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HomeMy WebLinkAboutPW On-Call Electrical Maintenance 2012CITY OF��,. 1� "4--"
Agenda Item No: 3. e
Meeting Date: November 5, 2012
SAN RAFAEL CITY COUNCIL AGENDA REPORT
Department: Public Works
Prepared by: `' ity Manager Approva .
Director of Public Works (LB)
elle No.: U1.Ul.UG.U1
SUBJECT: RESOLUTION AUTHORIZING THE PUBLIC WORKS DIRECTOR TO ENTER
INTO AN AGREEMENT WITH DC ELECTRIC FOR ON-CALL ELECTRICAL
MAINTENANCE SERVICES.
RECOMMENDATION: Waive the bidding requirements per Section 11.50.090 of the San Rafael
Municipal Code and authorize the Public Works Director to enter into an agreement with DC Electric for
on-call electrical maintenance services.
BACKGROUND:
The City of San Rafael maintains over 4,400 street lights, 86 traffic signals, 19 city owned buildings,
various pathways, twinkle lights, 12 storm pump stations, and additional lighting within the 10 public
parks. The City currently has a contract with Republic ITS for the routine and emergency maintenance of
the street lights and traffic signals only. Additional repairs of these two items, and for the remainder of the
City's electrical items is necessary in order to ensure public safety. Since the City of San Rafael does not
have electricians on staff, on-call services are required. Staff received a proposal from DC Electric for on-
call electrical maintenance services and found the proposal to be within industry standard.
ANALYSIS:
Staff has been contracting with DC Electric over the past several years for a variety of electrical
maintenance repairs and installations on a project by project basis. DC Electric and their staff, are highly
specialized and have a high level of knowledge regarding the City's existing electrical infrastructure.
When each of the small projects were bid, DC Electric was always the low bidder. In addition, it is our
experience that not many contractors would be interested, willing or knowledgeable to perform work
under this contract as the nature of work is to perform a large number of small jobs. Staff has left
voicemails for contractors in the past several weeks asking for prices on various small item projects and
have not received calls back, indicating that interest in these types of jobs is low. Because of these
items, it is unlikely that there would be any competitive advantage to bidding this contract, and staff
recommends that City Council waive the bidding requirements, per Section 11.50.090 of the San Rafael
Municipal Code and authorize the Public Works Director to enter into an agreement with DC Electric.
Previously, each time an electrical maintenance contractor was needed, staff called several companies to
receive competitive prices and then selected the lowest price to award the work to. By having an
electrical maintenance contract for on-call services, staff will save a significant amount of time spent on
negotiating each project with multiple contractors. In addition, it will reduce the response time for
necessary electrical repairs, thereby reducing the time during which outages are experienced, etc. An
FOR CITY CLERK ONLY
File No.: 4 - i —
Council Meeting: t j
Disposition: 114 1 I
SAN RAFAEL CITY COUNCIL AGENDA REPORT 1 Page: 2
on-call electrical contractor will be familiar with the Public Works Department's requirements which will
also save time and increase accuracy.
FISCAL IMPACT:
Staff recommends a one-year contract with the option for two one-year extensions based on mutual
agreement between the Public Works Director and DC Electric for the amount not to exceed $150,000
annually.
Currently, the City spends approximately $150,000 per year on City electrical maintenance repairs and
replacements. Some of the accident related costs are recovered. The remainder of the on-call electrical
maintenance services will be charged to the City's existing maintenance budget.
OPTIONS:
Council can reject the staff's recommendation and direct staff to competitively bid the Electrical
Maintenance Contract.
ACTION REQUIRED: Adopt Resolution.
Enclosures:
1) Resolution
2) Professional Services Agreement with attached proposal
' 30113
RESOLUTION NO. 13431
RESOLUTION AUTHORIZING THE PUBLIC WORKS DIRECTOR
TO ENTER INTO AN AGREEMENT WITH DC ELECTRIC FOR ON-
CALL ELECTRICAL MAINTENANCE SERVICES.
WHEREAS, the City requires professional electrical maintenance services for
various facilities throughout the City; and
WHEREAS, the electrical contracting firm of DC Electric provided a
proposal for such services; and
WHEREAS, City Council finds it is appropriate to waive the bidding
requirements for this contract as the work is of a highly specialized nature and it is unlikely
that there would be any competitive advantage to requiring bidding for the contract; and
WHEREAS, contracting with an electrical maintenance contractor for on-call
services will save the staff time, and increase response time for electrical repairs.
NOW, THEREFORE, BE IT RESOLVED that the Council of the City of
San Rafael does hereby authorize the Public Works Director to enter into a Professional
Services Agreement, in a form approved by the City Attorney, with DC Electric for a one-year
term in an amount not to exceed $150,000, with an option to extend this Agreement for two
additional one-year terms in an amount not to exceed $150,000 for each additional year,
subject to the approval of the Public Works Director.
1, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the
foregoing resolution was duty and regularly introduced and adopted at a regular meeting of the
Council of said City on the 5`h day of November, 2012, by the following vote, to wit:
AYES: COUNCILMEMBERS: Connolly, Heller, Levine, McCullough & Mayor Phillips
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
File No.: 01.01.02.01 fi-kES_TIIEMC. �FIRNE, City Cl k
City of San Rafael * California
Form of Contract Agreement
for
ON-CALL ELECTRICAL MAINTENANCE
This Agreement is made and entered into this 5th day of November, 2012 by and between the City
of San Rafael (hereinafter called City) and Don Caramagno, dba DC Electric (hereinafter called
Contractor). Witnesseth, that the City and the Contractor, for the considerations hereinafter
named, agree as follows:
I - Scope of the Work
The Contractor hereby agrees to furnish all of the materials and all of the equipment and labor
necessary, and to perform all of the work as required for various On -Call Electrical Services per
Exhibit A, attached to this contract. The liability 'insurance provided to City by Contractor under
-
this contract shall be primary and excess of any other insurance available to the City.
The Contractor shall carry commercial general liability insurance as well as automobile liability
insurance in the amount of $1 million with a carrier admitted to practice in California, and such
policies shall provide in their text or by separate endorsement that the City is a named additional
insured under the policies, and that such insurance shall be primary insurance. The Contractor
also shall carry worker's compensation insurance coverage for its employees as required by law.
The City shall be given 30 days notice of any cancellation or material change in coverage in these
policies. The Contractor shall provide the City with a Certificate of Insurance and endorsements
evidencing the foregoing coverages.
11 - Time of Completion
(a) The work shall be completed between November 15th, 2012 and November 15th, 2013, and
after the date of such notice and with such extensions of time as are provided for in the General
Conditions.
(b) At the discretion of the City, this contract can be renewed for up to two subsequent one year
terms at the same costs with adjustments as warranted by the consumer price index (CPI) and
with Contractor consent.
III - The Contract Sum
The City shall pay to the Contractor for the performance of the Contract per the hourly rates
provided in Exhibit B attached to this contract. The total annual contract amount shall not exceed
$150,000.00.
IV - Payments
The Contractor shall bill the City as agreed upon for each job performed under this contract.
