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HomeMy WebLinkAboutPW Traffic Signal LED Relamping Project/ w !
Department: Public Works
Agenda Item No: 3. g
Meeting Date: November 3, 2014
Prepared by: City Manager Approval`
Director of Public Works
File No.: 18.01.78
SUBJECT: A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
AWARDING A CONTRACT FOR THE CITYWIDE TRAFFIC SIGNAL LED
RELAMPING PROJECT, CITY PROJECT NO. 11253, TO MIKE BROWN
ELECTRIC CO., IN AN AMOUNT OF $139,088.80.
RECOMMENDATION: Staff recommends that the City Council adopt the resolution awarding the
construction contract to Mike Brown Electric Co. in an amount of $139,088.80 and authorize the Public
Works Director to negotiate with the low bidder to increase the number of lamps replaced as part of this
contract.
BACKGROUND: The City of San Rafael owns and maintains 86 traffic signals. Each traffic signal has
red, yellow and green signal lamps. Many intersections also have pedestrian signal lamps. Public Works
relamped all red and green indicators approximately 10 years ago with Light Emitting Diodes (LED's).
We have replaced failed yellow indicators with LED's on an individual basis, but the majority are still
incandescent. Incandescent bulbs require more electricity and therefore cost more to operate. In addition,
the most of the City's pedestrian indicators show only a walking man/flashing red hand and do not
include the preferred countdown feature.
Public Works staff inspects each intersection on a monthly basis to verify that all operations, lamps,
lights, pushbuttons, etc., are working properly. If anything is not working properly or is beginning to
show signs of failure, staff contacts the City's traffic signal maintenance contractor for replacement
and/or repair. The maintenance contractor charges the City on a time and material basis for these calls.
Over the past several months, staff has identified a significant number of failing LED signal and
pedestrian lamps, indicating that the majority are nearing their life expectancy.
The City has retained a traffic signal maintenance contractor to perform traffic signal preventive
maintenance and repair for each City -maintained traffic signal. This approach is quite expensive when
large numbers of lamps are failing because each lamp is replaced individually, rather than opening the
signal head once and replacing all indicators (red, yellow and green). It is also difficult to track
individually replaced indicators leading to a potential loss of warranty benefits.
The Citywide Traffic Signal LED Relamping Project will replace all incandescent lamps with new energy
efficient LED lamps and replace all existing LED lamps to ensure that the City's traffic signals function
File No.: L4 — t — l9S
Council Meeting: k\ 131101
at maximum efficiency. Furthermore, all pedestrian indicators will be replaced with units containing a
countdown timer, a feature which has increased pedestrian safety by reducing the number of pedestrians
stranded in the crosswalk when lights change.
Upgrading all signalized intersection to include count -down pedestrian indications is listed as a proposed
improvement in the San Rafael Bicycle/Pedestrian Master Plan as a high priority project to be completed
within the near-term (within 5 years of Plan adoption).
Replacing all lamps will reduce operational costs and will also greatly reduce the time and effort
expended by the City's on-call electrical contractor to replace failing lamps. This approach allows the
City to take advantage of a one year parts and labor warranty period in which any failed lamp will be
replaced at no cost to the City and a five year manufacturer's warranty during which the manufacturer
shall supply replacement parts for any failure due to a material defect.
This project was approved as part of the 2014-2015 5 -year Capital Improvement Program with a budget
of $350,000. During the design of the project, the engineer's cost estimate was greater than the approved
budget. Therefore, only 56 of the City's 86 intersections were included in the bid. Over the past year, the
cost of LED materials has decreased significantly and consequently, the bids received for the project were
much lower than the engineer's estimate. Due to the low bid prices received for this project, staff
recommends that the Public Works Director be authorized to negotiate with the low bidder to increase the
number of lamps replaced as part of this contract.
The project has been determined to have no significant effect on the environment and is categorically
exempt under the California Environmental Quality Act (CEQA).
The project was advertised in accordance with San Rafael's Municipal Code on October 3, 2014, and
sealed bids were publicly opened and read aloud on October 27, 2014 at 10:00 AM. Tile engineer's
estimate was $310,000. Contractors submitted the following bids:
NAME OF BIDDER
AMOUNT
Mike Brown Electric Co.
$139,088.80
DC Electric Group, Inc.
$142,835.00
St. Francis Electric, Inc.
$190,898.65
WBE
$195,171.00
Tennyson Electric, Inc.
$272,029.50
ANALYSIS: The referenced bids have been reviewed by Public Works staff and found to be responsive
and responsible. The $139,088.80 low bid from Mike Brown Electric Co. falls within the allocated
project budget.
FISCAL IMPACT: To date, a total of $1,585.49 has been charged to this project for document
reproduction. The remaining project expenditures include construction to be performed by Mike Brown
Electric Co. and a contingency of approximately 75% (the contingency shall include negotiating with the
contractor to increase the contract for the inclusion of all 86 City maintained traffic signals). The
following tables summarize the revenue and expenses associated with this project:
FUNDING SOURCES:
Project Funding Sources - Construction
Gas Tax Fund (Fund 206)
$350,000.00
Total Available Funds
$350,000.00
EXPENSES:
Category -Eden Expense Category
Amount
Notes
Already Charged Expenses
Construction -02
$1,585.49
1 Document reproduction
Remaining Expenses
Construction -02
$139,088.80
Base bid contract amount
Construction -02
$104,325.71
Contingency (approx. 75070) to expand the project
to relamp all 86 City -maintained traffic si nals
Total Project Cost
$245,000.00
1. Adopt the resolution awarding the contract to Mike Brown Electric Co., the lowest responsive
and responsible bidder, in the amount of $139,088.80 and authorize the Public Works Director to
negotiate with the low bidder to increase the number of lamps replaced as part of this contract.
If this option is chosen, construction will commence as soon as possible.
2. Adopt the resolution awarding the contract to Mike Brown Electric Co., the lowest responsive
and responsible bidder, in the amount of $139,088.80. If this option is chosen, construction will
commence as soon as possible.
3. Do not award the contract and direct staff to stop work on the project.
ACTION REQUIRED: Adopt the resolution awarding the construction contract to Mike Brown Electric
Co. in the amount of $139,088.80 and authorize the Public Works Director to negotiate with the low
bidder to increase the number of lamps replaced as part of this contract.
Enclosures: Resolution
Agreement
Will RU 0 !
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING A
CONTRACT FOR THE CITYWIDE TRAFFIC SIGNAL LED RELAMPING PROJECT, CITY
PROJECT NO. 11253, TO MIKE BROWN ELECTRIC CO., IN AN AMOUNT OF $139,088.80.
