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HomeMy WebLinkAboutFD Fire St. Apparatus Bay Heater Unit Upgrade Proj. 11254City of San Rafael ♦ California
Form of Contract Agreement for Informal Bids
for
Fire Station Apparatus Bay Heater Unit Upgrade Project
City Project No. 11254
This Agreement is made and entered into this %0 day of FOw�lwl 2015 by and between the City of San
Rafael (hereinafter called City) and 0006* i Wux ; W— (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 described in the specifications for the project entitled: Fire Station Apparatus Bay Heater
Unit Upgrade Project, City Project No. 11254, 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
Contractor further agrees to provide the insurance as specified in the Insurance Requirements Sheet attached hereto
as Attachment A. The liability insurance provided to City by Contractor under this contract shall be primary and
excess of any other insurance available to the City.
II- Time of Completion
(a) The work to be performed 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) All work shall be completed, including all punchlist work, within TWENTY (20) WORKING DAYS and with
such extensions of time as are provided for in the General Conditions.
III - Liquidated Damages
It is agreed that, if all the work required by the contract is not finished or completed by the date 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 $250 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.
NO. ITEM QUANTITY UNITS UNIT PRICE TOTAL PRICE
1. Upgrade Fire Station lieaters 1 1 'u' $ 19,992.00$ 19,992.00
................ .......................................
TOTAL BASE BID $19,992.00
V - Progress Payments
(a) On no 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) 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, shall be paid to the Contractor by the City as soon as
possible, provided Contractor has provided evidence satisfactory to the Engineer that all payrolls, material bills,
and other indebtedness connected with the 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 bod 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.
(b) 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.
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.
CITY OF SAN RAFAEL: CONTRACTOR:
fader Mansourian
Public Works Director for
B'
A—Paan Conau;anors IndemnAy Campany
6D1 S F'ilp,Ioln 5111101 Si erla 160,7„ L. 's 111q"ge, Q td nm? I"M 7
M,1111 N1 b49 01;Q0 fatAnkc, PO 64q 006
Public Works — Performance
Bond No. 1001030743
Premium: $ 600. 00
KNOW ALL MEN BY THESE PRESENTS, That we, BIGHAM SERVICES, INC.
DBA: ONE HOUR HEATING & AIR CONDITIONING , as Principal, and
AMERICAN CONTRACTORS INDEMNITY COMPANY, a corporation organized and existing under
the laws of the State of California, and authorized to transact a general surety business in the State of CA ,
as Surety, are held and firmly bound unto CITY OF SAN RAFAEL
, as Obligee, in the sum of NINETEEN
THOUSAND NINE HUNDRED AND TWO Dollars ($ 19,992.00 ), lawful money of
the United States of America, for the payment whereof, well and truly to be made, we hereby bind ourselves,
our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that
WHEREAS, the above -bounden Principal has entered into a contract dated JANUARY 22, 2015
with said Obligee to do and perform the following work, to wit:
FIRE STATION APPARATUS BAY HEATER UNIT UPGRADE PROJECT
NOW, THEREFORE, if the above -bounden Principal shall well and truly perform or cause to be performed,
"the works under the contract," then this bond shall be null and void; otherwise it shall remain in full force and
effect.
Signed, sealed and dated this 22ND day of JANUARY , 2015
BIGHAM SERVICES INC. DBA:
ONE HOUR HEATING & AIR CONDITIONING AMERICAN CONTRACTORS INDEMNITY COMPANY
Principal
By
CINDY BETH Attorney -in -Fact
HCCSZZ20004+10
N HCC
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i18T ascan Otpyntraactars IlSrJd' mnity C aBP9CSt y
oul w. Fi\°i il,?ff�c: S'A'C ' "rUltl.r.° 1600, �'n:eYdYgwk'ti" Cnl f41 nia 1-0017
Maici '106001"o
9,rasao-rorila ;td) G °'Y CF4roS�
Bond No. 1001030743
Premium: $ INCLUDED IN
PublicWorks— Payment PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS, That we, B I G H A M SERVICES INC.