V — Codes
All work shall be performed in compliance with Caltrans Standard Plans and Specifications 2010,
the California Building Code, the National Electrical Code and all other applicable codes and
regulations.
Page I
M
VI — Indemnification
The Contractor shall indemnify the City for any liability arising out of its work under this
Contract as provided in San Rafael Municipal Code Section 11.50.150.
IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to
execute this Agreement the day and year first written above.
sther C. Beirne
City Clerk
APPROVED AS TO FORM:
Robert E Epstein
City Attorney
CITY OF SAN RAFAEL:
Nader Mansourian
Public Works Director
CONTRACTOR:
for DC Electric
EXH161T 1� i
October 15, 2012
DC ELECTRIC is a locally based commercial electrical contractor and is currently providing, has providing or may
provide any of the following services to the City of San Rafael. We offer to perform the following services during
normal business hours of operation, after hours and on an on-call basis. Our services are available 24 hours a
day, 365 days a year.
Scope
Transportation
• Traffic signal installations, modifications and repairs
• Video system installation and repair — CCTV & video detection
• Underground utility installation & repair
• Utility locating and marking
• ADA pedestrian upgrades
• Lighted x -walk installation and repair
• After hours response
Lighting & General Services
• Building electrical — (interior and exterior) Installations, repair & maintenance
• Street lighting - Installations, repair & maintenance
• Indoor & outdoor parking lot lighting
• Parks lighting and ball field lighting
• Holiday and decorative lighting & banner installations
• Fountain, pool & spa electrical
• Electrical control work — Energy management systems, time clock & photo control
Lighting & Energy Efficiency Services
• Audits
• Upgrades — LED & Induction Lighting
• Electric vehicle charging stations
• Smart parking meters
• Energy management system installation & repair
Heavy Electrical Services
• Generator installation, maintenance and repairs
• Storm water pump and sanitary lift station maintenance and repairs
(707) 992-0141 Fax (888) 525-8419 P.O. Box 7525, Cotati, CA License # 949934
Confidential
Pricing
Journeyman (regular time)
Journeyman (overtime, after hours and weekend)
Bucket Truck
Dump Truck
Pick-up Truck
Compressor
$9S.UOper hour
$l42.50per hour
$24.00per hour
$1G.00per hour
$1S.0Oper hour
$1IO0per hour
All work will be performed on a time and material basis. Alternately, a written proposal can be
furnished at the request of the Public Works Director or his designee. Normal business hours will be
7arnto4pnn,Monday thruFriday.
Contact DC Electric:
(7O7)992'O141—During business hours
(888)525-8419—Fax
(707) 331-7807 — After hours & weekends / Emergency Calls
www.dcelectricgroup.com
(7D7)992-0141 Fax (888) 525-8419 P.O.Box 7525 Cotab,[A License #949934
DCELE-1 OP ID: EM
' RCERTIFICATE OF LIABILITY INSURANCE
°A�` °"Y""'
lthw' ,'�'..
12/05/12
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(les) must 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 800-591-9692
First Service Inc.
Lic.#OC13473 800-5914845
Don Sm€Bt
PHONE 800-591.9692 F c: 800-591-1845
215 Estates Dr.E-MAIL
Roseville,
Ro�ville, CA 95678678
Don Smith
ADDRESS: COMRanymailirstserviceweb.com
INSU s AFFORDING COVERAGE NAIL #
INSURER A: Colony Insurance Company 39993
INSURED D C Electric
Don Caramagno
640 West School Street
INSURER S: Wesco Insurance Company 25011
National Union Fire Ins. Co.
INSURER C: 19445
Cotati, CA 94931
INSURER D: Tower insurance Co 44300
INSURER E:
INSURER F .,
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
I TYPE OF INSURANCE AIM POLICY NUMBER
POLIO E POLIO EXP
MWD MMrDF MYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY X IGL3992582
CLAIMS MADE � OCCUR
11/18/12 11/18113
EACH OCCURRENCE $ 11000,
PUPJVLMr REMISES 1VKrN1cU
rrenca $ 100,00
MED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY $ 1,000,
GENERALAGGREGATE $ 2,000,0
PRODUCTS - COMPIOP AGG $ 2,000,WC
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY . PRO- 17 Loc
$
B
AUTOMOBILE
X
LIABILITY
ANY AUTO ! [WPA102934901
11/18/12 11118113
a accident) LIMIT 1,000,000
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED f
AUTOS AUTOS I
NON -OWNED
HIRED AUTOS AUTOS
i
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BODILY INJURY (Per accident) $
PROPERTY DAMAGE
accident $
$
UMBRELLA LIAR OCCUR
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EACH OCCURRENCE $ 6,000,000
C
X
CLAIMSWAOE� EBU021730808
11/18/12 i 11118113
AGGREGATE $ 5,000,
$
DED 1 X RETENTION $
D
WORKERS COMPENSATIONX
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORtPARTNER/EXECUTIVE N/Aj CCIm2724S00
OFFICERtPAEMBER EXCLUDED? ®
{Mandatory00
NH)
nder
SCRIdPriON OF OPERATIONS below
03/09/12 I 03109/13
I----
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v
E.L EACHACCIDENT $ 1,000,0
E.L.01 »EAEMPLOYEF $ 1,000,0
E.L. DISEASE - POLICY LIMIT ! $ 1,000,00000
}
r
DESCRIPTION OF OPERATIONS r LOCATIONS t VEHICLES (Attach ACORD 101 Addiffonal Remarks Schedule, M more space is required)
it is hereby understood and agreed that the City of San Ftafae€ and
Marin County, its officers, agents and employees are additional insureds
hereunder but only as respects liability arising out of the land and/or
property and/or work described in the -Public Works contract for the
p ct entitled, ON-CALL ELECTRICAL MAINTENANCE, between the City of++
City of San Rafael
Dept of Public Works
FAX: 415485-3334
111 Morphew St.
AW -001' .4011,101":alllll�ng;[:N,!L#14[WA:i�ioiTjiitolo
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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
or
Locations ) of Covered
All persons or organizations as required by written
contract with the insyred
A. SECTION If — WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown in the Schedule for Mom you are Performing operations when you and such person
or organization have agreed in writing in a contract or agreement that such person or organization be
added as an additional insured on your policy. Such person or organization is an additional insured 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.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This insurance does not apply to:
Addonal Insured Contractual Liability
"Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by
reason of the assumption of liability in a contract or agreement.
Finished Operations at Work
"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.
Negligence of Additional Insured
"Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional
insured(s).
U156-0310 Includes copyrighted material Of ISO Properties, Inc., Page I of I
with its permission.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of I
with its permission.
CITY OF SAN RAFAEL
INSTRUCTIONS: USE THIS FORM WITH EACH SUBMITTAL OF A CONTRACT, AGREEMENT,
ORDINANCE OR RESOLUTION BEFORE APPROVAL BY COUNCIL / AGENCY.
SRRA / SRCC AGENDA ITEM NO.
