HomeMy WebLinkAboutPW Grand and Linden CMP Replacement ProjectCITY OF SAN RAFAEL
Department of Public Works
111 Morphew Street
San Rafael, CA 94901
Public Works Contract for Projects up to $200,000
This public works contract ("Contract") is entered into by and between the City of San Rafael ("City") and
Ghilotti Construction Company, Inc. ("Contractor"), a Co poration, for work on the City's Grand and Linden
CMP Replacement ("Project"), and is effective on 2�2Effective Date").
The parties agree as follows:
1. Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies,
transportation, and any and all other items or services necessary to perform and complete the work
required for the Project ("Work"), as specified in Exhibit A, Scope of Work, and according to the terms
and conditions of this Contract, including all attachments to the Contract and any other documents and
statutes incorporated by reference. To the extent that any attachment contains provisions that conflict or
are inconsistent with the terms set forth in the body of this Contract, the Contract terms will control. This
Project requires a valid California contractor's license for the following classification(s): 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 $39,530 (the "Contract Price") for all of Contractor's direct and indirect costs to
perform the Work, including all labor, materials, supplies, equipment, taxes, insurance, bonds and all
overhead costs, in accordance with the payment provisions contained herein.
3.1 Payment. Contractor must submit an invoice on the first day of each month during the
Contract Time, defined in Section 4 below, and/or upon completion, for the Work performed during the
preceding month, itemizing labor, materials, equipment and any incidental costs incurred. Contractor
warrants that title to all work, materials and equipment incorporated into the Work will pass to City free of
any claims, liens, or encumbrances upon payment to Contractor.
3.2 Payment and Performance Bonds. If the Contract Price is over $25,000, then Contractor
must provide City with a payment bond and a performance bond using the bond forms included in this
Contract as Exhibit B, Bond Forms, and submit the bonds with the executed Contract. Each bond must
be issued by a surety admitted in California. If an issuing surety cancels a bond or becomes insolvent,
Contractor must provide a substitute bond from a surety acceptable to City within seven days after written
notice from City. If Contractor fails to substitute an acceptable surety within the specified time, City may,
in its sole discretion and without prior notice to Contractor, purchase such bond(s) at Contractor's
expense and deduct the cost from payments otherwise due to Contractor, or terminate the Contract.
Grand and Linden CMP Replacement Up to $200,000 Contract
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Approved by City Attorney, dated 03/28/2022
4. Time for Completion. Contractor will fully complete the Work within 6 months from the date the
City authorizes Contractor to proceed with the Work ("Contract Time").
5. Liquidated Damages. If Contractor fails to complete the Work within the Contract Time,
Contractor must pay liquidated damages in the amount of $500 per day for each day of unexcused delay
in completion.
6. Standard of Care. All Work must be provided in a manner that meets or exceeds the standard of
care applicable to the same type of work in the City of San Rafael. Contractor must promptly correct, at
Contractor's sole expense, any Work that the City determines is deficient or defective.
7. Permits and Licenses. Contractor, at its sole expense, must obtain and maintain during the
term of this Contract, all appropriate permits, certificates and licenses including, but not limited to, the
required California contractor's license and a City business license.
8. Indemnification. Contractor will indemnify, defend with counsel acceptable to City, and hold
harmless to the full extent permitted by law, City, its governing body, officers, agents, employees, and
volunteers (the "Indemnitees") from and against any and all liability, demands, loss, damage, claims,
settlements, expenses, and costs (including, without limitation, attorney fees, expert witness fees, and
costs and fees of litigation) (collectively, "Liability") of every nature arising out of or in connection with the
acts or omissions of Contractor, its employees, subcontractors, representatives, or agents in performing
the Work of failing to comply with any obligation of Contractor under this Contract, except such Liability
caused by the active negligence, sole negligence, or willful misconduct of an Indemnitee. This
indemnification obligation is not limited by any limitation on the amount or type of damages or
compensation payable under Workers' Compensation or other employee benefit acts, or by insurance
coverage limits, and will survive the expiration or early termination of this Contract. City will notify
Contractor of any third -party claim pursuant to Public Contract Code section 9201.
9. Insurance. Contractor will, at all times under this Contract, maintain the insurance coverage
required in this section to cover the activities of Contractor and any subcontractors relating to or arising
from performance of the Work. Each policy must be issued by a company licensed to do business in
California, and with a strength and size rating from A.M. Best Company of A-VIII or better. Contractor
must provide City with certificates of insurance and required endorsements as evidence of coverage with
the executed Contract, or through the PINSAdvantage website https://www.pinsadvantage.com/ upon
request by the City, and before the City authorizes Contractor to proceed with the Work.
9.1 Workers' Compensation. Statutory coverage is required by the California Workers'
Compensation Insurance and Safety Act. If Contractor is self -insured, it must provide its duly authorized
Certificate of Permission to Self -Insure. In addition, Contractor must provide employer's liability insurance
with limits of no less than one million dollars ($1,000,000) per accident for bodily injury or disease.
9.2 Liability. Commercial General Liability ("CGL") insurance issued on an occurrence basis,
including coverage for liability arising from Contractor's or its subcontractor's acts or omissions in
performing the Work, including Contractor's protected coverage, blanket contractual, products and
completed operations, broad form property damage, vehicular coverage, and employer's non -ownership
liability coverage, with limits of at least $1,000,000 per occurrence and $2,000,000 general aggregate.
9.3 Automotive. Commercial automotive liability coverage for owned, non -owned and hired
vehicles must provide coverage of at least $1,000,000 combined single limit per accident for bodily injury,
death, or property damage.
9.4 Subrogation Waiver. Each required policy must include an endorsement that the insurer
waives any right of subrogation it may have against the City or the City's insurers.
Grand and Linden CMP Replacement Up to $200,000 Contract
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Approved by City Attorney, dated 03/28/2022
9.5 Required Endorsements. The CGL policy and the automotive liability policy must include
the following specific endorsements:
(1) The City, including its Council, officials, officers, employees, agents, volunteers and
consultants (collectively, "Additional Insured") must be named as an additional insured for all
liability arising out of the operations by or on behalf of the named insured, and the policy
must protect the Additional Insured against any and all liability for personal injury, death or
property damage or destruction arising directly or indirectly in the performance of the
Contract.
(2) The inclusion of more than one insured will not operate to impair the rights of one
insured against another, and the coverages afforded will apply as though separate policies
have been issued to each insured.
(3) The insurance provided is primary and no insurance held or owned by City may be
called upon to contribute to a loss ("primary and non-contributory").
(4) Any umbrella or excess insurance must contain or be endorsed to contain a provision
that such coverage will also apply on a primary or non-contributory basis for the benefit of
City before the City's own insurance or self-insurance will be called upon to protect it as a
named insured.
(5) This policy does not exclude explosion, collapse, underground excavation hazard, or
removal of lateral support.
10. Labor Code Compliance. Unless the Contract Price is $1,000 or less, the Contract is subject to
all applicable requirements of Chapter 1 of Part 7 of Division 2 of the Labor Code, beginning at section
1720, and the related regulations, including but not limited to requirements pertaining to wages, working
hours and workers' compensation insurance. Contractor must also post all job site notices required by
laws or regulations pursuant to Labor Code section 1771.4.
10.1 Prevailing Wages. Each worker performing Work under this Contract that is covered under
Labor Code section 1720 or 1720.9, must be paid at a rate not less than the prevailing wage as defined in
sections 1771 and 1774 of the Labor Code. The prevailing wage rates are on file with the City Engineer's
office and are available online at http://www.dir.ca.gov/DLSR. Pursuant to Labor Code section 1775,
Contractor and any subcontractor will forfeit to City as a penalty up to $200 for each calendar day, or
portion of a day, for each worker paid less than the applicable prevailing wage rate, in addition to paying
each worker the difference between the applicable wage rate and the amount actually paid.