DBA: ONE HOUR HEATING & AIR CONDITIONING , as Principal, and
AMERICAN CONTRACTORS INDEMNITY COMPANY, a Corporation organized and existing under
the laws of the State of California, and authorized to transact a general surety business in the State of CA ,
as Surety, are held and firmly bound unto CITY OF SAN RAFAEL
, as Obligee, in the sum of NINETEEN
THOUSAND NINE HUNDRED AND TWO Dollars ($ 19,992.00 ), lawful money of
the United States of America, for the payment whereof, well and truly to be made, we hereby bind ourselves,
our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, that
WHEREAS, the above -bounden Principal has entered into a contract dated JANUARY 22, 2015
with said Obligee to do and perform the following work, to wit:
FIRE STATION APPARATUS BAY HEATER UNIT UPGRADE PROJECT
NOW, THEREFORE, if the above -bounden Principal shall faithfully pay all laborers, mechanics, subcontractors,
materialmen and all persons who shall supply such person or persons, or subcontractors, with materials and supplies
for the carrying on of such work, then this bond shall be null and void; otherwise it shall remain in ful force and effect.
Signed, sealed and dated this 22ND day of JANUARY
BIGHAM SERVICES INC. DBA:
ONE HOUR HEATING & AIR CONDITIONING
Principa
By
v
, 2015
AMERICAN CONTRACTORS INDEMNITY COMPANY
CINDY BETH Attorney -in -Fact
HCCSZZ81 I B04, 10
POWER OF ATTORNEY
AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY
KNOW ALL MEN BY THESE PRESENTS: That American Contractors Indemnity Company, a California corporation, United States
Surety Company, a Maryland corporation and U.S. Specialty Insurance Company, a Texas corporation (collectively, the
"Companies"), do by these presents make, constitute and appoint:
James Schieffer or Cindy Beth of Healdsburg, California
its true and lawful Attorney(s)-in-fact, each in their separate capacity if more than one is named above, with full power and authority
hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings
or other instruments or contracts of suretyship to -include riders, amendments, and consents of surety, providing the bond
penalty does not exceed *****Five Hundred Thousand***** Dollars ($ **500;000.00** ),
This Power of Attorney shall expire without further action on December 08, 2016. This Power of Attorney is granted under and by
authority of the following resolutions adopted by the Boards of Directors of the Companies:
Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full
power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following
provisions:
Attor•nev-in-Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknoHledge and deliver, any and all bonds,
recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings, including any and all consents for the release of retained
percentages andlor final estimates on engineering and construction contracts, and any and all notices and documents canceling or terminating the Company's liability
thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected
by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attome) or any certificate relating
thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to
any bond or undertaking to which it is attached.
IN WITNESS WHEREOF, The Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this
10th day of December, 2012.
AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY U.S. SPECIALTY INSURANCE COMPANY
Corporate Seals
-Y o•,PS,CTORJ gip, ` 5'sll� • ,` � ln5uq,,, o,
la4
SEPT ,3.1f90 . i iZ � i `� :• �
rs Daniel P. Aguilar, Vice President
State of California
County of Los Angeles SS:
On 10th day of December, 2012, before me, Vanessa Wright, a notary public, personally appeared Daniel P. Aguilar, Vice President of
American Contractors Indemnity Company, United States Surety Company and U.S. Specialty Insurance Company 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(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
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. 14..
V. WR 1
Commission 0 1996319
sWk
Signature �( `J J - (Seal) i NotuyP- cametola
Las Angeles County
My Comm. Expires Ose 6. 2016
I, Jeannie Lee, Assistant Secretary of American Contractors Indemnity Company, United States Surety Company and U.S. Specialty
Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by
said Companies, which is still in full force and effect; furthermore, the resolutions of the Boards of Directors, set out in the Power of
Attorney are in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this _.2.2ND,. day
of JANUARY ,2015
Corporate Seals
,oOV, T0RS�cti 5 suRFl, . �',ainsw'a ;•o,,,,,
Bond No. 1001030743 ">__ =o ;W Jeannie Lee, ssistant Secretary
Agency No. 2168 SE., s a
,:n;:,
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
A notary or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document
STATE OF CeI t Turn a c )
COUNTYOF Sconvma 1
On — I l.S before me, jan*S x� ,e T aP, No Ai/4personally
appeared Ca n § �twh-11 who proved to me on the basis of
satisfactory evidence to be the per on(s) ose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
JAMES SCHIEFFER16
COMM. #1956111 m
NOTARY PUBLIC - CALIFORNIA
W SONOMA COUWY
My Comm. Expims Nov. & 2015
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITN my hand and fi iallo 1.
(Si ure of Notary Public) �t
CERTIFICATE OF
LIABILITY INSURANCEDATE
.A_CORD.
01/21/2015
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ARTHUR E SCHIEFFER & SON
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
.