DATE OF MEETING: 11/5/12
FROM: NADER MANSOURIAN
DEPARTMENT: PUBLIC WORKS
DATE: 10/26/12
TITLE OF DOCUMENT:
RESOLUTION AUTHORIZING THE PUBLIC WORKS DIRECTOR TO ENTER INTO AN AGREEMENT WITH DC
ELECTRIC FOR ON-CALL ELECTRICAL MAINTENANCE SERVICES.
Department Head (signature)
(LOWER HALF OF FORM FOR APPROVALS ONLY)
APPROVED AS COUNCIL / AGENCY APPROVED AS TO FORM:
AGENDA ITEM:
" ��l �& a
City Manager (signature) City Attorney (signature)
PROFESSIONAL SERVICES AGREEMENT/CONTRACT
COMPLETION CHECKLIST AND ROUTING SLIP
Below is the process for getting your professional services agreements/contracts finalized and
executed. Please attach this "Completion Checklist and Routing Slip" to the front of your
contract as you circulate it for review and signatures. Please use this form for all professional
services agreements/contracts (not just those requiring City Council approval).
This process should occur in the order presented below.
Step
Responsible
Description
Completion
Department
Date
Y
City Attorney
Review, revise, and comment on draft
agreement.
2
Contracting Department
For -ward final agreement to contractor for
i.
we
their signature. Obtain at least two signed
from contractor.
3
--originals
Contracting Department
Agendize contractor -signed agreement for
Council approval, if Council approval
necessary (as defined by City Attorney/City
Ordinance*).
.4
City Attorney
Review and approve form of agreement;
bonds, and insurance certificates andga
endorsements.
5
City Manager 1 Mayor or
Agreement executed by Council authorized
Department Head
official.
6-
City Clerk
City Clerk attests signatures, retains original
agreement and forwards copies to the
contracting department.
To be completed by Contracting Department:
Project Manager: Project Name
0J oJ
Agendized for City Council Meeting of (if necessary):
If you have questions on this process, please contact the City Attorney's Office at 485-3080.
* Council approval is required if contract is over $20,000 on a cumulative basis.
DCELE-1 OP ID: EM
�a moo. CERTIFICATE OF LIABILITY INSURANCE
12105J/D12
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: N the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. M SUBROGATION IS WAIVED, suboct to
the berms 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).
PRIER 800-591-9692
rAOKNT Don Smith
First Service Inc.
Lk, fOC13473 80-591145
N.800-591-9692 -1 say
Ate; companymail@flrstserviceweb.com
215 Estates Dr. Ste.1
Roseville, CA 95678
11/18/13
Don Smith
s AFFOROM COVERAGE MAIC s
INstRtER A: Cot -y Ins'uamx Company 39993
PERSONAL & ADV INJURY $ 1,000,
INSURED D C Electric
Don CaramagnoINSURER
640 West School Street
INSURER B: Weaco Insurance Company 25011
c : National union Fire Ins. Co. 194x5
INSURER D: Tower Insurance Co 44300
Cotal , CA 94931
INSURER E:
INSURER F:
WPA102934901
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRADDHL
LTR
I TYPE OF INSURANCE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
POLICY NUMBER
POLICY EFF
P
LIMITS
A
NERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAW -MADE F_y_1 OCCUR
X
111 Morphew St.11Giiltl.�•
GL3992582
11/18/12
11/18/13
EACH OCCURRENCE i 110001
PREMISES Ea Gcourrence $ 100+
MED EXP (Any one permn) $ $,
PERSONAL & ADV INJURY $ 1,000,
GENERAL AGGREGATE $ 2,000,
GEN'L AGGREGATE LIMIT APPLIES PER:
7X POLICY PROJECT -LOC
PRODUCTS - COMP/OP AGG $ 2,000,00(
$
B
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OV*4ED SCHEDULED
AUTOS AUTOS
HIR D AUTOS AUUTTOS ED
WPA102934901
11/18112
11118113
COMBINED SINGLE LIMIT1,000, 000
me accident
BODILY INJURY (Per pxmn) $
BODILY INJURY (Per accident) $
c ��PERTY CIE $
accident)
$
C
X
UMBRELLA
EXCENLIAe
X00
OCCUR
CLAIMS -MADE
EBU021730808
11/18/12
11/18/13
EACH OCCURRENCE $ 5,000,0
AGGREGATE $� 51000,
DED I X I RETENTION s
$
D
WORI(ERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETO"ARTNERIEXECUTNE Y®
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
underrereC�
OF OPERATIONS Wow
N t A
CC40277A>�0
03/09/12
03/09/13
X WC STATU OTM
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE -EA EMPLOYEE $ 1,000,000
E.L. DISEASE . POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 141 AddItionai Remarks Schedule, N more space Is r*Wtred)
It is hereby understood and agreed that the City of San tkafael and
Marin County, its Officers, agents and employees are additional insureds
hereunder but only as respects liability ansingg out of the land and/or
property and/or work described In the -Public Works contract for the
project entitled, ON-CALL ELECTRICAL MAINTENANCE, between the City of++
t`ERTIFICATE HOLDER CANCELLATION
COFSANR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of San Rafael
ACCORDANCE WITH THE POLICY PROVISIONS.
Dept of Public Works
FAX: 415-4654334
A REPRESENTATIVE
111 Morphew St.11Giiltl.�•
San Rafael CA 94915
Q 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marcs of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL
OWNERS,OR CONTRACTORS — SCHEDULEi
r •`hiq� 1111,
• w • i 1 1 •
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or Organization(s)
Additional Insured):
Locations of Covered Operations:
All persons or organizations as required by written
contract with the insyred
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 for whom you are performing operations when you and such person
or organization have agreed in writing in a contract or agreement that such person or organization be
added as an additional insured on your policy. Such person or organization is an additional insured 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.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This insurance does not apply to:
InsuredAdditional Contractual Liability
Finished"Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by
reason of the assumption of liability in a contract or agreement.
Operations at W•
"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.
Negligence of Additional Insured
"Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional
U156-0310 a -s copyrighted material of i Properties,•_•- I of
with its permission.
. .
^
'We stern Surety CompaPERFORMANCE BONDBond Number:
KNOW ALL PERSONS BYTHESE PRESENTS, That we
640 W. School St., Cotati, CA 94931 Of
referred to as the Principal, and Western SuretV Company hereinafter
as Surety, are held and firmly bound unto City of San Rafael I
Of -111 MorL2hgIL.,�t., San Rafael, Qa 94915 hereinafter
referred to as the Obligee, in the sum of seventy -Three Thousand Eight Hundred One and 00/10 0
Dollars (S —7-3, 8 0 1 . _Oo ), for the payment of which we bind ourselves, our legal representatives, successors
and assigns, jointly and severally, firmly by these presents.