WHEREAS, on the 27`" day of October, 2014, pursuant to due and legal notice published
in the manner provided by law, inviting sealed bids or proposals for the work hereinafter
mentioned, as more fully appears from the Affidavit of Publication thereof on file in the office of
the City Clerk of the City of San Rafael, California, the City Clerk of said City did publicly open,
examine, and declare all sealed bids or proposals for doing the following work in said City, to
Wit:
"Citywide Traffic Signal LED Relamping Project"
City Project No. 11253
in accordance with the plans and specifications therefor on file in the office of said City Clerk;
and
WHEREAS, the bid of Mike Brown Electric Co. at the unit prices stated in its bid was
and is the lowest and best bid for said work and said bidder is the lowest responsible bidder; and
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF SAN RAFAEL
RESOLVES as follows:
1. The bid of Mike Brown Electric Co. is hereby accepted at said unit prices and that
the contract for said work and improvements is hereby awarded to Mike Brown
Electric Co. at the unit prices mentioned in said bid.
2. The Public Works Director and the City Clerk of said City are authorized and
directed to execute a contract with Mike Brown Electric Co. in a form approved
by the City Attorney, for said work and to return the bidder's bond upon the
execution of said contract.
3. The Public Works Director is hereby authorized to negotiate with the low bidder
to increase the scope of work associated with this project.
4. Funds totaling $245,000.00 will be appropriated from Gas Tax for City Project
No. 11253.
5. The Public Works Director is hereby authorized to take any and all such actions
and make changes as may be necessary to accomplish the purpose of this
resolution.
I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the
foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the
City Council of said City held on the Monday, the 3 d day of November, 2014 by the following
vote, to wit:
AYES: COUNCILMEMBERS: Bushey, Colin, Connolly, McCullough & Mayor Phillips
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
ESTHER C. BEIRNE, City Clerk
File No.: 18.01.78
City of San Rafael ♦ California
Form of Contract Agreement
for
Citywide Traffic Signal Relamping Project
Citv Project No. 11253
This Agreement is made and entered into this A; th day of X2014 by and between the City of San
Rafael (hereinafter called City) and Mike Brown Electric, Co., (hereinafter called Contractor). Witnesseth, that the
City and the Contractor, for the considerations hereinafter named, agree as follows:
1- 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 described in the plans and specifications for the project entitled: Citywide Traffic Signal
Relamping, City Project No. 11253, all in accordance with the requirements and provisions of the Contract
Documents as defined in the General Conditions which are hereby made a part of this Agreement. The required
additional insured coverage for City under Contractor's liability insurance policy shall be primary with respect to
any insurance or coverage maintained by City and shall not call upon City's insurance or self-insurance for an
contribution.
]I- Time of Completion
(a) The work to be perfonned under this Contract shall be commenced within FIVE (5) WORKING DAYS
after the date of written notice by the City to the Contractor to proceed.
(b) "Notice to Proceed" will signify the beginning of the 6 -week lead period to obtain materials. Howver, no
field work shall comence, until the delivery of the equipment.
(c) All work shall be completed, including all punchlist work, within THIRTY (30) WORKING DAYS
following the 6 -week lead period for material acquisition, and with such extensions of time as are
provided for in the General Provisions.
III - Liquidated Damages
It is agreed that, if all the work required by the contract is not finished or completed within the number of working
days as set forth in the contract, damage will be sustained by the City, and that it is and will be impracticable and
extremely difficult to ascertain and determine the actual damage which the City will sustain in the event of and by
reason of such delay; and it is therefore agreed that the Contractor will pay to the City, the sum of $1,900 for each
and every working day's delay in finishing the work in excess of the number of working days prescribed above; and
the Contractor agrees to pay said liquidated damages herein provided for, and further agrees that the City may
deduct the amount thereof from any moneys due or that may become due the Contractor under the contract.
IV - The Contract Sum
The City shall pay to the Contractor for the performance of the Contract the amounts determined for the total
number of each of the units of work in the following schedule completed at the unit price stated. The number of
units contained in this schedule is approximate only, and the final. payment shall be made for the actual number of
units that are incorporated in or made necessary by the work covered by the Contract.
ITEM
DESCRIPTION
ESTIMATED
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
1.
8" Red Ball
281
EA
@
S41.41
—
S11,636.21
2.
8" Yellow Ball
281
EA
@
S41.41
—
S1.1,636.21.
3.
8" Green Ball
278
EA
@
S41.51
=
S11,539.78
4.
12" Red Ball
269
EA
@
S41.42
—
S11,141.98
ITEM
DESCRIPTION
ESTIlVI_ATED
QL'_ANTITY
UNIT
L`NIT PRICE
TOTAL PRICE
5.
12" Yellow Ball
269
EA
62
$41.42
—
$11,141.98
6.
1.2" Green Ball
269
EA
«u
$41.42
—
$1 1,14198
7.
12" Red Arrow
58
EA
�_
$47.09
—
$2,731.22
8.
12" Yellow Arrow
63
EA
(-cis
$53.95
—
$3,398.85
9.
12" Green Arrow
76
EA
d
$59.43
—
$4,516.68
10.
1 l .
12" PV Red Ball
12" PV Yellow Ball
5
5
EA
EA
r
a
$85.60
$85.60
—
=
$428.00
$428.00
12.
12" PV Green Ball
4
EA
$92.50
=
$370.00
i 13.
12" PV Red Arrow
8
EA
$87.38
—
$699.04
14.
12" PV Yellow Arrow
8
EA
4,
$87.38
—
$699.04
15.
12" PV Green Arrow
9
EA
$87.23
-
$785.07
16.
Countdown Pedestrian
319
EA
a
$178.04
$56,794.76
GRAND TOTAL BID $ 139,488.80
V - Progress Payments
(a) On not later than the 6th day of every month the Public Works Department shall prepare and submit an
estimate covering the total quantities under each item of work that have been completed from the start of the
job up to and including the 25th day of the preceding month, and the value of the work so completed
determined in accordance with the schedule of unit prices for such items together with such supporting
evidence as may be required by the City and/or Contractor .
(b) As soon as possible after the preparation of the estimate, the City shall, after deducting previous payments
made, pay to the Contractor 95% of the amount of the estimate as approved by the Public Works Department.
(c) Final payment of all moneys due shall be made within 15 days after the expiration of 35 days following the
filing of the notice of completion and acceptance of the work by the Public Works Department.
(d) The Contractor may elect to receive 100% of payments due under the contract from time to time, without
retention of any portion of the payment by the public agency, by depositing securities of equivalent value with
the public agency in accordance with the provisions of Section 4590 of the Government Code. Such securities,
if deposited by the Contractor, shall be valued by the City's Finance Director, whose decision on valuation of
the securities shall be final.
VI - Acceptance and Final Payment
(a) Upon receipt of written notice that the work is ready for final inspection and acceptance, the Engineer shall
within 5 days make such inspection, and when he finds the work acceptable under the Contract and the
Contract fully performed, he will promptly issue a Notice of Completion, over his own signature, stating that
the work required by this Contract has been completed and is accepted by him under the terms and conditions
thereof, and the entire balance found to be due the Contractor, including the retained percentage, shall be paid
to the Contractor by the City within 15 days after the expiration of 35 days following the date of recordation of
said Notice of Completion.
(b) Before fmal payment is due the Contractor shall submit evidence satisfactory to the Engineer that all payrolls,
material bills, and other indebtedness connected with work have been paid, except that in case of disputed
indebtedness or liens the Contractor may submit in lieu of evidence of payment a surety bond satisfactory to
the City guaranteeing payment of all such disputed amounts when adjudicated in cases where such payment has
not already been guaranteed by surety bond.
