMPIOPAGG S 2,000,00c / / / / AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS (Ea accident) S / / / / SCHEDULED AUTOS BODILY INJURY DEN HIRED AUTOS (Per person) $ / / / / NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE GARAGE LIABILITY (Per accident) S ANY AUTO AUTO ONLY - EA ACCIDENT $ / / / / OTHER THAN EA ACC S B EXCESS LIABILITY 36313EO2680-01 AUTO ONLY: AGG $ 06/10/2021 06/10/2022 X OCCUR F-1CLAIMSMADE EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE Per project agg. $ 10, 000, 000 / / X RETENTION S 0 / / $ C 1Npfi1�ERS COMPENSATION AND 9085197-21 EMPLOYERS'LIABt4irr $ 01/01/2021 01/01/2022 X OTH- TORvuAnnTrs ER El FACHACCIDENT $ 1,000,000 E, L. DISEASE - EA EMPLOYEE S 1,000,000 OTHER E. I. DIS EASE - POLICY LIMIT S 1,000,000 D POLLUTION LIABILITY T210E10265-00 03/02/2021 03/02/2022 POLLUTION LIAB 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS DEDUCTIBLE 2,500 THE CITY OF SAN RAFAEL, NUTE ENGINEERING OF SAN RAFAEL AND THE LAS GALLINAS VALLEY SANITARY DISTRICT, THEIR ELECTIVE AND APPOINTIVE BOARDS, COMMISSIONS, OFFICERS, AGENTS AND EMPLOYEES ARE NAMED AS FORMS. ADDITIONAL INSURED AS PER ATTACHED CERTIFICATE HOLDER X ADD1730NAL INSURED; INSURER LETTER; CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF SAN RAPPEL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 1400 5TH AVE FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS QR REPRESENTATIVES_ SAN RAFAEL CA 94901 - RUTH REO S£NTAT CORD 25-S (7197) INS025S (991o).o1 © ACORD CORPORATION 1988 ELECTRONIC LASER FORMS, INC - (800)327-0545 Page 1 of 2 Policy Number: CA000014196-13 CG 20 10 04 13 Effective Date: 06/10/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART C(`urnirr c A. Section 11— Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in pan, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that whichyou are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: L All work, including materials, parts or equipment furnished in connection wi[h such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 13 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations For a principal as a Part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: L Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CC 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 ❑ Policy Number: CA000014196-13 CG 20 37 04 13 Effective Date: 06/10/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE RE" IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPE"riONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or ,:nixatiott(s) Any person or organization that is an owner or manager of real property or personal property for whom you work or have worked, or a contractor on whose behalf you work or have worked, but only if coverage as an additional insured extending to "bodily injury" or "property damage" included in the "products -completed operations hazard" is required by a written contract or written agreement that is an "insured contract" and provided that the "bodily injury" or "property damage" first occurs subsequent to the execution of the contract or aereement. Location And Description Of completed Operations All locations except locations where "your work" is or was related to a job or project involving single-family dwellings, multi -family dwellings (other than rental apartments in an apartment building: (a) originally constructed and at all times used for such purpose, or (b) converted from a commercial building), condominiums, townhomes, townhouses, time- share units, fractional -ownership units, cooperatives and/or any other structure or space used or intended to be used as a residence. Information r uiI to com [etc this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 -- Who Is An insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "Your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations liazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available tinder the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 13 POlicy #CAO0014196-13 Effective 6/10/2421 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the contra agreement that this insurance would be rY primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: CA000014196-13 CG 24 04 05 09 Effective Date: 6-10-2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization, but only if the following conditions are met; a. You have expressly agreed to the waiver in a written contract entered into by you; and b. The injury or damage occurs subsequent to the execution of the written contract. Infonnation re uired to coil, lcte this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we :hake for injury or dwnage aris- ing out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of I ❑ ENDORSEMENT AGREEMENT STATE WAIVER OF SUBROGATION FUND 1 BLANI{E T BAST S HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 1, 2021 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING JANUARY 1, 2022 AT 12-01 A.M. AT 1201 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME MIKSIS SERVICES, INC. PO BOX 5912 HEALDSBURG, CA 95448 WE HAVE THE RIGFifi TO LIABLE RECOVER OUR PAYMENTS FROM ANYONE FOR AN INJURY COVERED BY THIS POLICY. NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR WE WILL ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK TJNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGRERMNT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL, BE 2.005 OF THE TOTAL, POLICY PPEMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED ETAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB RnSC'RTpT=ON BLANKET WAIVER OF SUBROGATION REP B5 9085197-21 RENEWAL NA 1-77-81-62 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALT. BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: DECEMBER 23, 2820 4 E: .^.�/ LNZC�L� AUTHORIZED REpREsI }�T !VE SCIF FORM 10217 (REV,¢ -20181 PRESIDENT AND CEO 2572 OLD OP 217 1 RAP s 'rY V/ IT 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: Iman Kayani for AM Extension: 3352 Contractor Name: Miksis Services, Inc. Contractor's Contact: Gary Miksis Contact's Email: Click here to enter text ❑ 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 9/13/2021 Attorney c/o Laraine.Gittens@cityofsanrafael.org DIKK 2 City Attorney a. Review, revise, and comment on draft agreement Click here to and return to Project Manager enter a date. ❑ b. Confirm insurance requirements, create Job on Click here to PINS, send PINS insurance notice to contractor enter a date. ❑ 3 Department Director Approval of final agreement form to send to Click or tap ❑ contractor to enter a date. 4 Project Manager Forward three (3) originals of final agreement to Click here to ❑ contractor for their signature enter a date. 5 Project Manager When necessary, contractor -signed agreement ❑ N/A agendized for City Council approval * *City Council approval required for Professional Services Agreements and purchases of goods and services that exceed Or $75,000; and for Public Works Contracts that exceed $175,000 Click here to Date of City Council approval enter a date. PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form p J,2; /ZDZI 7 City Attorney Review and approve hard copy of signed agreement 7/ / 8 City Attorney Review and approve insurance in PIN , and Fonds f (for Public Works Contracts)�� 9 City Manager/ Mayor Agreement executed by City Council authorized City Clerk official 10 Attest signatures, retains original agreement and forwards copies to Project Manager