WHEREAS, Principal has entered into acontract with Obligee, dated the _!51hL__day of
October
__2llI2_-'fbr ��---`
11205 ' NOW,
—
NDVV THEREFORE, if the Principal ahoU '^pedbnn such contract or shall indemnify
and save harmless
the from all cost and damage by reason of Principal's failure so to do, then this obligation shall be nulland void; otherwise it shall remain infull force and
ANY PROCEEDING, legal or equitable, under this Bond may beinstituted inany court ofcompetent jurisdiction
in the location in which the work or part of the vmxk is located and ahe|be instituted within two years after
Contractor Default or within two years after the Contractor ceased working or within two years after the Sunyb/
refuses or fails to perform its obligations under this Bond'whichever
Paragraph are void or prohibited by law, the minimum periodof|in/rn«tne«er occurs first. |f the provisions of this
limitation available tosureties maadefense inthe
jurisdiction of the suit shall be applicable.
NO RIGHT OF ACTION shall accrue on this Bond to or for the use of any person mcorporation other than the
Obligee named herein nrthe heirs, executors, administrators orsuccessors nfthe Obligee.
SIGNED, SEALED AND DATED this ___2rld_—day uf ' _-2012_
WV2
We stern Surety Companj
Bond Number: 71342081
KNOW ALL PERSONS BYTHESE PRESENTS, That we Don Caramagno dba QC,Electric
640 W. WSch001 3t., Cotati, Ca 94931
M
referred toaathe Principal, and ompanhereinafter
as Surety, are held and firmly bound unto City
.hereinafter
referred toamthe Obligee, inthe sum of s 7 -Three Th d 00/100
Dollars ($7 ). for the payment cf which we bind ouraa|mamour|�ga|napnaa�ntsd/waosuccessors
and assigns, jointk/and eevensUy.firnn�bythese presents. ' '
WHEREAS, Principal has entered into a contract with Obligee, d day of .
_-,LDI2_-^for.Parking
No. 11205
copy mwnmncontract mUyreference made apart hereof.
NOW, THEREFORE, if Principal shall, in accordance with applicable Statutes, promptly make payment to allpenyonmeupp��U�borendnnote�dinthepnoeecubonofthewnrkpnmidedfor�noa|doontnact,andanyandoU
duly authorized modifications of said contract that may hereafter be made, notice of which modifications to Surety
being waived, then this obligation to be void; otherwise to remain infull force and effect.
Nosuit oraction shall becommenced hereunder
(a) After the expiration of one (1)year following the date onwhich Principal ceasedworkonsaid contract it
being undensbomd, however, that if any limitation embodied in this bond is prohibited by any law
controlling the construction hereof such limitation mhmU be deemed to be amended so mato beequal to
the minimum period oflimitation permitted bysuch law.
(b) Other than in m state court cfcompetent jurisdiction in and for the county orother political subdivision of
the state in which the project, or any part thereof, is situated, or in the United States District Court for the
district in which the project, or any part thereof, is situated, and not elsewhere.
The amount of this bond shall Lmreduced byand to the extent ofany payment orpayments made ingood faith
SIGNED, SEALED AND DATED this ___2nd __day of '__�l�L_
0 Acknowledgment or Principal
WX Acknowledgment of Surety (Attorney -in -Fact)
STATE OF CALIFORNIA
COUNTY OF Placer j ss
On 11-7 before me.4 4 A 11"
date here insert name and title oPthe officer
personally appeared Mn -1— Andrew Lindley
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(ios), and that by histher/their signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted, executed the instrument.
I certifv under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct,
JenrAW DWO Mokkup
WITNESS my hand and official seal,cow. ms"=
MrAAYKVM-*CALlF0MA
MAMCMMY
Signature (Seal) --- 2Mj
(The balance of this page is intentionally left blank.)
Westem Surety Company Form 1900-1-2009 —41*—
re *7
Western Surety Company
POWER OF ATTORNEY - CERTIFIED COPY
Bond No. -- 713 4 20_8 1
Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws
of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents make,
constitute and appoint
LL law'Lu auL0rneYks)-1n-tact, with tuH power and authority hereby conferred, to execute, acknowledge and deliver for and on its
behalf as Surety, bonds for:
Principal: Don Cararaagno dba DC Electric
Obligee: City of San Rafael
Amount: $500,000.00
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with
the corporate sea] of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorneys) -in -fact
may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety
Company which remains in full force and effect.
"Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.*"
All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of _--March 15
2013
, but until such time shall be irrevocable and in full force and effect.
In Witness Whereof, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its
corporate s
xed this 2nd day of November 2012
STk4W
CoUa
GEST �R SURE54 COMPANY — r 7
P—
T. rufl-t, Vice President
On this --2nd - day of -----Nov —errber in the year2
L _ , before me, a notary public, personally appeared
Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of
WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and dee fsaid co aflon
.1 +
S. PETRIK S
AL NOTARY PAJOUC 9
MUTH DAKOTA It otary Public - South Dakota
+
My Commission Expires August 11, 2016
I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the
attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as
set forth in the Power of Attorney is now in force.
In testimony whereof, I have hereunto set ray hand and seal of Western Surety Company this 2nd
lido V e.Th e r 2012
day of
, --1—.
WESTqR SURE;�,Y COMPANY
�Pa.17 uflatVice President
State of California
County of Sonoma
On November 2, 2012
ACKNOWLEDGMENT
before me, Shannon Long, Notary Public
(insert name and title of the officer)
personally appeared Don Caramagno
who proved to me on the basis of satisfactory evidence to be the person whose name(q) is/al*
subscribed to the within instrument and acknowledged to me that he/sheMiey executed the same in
his/hextthek authorized capacity(i*, and that by his/heYM7& signature(s) on the instrument the
person(,$), 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.
SHANNON TONG
Commission # 1877656
WITNESS my hand and official seal. mo Notary Public - California>
Marin County
Comm. Excires Jan 22, 2O1A
Signature (Seal)
F FIRST
SERVICE
A I N S U R A N C E
11/2/2012
D C Electric
Don Caramagno
640 West School Street
Cotati, CA 94931
Bond Type: Performance & Payment Bond
Obligee: City Of San Rafael
Project: Parking Structure -Garage lighting replacement project, City project No.
11205
Bond Number: 71342081
Premium Due: $2,214, due upon bond issuance - PIF
•-M
Thank you for working with us for issuance of this bond.
Enclosed is an original bond. Note that the original needs to be signed and sealed by
you and then delivered to the Obligee per their instructions. Please retain a copy for
your records.
Call anytime with questions.
Sincerely,
z
Don Sinfttr--
www,F1rstServiceWeb com
First Service Insurance Agents & Brokers, Inc.
215 Estates Dr. Suite 1 - Roseville, Califomia 95678 - ph 800.591.9692 - fax 800.591.1845 - License #OC13473
DCELE-1 OP ID: EM
A4c" ix
164,...,..--- CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDYYYY)
1 12/06/12
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(les) must 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 endorsements
PRODUCER _ 800-591-9692
NAME: CT
Don Smith
First Service Inc. 800-591-1845CNNo
Lie. #OC13d73
215 Estates Dr. Ste. 1
Roseville, CA 95678
Don Smith
Ext : 800-591-9692 A/c No): 800-591-1$45
EMAIL
ADDREss: companymail@firstserviceweb.com
INSURERS) AFFORDING COVERAGE NAIC #
INSURERA: Colony Insurance Com pany 39993
MED EXP (Any one psrsun) $ 5,000
INSURED D C Electric
INSURER B: Wesco Insurance Company 25011
Don Caramagno
640 West School Street
Cotati, CA 94931
INSURER c: National Union Fire Ins. Co. 19445
INSURERD: Tower Insurance Co 44300
INSURER E:
B
INSURER F,
• r + H1raTi4 33 lild11 e1ye -J:ITJky[*7A11111AIII IrdC1�:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVd 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.
INTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MM OD YYW MMIDDIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABIUTY
CLAIMSMADEa OCCUR
X
AUTHORIZED REPRESENTATIVE
t -
GL3992582
11/18112 11!1$(13
EACH CCCURRENCE $ 1,000,000
I ED
PREMISES Ea i7E 10 occurrence)$ 100,000
MED EXP (Any one psrsun) $ 5,000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGRESATE _IMIT APPLIES PER:
X POLICY PRO- LOC
.PRODUCT'S-COMPIOPAGG $ 2,000,000
$
B
AUTOMOBILE LIABILITY
X ANr AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREC AUTOS AUTOS
WPA102934901
11118112 11/18113
-
C0VBINED SINGLE _IMiT 1,Q00 000
Ea accidert $ ,
BODILY INJURY (Per person) $
BODILY INJURY (Per at-ident) $
PROPERT" D.AM.AGE $
Per accident
$
C
X
UMBRELLA LAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
EBU021730808
11118(12 11/18/13
EACH CCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
DED X I RETENTION$
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE Y❑
OFFICERIMEMBER EXCLUDED'
(Mandatory in NH)
If{es, describe under
DESCRIPTION OF OPERATION'Sbelcw
NIA
WCCO02724800
03109112 03109113
X WO STATU- OTH-
? R I 1 T. ER
EL HACH ACCICENT $ 1,000,000
E.L DISEASE- EAEMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
I
I
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of San Rafael is shown as Additional Insured with respect to liability
arising out of operations performed by named insured.
!`C DT4 Cit`,tTC U^1 RCD t-Ahirizi I LUTA')Ai
COFSANR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of San Rafael
1400 5th Ave
AUTHORIZED REPRESENTATIVE
t -
San Rafael, CA 94901
N..
IIddU-1U1U AUVKU L;UKI-UKAI IUN. An rig nis reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
N
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -
OWNERS, LESSEES OR CONTRACTORS - SCHEDULET
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Name of Additional Insured Person(s) or Organization(s)
(Additional Insured): Location(s) of Covered Operations:
All persons or organizations as required by written
contract with the insyred
A. SECTION 11—WHO |SANINSURED is amended to include asanadditional insured the penmn(s)nr
organization(s) shown iDthe Schedule for whom you are performing operations when you and such person
or organization have agreed in writing in m contract oragreement that such person or organization be
added @5aOadditional insured onyour policy. Such person or organization is an additional insured only
with respect to |iab||h» for "bodily injury", "property damage" or "personal and advertising injury" caused, in
whole V[in part. by:
1. Your acts oromissions; or
2' The acts oromissions ufthose acting onyour behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated
obovw.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
B. With respect to the insurance afforded to these additional iDsWreds, the following additional exclusions
app|y:
This insurance does not apply to:
Additional Insured Contractual Liability
"Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by
reason Vfthe assumption Vfliability inocontract oragreement.
Finished Operations at Work
"Bodily in'Wry/'or"property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such vvo[k' on the
project (other than sgn/ica' maintenance or repairs) to be performed by or on behalf of the
additional iDsVred(s)atthe location o[the covered operations has been completed; or
2. That portion of"your work" out ofwhich the injury ordanlageoriaeahasbeeDpUttVitsintundedUse
byany person or organization.
Negligence mfAdditional Insured
"Bodily injury" or "property damna0e" arising directly or indirectly out of the nmQ{iggDca of the additional
iDsUred(s).
U156-0D}1O Includes copyrighted material of |S{] Properties. Inc., Page 1 of
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
U15G-O31O Includes copyrighted mmtmha|of|8O Properties, Inc., Page Zof1
DCELE-1 OP ID: EM
CERTIFICATE OF LIABILITY INSURANCE
ATE(MM/DD/YYYY)
r12/04/12
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 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).
PRODUCER800-591-9692
FlrSt Service Inc.
Lica #OC13473 800-591-1845
215 Estates Dr. Ste. 1
Roseville, CA 95678
Don Smith
NAME GT Don Smith
PHONEFAX
Arc No Ext): 800-591-9692 A/C No): 800-591-1845
E-MAIL companymail@firstserviceweb.com -
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Colony Insurance Company 39993
INSURED D C Electric
Don Caramagno
640 West School Street
Cotati, CA 94931
INSURER B: Wesco Insurance Com any 25011
INSURER C: National Union Fire Ins. Co. 19445
INSURER D:Tower Insurance Co 44300
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
INSR
UB
POLICY NUMBER
I
MMLDD/YYYY
MEFF LICY EXP
M/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I:xl OCCUR
X
San Rafael, CA 94901
GL3992582
11/18/12
[11/18/13
EACH OCCURRENCE
$__ 1,000,00
AGET RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- LOC
ECTAUTOMOBILE
PRODUCTS - COMP/OP AGO
$ 2,000,000
$
B_
LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
WPA102934901
11/18/12
11/18/13
COMBINED SINGLE LIMIT
Ea acadent
$ 1,000 OO
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
PROPERTY DAMAGE
APer accident'
$
$
C
X
UMBRELLA LIAR X
EXCESS LIAR
OCCUR
, CLAIMS -MADE
EBU021730808
11118!12
11/18!13
EACH OCCURRENCE
� $ 5,000,000
AGGREGATE
$ 5,000,00
DED I X I RETENTION $
$
D
WORKERS COMPENSATIONWC
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? ®
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N J A
.
WCCO02724800
!
!
! 03109/12
(( 03/09113
STATU- OTH-
X T RY LIMITS ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,00
E
I
i
I
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
City of San Rafael is shown as Additional Insured with respect to liability
arising out of operations performed by named insured.
*Additlonal Insured Endorsement to follow
C`ERTIFIC'ATE 1 -ICH r1FR CANCELLATION
COFSANR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of San Rafael
1400 5th Ave
AUTHORIZED REPRESENTATIVE
San Rafael, CA 94901
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
DCELE-1 OP ID: JC
CERTIFICATE OF LIABILITY INSURANCE
DATE ( YY„
101 261126,12
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 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 800-591-9692
NTA
NAME: cT Don Smith
First Service Inc.800-591-1845
Lic. #OC13473
215 Estates Dr. Ste. 1
Roseville, CA 95678
PHIC N E4: 800-591-9692 AIC Nv :800-591-1$45
ADDDRESS: info@firstserviceweb.com
Don Smith
INSURER(S) AFFORDING COVERAGE
NAIC x
INSURER A: Scottsdale Insurance Co.