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
338 Center Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O.Box 515
INSURERS AFFORDING COVERAGE
Healdsburg CA 95448 -
INSURED
I INSURER FINANCIAL PACIFIC INSURANCE COMPANY
BIGHAM SERVICES INC, DBA ONE HOUR HEATING & AIR IINSURER BALLIED /NATIONWIDE
CONDITIONING, MISTER SPARKY
IINSURERcTOPA INSURANCE COMPANY
1400 PETALUMA HILL ROAD
IINSURER
SANTA ROSA CA 95404-
IINSURER
COVERAGES
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,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID
CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR DATE (MM/DD/YYI DATE (MM/DD/YY)
LIMITS
A GENERAL LIABILITY 60416643
09/01/2014 09/01/2015
EACHOCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire) $ 50,000
=CLAIMS MADE a OCCUR
/ / / /
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
I PRODUCTS - COMP/OP AGG $ 2,000,000
JEC
POLICY I I LOC
B At TOMOBILE LIABILITY ACP7835064523
06/15/2014 06/15/20151
COMBINED SINGLE LIMIT
X ANY AUTO
(Ea accident) $ 1,000,000
ALL OWNED AUTOS
/ / / /
BODILY INJURY
SCHEDULED AUTOS
(Per person) $
X HIRED AUTOS
/ / / /
I BODILY INJURY
X NON -OWNED AUTOS
(Per accident) $
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
I AUTO ONLY - EA ACCIDENT I $
ANY AUTO
/ / / /
I OTHER THAN EA ACC Is
AUTO ONLY: AGG Is
C EXCESS LIABILITY XL6604756
09/01/0203 09/01/20141 EACH OCCURRENCE Is 2,000,000
X] OCCUR E� CLAIMS MADE
I AGGREGATE I$ 2,000,000
Is
DEDUCTIBLE
/ / / / I Is
RETENTION $
I Is
COMPENSATION AND
I IOLITI IEEMPLOYERS
R
TRY IMS
E L EACH ACCIDENT Is
EL DISEASE - EA EMPLOYEEI $
E L. DISEASE -POLICY LIMIT I$
OTHER
B AUTO PHYSICAL DAMAGE ACP7835064523
06/15/2014 06/15/2015
COMPREHENSIVE DED 500
COLLISION DEDUCTIBLE 1,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
THE CITY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY
AND AUTO LIABILITY PER ATTACHED FORMS.
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER:
CITY OF SAN RAFAEL
P.O. BOX 151560
SAN RAFAEL
A ORD 25-S (7/97)
,, INS026S (9910) 01
CA 94915-1560
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTH jq R F TA7y E
ELECTRONIC LASER FORMS, INC. - (800)327-0545
© ACORD CORPORATION 1988
Page 1 of 2
POLICY NUMBER: 60416643
CG 20 10R 12 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
(WITH LIMITED COMPLETED OPERATIONS COVERAGE)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
NAME OF PERSON OR ORGANIZATION
Any person or organization to whom or to which
the named insured is obligated by a virtue of a
written contract to provide insurance that is
afforded by this policy. Where required by
contract, the officers, officials, employees,
directors, subsidiaries, partners, successors,
parents, divisions, architects, surveyors and
engineers are included as additional insureds.
All other entities, including but not limited to
agents, volunteers, servants, members and
partnerships are included as additional insureds,
if required by contract, only when acting within
the course and scope of their duties controlled
and supervised by the primary (first) additional
insured. If an Owner Controlled Insurance
Program is involved, the coverage applies to off-
site operations only. If the purpose of this
endorsement is for bid purposes only, then no
coverage applies.
WHO IS AN INSURED: (Section II)
This section is amended to include as an
insured the person or organization within the
scope of the qualifying language above, but only
to the extent that the person or organization is
held liable for your acts or omissions in the
course of "your work" for that person or
organization by or for you. The "products -
completed operations hazard" portion of the
policy coverage as respects the additional
insured does not apply to any work involving or
related to properties intended for residential or
habitational occupancy (other than apartments).
This clause does not affect the "products -
completed operations" coverage provided to the
named insured(s).
WAIVER OF SUBROGATION:
We waive any right of recovery, when required
by written contract, that we may have against
the person or organization within the scope of
the qualifying language above because of
payments we make for injury.
LOCATION OF JOB:
The job location must be within the State of
domicile of the named insured, or within any
contiguous State thereto.
DESCRIPTION OF WORK:
The type of work performed must be that as
described under classifications in the CGL
Coverage Part Declarations.