10.2 Working Day. Pursuant to Labor Code section 1810, eight hours of labor consists of a
legal day's work. Pursuant to Labor Code section 1813, Contractor will forfeit to City as a penalty the sum
of $25 for each day during which a worker employed by Contractor or any subcontractor is required or
permitted to work more than eight hours during any one calendar day, or more than 40 hours per
calendar week, unless such workers are paid overtime wages under Labor Code section 1815. All Work
must be carried out during regular City working days and hours unless otherwise specified in Exhibit A or
authorized in writing by City.
10.3 Payroll Records. Contractor and its subcontractors must maintain certified payroll records
in compliance with Labor Code sections 1776 and 1812, and all implementing regulations promulgated by
the Department of Industrial Relations ("DIR"). For each payroll record, Contractor and its subcontractors
must certify under penalty of perjury that the information in the record is true and correct, and that it has
complied with the requirements of Labor Code sections 1771, 1811, and 1815. Unless the Contract Price
Grand and Linden CMP Replacement Up to $200,000 Contract
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Approved by City Attorney, dated 03/28/2022
is under $25,000, Contractor must electronically submit certified payroll records to the Labor
Commissioner as required under California law and regulations.
10.4 Apprentices. If the Contract Price is $30,000 or more, Contractor must comply with the
apprenticeship requirements in Labor Code section 1777.5.
10.5 DIR Monitoring, Enforcement, and Registration. This Project is subject to compliance
monitoring and enforcement by the DIR pursuant to Labor Code section 1725.5, and, subject to the
exception set forth below, Contractor and any subcontractors must be registered with the DIR to perform
public works projects. The registration requirements of Labor Code section 1725.5 do not apply if the
Contract Price is for under $25,000.
11. Workers' Compensation Certification. Under Labor Code section 1861, by signing this
Contract, Contractor certifies as follows: "I am aware of the provisions of Labor Code section 3700 which
require every employer to be insured against liability for workers' compensation or to undertake self-
insurance in accordance with the provisions of that code, and I will comply with such provisions before
commencing the performance of the Work on this Contract."
12. Termination.
12.1 Termination for Convenience. City reserves the right to terminate all or part of the
Contract for convenience upon written notice to Contractor. Upon receipt of such notice, Contractor must:
immediately stop the Work, including under any terms or conditions that may be specified in the notice;
comply with City's instructions to protect the completed Work and materials; and use its best efforts to
minimize further costs. In the event of City's termination for convenience, Contractor waives any claim for
damages, including for loss of anticipated profits from the Project. If City terminates the Contract for
convenience, City will only owe Contractor payment for the Work satisfactorily performed before Contract
termination, as well as five percent of the total value of the Work performed as of the date of notice of
termination or five percent of the value of the Work yet to be completed, whichever is less, which is
deemed to cover all overhead and profit to date.
12.2 Termination for Default. The City may terminate this Contract for cause for any material
default. Contractor may be deemed in default for a material breach of or inability to perform the Contract,
including Contractor's refusal or failure to supply sufficient skilled workers, proper materials, or equipment
to perform the Work within the Contract Time; refusal or failure to make prompt payment to its employees,
subcontractors, or suppliers or to correct rejected work; disregard of laws, regulations, ordinances, rules,
or orders of any public agency with jurisdiction over the Project; lack of financial capacity to complete the
Work within the Contract Time; or responsibility for any other material breach of the Contract
requirements. If City terminates the Contract for cause, City will only owe Contractor payment for the
Work satisfactorily performed before Contract termination.
13. Dispute Resolution. Any dispute arising under or related to this Contract is subject to the
dispute resolution procedures of Public Contract Code sections 9401 and 20104 et. seq., which are
incorporated by reference.
14. Waiver. A waiver by City of any breach of any term, covenant, or condition in this Contract will
not be deemed a waiver of any subsequent breach of the same or any other term, covenant, or condition
contained herein, regardless of the character of any such breach.
15. Warranty. Contractor guarantees and warrants the Work and the materials used or provided for
the Project for a period of one year, beginning upon City's acceptance of the Work for the Project as
complete ("Warranty Period"). During the Warranty Period, upon notice from the City of any defect in the
Work or the materials, Contractor must, at its sole expense, promptly repair or replace the defective Work
Grand and Linden CMP Replacement Up to $200,000 Contract
Page 4
Approved by City Attorney, dated 03/28/2022
or materials, including repair or replacement of any other Work or materials that is or are displaced or
damaged during the warranty work, excepting any damage resulting from ordinary wear and tear.
16. Worksite Conditions.
16.1 Clean and Safe. Contractor must maintain the Work site and staging and storage areas in
a clean and neat condition and must ensure it is safe and secure. On a daily basis the Contractor must
remove and properly dispose of debris and waste materials from the Work site.
16.2 Inspection. Contractor will make the Work accessible at all times for inspection by the City
16.3 Hazardous Materials. Unless otherwise specified in the Contract documents, this Contract
does not include the removal, handling, or disturbance of any asbestos or other hazardous materials, as
identified by any federal, state, or local law or regulation. If Contractor encounters materials on the
Project site that Contractor reasonably believes to be asbestos or other hazardous materials, and the
asbestos or other hazardous materials have not been rendered harmless, Contractor may continue Work
in unaffected areas reasonably believed to be safe, but must immediately cease Work on the area
affected and report the condition to City. No asbestos, asbestos -containing products or other hazardous
materials may be used in performance of the Work.
16.4 Utilities, Trenching and Excavation. As required by Government Code section 4215, if,
during the performance of the Work, Contractor discovers utility facilities not identified by City in the
Contract documents, Contractor must immediately provide written notice to City and the utility. In
performing any excavations or trenching work, Contractor must comply with all applicable operator
requirements in Government Code sections 4216 through 4216.5. If the trenching or excavation extends
deeper than four feet below the surface, then it must also comply with Public Contract Code section 7104.
17. Records. Unless otherwise specified in Exhibit A, Contractor must maintain and update a
separate set of as -built drawings while the Work is being performed, showing changes from the Work as
planned in Exhibit A, or any drawings incorporated into this Contract. The as -built drawings must be
updated as changes occur, on a daily basis if necessary.
18. Conflicts of Interest. Contractor, its employees, subcontractors and agents, may not have,
maintain or acquire a conflict of interest in relation to this Contract in violation of any City ordinance or
policy or in violation of any California law, including under Government Code section 1090 et seq. and
under the Political Reform Act as set forth in Government Code section 81000 et seq. and its
accompanying regulations. Any violation of this Section constitutes a material breach of the Contract.
19. Non -Discrimination. No discrimination will be made in the employment of persons under this
Contract because of the race, color, national origin, ancestry, religion, gender or sexual orientation of
such person.
20. Independent Contractor. City and Contractor intend that Contractor will perform the Work under
this Contract as an independent contractor. Contractor is solely responsible for its means and methods in
performing the Work. Contractor is not an employee of City and is not entitled to participate in health,
retirement or any other employee benefits from City.
21. Assignment of Unfair Business Practice Claims. Under Public Contract Code section 7103.5,
Contractor and its subcontractors agree to assign to City all rights, title, and interest in and to all causes
of action it may have under section 4 of the Clayton Act (15 U.S.C. section 15) or under the Cartwright
Act (Chapter 2 (commencing with section 16700) of Part 2 of Division 7 of the Business and Professions
Code), arising from purchases of goods, services, or materials pursuant to the Contract or any
subcontract. This assignment will be effective at the time City tenders final payment to Contractor,
without further acknowledgement by the parties.
Grand and Linden CMP Replacement Up to $200,000 Contract
Page 5
Approved by City Attorney, dated 03/28/2022
22. Notice. Any notice, billing, or payment required by or pursuant to the Contract documents must
be made in writing, signed, dated and sent to the other party by personal delivery, U.S. Mail, a reliable
overnight delivery service, or by email as a PDF (or comparable) file. Notice is deemed effective upon
delivery unless otherwise specified. Notice for each party must be given as follows:
City:
Address: 111 Morphew Street
City/State/Zip: San Rafael, CA 94901
Phone: (415)485-3373
Attn: Ryan Montes
Email: ryan.montes@cityofsanrafael.org
Contractor:
Name: Ghilotti Construction Company, Inc.