41297
INSURED D C Electric
INSURER B: Wesco Insurance Company
25011
Don Caramagno
640 West School Street
Cotati, CA 94931
INSURER C: National Union Fire Ins. Co.
19445
INSURER D : Tower Insurance Co
44300
INSURER E;
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IPOLICY
LTSRR
TYPE OF INSURANCE
1 SRAVUL
D?Subm
POLICY NUMBER
EFF
MMIODIYYYY
POLICY EXP
MMIDDIYYYY i LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,00
A
X COMMERCIAL GENERAL TY
X
CPS1469364
11118111
JAZ; 10RLN IEU
1111$112 �PREMISGs(Ed occurrence) $ 100,00
CLAIMS -MADE L " i OCCUR
ME{Any cne person) $ 5,00
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENT AGGREGATE LIMIT APPLIES PER
PRODUCTS- COMP/OP AGG $ 2,000,00
POLICY X PR LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,00
Ei
X
ANY AUTO
WPA102934900
11/18/11
11/18/12 BODILY INJURY (,Per person) $
ALL OWNED SCHEDULED
`
AUTOS AUTOS
= BODILY INJURY wer accident) $
HIRED AUTOS NON -OWNED
AUTOS
PROPERT'f DAMAGE $
UMBRELLA LIAB
X
OCCUR
i EflCH OCCURRENCE $
C
X
EXCESS LIAB
CLAIMS -MADE
EBU013776722
11/18/11
11/18/12 I AGGREGATE $ 1,000,00
DED I I RETENTION $
1 $
WORKERS COMPENSATION
I X W C STATU-OTH-
'S
AI EMPLOYERS' LIABILITY YIN
I Y L IM �_
D
ANY PR�PRIETCRPARTNERIE;�ECUTI'✓E �
WCC002724800
03109!12
03/09113 j E.L. EACH ACC DENT $ 1,000,000
OFFICER,VEMSER E {CLUDEC? Iy
(Mandatory In NH)
NIA
--
E.L DISEASE EA EMPLOYEE $ 1,000,00
If yes, describe under
DESCRIP T O`d OF OPERATIONS below
� � E L DISEASE POLICY LIMIT $ 1,000,00
j
4
I
i
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
It is hereby understood and agreed that the City of San Rafael and
Marin County, its officers, agents and employees are additional insureds
hereunder but only as respects liability arising out of the land and/or
property and/or work described in the Public Works contract for the
project entitled, Parking Structure -Garage Lighting Replacements Project—
C-CK I II-R.A i t MVL IJr-K UANC.CLLA I IUN
COFSANR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of San Rafael ACCORDANCE WITH THE POLICY PROVISIONS.
Dept of Public Works
111 Morphew St. AUTHORIZED REPRESENTATIVE
San Rafael, CA 94915 t�
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABIU7Y
CG 20 33 07 04
THIS ENDORSEMENT CHANGES 7HE POLICY. PLEASE READ IT CAREFULLY.
W A 0 a
H.110110MUIS-149 41 Al
9 k
This endorsement mod ffies insurance provided utdarft followlng-_
GOINIVERCIAL GENERAL LIABILITY COVE RA3 E FART
A Section ii - Who Is An Insured Is arne rded to ii-
clude as an additional insured any person or
organization for whom yoj are perforning, opera-
tions when you and such person o- organization
have agreed in writing in a contract tor agreement
that such persm or organization be add -ed as an
additional insured on your policy. Such person or,
organization is an additional insurac only oath ra-
spectio liability for 'bodily injury", "prooperty dam-
age" or 'personal aril advertising injury' caused, in
Wide or in part, by:
1. Your acts or omissicns; or
2. The acts or omissions of those anti rxi on -Avur
behalf;
in the performance of your ongoing operations for
the addlitionalin%ured.
A person's or organization's status as an additional
insured under this endorsement ends w1her your
operations for that additional insured are cor-i-
piated.
E. Wih -espect to the insurance afforded to these ad-
dtioral Insureds, the following additional exclu-
sions apply.
This h!su tance dogs riot applyto:
1. "Bod ly injury. "property damage" or "personal
aW advertising injury arising out of the ren-
c1edn3 of. or the failure to render, any profes-
sionalarc-hiteMrad, engineering or surveying
services, including:
a. The preparing, approying, or failing to pre-.
pare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,
c*icngc crdcra or drowingo and opcofta
tions; or
L. Supervisory, inspection, architectural or
engineering activities.
I "Bed ly injury" or 'property damage" occurring
after:
a Al work, including materials, parts or
equipment furnished in connection with
such work, on the project (other than swv-
ice maintenance or repairs) to be per-
formed by or on t�eehaff of the additional
ins ured(s) at the location of the covered
operations has been completed; or
lb. That portion of "your work" out of which
the injury or damage arises has been pit
to is intended use by any person or or-
ganization other thari another contractor
or SLIocontrac1or engaged in performing
operations for a principal as a part of the
sane project.
CS 20 33 07 04 Capytight, 180 Properties, I na., 2w4 Page 1 of 1
AAGEN "I
POLICY NUMBER: CPS1459364
COMM ERGIAL GENERAL LIABILITY
CG 24 D4 05 09
Thils endorsement modifies insurance p rcvded undarthe folia g:
COMMERCIAL GENERAL LIABILITY MVERA3 E PART
PRODUCTS/COMPI ETED OPERA711ONS LIA131:1.17YCOVE RAGE PARI
SCHEDULE
Name 01 Person Or Organization:
.ANY PERSON OR ORGANIZATION %IUE NEOM THE INSURED HAS AC -REED To WhIVE RIGHTS OF
RECOVERY PROVIDED SUCE AGREEMEFT IS NADE IN WRITING ANE PRIOR TO THE LOS,9-
I Information required to cernpilete thls Schedul e, F rxA s hown above, will be shown i n the Dec-Arations. I
The following is added to Paragraph S. Transfer Di
RIghts Of Recovery Against Others To Us of
Section IV -Conditions;
We waive any right of recovery we may have agairal
the person or organization shown In the Sched-ole
above because of payments we rnak-- For injury or
ciamage ansing our or your or -going operations or
"your work" done under a contract with ttat pe!rscn or
organization and included In the 'products-=mpileted
operations hazard". This waiver applies onlir to the
person or organization skmm in the Sciedu le above.
CG 2404 0509 Copyright, Irmuranc-, ServicesOffica Inc., Ma Pagel oft
A7 �GENT cg2404a. faLp
POLICYINIUMBER: CTS1469364 COIAMEROAL GENERAL UABILITY
CG 26 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 17 CAREFULLY.
i
" :*%% CIA 0 M21 W -Wel -.1 9
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Designated Construwtion Frojecl(s):
ALL PROJECT AWAY FROM PREMISES 494NED OR RENTED 3Y YOU.
I Irifortmdon required to connplate this Schedule, I not shown above, wilil te shown in the Declarations.