PRIMARY CLAUSE:
When this endorsement applies and when
required by written contract, such insurance as
is afforded by the general liability policy is
primary insurance and other insurance shall be
excess and shall not contribute to the insurance
afforded by this endorsement.
EXCLUSION
This insurance provided to the additional insured
does not apply to "bodily injury", "property
damage" or "personal and advertising injury"
arising out of an architect's, engineer's or
surveyor's rendering or failure to render any
professional services, including:
1. The preparing, approving, or failing to
prepare or approve, maps, designs,
shop drawings, opinions, reports,
surveys, field orders, change orders, or
drawings and specifications; and
2. Supervisory, inspection, architectural or
engineering activities.
Endorsement EFFECTIVE DATE: SEE DEC
Endorsement EXPIRATION DATE: SEE DEC
CG 2010R 1211 Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission
1308 10-01-2014
fPOLICY NUMBER: 60418966
COMMERCIAL GENERAL LIABILITY SUPPLEMENTAL DECLARATIONS - ADDITIONAL INSUREDS
Schedule of Additional Insureds
Premium
OWNERS, LESSEES OR CONTRACTORS (LIMITED COMPLETED OPERATIONS COVERAGE) 739
CG201OR— —CALIFORNIA
ENDORSEMENT EFFECTIVE FROM: 10/01/2014 TO: 10/01/2015
THIS ENDORSEMENT APPLIES TO THE FOLLOWING CLASSES ON THE POLICY
21342 COMMERCIAL CARPENTRY
21560 COMMERCIAL CONCRETE CONSTRUCTION
21585 COMM CONTRACTORS—SUBCONTRACTED BUILDING CONSTRUCTION
22338 COMMERCIAL DRYWALL/WALLBOARD INSTALLATION
22478 COMMERCIAL ELECTRICAL WORK — WITHIN BUILDINGS
28304 COMM PAINTING—EXTERIOR—BLDGS STRUCTURES -3 STORIES OR LESS
29746 COMM TILE STONE MARBLE MOSAIC TERRAZZO WORK—INTERIOR CONST
91340 CARPENTRY—CONST OF RESIDENTIAL PROP NOT EXCEEDING 3 STORIES
91560 RESIDENTIAL CONCRETE CONSTRUCTION
91583 CONTRACTORS—SUBCONTRACTED WORK ONE OR TWO FAMILY DWELLINGS
91590 CONTRACTORS PERMANENT YARDS— EQUIP MAINTENANCE INCL PR/CO
92338 RESIDENTIAL DRYWALL/WALLBOARD INSTALLATION
92478 RESIDENTIAL ELECTRICAL WORK— WITHIN BUILDINGS
98304 RESIDENTIAL PAINTING—EXTERIOR BLDGS-3 STORIES OR LESS
98482 PLUMBING—COMMERCIAL AND INDUSTRIAL
98483 PLUMBING—RESIDENTIAL OR DOMESTIC
99746 RESIDENTIAL TILE/STONE/MARBLE MOSIAC/TERRAZZO—INTERIOR CONST
CG 7154 0107
COMMERCIAL AUTO
CA 20 01 12 93
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply
unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another
date is indicated below.
Endorsement Effective
1-21-15
Named Insured Countersigned By
BIGHAM SERVICES INC _ _
(Authorized Representative)
SCHEDULE
Insurance Company ALLIED INSURANCE
Policy Number ACP7835064523
Effective Date 6-15-2014 Expiration Date 6-15-2015
Named Insured BIGHAM SERVICES INC
Address 1400 PETALUMA HILL ROAD, SANTA ROSA, CA 95404
Additional Insured (Lessor) CITY OF SAN RAFAEL, ITS OFFICERS, EMPLOYEES, AGENTS
& VOLUNTEERS
Address P.O. BOX 151560
SAN RAFAEL, CA 94915-1560
Designation or Description of Leased "Autos"
PER SCHEDULE ON FILE.
Primary Clause: It is understood and agreed that this insurance is primary insurance and any other insurance maintained
by the additional insured shall be excess only and not contributing with this insurance, but only with respects to liability
arising out of "your work" for that insured by or for you.
Cancellation Clause: It is hereby understood and agreed there will be no cancellation, reduction or modification of
coverage without (30) days prior written notice.
Waiver of Subro ate ion: If required by written contract or agreement; we waive the right of recovery we may have
against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury
or damage arising out of "your work" done under a contract with that person or organization.
CA 20 01 120 93 (MODIFIED)
Includes copyrighted material of Insurance Services Office, Inc., with its permission