Address: 2301 Kerner Blvd. Suite E
City/State/Zip: San Rafael, CA 94901
Phone: (415)256-1525
Attn: James Clary
Email: Jamesc@ghilotti.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
Grand and Linden CMP Replacement Up to $200,000 Contract
Page 6
Approved by City Attorney, dated 03/28/2022
is a corporation, signatures from two officers of the corporation are required pursuant to California
Corporation Code section 313.
[Signatures are on the following page.]
Grand and Linden CMP Replacement
Approved by City Attorney, dated 03/28/2022
Up to $200,000 Contract
Page 7
The parties agree to this Contract as witnessed by the signatures below:
CITY: n
L� y
JIM`SCHUTZ, City Manager
Date: f Z� is
Attest:
s/ .� , N
LINDSAY LARA, City Clerk
u� Date:ZL
A�vr
oto form:
s/
ae
RO %F.�EPST IN ty Attorney
Date: VL I z;-z,
CONTRACTOR: Ghilotti Construction Company, Inc.
Business Name
s/
Terence Huie
CFO / Treasurer
Name/Title
Date:�,`�
s/,
t
644515 Exp 5/31 /24
Zd
Seal
Contractor's California License Number(s) and Expiration Date(s)
Exhibit A: Scope of Work
Exhibit B: Bond Forms
Exhibit C: Noncollusion Declaration
Exhibit D: Bid Schedule
Exhibit E: Subcontractor List
END OF CONTRACT
Grand and Linden CMP Replacement
Approved by City Attorney, dated 03/28/2022
Up to $200,000 Contract
Page 8
Exhibit A
SCOPE OF WORK
Grand and Linden CMP Replacement
Approved by City Attomey, dated 03/28/2022
Up to $200,000 Contract
Scope of Work
1.
Exhibit A G N I L O T T
December 10" 2022
5in,, 1914
City of San Rafael
111 Morphew St.
San Rafael, CA 94901
Attention: JC Agcaoili
Subject: Replacement of Existing CMP SD System with HDPE ROM
Dear JC,
Per the request of the City of San Rafael, GCC is pleased to provide a ROM cost to replace a 125 LNFT of existing
CMP with HDPE Pipe as well as replacement of sidewalk.
The ROM of the above mentioned scope of work is approximately $39,530.00, GCC is recommending the work be
performed at Force Account with standard markups.
See attached Backup for reference on how GCC worked up the ROM Price.
Please respond at your earliest convenience.
Please contact me with any questions you have regarding this matter
Very truly yours,
James Clary
Project Manager
2301 Kerner Blvd. Suite E, San Rafael, CA 94901 - PH: (415) 256-1525 - FX: (415) 256-1520 - License No. 644515
Page I
Ghilotti Construction Co. Page 1
6043 2022 CENTRAL REGION ROAD REHAB -BUDGET 01/10/2023 11:04
JIMMY CLARY CMP SD REPLACEMENT COSR
Activity Desc Quantity Unit Perm Constr Equip Sub -
Resource PCs Unit Cost Labor Material Matl/Exp Ment Contract Total
BID ITEM
999
Description =
SD REPLACEMENT
Unit =
LNFT Takeoff Quan:
125 000 Engr Quan:
125.000
A95M
BUY SD PIPE
Quan:
125.00 LNF Hrs/Shff:
8.00 Cal: STD WC: COMP
"Unreviewed
$3,662.40
[ ] 3,662
3,662
A954102
SD MAIN - INSTALL (ONSITE)
Quan:
125.00 LF Hrs/Shft:
8.00 Cal: STD WC: COMP
*'Unreviewed
4202
(Mod) SD MAIN - INSTALL (ONSITE) 24.00
CH
Prod: 41.6667 US
Lab PCs: 7.00 Eqp PCs:
4.00
$22,110,72
1.3440 MH/LF 168.00 MH
[ 62.661 ] 14,759
2,000 5,352
22,111
A35511
SIDEWALKCREW
Quan:
125.00 LNF lirwShft:
8.00 Cal: STD WC: COMP
"Unreviewed
2614
(Mod) SIDEWALK CREW 16.00
CH
Prod: 62.5000 US
Lab PCs: 500 Eqp PCs:
200
$7,637.54
0.6400 MH/LNFT 80.00 MH
[ 27,391] 6,438
1,200
7,638
A35401
BUY CONCRETE READYMIX
Quan:
125.00 CY Hrs/Shft:
8.00 Cal: STD WC: COMP
"Unreviewed
$1,981.62
[ ] 1,982
1,982
A35402
BUY MISC MATL FOR MINOR CONCRETE
Qum
1.00 IS Hrs/Shft:
8.00 Cal: STD WC: COMP
"Unreviewed
$2,035.69
[ ] 2,036
2,036
A4420
DUMP FEES (LD)
Quan:
1.00 LS tlrs/Shft:
8.00 Cal: STD WC: COMP
"Unreviewed
$500.00
[ ]
500
500
A15111
BUY 3/4" CLASS 2 AB - VIRGIN
Quan:
40.00 TN Hrs/Shft:
8.00 Cal: STD WC: COMP
*'Unreviewed
$763 00
[ ] 763
763
AI5112
BUY 3/4" CLASS 2 AB - RECYCLE
Quan:
5.00 TN Hrs/Shft:
8.00 Cal: STD WC: COMP
"Unreviewed
$54.50
[ ] 55
55
A650
BUY 2 SACK SLURRY
Quan:
125.00 LNF Hrs/Shft:
8.00 Cal: STD WC: COMP
"Unreviewed
$784.80
[ ] 785
785
> Item Totals: 999 - SD REPLACEMENT
$39,530 27
1.9840 MH/LNFT 248.00 MH
[ 90 052 ] 21,196 9,282
2,500 6,552
39,530
316.242
125 LNFT
169.57 74.26
20.00 52.42
316.24
$399530.27
*** Report Totals *** 248.00 MH
21,196 9,282 2,500 6,552
39,530
>>> indicates Non Additive Activity
------R-ft Mnfvc-------
The estimate was prepared with TAKEOFF Quantities.
This report shows TAKEOFF Quantities with the resources
'Unreviewed' Activities are marked.
Bid Date: 09/08/22 Owner: COUNTY OF MARIN Engineering Firm:
Estimator -In -Charge: 05
Exhibit B
BONDFORMS
Required for contracts over $25, 000.
Grand and Linden CMP Replacement
Approved by City Attorney, dated 03/28/2022
Up to $200,000 Contract
Bond Forms
Premium is for Contract Term and is Subject
to Adjustment Based on Final Contract Price.
Performance Bond
Bond #070220106
Premium $484.00
Executed in Duplicate
City of San Rafael ("City") and Ghilotti Construction Company, Inc. ("Contractor") have entered into a
contract, dated May 19 2023 ("Contract") for work on the Grand and Linden CMP
Replacement ("Project"). The Contract is incorporated by reference into this Performance Bond
("Bond").
General. Under this Bond, Contractor as Principal and Liberty Mutual Insurance Company , its
surety ("Surety"), are bound to City as obligee for an amount not less than $ 39,530.00
By executing this Bond, Contractor and Surety bind themselves and their respective heirs,
executors, administrators, successors and assigns, jointly and severally, to the provisions of this
Bond.
2. Surety's Obligations; Waiver. If Contractor fully performs its obligations under the Contract,
including its warranty obligations under the Contract, Surety's obligations under this Bond will
become null and void upon City's acceptance of the Project, provided Contractor has timely
provided a warranty bond as required under the Contract. Otherwise Surety's obligations will
remain in full force and effect until expiration of the one year warranty period under the Contract.
Surety waives any requirement to be notified of and further consents to any alterations to the
Contract made under the applicable provisions of the Contract documents, including changes to the
scope of Work or extensions of time for performance of Work under the Contract. Surety waives
the provisions of Civil Code sections 2819 and 2845.