(c) Contractor shall provide a "Defective Material and Workmanship Bond" for 50% of the Contract Price, before
the final payment will be made.
(d) The making and acceptance of the final payment shall constitute a waiver of all claims by the City, other than
those arising from any of the following: (1) unsettled liens; (2) faulty work appearing within 12 months after
final payment; (3) requirements of the specifications; or (4) manufacturers' guarantees. It shall also constitute
a waiver of all claims by the Contractor, except those previously made and still unsettled.
(e) if after the work has been substantially completed, full completion thereof is materially delayed through no
fault of the Contractor, and the Engineer so certifies, the City shall, upon certificate of the Engineer, and
Without terminating the Contract, make payment of the balance due for that portion of the work fully completed
and accepted.
Such payment shall be made under the terms and conditions governing final payment, except that it shall not
constitute a waiver of claims.
IN WITNESS WHEREOF, City and Contractor have caused their authorized representatives to execute
this Agreement the day and year first written above.
ATTEST: CITY OF SAN RAFAEL:
L"Wher C. Beirne Nader Mansourian
City Cleric Public Works Director
APPROVED AS TO DORM: Mike Brown Electric. Co.
Robert F. Epstein ed Name:ratio
I
City Attorney it
File No.: 18.01.78
fFonj �6nic
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I a
CERTIFICATE OF LIABILITY I
DATE (MMIDDNYYY)
11/17/2014
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.
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 LIC #01329370 1-707-794-7400
CONTACT Jennifer Heliates
NAME:
Edgewood Partners Insurance Center (EPIC)
_
PHONE FAX
[Petaluma Branch]
C No Ezt:w707-794-7414 — A No`707-794-7401
E-MAIL gPICre eatsC9ed ewoodina.com
ADDRESS: 9
5350 Old Redwood Highway
Suite 600
--"-
Petaluma, CA 94954
_ INSURER S)( AFFORDING COVERAGE MAIC #
INSURER A: TRAVELERS PROP CAS CO OF AMER 125674
_
INSURED
INSURER B: TRAVELERS IND CO OF CT 25682
Mike Brown Electric Co.
INSURER C: NAVIGATORS INS CO 42307
INSURER D:
561-A Mercantile Drive
INSURER EE�
Cotati, CA 94931
INSURER F:
COVERAGES CERTIFICATE NUMBER: 42119354 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
ADDL
SUBR
POLICY NUMBER
POLICY EFF
/YYY
MMIDDY
POLICY EXP
MM/DDIYYYY
LIMtTS
A
GENERAL LIABILITY
X
X
DT22-CO-BD615843-TIL-13
12/31/1--12/31/14
EACHOCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
REMISES(-ld�N
PREMISES (Ea occurrence
300, 000 v
$ _
CLAIMS -MADE XI OCCUR
MED EXP (Anyone person)
$ 10,000
X PD Deductible $5,000
PERSONAL &ADV INJURY$
1,000,000
_
_
'
GENERAL AGGREGATE
2,000,000
GENT AGGREGATE LIMIT APPLIES PER: '
--$
PRODUCTS- COMPIOP AG_ G
$ 2,000,000
JECT POLICY X PRO- LOC
$ W
13
AUTOMOBILE
LIABILITY
X
X
DT -810 -8D615843 -TCT -13
12 1/1-
12/31/14
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
X
._
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS AUTOS
X
PROPERTY DAMAGE
$
NON -OWNED
X
HIRED AUTOS AUTOS
(Paraccident l
C
UMBRELLA LIAB
X
OCCUR
X
X
LA13EXC764782IV
12/31/1
12/31/14
EACHOCCURRENCE
$ 10,000,000
AGGREGATE v�
S 10, 000, 000
g
EXCESS LIAB
CLAIMS -MADE
DED I RETENTIONS
S
A
WORKERS COMPENSATION
X
DTJ-UB-BD61584-3-13
12/31/1
12/31/14
X WCSTATIT- OTH-
ER_
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
OFFICER/MEMBER EXCLUDED?
NIA
E.L. DISEASE - EA EMPLOYEE
$_1,000,000__
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
El. DISEASE -POLICY LIMIT
$ 1,000,000
)ESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
:e: MBE Job #: 2047 - OCJ Job #: 214124 - Facebook Mitigation
additional Insured(s): O.C. Jones & Sons, Inc., Facebook, Inc. and ALL OTHER ENTITIES, AS REQUIRED BY CONTRACT are
.dditional insureds on a primary and non-contributory basis as per written contract.
laiver(a) of Subrogation: Apply in favor of the additional insureds for all policies as required by written contract.
Imbrella/Excess Follows Form.
0 Days Written Notice of Cancellation for Non -Renewal and 10 Days Notice of Cancellation for Non -Payment of Premiums
:ERTIFICATE HOLDER CANCELLATION
.C. Jones & Sons, Inc., and all other parties as required
y contract
520 Fourth Street
erkeley, CA 94710
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2010 ACORD CORPORATION. All rights reserved.
iCORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
3lischinaki
Policy: DT22-CO-8D615843-TIL-13
COMMERCIAL GENERAL LIABILITY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization_
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section III - Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury", °'prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, including:
L The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products -completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible 'other insurance", whether primary,
excess, contingent or on any other basis, that is
available to the additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non-contributory basis,
this insurance is primary to 'other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2
COMMERCIAL GENERAL LIABILITY
L How, when and where the "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the 'occurrence" or
offense,
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
L Immediately record the specifics of the
claim or "suit' and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit' as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit", cooperate
with us in the investigation or settlement of
the claim or defense against the "suit", and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to "other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the policy period.
Page 2 of 2 @ 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
byany ordinance, law or building code to include
as an additional insured on this Coverage Pod is
on insured, but only with respect to |ioN|ih/ for
"bodily injury", "property damage", "personal in-
jury" or "advertising injury" arising out of such op'
The insurance provided to such state or political
subdivision does not apply to:
a. Any "bodily injury," "property damage," "per-
sonal injury" or "advertising injury" arising out
of operations performed for that state or po-
litical subdivision; or
b' Any "bodily injury" or "property damage" in-
cluded inthe "pvoducts-comp|ebedoperations
hazard".
J. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
The following is added to Paragraph 2., Duties In
The Event of Occurrence, Offense, Claim o/
Suit. of SECTION /\/ — COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS:
e. The following provisions apply to Paragraph
a. ebove, but only for the purposes of the in-
surance provided under this Coverage Part hz
you orany insured listed inParagraph 1.n/2.
ofSection ||— Who |aAnInsured:
(1) Notice to us of such ^wcournanma^ or of-
fense must be given as soon as practica-
ble
f-[ensomustbegivenaoaoonaopruchca-
b|e only after the "occurvemoe''wroffense
isknown byyou (if you are onindividuo|).
any of your partners or members who is
on individual (if you are o partnership or
joint venture), any wfyour managers who
is an individual (if you are a limited liability
oompany), any of your "executive offi-
cers" or directors (if you are on organiza-
tion other than a partnership, joint venture
or limited liability company) or any "em-
p|oyee^euthwrized by you (ogive notice
of an "occurrence" or offense.