A For adi sums which the Insured becomes legally
S. Any payments made under Coverage A for
obligated to pay as darmges caused by 'occur-
damages or under Coverage C for medical
rences" under Section I - Covens ge A, and for all]
expenses shall reduce the Designated Con -
medical expenses caused by accidentstunider
stn_xton Project General Aggregate Limit for
Section I - Coverage 0, which can be atribrilad
tUal designalled construction "eat. Such
nnly to nnojoing operaticne at a cin& doeigraia�d
pctymanto ohall not reduce the Conered Ag -
construction project: show in the Schedule
gegate Limit shown in the Declarations nor
above,
sha I they reduce any other Designated Com
1. A separate Designated Construction Project
sruction Project General Aggregate Limit for
Cianaral Aggregate Unit applies to each des.-
any other designated construction project
ignated construction project, and that If nit is
shown in the Schedule above.
equal to the amourt of the General Aggre-
4. Thelimitsshown in the Declaratkmsfior Each
gate Limit show In the Declarations.
Occurrence, Camga To Premises Panted To
2. The Designated Construction Project General
You and Medical Expense continue to apply,
Aggregate Limit is the most we will pay for
113,wever, Inslead of being subject to the
the sum of all danageS under Coverage A.
Gareral Aggregate Urnit shown in the Decla-
except damages because of "t ocillif hjurir o t
rations, such limits will be subject to the
"property damage included in the 'pio-
applicable Designalad Construction Project
ducts -completed operations hazard", and for
Garetal Aggregate Unfit,
medical expenses under Coverage C re!gard-
less of the number of:
a. Insureds;
b. Claims made WSW brought or
c. Persons or wVanizallons ma idM chins
or bringing "stfte-
CG 25 03 05 D9 Copyright, Insuance 3ervices Clft e, Inc., 2ooa Page I of 2
AGENT C92503-b-fap
B. For all sums which the insured bEcarnes lagaly
C. 'Nh-en coverage for liability arising out of the
obligated to pay as damages caused by "occur-
'prokcis-complatk operations hazard" is pro-
reqcee under Section I - Coo /erage A. and for all
AdeJ, any payments for damages because of
rnedicall expenses caused by accidleits. under
'b(>cily inijry* or 'property damage" included in
Section I - Coverage C, which cannot ire alrb-
*.he *V.-oducts-cornplateo operations hazard" will
Lited cnly to ongoing operations at a single desig-
edLc:e be Products -completed Operations
nated construction project shown in he Scheftie
kgg,egate Limit, and not reckice the General Ag -
above.
jragate Unit nor the Designated Construction
1. Any payments made urder Cmerage A for
:3roijact General Aggregate Limit.
damages or under Coverage C for medical
0. if the applicable designated construction project
e)(penses shall reduce the amount available
bras been abandoned, delayed, or abandoned
under the General Aggregate Llinh or the
3rd Men restarted, or If the authorized contract-
Prooducts-corripleted Dperations Aggregate
ng parties deviate from plans, blueprints, do -
Lin -A, whichever is apoicable: and
&1grs. specifications or timetables, the project
2. Such payments shall nct reduce, a nf Desig-
Mill still be deemed to be the same construction
nated Construction Prciect Genera Aggie-
prcqKt-
gate Umft.
E. The provisions d Section 01 - Limits Of Insurance
not otherwise modified by this endorsement shall
cordrue to apply as stipulated_
Pagle2d2 Copyright linsirance Services Office, line., 2008 CG 25 03 05 09
ENDORSEMENT
SCCTrSDALE INSURANCE COMPANY O NO.
ATTACHED TCT AND
FORMING A PART OF=
ENDCWGEWENrT EFFECTIVE DATE
MLIQYNUMBER
0 2:M R.M. STANDARD TIME)
NAMED NSURED
AGENT 40.
CPS1469361
D C SLECIRIC
04058
THIS ENDORSEMENT CI-114MESTKE POU Cil. PLEASE READ ITCAREFULLY.
a NZW 9 1 �
91 0 1 go -f-9401 -'RS-1z14*j rn W0101 0 10111 to] 0 1
It any of the endorsements below are attached to this pd icy, coverage provided by the additional insured
endorsement is amended to be affcrcbd or a primary, nonc-,cn1ribiXo,,y or prirnary and noncontributory
basis when and asagreed toinwrifing h a contract or agreemaIrt beK"en youandtheadckional insured.
Additional insured- Owners, LesseesOr Ccniractors - Sctiecided Person 0,rOrgarization (CG 2010)
Additional Insured- State Or P(ONC31 SubAyisions -Perfnils (CG 20 12J
Addillonal Insured - DwrIers, Lesisew Or Contractors -Automatic Status When Required In Construc-
tion Agreement With You (CG 20 mn)
Addkional Insured- Owners, lessee sor Ccniractors-Cornpi-eted Operaticns (CG 2037)
Other: (Spec ffy We and farm nurn b--r,i
ME��
ALTHO�iZED REPFUEW ATM
Fage I of 1
AGE)n
9138295S.fap
0
Western Surety
PERFORMANCE BOND
Bond Number: 71342061
KNOW ALL PERSONS BY THESE PRESENTS, That we _Don Caramacrno dba DC Elect is
640 W. School 3t., Catati CA 94931 or
referred to as the Principal, and Western Surety comanv
hereinafter
as Surety, are held and firmly bound unto City of San Rafael
of 111 Mar2hew 3t San �f�el Cly 9d9� 8
> he
referred to as the Obliges, in the sum of Sevent Three Thousand Eicrht Hundxed One and 00/10o
reins
Dollars ($ 73 , 6 01. o o j, ibr the payment of which we bind ourselves our legal re
and assigns, jointly and severally, flrmly by these presents. representatives, successors
WHEREAS, Principal has entered into a contract with Obligee, dated the—J-5111day of octohpr
2(112 , for'ParkinQ S r�!`,1'tr.�.�";ran� T•iQh�„ina Rt�UTAc�.mE.nt Arn gni- C ,
11205
NOW, THEREFORE, if the Principal shall faithfully perform such contract or shall Indemnity and save harmless
the Obliges from all cost and damage by reason of Principals failure so to do, then this obligation shall be null
and void; otherwise it shall remain in full ibrce and effect,
ANY PROCEEDING, legal or equitable, under this Bond may be instituted in any court of competent jur(sdlction
In the Location 1n which the work or part of the work is located and shall be Instituted within two years after
Contractor Default or within two years after the Contractor ceased woridng or within two yeare after the Surety
refuses or fails to perform its obligations under this Band, whichever occurs first. If the provisions of this
Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense In the
Jurisdiction of the suit shall be applicable.
NO RIGHT OF ACTION shalt accrue on this Bond to or for the use of any person or corporation other than the
Obligee named herein or the heirs, executors, administrators or successors of the Obligee,
SIGNED, SEALED AND DATED this _2n d day of November 2012
I&- ,
Don Caramagno dba Dc Electric
PrInelpaQ
By {meq
G
OD°l
Western Surety Company
PAYMENTBOND
Bond Number, 71342081
KNOW ALL PERSONS BY THESE PRESENTS, That we Don Cazarnagna dice DC ��
e tris
640 W. School St., Cotati CA 94931 or
,
referred to as the Principal, and Western Surat Com an hereinafter
as Surety, are held and firmly bound unto City of San Rafael
Of "'—
hereinafter
referred to as the Obligee, in the sum of seventy -Three
na and 001100
Dollars ($ 73, 801.00 ), for the payment of which we bind ourselves, our legal representatives, successors,
and assigns, jointly and severalty, firmly by these presents.