3. Application of Contract Balance. Upon making a demand on this Bond for completion of the
Work prior to acceptance of the Project, City will make the Contract Balance available to Surety for
completion of the Work under the Contract. For purposes of this provision, the Contract Balance is
defined as the total amount payable by City to Contractor as the Compensation minus amounts
already paid to Contractor, and minus any liquidated damages, credits, or backcharges to which
City is entitled under the terms of the Contract.
4. Contractor Default. Upon written notification from City that Contractor is in default under the
Contract, time being of the essence, Surety must act within seven calendar days of receipt of the
notice to remedy the default through one of the following courses of action:
4.1 Arrange for completion of the Work under the Contract by Contractor, with City's consent,
but only if Contractor is in default solely due to its financial inability to complete the Work;
4.2 Arrange for completion of the Work under the Contract by a qualified contractor
acceptable to City, and secured by performance and payment bonds issued by an admitted
surety as required by the Contract documents, at Surety's expense; or
4.3 Waive its right to complete the Work under the Contract and reimburse City the amount
of City's costs to have the remaining services completed.
5. Surety Default. If Surety defaults on its obligations under the Bond, City will be entitled to recover
all costs it incurs due to Surety's default, including legal, design professional, or delay costs.
6. Notice. Notice to Surety must be given or made in writing and sent to the Surety via personal
delivery, U.S. Mail, or a reliable overnight delivery service, or by email as a PDF (or comparable)
file. Notice is deemed effective upon delivery unless otherwise specified. Notice for the Surety
must be given as follows:
Grand and Linden CMP Replacement Up to $200,000 Contract
Performance Bond
Approved by City Attorney, dated 03/28/2022
Attn: Liberty Mutual Surety
Address: 1340 Treat Blvd., Suite 400
City/State/Zip: Walnut Creek, CA 94597
Phone: Ed Campos 925-979-6705
Fax: 925-979-6754
Email: eduarco.campos@libertymutual.com
7. Law and Venue. This Bond will be governed by California law, and any dispute pursuant to this
Bond will be venued in the Superior Court of Marin County, and no other place. Surety will be
responsible for City's attorneys' fees and costs in any action to enforce the provisions of this Bond.
8. Effective Date; Execution. This Bond is entered into and effective on June 5
20 23 . Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: Liberty Mutual Insurance Company
sl
Dona Lisa Buschmann, Attorney -In -Fact
Name/Title [print]
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRACT : Ghilotti Construction Company, Inc.
A/ Business a
sl /v �
Name/Title
s/
Name/Title
APPIR - D BY CITY:
s/
ROBE F. EPSTE , , City Attorney
CFO / Treasurer
'�4�12ra,F 1�1�✓1� CX-
r� l [ 1Q � 2-,
Date
END OF PERFORMANCE BOND
Grand and Linden CMP Replacement
Approved by City Attorney, dated 03/28/2022
Up to $200,000 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 Placer
On .June 5, 2023
before me, Alexis Estrada, Notary Public
(insert name and title of the officer)
personally appeared Dona Lisa Buschmann
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature
ALEXIS ESTRADA
Notary Public - California
Placer County
Commission / 2335353
#6M Comm. Expires Oct 13, 2024
(Seal)
Liberty
MUM,.
SURETY
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8208535-977442
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the Stale of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Alcxis
Estrada. C'unis A. Bowden, Dona Lisa Buschmann, Edward D. Johnson, .1. Buschnlann. Julie A. Shiruma. K. I lanley, Kathy Rangel. Lisa Wilson. Maggie Dendw-
Johnson, Robert D. Laux
all of the city of Roseville state of CA each individually if there be more than one named, its true and lawful attorney -in -fact to make.
execute, seal, acknowledge and deliver, for and on its behalf as surely and as its act and deed, any and all undertakings, bonds, recognizances and other surely obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 2nd day of August 2022
Liberty Mutual Insurance Company
INSUR "Al IN$&q ill,INstlg The Ohio Casualty Insurance Company
�JP`ppPo" yC' yJP pPPOp+F`�y VP 4100+4"f Z0bi West American Insurance Company
IF
1912 a 1919 0 f 1991 �/J
d ~'Q+C ne*�~^ L; ° spkM+M9l+p�L�° 6 S �+'°u M► aD3 fi' 1
gar) *aa ,,hl By:
David M Carey, Assistant Secretary
ro Stale of PENNSYLVANIA
.� County of MONTGOMERY its
On this 2nd day of August . 2022 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania
"As/.
SP
,2& upww F�
p� f'P4
2 9
C4mrn""3nhd PcmSAi, q Notary Soal
Teresa Pastella Notary Public
Montgomery County
Of
My commission expires March 28. 2025
By.
4hpi
commission number 1126044
�aRy 1�
y+diAiul&iiciWrNownes
WrritirP+nmrro
on the day and year first above written.
Notary Public
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casually Insurance Company, Liberty Mutual Insurance
Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV — OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President
may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surely any and all
undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full
power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall
be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this
article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shag appoint such atlomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of atlorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as If
signed by the president and allesied by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surely
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company cdnsenls that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 5th day of .lone 2023 .
INSUR 01 INSU a INS0.0
'0q,q2[� yJP`onPo�+qZ 4P c°aP0 1C�
J d �o
: 1912 o _ 1919 f 1991
0 11.Mt9 as ''s"a""' as Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Co 02121
Bond #070220106
Premium is for Contract Term and is Subject Premium Included
to Adjustment Based on Final Contract Price Executed in Duplicate
Payment Bond
City of San Rafael ("City") and Ghilotti Construction Company, Inc. ("Contractor") have entered
into a contract, dated May 19 , 20 23 ("Contract") for work on the Grand and
Linden CMP Replacement ("Project"). The Contract is incorporated by reference into this
Payment Bond ("Bond").
1. General. Under this Bond, Contractor as principal and Liberty Mutual Insurance Company
its surety ("Surety"), are bound to City as obligee In an amount not less than
$ 39,530.00 , under California Civil Code sections 955Q, 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: Liberty Mutual Surety
Address: 1340 Treat Blvd., Suite 400
City/State/Zip: Walnut Creek, CA 94597
Phone: Ed Campos 925-979-6705
Fax. 925-979-6754
Email: eduardo.camr)os(@Iibertymutual 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.
Grand and Linden CMP Replacement Up to $200,000 Contract
Payment Bond
Approved by City Attorney, dated 03/28/2022
Effective Date; Execution. This Bond is entered into and is effective on June 5
2023. Three identical counterparts of this Bond, each of which is deemed an original for all
purposes, are hereby executed and submitted.
SURETY: Liberty Mutual Insurance Company
Business Name
s/ 4�
Dona Lisa Buschmann, Attorney -In -Fact
Name/Title
(Attach Acknowledgment with Notary Seal and Power of Attorney)
CONTRA
R: Ghilotti Construction Company, Inc.
Busines Name
sl
I. Terence Huie
CEO/ Treasurer
Name/Title
s/ oz / t_lf'
All Yaxdl
Name/Title
APPRqjtD BY CITY.
(Q�
s/ W' ( 'I (J-1
ROBEV F. EPSTEIN,,Cfi Attorney
END OF PAYMENT BOND
Grand and Linden CMP Replacement
Approved by City Attorney, dated 03128/2022
Date
Up to $200,000 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 Placer
On June 5, 2023
before me, Alexis Estrada, Notary Public
(insert name and title of the officer)
personally appeared Dona Lisa Buschmann
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Signature 011t-4�Y
(Seal)
ALEXIS ESTRADA
Notary Public • California
Placer County
Commission # 2335353
L4.P....Mycomm. Expires Oct 13, 2024
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Libertj
Muttl�I' Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company Certificate No: 8208535-977442
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casually Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"). pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Alexis
Esiroda. Collis A. Bowden. Dona Lisa Buschmann, Edward D. Johnson, J. Buschnlann..lulic A. Shironta. K. Hanley. Kathy Ranyel. Lisa Wilson, Maggie Bender -
Johnson, Robert D. Laux
all of the city of Roseville slate of CA each individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surely obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 2nd day of August 1 2022
Liberty Mutual Insurance Company
P` 1NSU,p9 P'SY INS& d 1NSU4 The Ohio Casualty lnstxance Company
,�`� �o*°Oq•• y0 yJ �opvOAt,
��y West American Insurance Company
J 3 °o rn Q d '�o C� Q• t To t°
f 1912 0 1919 1991 n
Q /
d� �J.cNuad da O .u°e F L� / 'hor.p* D3 If �Y
a Fad By, i
David M. Carey, Assistant Secretary
Slate of PENNSYLVANIA sa
County of MONTGOMERY
On this 2nd day of August 2022 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
Company, The Ohio Casually Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meetin
6F PAST
:.fiWrt F(,
u s
ur
Co..om mDAh OI PemYfk. r Notnnr S"
Teresa Pastella Notary Public
Montgomery County
My commission expires Mardi 28. 2025
ht
4rry w30'
Commission number 1126044
M~, P~aW Aowo aN""
Pennsylvania, on the day and year first above written.