(2) If you are m podnerohp, joint venture or
limited liability company, and none ofyour
pudners, joint venture members wrman-
agers are individuals, notice housofsuch
"occurrence" or offense must be given as
soon as practicable only after the "occur-
rence" or offense is known by:
000uprence"wroKenae|oknownby:
(ii) A manager of any limited Uo@hy
company; or
(iii) An executive nfhuwr ordirector o[
any other organization;
that is your partner, joint venture
member ormanager; mr
(b) Any "employee" authorized by such
partnensh/p, joint venture, limited li-
ability company or other organization
i'mbiUh/componyorotherorgonizohon
to give notice of an "occurrence" or
offense.
(3) Notice houaofsuch "000unencm°orcfon
offense will be deemed to be given as
soon as practicable if it is given in good
faith as soon as pnaodcob|o to your work-
ers' compensation |neunsc This oppUoa
only if you subsequently give notice to us
ofthe °oncunence"oroffense aosoon aa
practicable after any of the persons de-
scribed in Paragraphs e. (1) or (2) above
discovers that the °oocunenno"oroffense
may result )nsums towhich the insurance
provided under this Coverage Pod may
opp|y�
However, if this Coverage Part includes an en-
dorsement that provides limited coverage for
"bodily io)uq/' or "property damage" or pollution
costs arising mut of o discharge, release or es-
cape of"poUu(an(o''which contains o requirement
that the disnharQe, release or escape of"pollut-
ants" must be reported to us within o specific
number ofdays after its abrupt commencement,
this PmnmQoyph e. does not affect that require-
ment,
The following is added to Paragraph 6.. Repre-
sentations, of SECTION h/ — COMMERCIAL
GENERAL LIABILITY CON0O8N&
The uninhanUnmo| omission of, or unintentional
error in, any /n8nnnaUon provided by you which
we relied upon in issuing this policy will not preju-
dice your rights under this insurance. However,
this provision does not affect our right hzcollect
additional premium or to exercise our rights of
cancellation or nonrenewal in onoondonnm with
applicable insurance laws orregulations,
++*+
L. BLANKET WAIVER OF SUBROGATION
(a) Any individual who is: The following ioadded toParagraph 8..Transfer
()) Apartner ormember cfany part- 0fRights (JfRecovery Against Others TmUs,
nenship or joint venture; of SECTION |V — COMMERCIAL GENERAL LI-
ABILITY CONDITIONS:
CG D3161111 zo11The Travelers Indemnity Company. All rights reserved. Page 5o[8
Pc?l,icy: DT22-CO-8D615843-TIL-13
COMMERCIAL GENERAL LIABILITY
If the insured has agreed in a contract or agree-
ment to waive that insured°s right of recovery
against any person or organization, we waive our
right of recovery against such person or organiza-
tion, but only for payments we make because of:
a. "Bodily injury" or "property damage" that oc-
curs; or
b. "Personal injury" or "advertising injury"
caused by an offense that is committed;
subsequent to the execution of that contract or
agreement.
A. AMENDED BODILY INJURY DEFINITION
The following replaces the definition of "bodily
injury" in the DEFINITIONS Section:
3. "Bodily injury" means bodily injury, mental
anguish, mental injury, shock, fright, disability,
humiliation, sickness or disease sustained by
a person, including death resulting from any
of these at any time.
N. CONTRACTUAL LIABILITY — RAILROADS
1. The following replaces Paragraph c. of the
definition of "insured contract' in the DEFINI-
TIONS Section:
c. Any easement or license agreement;
2. Paragraph f.(1) of the definition of "insured
contract` in the DEFINITIONS Section is de-
leted.
Page 6 of 6 © 2011 The Travelers Indemnity Company. All rights reserved. CG D3 16 11 11
COMMERCIAL GENERAL LIABILITY
pOL/CyNUK48EF� Z)T22-CO-8I}6I5843-TIL-I3 ISSUE DATE: l2, -]-1-I3
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Project(s):
Designated Project
General Aggregate(s):
EACH "eRoJEcz" FOR msz[o YOU HAVE AGREED, IN A WRITTEN ComTnuyCz WHICH IS
onRzNg THIS POLICY PERIOD, TO PROVIDE A oEeAaAzo GENERAL AGGREGATE LzMzz'
THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY
"PROPERTY DAMAGE" OCCURS.
A- For all sums which the insured becomes |oyaUy
obligated to pay as damages caused by"occur-
rences" under COVERAGE A. (SECTION |), and
for all medical expenses caused by accidents un-
der COVERAGE C (SECTION |), which can be
attributed only to operations at o single desig-
nated ~pnoject"shown inthe Schedule above:
1' A separate Designated Project General Ag-
gnegeteLimit applies toeach designated ^pnu-
ject". and that limit /oequal tothe amount of
the General Aggregate Limit shown in the
Dedanadnnu, unless separate Designated
Project General Aggregate(s) are nuhed-
u|ednbove,
2' The Designated Project E)enens| Aggregate
Limit is the most we will pay for the sum of all
damages under COVERAGE A.. except
damages because of "bodily injury" or^prop-
edy damage" included in the "products -
completed operations hazard", and for medi-
cal expenses under COVERAGE C. regard-
less ofthe number of:
a. Insureds;
b. Claims made or"suits^brought; ur
c. Persons or organizations making claims
urbringing ''suibn^.
IN EFFECT
3. Any payments made under COVERAGE A.
for damages or under COVERAGE C. for
medical expenses shall reduce the Desig-
nated Project General Aggregate Limit for
that designated "project". Such payments
shall not reduce the General Aggregate Limit
shown in the Declarations nor shall they re-
duce any other Designated Project General
Aggregate Limit for any other designated
°projeut"shown inthe Schedule above.
4. The limits shown inthe Declarations for Each
Occurrence, Damage To Premises Rented
To You and KOed1om/ Expense continue to
apply. However, instead of being subject to
the General Aggregate Limit shown in the
Dec|araUonm, such limits will be subject to the
applicable Designated Project General Ag-
gregate Limit.
g'gnegateL/mU.
B. For all sums which the insured becomes legally
obligated to pay as damages caused by "occur-
rences" under COVERAGE A. (SECTION |), and
for all medical expenses caused by accidents un-
der COVERAGE C. (SECTION |)' which cannot
be attributed only tooperations etasingle desig-
nated "project" shown in the Schedule above:
eaig'nabad"pnojeot'shmwnintheSohedu|eabove:
CG D2110104 Copyright, The Travelers Indemnity Company, 2OO4 Page 1of2
COMMERCIAL GENERAL LIABILITY
1. Any payments made under COVERAGE A.
for damages or under COVERAGE C. for
medical expenses shall reduce the amount
available under the General Aggregate Limit
or the Products -Completed Operations Ag-
gregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Desig-
nated Project General Aggregate Limit.