WHEREAS, Principal has entered Into a contract with Obligee, dated_ 15th _ day of oc+-ober
2012 , fbr ParkiaQ 4f r nt„rr� (zaracre T.iahtincr R@D�eaemant Prn ic,.+ ri s
No. 11205
oopY of which contract is by reference made a part hereof.
NOW, THEREFORE, if Principal shall, in accordance with applcabie Statutes, promptly malas payment to all
Persons supplying tabor and material in the prosecutbn of the work provided far in said contract, and any and a�
duty authorized modifications of said contract that may hereafter be made, notice of which 0 ra ti, lid a to Surety
being waived, then this obligation to be void; otherwise to remain In full force and effect.
No suit or action shalt be commenced hereunder
(a) After the expiration of one (1) year foliowtng the date on which Principal ceased work on said contract It
being understood, however, that if any limitation embodied in this bond is prohibited by any taw
controlling the construction hereof such limitation shall be deemed to be amended so as to be equal to
the minimum period of limitation permitted by such law.
(b) Other than In a state court of competent jurisdiction In and for the county or other political subdivision of
the state in which the project, or any part thereof, Is situated, or In the United States District Court for the
district in which the project, or any part thereof, Is situated, and not elsewhere.
The amount of this bond shalt be reduced by and to the extent of any payment or payments made in good faith
hereunder.
SIGNED, SEALED AND DATED this 2nd day of Navember 20 ► 2
Di _i s i{„:ctr _
.rl sy �zT
D• s .re yM1
[-1 Acknowledgment of Principal
® Acknowledgment of Surety (Attorney -in -Fact)
STATE OF CALIFORNIA:
}u
COUNTY OF Placer }
On _ k111111. before me, :()Ant Lli �+t h MAO �6t>9►ItiPa.,�G
data pare ius rt mane and tit]* Chu oi$csr I
personally appeared Douulas Andrew I,indlev
nRme(s) of
who proved to me on the basis of satisfactory evidence to be the Person(s) whose names) in/" subscribed
to the within instrument and acimowledged to cue that helshelthey executed the same in his&ar/their
authorized capacity(ies), and that by his/her/their signatures) on the instrument the person(s), or the
entity upon behalf of ,which the person(s) acted, executed the instrument.
I owt* under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph • correct.
WITNESS"kiliowl
hand • offidal seal.
t4�
Signature (Seno
(The balance of this page is Uttontlonally loft blank.)
Western surety company Form tsOm-200#
21
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
CML COD! f 1188
County of -"iii
I =,
i
On _'` before me,.'�-�,'>�'�i� �., f �; w
Dae 9 Hera Insert N a d Title of fhe Officeer I
personally appeared 1
who proved to me on the basis of satisfactory
evidence to be the person(sy whose name(s�-is/a w
subscribed to the within instrument and acknowledged
to me that he/sheA hep- executed the same in
his/herftheir" authorized capacity(iee), and that by
LCtNG his/herftheir signature(s) on the instrument the
;mesion 1877656 person(s), or the entity upon behalf of which the
h..ary Public - Ga�itornta 3 person(s) acted, executed the instrument.
Marin county
V, comm. Ex ires Jan 22. 2014
1 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.
i
Signature:"
Place Notary Seal Above OPTIONAL gnature of Notary Rdbllc
Though the information below is not required by taw, it may prove valuable to persons retying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached ocu nt
s
Title or Type of Document: - _1 1
'
Document Date: I
Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name:
Corporate Officer — Title(s):
Individual RIGHTTHUMBPRWT',
OF SIGNER
Limited7 Partner E� General I -,Op of tj_ur_b here
Attorney
Trustee
Guardian or f •
111111111MOIJIM
Number of Pages:
Signer's Name:
Corporate Officer — Title(s):
Individual HUMBPRINT
f?F SIGNER
-i -
Top of thurnb here
Attorney in Fact
Trustee
Guardian or • •
i
Signer Is Representing:
2T9 National Notary Associaton - Nationa#Netary.crg - 1 -8W -US "iOTARY (1-800-876-6U7) Item #5907
e
---------------
Surety
Com
PERFORMANCE BUND
Bond Number; 71342081
KNOW ALL PERSONS BY THESE PRESENTS, That we Don Caramauno dba DC Electric
640 W. School St. Cotati CA 94931 Of
referred to as the Principal, and western surety company hereinafter
as Surety, are held and firmly bound unto Citv of San Rafael
Of it Mar�hew 3t San Rafael A 94915
Thhere[nafter
referred to as the Obligee, in the sum of Seventy- -ree Thousand Eight Hundred One and herdna
Dollars ($ 3, e 01, o o ), for the payment Of which we bind ourselves, our legal re
and assigns, jointly and severally, firmly by these presents. representatives, successors
WHEREAS, Principal has entered into a contract with Obligee, dated the 15-tb day of to
ClttfT Prz?�Pcr tuo
11205
NOW, THEREFORE, if the Principal shall faithfully perform such contract or shall indemniijr and save harmless
the ObIlgee from all cost and damage by reason of Principal's failure so to do, then this obligation shah be null
and void; otherwise It shag remain in full force and effect.
ANY PROCEEDING, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction
In the location In which the work or part of the work is located and shall be instituted within two years after
Contractor Default or within two years after the Contractor ceased woridng or within two years after the Surety
refuses or fails to perform its obligations under this Bond, whichever occurs first. if the provisions of this
Paragraph are void or prohibited by law, the minimum period of (Imitation available to sureties as a defense in the
Jurisdiction of the suit shall be applicable.
NO RIGHT OF ACTION shall accrue on this Bond to or for the use of arty person or corporation other than the
Obligee named herein the heirs, executors, administrators or successors of the Obogee.
SIGNED, SEALED AND DATED this 2nd day of November 2012
Don Caramagno dba DC Electric
Principal]
By
{Seal)
11
D Acknowledgment of principal
® Acknowledgment of Surety (Attorney iu Fact)
STATE OF CALIFORNIA
COUNTY OF Placer
On ��_�. l'Z., and t3t1e date --before me, ��Nn�F�r✓ A b1c�f�® /V6i'�t/T(tfer..
hers insert name officer
personally appeared Douglas Andrew Lindley
nW=*(X)ofsignr x)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed
to the within instrument and acknowledged to me that hetshetthey executed the same in hislheritheir
authorized capacity(ies), and that by hislherttheir 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. saywwiwew
.IN+af1�9E1iNla MolrMap
WITNESS my hand and official seal. ion
Signature (,ems
(The balance of this page Is InUnflonally left blank.)
Western 9wety Company Form 1000.4-2009
21