By: � & e.4xi /Q441Z1
Pastella, Notary Public
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual Insurance
Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV— OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President
may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all
undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full
power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall
be as binding as if signed by the President and attested to by the Se.mlery, Any power or authority granted to any representative or allomey-in-fact under the provisions of this
article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority,
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such allomeys�n-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surely any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations,
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casually Insurance Company, Liberty Mutual Insurance Company, and Wesl American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 5th day of .ILlnc 1 2023 .
P` it 31Jq FVAl INS&
°oq4�OyF QJ °°a1Oq• o9y[+
f 1912 f/ ou 1919 n
i l Q
LMS-12873 LMIC OCIC WAIC Multi Co 02121
1NSU.0
VPaOq� q'Jr
1991 0
s
By
,e °1. p �Naa� Renee C. Llewellyn. Assistant Secrelary
oO
N
1714
r9
Bid Bond
("Bidder') has submitted a bid,
dated 20 ("Bid"), to the City of San Rafael ("City") for work on
the ("Project"). Under this duly executed bid bond ("Bid Bond"), Bidder as Principal and
, its surety ("Surety"), are bound to City as obligee in the penal sum
of ten percent of the maximum amount of the Bid (the "Bond Sum"). Bidder and Surety bind themselves
and their respective heirs, executors, administrators, successors and assigns, jointly and severally, as
follows:
General. If Bidder is awarded the Contract for the Project, Bidder will enter into the Contract with
City in accordance with the terms of the Bid.
2. Submittals. Within ten days following issuance of the Notice of Award to Bidder, Bidder must
submit to City the following:
2.1 Contract. The executed Contract, using the form provided by City in the Project contract
documents ("Contract Documents");
2.2 Payment Bond. A payment bond for 100% of the maximum Contract Price, executed by a
surety licensed to do business in the State of California using the Payment Bond form
included with the Contract Documents;
2.3 Performance Bond. A performance bond for 100% of the maximum Contract Price,
executed by a surety licensed to do business in the State of California using the Performance
Bond form included with the Contract Documents; and
2.4 Insurance. The insurance certificate(s) and endorsement(s) required by the Contract
Documents, and any other documents required by the Instructions to Bidders or Notice of
Award.
3. Enforcement. If Bidder fails to execute the Contract and to submit the bonds and insurance
certificates as required by the Contract Documents, Surety guarantees that Bidder forfeits the Bond
Sum to City. Any notice to Surety may be given in the manner specified in the Contract and
delivered or transmitted to Surety as follows:
Attn
Address _
City/State/Zip:
Phone:
Fax:
Email
4. Duration and Waiver. If Bidder fulfills its obligations under Section 2, above, then this obligation
will be null and void; otherwise it will remain in full force and effect for 60 days following the bid
opening or until this Bid Bond is returned to Bidder, whichever occurs first. Surety waives the
provisions of Civil Code §§ 2819 and 2845.
[Signatures are on the following page.]
Grand and Linden CMP Replacement Up to $200,000 Contract
Bid Bond
Approved by City Attorney, dated 3/28/2020
This Bid Bond is entered into and effective on 20
SURETY:
Business Name
s/
Date
Name, Title
(Attach Acknowledgment with Notary Seal and Power of Attorney)
BIDDER:
Business Name
s!
Date
Name, Title
END OF BID BOND
Grand and Linden CMP Replacement
Approved by City Attorney, dated 3/28/2020
Up to $200,000 Contract
Bid Bond
Exhibit C
NONCOLLUSION DECLARATION
TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
The undersigned declares:
I am the [title] of _
[business name], the party making the foregoing bid.
The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company,
association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has
not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has
not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in
a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by
agreement, communication, or conference with anyone to fix the bid price of the bidder or any other
bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder. All
statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid
price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to
any corporation, partnership, company, association, organization, bid depository, or to any member or
agent thereof, to effectuate a collusive or sham bid, and has not paid and will not pay, any person or
entity for such purpose.
This declaration is intended to comply with California Public Contract Code § 7106 and Title 23 U.S.0 §
112.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and
correct and that this declaration is executed on [date], at
[city], [state]
s/
Name [print]
END OF NONCOLLUSION DECLARATION
Grand and Linden CMP Replacement
Approved by City Attorney, dated 3/28/2022
Up to $200,000 Contract
Noncollusion Declaration
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.)
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.
Grand and Linden CMP Replacement Up to $200,000 Contract
Bid Schedule
Approved by City Attorney, dated 3/28/2022
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
OF WORK
SUBCONTRACTOR
NAME
CALIFORNIA
CONTRACTOR
LICENSE NO.
LOCATION OF
BUSINESS
DIR REG. NO.
PERCENT
OF
WORK
END OF SUBCONTRACTOR LIST
' For street or highway construction this requirement applies to any subcontract of $10,000 or more.
Grand and Linden CMP Replacement Up to $200,000 Contract
Subcontractor List
Approved by City Attorney, dated 3/28/2022
This Bid Proposal is hereby submitted on
s/
s/
Company Name
Address
City, State, Zip
Contact Name
20_
Name and Title
Name and Title
License #, Expiration Date, and Classification
DIR Registration #
Phone
Contact Email
Addenda. Bidder agrees that it has confirmed receipt of or access to, and reviewed, all addenda issued
for this Bid. Bidder waives any claims it might have against the City based on its failure to receive,
access, or review any addenda for any reason. Bidder specifically acknowledges receipt of the following
addenda:
Addendum: Date Received. Addendum: Date Received
#01 #05
#02 #06
#03 #07
#04 #08
END OF BID SCHEDULE
Grand and Linden CMP Replacement
Approved by City Attorney, dated 3/28/2022
Up to $200,000 Contract
Bid Schedule
,Ac_vRo" CERTIFICATE OF LIABILITY INSURANCE DATE 0 /2023"'
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 CA LIC OB29370 1-925-798-3334 CONTACT Sara Dorrisey
Edgewood Partners Insurance Center (EPIC) PHONE ):925-822-9009 FAX 925-887-6815
[Concord - Branch ID 154691 IA/C.No):
P.O. Box 5668
ADDRESS: sara.dorrisey®epicbrokers.com
Concord, CA 94524
INSURED
Ghilotti Construction Company, Inc.
246 Ghilotti Avenue
INSURERS AFFORDING COVERAGE NAIC 4
NATIONAL UNION FIRE INS CO OF PITTS 19445
NAVIGATORS SPECIALTY INS CO 136056
(Santa Rosa, CA 95407 1INSURER F:
rr1VFRAr:FC rFRTIFIrATF NIIMRFR• 68897213 REVISION NUMRER-
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
A L
SUB
POLICY NUMBER
EFF
MMIDDDPOLICYIYYYY
Y EXP
MMIDD//YYYY
I LIMITS
A
X
COMMERCIALGENERALLIABILITY
X
X
GL9894974
04/01/23
04/01/24
EACH OCCURRENCE
$ 2,000,000
CLAIMS-MADE OCCUR
$ 500,000
DAMAGE TO PYRTra-
PREMISES(E occ rr n
MED EXP (Any one person)
$ 25,000
PERSONAL& ADV INJURY
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
$ 4,000,000
POLICY JEa LOC
$ 4,000,000
PRODUCTS - COMP/OP AGG
$
OTHER:
I
A
AUTOMOBILE LIABILITY
X
X
CA2970066
04/01/23
04/01/24
COMBINEDaMoanSINGLE$
2,000,000
BODILY INJURY (Per person)
ANY AUTO
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
IX HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
$
$
BODILY INJURY (Per accident)
PROPDAMAGE
Per 8ERTY1
B
UMBRELLA LIAB
X
OCCUR
LA23EXCZOAXPDIC
04/01/23
04/01/24
EACH OCCURRENCE
$ 5,000,000
N
AGGREGATE
$ 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
I
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE �
OF FICER/MEMBEREXCLUDED?