C. Part 2. of SECTION III — LIMITS OF INSURANCE
is deleted and replaced by the following:
2. The General Aggregate Limit is the most we
will pay for the sum of:
a. Damages under Coverage B; and
b. Damages from 'occurrences" under
COVERAGE A (SECTION 1) and for all
medical expenses caused by accidents
under COVERAGE C (SECTION 1) which
cannot be attributed only to operations at
a single designated "project' shown in the
SCHEDULE above.
D. When coverage for liability arising out of the
"products -completed operations hazard" is pro-
vided, any payments for damages because of
"bodily injury" or "property damage" included in
the "products -completed operations hazard" will
reduce the Products -Completed Operations Ag-
gregate Limit, and not reduce the General Aggre-
gate Limit nor the Designated Project General
Aggregate Limit.
E. For the purposes of this endorsement the Defini-
tions Section is amended by the addition of the
following definition:
"Project" means an area away from premises
owned by or rented to you at which you are per-
forming operations pursuant to a contract or
agreement. For the purposes of determining the
applicable aggregate limit of insurance, each
"project" that includes premises involving the
same or connecting lots, or premises whose con-
nection is interrupted only by a street, roadway,
waterway or right-of-way of a railroad shall be
considered a single "project'.
F. The provisions of SECTION III — LIMITS OF
INSURANCE not otherwise modified by this en-
dorsement shall continue to apply as stipulated.
Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsernen1. the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
odi-hadbyiheendorsemenL
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
injory, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
agedesmhpiion only. Limitations and exclusions may apply hm these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
n'doroemen(andtherestofyourpo|inyoerefuUytodebanninerighbs.duhes.undwhatisandisnotoovered.
C. EMPLOYEE HIRED AUTO
DEMPLOYEES AS INSURED
E, SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
F. HIRED AUTO — LIMITED WORLDWIDE
COVERAGE — INDEMNITY BASIS
G, WAIVER OF DEDUCTIBLE — GLASS
PROVISIONS
A. BROAD FORM NAMED INSURED
The following iaadded hoParagraph A.1..Who Us
An Insured, of SECTION 01 — LIABILITY COV-
ERAGE:
Any organization you newly enquire or form dur-
ing the policy period over which you maintain
5096 or more ownership interest and that is not
oepmnaha|y insured for Business Auto Coverage.
Coverage under this provision is afforded only un-
til the 1 80t day after you acquire or form the or-
ganization or the end of the policy period, which-
ever inearlier,
H. HIRED AUTO PHYSICAL DAKNAGE—LDSS
OF USE — INCREASED LIMIT
8. PHYSICAL DAMAGE—TRANSPORTATON
EXPEWSES—|NCREASEQUM|T
J. PERSONAL EFFECTS
K. AIRBAGS
L. NOTICE AND KNOWLEDGE OF ACCIDENT
OR LOSS
M. BLANKET WAIVER OF SUB8QG4ZM
executed by you before the "bodily injury" or
"property damage" occurs and that is in effect
during the policy period, tobenamed msunaddi-
tional insured is on "insured" for Liability Cover-
age, but only for damages to which this insurance
cwepage`buton|yfordamogestovvhiohthiminmunanom
applies and only to the extent that person oror-
ganization quoU5mm as an "insured" under the
Who |sAn Insured provision contained in Section
111.
The following is added to Paragraph A^1.,
Who Is An Insured, of SECTION U — L|ABILITY COVERAGE:
-
The following is added to Paragraph c. in A.I.. An "employee" of yours is on "insured" while
Who Is An Insured, of SECTION 11 —LV\EWLNFY operating an "auto" hired or rented under o
COVERAGE: contract or agreement in that "employee's"
name, with your permission, while performing
Any person or organization who is required under duties related to the conduct of your busi
m written contract oragreement between you and ness.
that person or organization, that is signed and
CAT353O2 12 m2u10The Travelers Indemnity Company Page of
Includes copyrighted material mfInsurance Services Office, Inc. with its permission.
COMMERCIAL AUTO
2. The following replaces Paragraph b. in B.5.,
Other Insurance, of SECTION IV — BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
that individual "employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
D. EMPLOYEES AS INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II — LIABILITY COV-
ERAGE:
Any "employee" of yours is an "insured" while us-
ing a covered "auto" you don't own, hire or borrow
in your business or your personal affairs.
E. SUPPLEMENTARY PAYMENTS — INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2),
of SECTION II — LIABILITY COVERAGE:
(2) Up to $3,000 for cost of bail bonds (in-
cluding bonds for related traffic law viola-
tions) required because of an "accident"
we cover. We do not have to furnish
these bonds.
2. The following replaces Paragraph A.2.a.(4),
of SECTION 11— LIABILITY COVERAGE:
(4) All reasonable expenses incurred by the
"insured" at our request, including actual
loss of earnings up to $500 a day be-
cause of time off from work.
F. HIRED AUTO — LIMITED WORLDWIDE COV-
ERAGE — INDEMNITY BASIS
The following replaces Subparagraph (5) in Para-
graph B.7., Policy Period, Coverage Territory,
of SECTION IV — BUSINESS AUTO CONDI-
TIONS:
(5) Anywhere in the world, except any country or
jurisdiction while any trade sanction, em-
bargo, or similar regulation imposed by the
United States of America applies to and pro-
hibits the transaction of business with or
within such country or jurisdiction, for Liability
Coverage for any covered "auto" that you
lease, hire, rent or borrow without a driver for
a period of 30 days or less and that is not an
"auto" you lease, hire, rent or borrow from
any of your "employees", partners (if you are
a partnership), members (if you are a limited
liability company) or members of their house-
holds.
(a) With respect to any claim made or "suit"
brought outside the United States of
America, the territories and possessions
of the United States of America, Puerto
Rico and Canada:
(i) You must arrange to defend the "in-
sured" against, and investigate or set-
tle any such claim or "suit" and keep
us advised of all proceedings and ac-
tions.
(ii) Neither you nor any other involved
"insured" will make any settlement
without our consent.
(iii) We may, at our discretion, participate
in defending the "insured" against, or
in the settlement of, any claim or
°'suit".
(iv) We will reimburse the "insured" for
sums that the "insured" legally must
pay as damages because of "bodily
injury" or "property damage" to which
this insurance applies, that the "in-
sured" pays with our consent, but
only up to the limit described in Para-
graph C., Limit Of Insurance, of SEC-
TION II — LIABILITY COVERAGE.
(v) We will reimburse the "insured" for
the reasonable expenses incurred
with our consent for your investiga-
tion of such claims and your defense
of the "insured" against any such
"suit", but only up to and included
within the limit described in Para-
graph C., Limit Of Insurance, of
SECTION II — LIABILITY COVER-
AGE, and not in addition to such limit.
Our duty to make such payments
ends when we have used up the ap-
plicable limit of insurance in pay-
ments for damages, settlements or
defense expenses.
(b) This insurance is excess over any valid
and collectible other insurance available
Page 2 of 4 © 2010 The Travelers Indemnity Company CA T3 53 02 12
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
to the "insured" whether primary, excess
contingent or on any other basis.