(Mandatory in NH)
NIA
X WC80878253 04/01/23
04/01/24
X PER OTH-
TAT TE I ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1, 000, 000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: GCC Job #2168, Grand and Linden CMP Replacement.
Additional Insured(s): City of San Rafael, including its Council, officials, officers, employees, agents, volunteers
and consultants.
When required by written contract, Additional Insured status with Primary & Non -Contributory coverage applies to
General Liability and Automobile Liability and Waiver of Subrogation applies to General Liability, Automobile Liability
and Workers Compensation, all as per the attached endorsements.
rFRTIFIrATF FIAT r)FR rANCFI 1 ATION
GCC Job #2168
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of San Rafael
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
111 Morphew Street
AUTHORIZED REPRESENTATIVE
San Rafael, CA 94901
I USA
(U 1958-2015 AGURD GURPURATIUN. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
PATRA01
68897213
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
06/OS/2023
NAME OF INSURED: Ghilotti Construction Company, Inc.
Additional Description of Operations/Remarks from Page 1:
Additional Information:
SUPP (05104)
POLICY NUMBER: CA 297-00-66 COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Co-
verage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter
coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is
indicated below.
Named Insured:
GHILOTTI CONSTRUCTION COMPANY, INC.
Endorsement Effective Date: 04/01/2023
SCHEDULE
Name Of Person(s) Or Organization(s):
AS REQUIRED PER WRITTEN CONTRACT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule
is an "insured" for Covered Autos Liability Cover-
age, but only to the extent that person or organ-
ization qualifies as an "insured" under the Who Is
An Insured provision contained in Paragraph A.1.
of Section II - Covered Autos Liability Coverage in
the Business Auto and Motor Carrier Coverage
Forms and Paragraph D.2. of Section I - Covered
Autos Coverages of the Auto Dealers Coverage
Form.
CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1
ENDORSEMENT
This endorsement, effective 12:01A.M. 04/01/2023 forms a part of
policy No. CA 297-00-66 issued to GHILOTTI CONSTRUCTION COMPANY, INC.
by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH , PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is
amended by the addition of the following sentence:
The insurance afforded under this policy to an additional insured will apply as primary insurance
for such additional insured where so required under an agreement executed prior to the date of
accident. We will not ask any insurer that has issued other insurance to such additional insured to
contribute to the settlement of loss arising out of such accident.
All other terms and conditions remain unchanged.
Authorized Representative or
Countersignature (in States Where
Applicable)
74445 (10/99)
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/O1/2023 forms a part of
policy No. CA 297-00-66 issued to GHILOTTI CONSTRUCTION COMPANY, INC.
by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA
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:
BUSINESS AUTO COVERAGE FORM
Section IV - Business Auto Conditions, A. - Loss Conditions, 5. - Transfer of Rights of Recovery
Against Others to Us, is amended to add:
However, we will waive any right of recover we have against any person or organization with whom you have
entered into a contract or agreement because of payments we make under this Coverage Form arising out of
an "accident" or "loss" if:
(1) The "accident' or "loss" is due to operations undertaken in accordance with the contract existing
between you and such person or organization; and
(2) The contract or agreement was entered into prior to any " accident' or " loss".
No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the
person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained
by any injured employee.
��
AUT ORIZED REPRESENTATIVE
62897 (6/95)
ENDORSEMENT
This endorsement, effective 12:01 A.M. 04/01/2023 forms a part of
policy No.GL 989-49-74 issued to GHILOTTI CONSTRUCTION COMPANY, INC.
by NATIONAL UNION FIRE INSURANCE COMPANY OF P I TTSBURGH , PA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT OF LIMITS OF INSURANCE
(Per Project or Per Location Aggregate Limit)
This endorsement modifies insurance provided under the following. -
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
I. Your policy is amended to include either a Per Project General Aggregate Limit, a Per Location
General Aggregate Limit or a Per Project and Per Location General Aggregate Limit. Please select
only one of the following:
[ XI Per Project General Aggregate Limit $ 4,000,000
[ I Per Location General Aggregate Limit $
1 Per Project and Per Location General Aggregate Limit $
IF NEITHER OF THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. IF MORE THAN ONE
OF THE THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID.
II. SECTION III - LIMITS OF INSURANCE , is amended to include the following:
1. The Limits of Insurance and the rules below fix the most we will pay regardless of the
number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits".
2. The General Aggregate Limit is the most we will pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of "bodily injury" or "property
damage" included in the products -completed operations hazard"; and
c. Damages under Coverage B.
3. The Products -Completed Operations Aggregate Limit is the most we will pay under
Coverage A for damages because of "bodily injury" and "property damage" included in the
"products -completed operations hazard".
4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under
Coverage B for the sum of all damages because of all "personal and advertising injury"
sustained by any one person or organization.
5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will
pay for the sum of:
a. Damages under Coverage A; and
b. Medical expenses under CoverageC
86681 (9/04) Page 1 of 2
because of all "bodily injury" and "property damage" arising out of any one "occurrence".
6. Subject to 5. above, the Damage to Premises Rented To You Limit is the most we will pay
under Coverage A because of "property damage" to any one premises, while rented to you,
or in the case of damage by fire, while rented to you or temporarily occupied by you with
permission of the owner.
7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C
for all medical expenses because of "bodily injury" sustained by any one person.
8. Subject to 2., 4., 5., 6., and/or 7. above, the Per Project Aggregate Limit is the most we
will pay under Coverages A, B, and C combined for the sum of:
a. Damages under Coverage A;
b. Damages under Coverage B; and
c. Medical Expenses under Coverage C
arising out of any single Project described above.
9. Subject to 2., 4., 5., 6., and/or 7. above, the Per Location Aggregate Limit is the most we
will pay under Coverages A, B, and C combined for the sum of:
a. Damages under Coverage A;
b. Damages under Coverage B; and
c. Medical expenses under CoverageC
arising out of the any single Location described above.
The Limits of Insurance of this Coverage Part apply separately to each consecutive annual
period and to any remaining period of less than 12 months, starting with the beginning of the
policy period shown in the Declarations, unless the policy period is extended after issuance for
an additional period of less than 12 months. In that case, the additional period will be deemed
part of the last preceding period for purposes of determining the Limits of Insurance.
III. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by
the Limits of Insurance set forth below.
Limits of Insurance
General Aggregate Limit
$
10,000,000
Each Occurrence Limit
$
2,000,000
Products -Completed Operations Aggregate Limit
$
4,000,000
Personal & Advertising Injury Limit
$
1,000,000
Damage to Premises Rented to You
$
500,000
Medical Expense Limit
$
25,000
Per Project General Aggregate Limit, Per Location
$
4,000,000
General Aggregate Limit or Per
Project and Per Location General Aggregate Limit
IV. SECTION V - DEFINITIONS, is amended to include the following:
23. "Location" means premises involving the same or connecting lots, or premises whose
connection is interrupted only by a street, roadway, waterway, or right-of-way railroad.
All other terms and conditions of this policy remain the same.