(c) This insurance is not a substitute for re-
quired or compulsory insurance in any
country outside the United States, its ter-
ritories and possessions, Puerto Rico and
Canada.
You agree to maintain all required or
compulsory insurance in any such coun-
try up to the minimum limits required by
local law. Your failure to comply with
compulsory insurance requirements will
not invalidate the coverage afforded by
this policy, but we will only be liable to the
same extent we would have been liable
had you complied with the compulsory in-
surance requirements.
(d) It is understood that we are not an admit-
ted or authorized insurer outside the
United States of America, its territories
and possessions, Puerto Rico and Can-
ada. We assume no responsibility for the
furnishing of certificates of insurance, or
for compliance in any way with the laws
of other countries relating to insurance.
G. WAIVER OF DEDUCTIBLE — GLASS
The following is added to Paragraph D., De-
ductible, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered "auto" will apply to
glass damage if the glass is repaired rather than
replaced.
H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF
USE — INCREASED LIMIT
The following replaces the last sentence of Para-
graph AA.b., Loss Of Use Expenses, of SEC-
TION III — PHYSICAL DAMAGE COVERAGE:
However, the most we will pay for any expenses
for loss of use is $65 per day, to a maximum of
$750 for any one "accident'.
COMMERCIAL AUTO
J. PERSONAL EFFECTS
The following is added to Paragraph A.4„ Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Personal Effects
We will pay up to $400 for "loss" to wearing ap-
parel and other personal effects which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto".
This coverage applies only in the event of a total
theft of your covered "auto".
No deductibles apply to this Personal Effects
coverage.
K. AIRBAGS
The following is added to Paragraph B.3., Exclu-
sions, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to "loss" to one or
more airbags in a covered "auto" you own that in-
flate due to a cause other than a cause of "loss"
set forth in Paragraphs A.1.b, and A.1.c., but
only:
a. If that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one 'loss".
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
The following is added to Paragraph A.2.a., of
SECTION IV — BUSINESS AUTO CONDITIONS:
Your duty to give us or our authorized representa-
tive prompt notice of the "accident" or 'loss" ap-
plies only when the "accident' or "loss" is known
to:
L PHYSICAL DAMAGE — TRANSPORTATION (a) You (if you are an individual);
EXPENSES — INCREASED LIMIT (b) A partner (if you are a partnership);
The following replaces the first sentence in Para- (c) A member (if you are a limited liability com-
graph AA.a., Transportation Expenses, of pany);
SECTION III — PHYSICAL DAMAGE COVERA- (d) An executive officer, director or insurance
GE: manager (if you are a corporation or other or -
We will pay up to $50 per day to a maximum of ganization); or
$1,500 for temporary transportation expense in- (e) Any "employee" authorized by you to give no-
curred by you because of the total theft of a cov- tice of the "accident" or "loss".
ered "auto" of the private passenger type.
CA T3 53 02 12 Q 2010 The Travelers Indemnity Company Page 3 of 4
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
COMMERCIAL AUTO
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.S, Transfer
Of Sights Of Recovery Against Others To Us.
of SECTION |V — BUSINESS AUTO CONDI-
TIONS:
5. Transfer Of Rights Of Recovery Against
Others ToOs
We waive any right cJrecovery we may have
against any person or organization to the ex-
tent required of you by a written contract
signed and executed prior to any "accident"
or"|oss".provided that the ^onoidant"or"loxa^
arises out of operations uonhamp|obad by
such contract, The waiver applies only to the
person or organization designated in such
The following badded to Paragraph B.2, Con-
cealment, Misrepresentation, Or Froud. of
GECT|ON |V— BUSINESS AUTO CONDITIONS:
The unintentional omission of, or unintentional
error /n, any information given by you ahoU not
prejudice your rights under this insurance. How-
ever this provision does not affect our right tocol-
lect additional premium or exercise our right of
cancellation ornon-renewo|.
Page 4of4 (Dco1nThe Travelers Indemnity Company CA T3530212
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
A01k WORKERS COMPENSATION
TRAVELERSJ AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 ( A) —
POLICYNUMBER: DTJ-UB-8D61584-3-13
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule.
The additional premium for this endorsement shall be 3 % of the California workers' compensation pre-
mium.
Person or Organization
mmm�-
Any person or organization for which the insured has agreed by
written contract executed prior to loss to furnish this waiver.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise
stated.
(The information below is required only when this endorsement is issued subsequent to preparation of
the policy.)
Endorsement Effective 12 - 31-13 Policy No, DTJ- UB - 8D6 15 B4 - 3 -13 Endorsement No,
Insured Mike Brown Electric Co Premium
Insurance Company Countersigned by
Travelers Property & Casualty Company of America
DATE OF ISSUE:12 -31- 13 ST ASSIGN: Page 1 of 1
TZ
SURETY
Bond Number: 070018483
PERFORMANCE BOND
Premium : $835.00
KNOW ALL MEN BY THESE PRESENTS, that we
Mike Brown Electric Co.
Interchange Corporate Center
450 Plymouth Road, Suite 400
Plymouth Meeting, PA. 19462-1644
Ph. (610) 832-8240
as principal (the "Principal"),
and LIBERTY MUTUAL INSURANCE COMPANY, a Massachusetts stock insurance company, as surety (the
"Surety"), are held and firmly bound unto City of San Rafael
as obligee (the "Obligee"), in
the penal sum of
One Hundred Thirty Nine Thousand Eighty Eight & 80/100 -------------------------------- Dollars ($ 139,088.80 )
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has by written agreement, dated the 3rd day of November , 20 14
entered into a contract (the "Contract") with the Obligee for
Citywide Traffic Signal LED Relamping Project, Project No. 11253
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall promptly and
faithfully perform the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and
effect.
PROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT:
1. Whenever the Principal shall be, and declared by the Obligee to be in default under the Contract, the Obligee
having performed the Obligee's obligations thereunder, the Surety may promptly remedy the default, or shall
promptly:
1.1 Arrange for the Principal, with consent of the Obligee, to perform and complete the Contract; or
1.2 Undertake to perform and complete the Contract itself, through its agents or through independent
contractors: or
1.3 Obtain a bid or bids from alternative contractors to complete the Contract in accordance with its terms and
conditions, and upon determination by the Surety of the lowest responsible bidder, or if the Obligee elects,
upon determination by the Obligee and the Surety jointly of the lowest responsible bidder, arrange for a
contract between such bidder and the Obligee, and make available as work progresses (even though
there should be a default or a succession of defaults under the contract or contracts of completion
arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the contract
price; but not exceeding the amount set forth in the first paragraph of this bond. The term "balance of the
contract price," as used in this paragraph, shall mean the total amount payable by the Obligee to the
Principal under the Contract and any amendments thereto, less the amount properly paid by the Obligee to
the Principal; or
1.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with
reasonable promptness under the circumstances:
a. After investigation, determine the amount for which it may be liable to the Obligee and, as soon as
practicable after the amount is determined, tender payment therefore to the Obligee; or
b. Deny liability in whole or in part and notify the Obligee citing reasons therefore.