Auth rized Representative or
Countersignature (in States Where
Applicable)
86681 (9/04) Page 2 of 2
POLICY NUMBER: GL 989-49-74
COMMERCIAL GENERAL LIABILITY
CG20120413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - STATE OR GOVERNMENTAL
AGENCY OR SUBDIVISION OR POLITICAL
SUBDIVISION - PERMITS OR AUTHORIZATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
State Or Governmental Agency Or Subdivision Or Political Subdivision:
ANY AND ALL STATE OR POLITICAL SUBDIVISIONS CONTRACTUALLY REQUIRING
ADDITIONAL INSURED STATUS IN CONNECTION WITH ISSUANCE OF PERMITS TO
YOU, RELATING TO PREMISES.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - Who Is An Insured is amended to in-
clude as an additional insured any state or
governmental agency or subdivision or political
subdivision shown in the Schedule, subject to
the following provisions:
1. This insurance applies only with respect to
operations performed by you or on your be-
half for which the state or governmental
agency or subdivision or political subdivision
has issued a permit or authorization.
However:
a. The insurance afforded to such additional
insured only applies to the extent permit-
ted by law; and
b. If coverage provided to the additional in-
sured is required by a contract or agree-
ment, the insurance afforded to such ad-
ditional insured will not be broader than
that which you are required by the con-
tract or agreement to provide for such
additional insured.
2. This insurance does not apply to:
a. "Bodily injury", "property damage" or
"personal and advertising injury" arising
out of operations performed for the fed-
eral government, state or municipality; or
b. "Bodily injury" or "property damage" in-
cluded within the "products -completed
operations hazard".
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 under the applicable Limits of In-
surance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applica-
ble Limits of Insurance shown in the Declara-
tions.
CG 20 12 04 13 (D Insurance Services Office, Inc., 2012 Page 1 of 1 0
POLICY NUMBER: GL989-49-74
COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19
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
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
ANY PERSON OR ORGANIZATION WHOM YOU
PER THE CONTRACT OR AGREEMENT.
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTACT OR AGREEMENT YOU HAVE ENTERED
INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury",
"property damage" or "personal and advertising
injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on
your behalf;
in the performance of your ongoing operations
for the additional insured(s) at the location(s)
designated 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 which you are required by the contract
or agreement to provide for such additional
insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury"
or "property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at
the location of the covered operations has
been completed; or
2. That portion of "your work" out of which
the injury or damage arises has been put to
its intended use by any person or
organization other than another contractor or
subcontractor engaged in performing
operations for a principal as a part of the
same project.
CG 20 10 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 2
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:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
Page 2 of 2 ® Insurance Services Office, Inc., 2018 CG 20 10 12 19
POLICY NUMBER: GL989-49-74
COMMERCIAL GENERAL LIABILITY
CG20371219
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 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 OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
ANY PERSON OR ORGANIZATION WHOM YOU
BECOME OBLIGATED TO INCLUDE AS AN
ADDITIONAL INSURED AS A RESULT OF ANY
CONTRACT OR AGREEMENT YOU HAVE ENTERED
INTO.
Location And Description Of Co
PER THE CONTRACT OR AGREEMENT
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, 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
hazard".
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 under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
CG 20 37 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
Policy #GL9894974
or organization for care, loss of services or
death resulting at any time from the "bodily
injury".
2. Exclusions
This insurance does not apply to:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" ex-
pected or intended from the standpoint of
the insured. This exclusion does not apply to
"bodily injury" resulting from the use of
reasonable force to protect persons or
property.
b. Contractual Liability
"Bodily injury" or "property damage" for
which the insured is obligated to pay dama-
ges by reason of the assumption of liability
in a contract or agreement. This exclusion
does not apply to liability for damages:
M That the insured would have in the ab-
sence of the contract or agreement; or
(2) Assumed in a contract or agreement that
is an "insured contract", provided the
"bodily injury" or "property damage"
occurs subsequent to the execution of
the contract or agreement. Solely for the
purposes of liability assumed in an
"insured contract", reasonable attorneys'
fees and necessary litigation expenses
incurred by or for a party other than an
insured are deemed to be damages
because of "bodily injury" or "property
damage", provided:
(a) Liability to such party for, or for the
cost of, that party's defense has also
been assumed in the same "insured
contract"; and
(b) Such attorneys' fees and litigation
expenses are for defense of that party
against a civil or alternative dispute
resolution proceeding in which
damages to which this insurance
applies are alleged.
c. Liquor Liability
"Bodily injury" or "property damage" for
which any insured may be held liable by
reason of:
(1)Causing or contributing to the
intoxication of any person;
(2) The furnishing of alcoholic beverages
to a person under the legal drinking
age or under the influence of alcohol;
or
(3) Any statute, ordinance or regulation
relating to the sale, gift, distribution
or use of alcoholic beverages.
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in:
(a) The supervision, hiring, employment,
training or monitoring of others by
that insured; or
(b) Providing or failing to provide trans-
portation with respect to any person
that may be under the influence of al-
cohol;
if the "occurrence" which caused the "bodily
injury" or "property damage", involved that
which is described in Paragraph (1), (2) or
(3) above.
However, this exclusion applies only if you
are in the business of manufacturing, distri-
buting, selling, serving or furnishing al-
coholic beverages. For the purposes of this
exclusion, permitting a person to bring al-
coholic beverages on your premises, for
consumption on your premises, whether or
not a fee is charged or a license is required
for such activity, is not by itself considered
the business of selling, serving or furnishing
alcoholic beverages.
d. Workers' Compensation And Similar Laws
Any obligation of the insured under a
workers' compensation, disability benefits or
unemployment compensation law or any
similar law.
e. Employer's Liability
"Bodily injury" to:
(1)An "employee" of the insured arising out
of and in the course of:
(a) Employment by the insured; or
(b) Performing duties related to the con-
duct of the insured's business; or
(2)The spouse, child, parent, brother or
sister of that "employee" as a con-
sequence of Paragraph (1) above.
This exclusion applies whether the insured
may be liable as an employer or in any other
capacity and to any obligation to share
damages with or repay someone else who
must pay damages because of the injury.
This exclusion does not apply to liability
assumed by the insured under an "insured
contract".
Page 2 of 16 0 Insurance Services Office, Inc., 2012 CG 00 01 04 13 ❑
POLICY NUMBER: GL989-49-74
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
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
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
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
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
CG 20 01 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: GL 989-49-74
COMMERCIAL GENERAL LIABILITY
CG 24 17 10 01
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTUAL LIABILITY - RAILROADS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Scheduled Railroad: Designated Job Site:
ANY RAILROAD ORGANIZATION WHOM HAS
GRANTED YOU AN EASEMENT FOR ANY JOB
SITE TO PERMIT YOU TO PERFORM WORK AS
A RESULT OF ANY CONTRACT OR AGREEMENT
YOU HAVE ENTERED INTO.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
With respect to operations performed for, or
affecting, a Scheduled Railroad at a Designated
Job Site, the definition of "insured contract" in the
Definitions section is replaced by the following:
9. "Insured Contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person or
organization for damage by fire to premises
while rented to you or temporarily occupied
by you with permission of the owner is not
an "insured contract";
b. A sidetrack agreement;
c. Any easement or license agreement;
d. An obligation, as required by ordinance, to
indemnify a municipality, except in
connection with work for a municipality;
e. An elevator maintenance agreement;
f. That part of any other contract or agreement
pertaining to your business (including an in-
demnification of a municipality in connection
with work performed for a municipality)
under which you assume the tort liability of
another party to pay for "bodily injury" or
"property damage" to a third person or
organization. Tort liability means a liability
that would be imposed by law in the
absence of any contract or agreement.
Paragraph f. does not include that part of any
contract or agreement:
(1) That indemnifies an architect, engineer or sur-
veyor for injury or damage arising out of:
(a) Preparing, approving or failing to prepare or
approve maps, shop drawings, opinions, re-
ports, surveys, field orders, change orders
or drawings and specifications; or
(b) Giving directions or instructions, or failing to
give them, if that is the primary cause of the
injury or damage;
(2) Under which the insured, if an architect,
engineer or surveyor, assumes liability for an in-
jury or damage arising out of the insured's
rendering or failure to render professional
services, including those listed in Paragraph (1)
above and supervisory, inspection, architectural
or engineering activities.