LMIC-5100 Page 1 of 2 Rev. 3/12
2. Notwithstanding any other provision of this bond or the Contract, or otherwise, the Surety is not responsible for
and shall not be held liable to the Obligee for any hazardous waste removal and the Surety shall not be held
liable to, or in any other respect be responsible to, the Obligee by way of indemnity, claims or otherwise, or to
any public authority or to any other person, firm or corporation, for or on account of any fines or claims by any
public authority or for bodily injuries or property damage to any person or thing, including; but not limited to, injury
or damage due to the release or threat of release of hazardous substances of any kind or damage to real estate
or to the environment or clean-up costs or other damages of whatever kind or nature arising out of any act of
commission or omission by the Principal, the Principal's agents, servants, employees, subcontractors or
suppliers or any other person in connection with the performance of the Contract. This limitation applies
regardless of when any such fine is assessed, claim is made, or injury, damage, release or threat of release
occurs and without regard to any term or condition of the Contract.
3. The Surety hereby waives notice of any alteration or extension of time made by the Obligee.
4. Any suit under this bond must be instituted before the expiration of one (1) year from the date on which the
Principal ceased to work on the Contract. 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.
5. No right of action shall 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.
6. Any claims must be presented in writing to Liberty Mutual Insurance Company to the attention of the Surety Law
Department at the above address.
DATED as of this 14th day of November 20 14
WITNESS/ATTEST
Mike Brown Electric Co
(Princi 1)
By: - f (Seal)
Name: ames brown
Title: President
LIB
By:
S
al)
LMIC-5100 Page 2 of 2 Rev. 3/12
TRIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
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.
Certificate No. 6739313
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company WestAmerican Insurance Company
90-1,101 =1Cz•]y_ll611000'LlI
KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized underthe laws of
the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State 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, Catherine A. Pinney: Donnalvn Hevis: K. Dixon Wright; Lynn Ellen Patton: Nancy L. Wallis: Natalie Ann Horder: Nicki Moon; Stacy fdl.
all of the city of Petaluma , state of CA each individually if there be more than one named, its true and lawful attomey-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 surety 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 Pourer 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 13th day of October , 2014
STATE OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY
American Fire and Casualty Company
The Ohio Casualty Insurance Company
Liberty Mutual Insurance Company
West American Insurance Company
9 n
By:
David M. Care Assistant Secretary
On this 13th day of October 2014 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and
Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance 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, on the day and year first above written.
By:
Teresa Pastella , Notary Public
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations ofAmerican Fire and Casualty Company, 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 attomeys-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 attomeys-in-fact, subject to the limitations set forth in their respective
powers of attomey, 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, shall appoint such attomeys-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 attomeys-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 Secretaryto appoint such attomeys-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, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, 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 Attomey 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 14th day of November .20 14
By:
Gregory W. Davenport, Assistant Secretary
LMS_12873_122013 6 of 200
State of California )
SS.
County of Sonoma )
On November 14, 2014, before me, Susan Heath Allred, Notary Public,
personally appeared James G. Brown, who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized
capacity, and that by his signature on the instrument the person, or the entity upon
behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Susan Heath Allred
`qq�O�3C3k�?� COUNTY
TY
�
State of California
County of Sonoma
On November 14 2014 before me, Nancy L. Wallis, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Stacy M. Clinton
Place Notary Seal Above
of
who proved to me on the basis of satisfactory evidence to
be the person whose name( is/ re subscribed to the
wit ' instrument and ac o edged to me that
In h y executed the sam n h' er r authorized
c a (ij, and that by/her Ign ture on the
instrument the person or e entity upon behalf of
which the person cted, 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 and and official seal.
Signature
r�lgnature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
Fj Individual
Stacy M. Clinton
Corporate Officer —Title (s): —
0 Partner — ❑ Limited ❑ General
❑x Attorney in Fact
0 Trustee
El Guardian or Conservator
M Other:
Signer Is Representing
RIGHTTHUMBPRINT
OF SIGNER
...
Number of Pages:
Signer's Name:
❑Individual
0 Corporate Officer — Title(s):
Partner — ❑ Limited ❑ General
Attorney in Fact
OTrustee
❑Guardian or Conservator
Other:
Signer Is Representing:
RIGHTTHUMBPRINT'
OF SIGNER
of thumb here
©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402• wwvaNationalNolary.org Item 55907 Reorder: Cali Tall -Free 1-800-876-6827
Bond Number: 070018483
KNOW ALL MEN BY THESE PRESENTS, that we Mike Brown Electric Co
Interchange
450 Plymouth Road, Suite 400
Plymouth Meeting, PA. 19462-1644
px�(61Naa2-a24o
aaprincipal (the ^Phncipar)
and Liberty Mutual Insurance Company, a Massachusetts stock insurance company, as surety (the "Surety"),
are held and firmly bound unto City of San Rafael
as obligee (the "Obligee"),
in the penal sum of
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents,
WHEREAS, the Principal has bywritten agreement dated the _lrdday o .20 1£___.
entered into (the "Contract") with the Obligee for
Citywide Traffic Signal LED Relamping Project, Project No. 11253
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall promptly
make payment to all C|aimants, as hereinafter defined, for all labor and material used or reasonably required for
use in the performance of the Contract, then this obligation shall be null and void; otherwise it shall remain in full
force and effect.
1� A^Claimant" is defined asone having edirect contract with the Principal orwith usubcontractor of the Principal
for |abor, material, or both, used o/ reasonably required for use in the performance of the Contract, labor and
material being construed 0zinclude that part ofwater, gas, power, light, heat, oil, gasoline, telephone service or
rental ofequipment directly applicable iothe Contract,
Z The Principal and the Surety hereby jointly and severally agree with the Obligee that every Claimant, who
has not been paid in full before the expiration of o period of ninety (90) days (or such lesser or greater
time period as otherwise permitted by relevant |ew) after the doba on which the |oo| of such Claimant's
work orlabor was done or parfbrmed, or materials were furnished by such C|uimant, may sue on this bond
for the use of such C|oimant, prosecute the suit to final judgment for such sum or sums as may be justly
due Claimant, and have execution thereon. The Obligee shall not be liable for the payment of any costs or
expenses ofany such suit.
3� Nosuit oraction shall becommenced hereunder byany Claimant:
(a) Unless Claimant, other than one having e direct contract with the Phndpd, shall have given written
notice to the Principal and the Surety within ninety (90) days (or such lesser or greater time period as
otherwise permitted by relevant law) after such C|eknont did or performed the last of the work or |obor,
or furnished the last of the materials for which said claim is mede, stating with oubobanbo| accuracy
the amount claimed and the name of the party to whom the materials were humiohed, or for whom the
work or labor was done or performed. Such notice shall be served by mailing the same by registered
mail or certified moi|, postage prepoid, in separate envelopes addressed to the Principal and Surety.