CG 24 17 10 01 0 ISO Properties, Inc., 2000 Page 1 of 1 0
Policy #GL 989-49-74
primary, our obligations are not affected un-
less any of the other insurance is also
primary. Then, we will share with all that
other insurance by the method described in
Paraoraoh c. below.
b. Excess Insurance
(1)This insurance is excess over:
(a) Any of the other insurance, whether
primary, excess, contingent or on any
other basis:
(i) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work";
(ii) That is Fire insurance for premises
rented to you or temporarily occu-
pied by you with permission of the
owner;
(iii)That is insurance purchased by
you to cover your liability as a
tenant for "property damage" to
premises rented to you or tempo-
rarily occupied by you with per-
mission of the owner; or
(iv)If the loss arises out of the main-
tenance or use of aircraft, "autos"
or watercraft to the extent not
subject to Exclusion g. of Section I
- Coverage A - Bodily Injury And
Property Damage Liability.
(b) Any other primary insurance available
to you covering liability for damages
arising out of the premises or opera-
tions, or the products and completed
operations, for which you have been
added as an additional insured.
(2) When this insurance is excess, we will
have no duty under Coverages A or B to
defend the insured against any "suit" if
any other insurer has a duty to defend
the insured against that "suit". If no
other insurer defends, we will undertake
to do so, but we will be entitled to the
insured's rights against all those other
insurers.
(3) When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(a) The total amount that all such other
insurance would pay for the loss in
the absence of this insurance; and
(b) The total of all deductible and
self -insured amounts under all that
other insurance.
(4) We will share the remaining loss, if any,
with any other insurance that is not
described in this Excess Insurance pro-
vision and was not bought specifically to
apply in excess of the Limits of Insurance
shown in the Declarations of this
Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contri-
bution by equal shares, we will follow this
method also. Under this approach each
insurer contributes equal amounts until it
has paid its applicable limit of insurance or
none of the loss remains, whichever comes
first.
If any of the other insurance does not permit
contribution by equal shares, we will contri-
bute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
5. Premium Audit
a. We will compute all premiums for this
Coverage Part in accordance with our rules
and rates.
b. Premium shown in this Coverage Part as
advance premium is a deposit premium only.
At the close of each audit period we will
compute the earned premium for that period
and send notice to the first Named Insured.
The due date for audit and retrospective
premiums is the date shown as the due date
on the bill. If the sum of the advance and
audit premiums paid for the policy period is
greater than the earned premium, we will
return the excess to the first Named Insured.
c. The first Named Insured must keep records
of the information we need for premium
computation, and send us copies at such
times as we may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accu-
rate and complete;
b. Those statements are based upon re-
presentations you made to us; and
c. We have issued this policy in reliance upon
your representations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned in
Page 12 of 16 0 Insurance Services Office, Inc., 2012 CG 00 01 04 13 ❑
this Coverage Part to the first Named Insured, 4. "Coverage territory" means:
this insurance applies: a. The United States of America (including its
a. As if each Named Insured were the only territories and possessions), Puerto Rico and
Named Insured; and Canada;
b. Separately to each insured against whom
claim is made or "suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of
any payment we have made under this
Coverage Part, those rights are transferred to
us. The insured must do nothing after loss to
impair them. At our request, the insured will
bring "suit" or transfer those rights to us and
help us enforce them.
9. When We Do Not Renew
If we decide not to renew this Coverage Part,
we will mail or deliver to the first Named In-
sured shown in the Declarations written notice
of the nonrenewal not less than 30 days before
the expiration date.
If notice is mailed, proof of mailing will be suffi-
cient proof of notice.
SECTION V - DEFINITIONS
1. "Advertisement" means a notice that is broad-
cast or published to the general public or speci-
fic market segments about your goods, pro-
ducts or services for the purpose of attracting
customers or supporters. For the purposes of
this definition:
a. Notices that are published include material
placed on the Internet or on similar elec-
tronic means of communication; and
b. Regarding web sites, only that part of a web
site that is about your goods, products or
services for the purposes of attracting custo-
mers or supporters is considered an adver-
tisement.
2. "Auto" means:
a. A land motor vehicle, trailer or semitrailer
designed for travel on public roads, including
any attached machinery or equipment; or
b. Any other land vehicle that is subject to a
compulsory or financial responsibility law or
other motor vehicle insurance law where it is
licensed or principally garaged.
However, "auto" does not include "mobile
equipment".
3. "Bodily injury" means bodily injury, sickness or
disease sustained by a person, including death
resulting from any of these at any time.
b. International waters or airspace, but only if
the injury or damage occurs in the course of
travel or transportation between any places
included in Paragraph a. above; or
c. All other parts of the world if the injury or
damage arises out of:
(1) Goods or products made or sold by you
in the territory described in Paragraph a.
above;
(2) The activities of a person whose home is
in the territory described in Paragraph a.
above, but is away for a short time on
your business; or
(3) "Personal and advertising injury" offenses
that take place through the Internet or
similar electronic means of communi-
cation;
provided the insured's responsibility to pay
damages is determined in a "suit" on the me-
rits, in the territory described in Paragraph a.
above or in a settlement we agree to.
5. "Employee" includes a "leased worker".
"Employee" does not include a "temporary
worker".
6. "Executive officer" means a person holding any
of the officer positions created by your charter,
constitution, bylaws or any other similar
governing document.
7. "Hostile fire" means one which becomes un-
controllable or breaks out from where it was in-
tended to be.
8. "Impaired property" means tangible property,
other than "your product" or "your work", that
cannot be used or is less useful because:
a. It incorporates "your product" or "your
work" that is known or thought to be defec-
tive, deficient, inadequate or dangerous; or
b. You have failed to fulfill the terms of a cont-
ract or agreement;
if such property can be restored to use by the
repair, replacement, adjustment or removal of
"your product" or "your work" or your fulfilling
the terms of the contract or agreement.
9. "Insured contract" means:
a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person or
CG 00 01 04 13 0 Insurance Services Office, Inc., 2012 Page 13 of 16 0
POLICY NUMBER: GL989-49-74
COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
PURSUANT TO APPLICABLE WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV — Conditions:
We waive any right of recovery against the
person(s) or organization(s) shown in the Schedule
above because of payments we make under this
Coverage Part. Such waiver by us applies only to
the extent that the insured has waived its right of
recovery against such person(s) or organization(s)
prior to loss. This endorsement applies only to the
person(s) or organization(s) shown in the Schedule
above.
CG 24 04 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different
date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy).
This endorsement, effective 12:01 AM 04/02/2023 forms a part of Policy No. WC 808-78-253
Issued to GHILOTTI CONSTRUCTION COMPANY, INC.
By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against any person or organization with whom you have a written contract that requires you to obtain this
agreement from us, as regards any work you perform for such person or organization.
The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium
for this policy.
WC 04 03 61 Countersigned b
(Ed. 11/90)
Authorized Representative
RAFq�`
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o
WITH PP
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: Nataly Torres (for Ryan Montes) Extension: 3353
Contractor Name: Ghilotti Construction Company, Inc.
Contractor's Contact: James Clary Contact's Email: Jamesc@ghilotti.com
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
Project Manager
DATE
Check/Initial
1
a. Email PINS Introductory Notice to Contractor
Click here to
enter a date.
b. Email contract (in Word) and attachments to City
5/19/2023
Attorney c/o Laraine.Gittens@cityofsanrafael.org
❑X NT
2 City Attorney a. Review, revise, and comment on draft agreement
5/19/2023
and return to Project Manager
5/19/2023
❑X NT
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
® NT
3 Department Director Approval of final agreement form to send to
5/19/2023
❑X AM
contractor
4 Project Manager Forward three (3) originals of final agreement to
5/19/2023
contractor for their signature
❑X N/A
5 Project Manager When necessary, contractor -signed agreement
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
6/13/2023 NT
City Attorney
Attorney with printed copy of this routing form
7
Review and approve hard copy of signed
agreement
8
City Attorney
Review and approve insurance in PINS , and bonds
(for Public Works Contracts)
9
City Manager / Mayor
Agreement executed by City Council authorized
Z�
official
10
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager
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