The Principal may be served at any place where an office is nagu|edy maintained for the transaction of
business, or in any manner in which legal process may be served in the state in which the aforesaid project
is |0000ad, save that such service need not bemade by e public officer, The Surety may be served to the
attention ofThe Surety Law Department et the above -listed address.
y8 Other than inostate court ofcompetent jurisdiction inand for the county orother political subdivision nfthe
state in which the project, or any port 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,
Lm|c'5200 Page of Rev. 03/04
(c) After the expiration of one (1) year (or such lesser or greater time period as otherwise permitted by relevant
law) following the date on which the Subcontractor provided the last labor and/or materials to the project. If
the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to
sureties aaadefense inthe jurisdiction ofthe suit shall beapplicable.
4. Surety shall have no liability to any Claimant under this Bond for any amount unless it is due and owing to the
Claimant by the Principal pursuant to the express terms of the contract between the Principal and Claimant or, if
the Claimant does not have u direct Contract with Phndpd, pursuant to the terms and conditions of the
Contract between the Claimant and the Subcontractor to the Principal. The Bond incorporates all of the
Principal's contractual defenses, including but not limited to pay -if -paid pmva}ona, whereby payment to the
Claimant is subject to the condition precedent of the Obligee's payment to the Principal, and other limitations on
amounts due under the contract between Principal and Claimant.
5. The amount of this bond shall bereduced by and to the extent of any payment orpayments made |ngood faith
hereunder, inclusive of the payment by Surety of mechanics' |iena, which may be filed of record against
such improvement, whether or not a claim for the amount of such lien be presented under and against this
bond.
DATED asofthis 14tday of November 2l_14 _'
WITNESS /ATTEST
Mike Brown Electric Co.
(Principal)
By: (Sea|)
LMIC-5200 Page 2 of 2 Rev. 03/04
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
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.
Certificate No. 6739314
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State 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, Catherine A. Pinney: Donnalyn Revis; K. Dixon Wright: Lynn Ellen Patton: Nancy L. Wallis; Natalie Ann Horder: Nicki Moon: Stacy M.
Clinton
all of the city of Petaluma state of CA each individually if there be more than one named, its true and lawful attomey-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 surety 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 13th day of October 2014
American Fire and Casualty Company
The Ohio Casualty Insurance Company
Liberty Mutual Insurance Company
West merican Insurance Company
By:
STATE OF PENNSYLVANIA ss David M. Care , Assistant Secretary
COUNTY OF MONTGOMERY
On this 13th day of October 2014 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and
Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance 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, on the day and year first above written.
By:
Teresa Pastella Notary Public
This Power of Attomey is made and executed pursuant to and by authority ofthe following By-laws and Authorizations ofAmehcan Fire and Casualty Company, 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 attomeys-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 attomeys-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 to writing by the chairman or the president,
and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-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 attomeys-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 attomeys-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 powder 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, Gregory W. Davenport, the undersigned, Assistant Secretary, ofAmerican Fire and Casualty Company, 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 Attomey 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 14th day of November 20 14
By:
Gregory W. Davenport, Assistant Secretary
LMS_12873_122013 7 of 200
State of California )
SS.
County of Sonoma )
On November 14, 2014, before me, Susan Heath Allred, Notary Public,
personally appeared James G. Brown, who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized
capacity, and that by his signature on the instrument the person, or the entity upon
behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Susan Heath Allred
4 i r i EFT
s�
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California
County of
Sonoma
On November 14, 2014before me, Nancy L. Wallis, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared Stacy M. Clinton
Name(s) of Signer(s)
who proved to me on the basis of s isfactory evidence to
be the person(,s�whose nam/ho
Is/ e subscribed to the
wi in instr ment and ac ed d t me that
y executed the same ' er r authorized
- c cit ( ), and that by i er/ signature on the
instrument the person or e entity upon behalf of
which the person�j cted, 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.
• • " • J . WITNESS m hand and official se
Signature
Place Notary Seal Above p� p� Signature of Notary Public
OPTION
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Stacy M. Clinton
Individual
0 Corporate Officer — Title(s): _
Q Partner — ❑ Limited ❑ General
❑x Attorney in Fact
0 Trustee
Guardian or Conservator
Q Other:
Signer Is Representing
RIGHTTHUMBPRINT
OF SIGNER
Number of Pages:
Signer's Name:
OIndividual
OCorporate Officer—Title(s):
0 Partner — ❑ Limited ❑ General
DAttorney in Fact
OTrustee
OGuardian or Conservator
0 Other:
Signer Is Representing
RIGHTTHUMBPRINT;
OF SIGNERTop of thumb here"
n
©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402• tnvw.NalionalNolaryorg Item :5907 Reorder: Call Toll -Free 1-800-876-6827
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
- ----------------------------------
t
City Attorney
Review, revise, and comment on draft
a regiment.
2
Contracting Department
_ ...............
Forward final agreement to contractor for
their signature. Obtain at least two signed
. .......... .
..................................................... --—
originals from contractor.
----- .......
3
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;
C_A�4,
bonds, and insurance certificates and
. ................................ -
— --------------------------------------------------------------------------------------- — ---------------- . .
endorsements.
...................................... .......... ................................
5
City Manager / Mayor / or
Agreement executed by Council authorized
Department Head
official.
6-
City Clerk
City Clerk attests signatures, retains original
it?Pl.
agreement and forwards copies to the
/
contracting
- — -------------------------
To be completed by Contracting Department:
Frog ectManager:
Prod ectName:
Agendized for City Council Meetn`ig 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.
November 18, 2014
Ms. Leslie Blooniquist
City of San Rafael
111 Morphew Street
San Rafael, CA 94915-1560
561 -A Mercantile Drive
Cotati, CA 94931-3040
(707) 792-8100 e Fax (707) 792-8110
Cont. Lic. #306767
DJR.#1000000469
MBE Job #2046
RE: Citywide Traffic Signal LED Rulamping Project; Project No. 11253
Dear Ms. Bloomquist:
Enclosed please find our executed ContraL' Agreement and the required insurance certificate and
bonds for the above referenced project.
Please return a fully executed copy of the CuilU.IC! to our office as soon as possible as we cannot
begin work until it has been received.
Should you have any questions or require any additional information, please don't hesitate to
call.
As always, we look forward to working with you on this project.
Sincerely,
MIKE BROWN ELECTRIC CO.
Rene6 Harrison
Accounting Administrator
//rh
Encl,(s)
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: 11/03/14
FROM: Nader Mansourian
DEPARTMENT: Public Works
DATE: 11/03/14
TITLE OF DOCUMENT:
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AWARDING A CONTRACT
FOR THE CITYWIDE TRAFFIC SIGNAL LED RELAMPING PROJECT, CITY PROJECT NO. 11253, TO
MIKE BROWN ELECTRIC CO., IN AN AMOUNT OF $139,088.80.
Department Head (signature)
APPROVED AS COUNCIL / AGENCY
AGENDA ITEM:
d
City Manager (signature)
zrffllw.... �91
REMARKS:
F -Al z I z I : [SAVA: 4 91yr-T-AAARAV-21 0
FE
City Attorney (signatureV I t
File No.: 18.0 1.78