HomeMy WebLinkAboutPW Multi-Use Pathway Repairs ProjectCity of San Rafael + California
Form of Contract Agreement
for
Multi -Use Pathway Repairs
City Proiect No. 11256
This Agreement is made and entered into this .2" day of `*'- —, 2015 by and between the City of San
Rafael (hereinafter called City) and W.R. Forde Associates, a general partnership (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 plans and specifications for the project entitled: Multi -Use Pathway
Repairs, City Project No. 11256, 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 any
contribution.
If- 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 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
BASE BID
I
Mobilization
I
LS
@
$3,000.00
=
$3,000.00
2.
Signs and Traffic Control
I
LS
@
$6,000.00
=
$6,000.00
3.
Clearing and Grubbing
I
LS
@
$65,000.00
=
$65,000.00
4.
Aggregate Base (Class 2)
145
TON
@
$75.00
=
$10,875.00
5.
Minor Concrete Minor Structures
a. Type A Curb and Gutter"
10
LF
@
$85.00
=
$850.00
b. 6 -inch Thick PCC Driveway"
285
SF
@
$25.00
=
$7,125.00
c. 6 -inch Thick PCC Sidewalk"
140
SF
@
$19.00
=
$2,660.00
ITEM
DESCRIPTION
ESTIMATED
QUANTITY
UNIT
UNIT PRICE
TOTAL
PRICE
6.
Hot Mix Asphalt
225
TON
@
$230.00
=
$51,750.00
7.
Decomposed Granite
660
SF
@
$15.00
=
$9,900.00
8.
Retaining Wall
315
LF
@
$35.00
1 =
$11,025.00
SUBTOTAL BASE BID $168,185.00
ALTERNATE BID ITEM NO. 1
1.
1 Slurry Seal (Bahia Vista School Pathway)"
1 1,780
1 SY
1@1
$15.00
=
$26,700.00
SUBTOTAL ALTERNATIVE BID ITEM NO. 1
$26,700.00
"Final Pay Item
GRAND TOTAL BID S .194,885.00
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 final 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:
Esther C Beirne Kevin McGowan
City Clerk Acting Public Works Director
APPROVED AS TO FORM: W.R. Forde Associates
By:
Robert F. Epstein Printed Name� . .....
City Attorney Title: Partne Donald J. Russell
President, Donald J. Russell Inc.
General Partner of
File No.: 22.04.43 W. R. Forde Associates
EXECUTED IN DUPLICATE
FAITHFUL PERFORMANCE BOND Bond No 9178208
PUBLIC WORK
(The premium charged on this bond is $ 3,798.00 — , being at
the rate of 24.20 first $100,000 and per thousand of the contract price)
$14.52 next $400,000
KNOW ALL MEN BY THESE PRESENTS:
THAT, WHEREAS the -City of San Rafael
State of California, entered into a contract dated June 1 2015 with
W. R. FORDE ASSOCIATES
hereinafter designated as the "Principal,"
for the work described as follows: Multi -Use Pathway Repairs, City Project No. 11256
and
WHEREAS, the said Principal is required under the terms of said contract to furnish a bond for the faithful
performance of said contract.
NOW, THEREFORE, We, the Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND ' a
corporation organized and existing under the laws of the State of MARYLAND , and duly authorized to transact
business under the laws of the State of California, as Surety, are held and firmly bound unto
City of San Rafael in the penal sum of
One Hundred Ninety Four Thousand Eight Hundred Eighty Five ................................. Dollars ($ 194,885.00 _),
lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our
heirs, executors, administrators, and successors, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the above bounden Principal, his or its heirs,
executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and
perform the covenants, conditions and agreements in the said contract and any alteration thereof made as therein
provided, on his or their part, to be kept and performed at the time and in the manner therein specified, and in all
respects according, to their true intent and meaning, and shall indemnify and save harmless the
City of San Rafael its officers and agents, as therein stipulated, then this obligation
shall become null and void; otherwise it shall be and remain in full force and virtue.
And the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration
or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying
the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change,
extension of time, alteration or addition to the terms of the contract or to the work or to the specifications.
IN WITNESS WHEREOF, We have hereunto set our hands and seals this I day of June — 2015
W. R,-FORDE ASSOCIATES
By Principal
DONALD J. RWELL, INC, GENERAL PARTNER
DONALD J. RUSSELL PRESIDENT
FIDELITY AND DEPOSJ COMPANY OF MARYLAND
PRF71 00 1 CA0201 f By
JEFF VRICKSON t� _ V
Atforne. -in-Fact
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of Callfomla
County of NAPA
On JUNE 1, 2015 before me,
K. M. WILLBACK, NOTARY PUBLIC
Date
Here Insert Name and Title of the Officer
personally appeared
JEFFREY D. ERICKSON
Name(; of Signer(y)
who proved to me on the basis of satisfactory evidence to be the person(%) whose narne(4 WANK
subscribed to the within instrument and acknowledged to me that he1xbm2Mft executed the same in
his/kmitheir authorized capacitykb*, and that by hlsA)adjhRix signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
of the State of Califomia that the foregoing paragraph
is true and correct.
K. M. WILLBACK
WITNESS my hand and official seal.
Commission # 2057918
Z Notary Public - California Zz
Z Napa County ?!
r
Signature
Mg Comm. Ex ares Feb 14, 2018
Signature of Notary Public
Place Notary Seal Above
, OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages: _ Signer(s) Other Than
Capacity(ies) Claimed by Signer(s)
Signer's Name:
• Corporate Officer — Title(s):
• Partner — 0 Limited 0 General
• Individual 0 Attorney in Fact
• Trustee 0 Guardian or Conservator
0 Other:
Signer Is Representing:
Document Date:
Named Above:
Signer's Name:
171 Corporate Officer — Title(s):
• Partner — El Limited 0 General
• Individual 0 Attorney in Fact
0 Trustee 0 Guardian or Conservator
E] Other:
Signer Is Representing:
Bond No. 9178208
PAYMENT BOND
PUBLIC WORK
Section 3247-3252 inclusive, Civil code)
(Premium included in Faithful Performance Bond)
KNOW ALL MEN BY THESE PRESENT:
That, Whereas
City of San Rafael
has awarded to
W. R. FORDE ASSOCIATES
as Principal, a contract for the work described as follows: Multi -Use Pathway Repairs, City Project No. 11256
AND WHEREAS, said Principal is required ad to furnish a bond in connection with said contract, to secure the
payment of claims of laborers, mechanics, materialmen, and other persons as provided by law:
NOW, THEREFORE, We the undersigned Principal and Surety are held and firmly bound unto the
of San Rafael
in the amount required by law, the sum of
One Hundred Ninety Four Thousand Eight Hundred Eighty Five............................................................................
Dollars ($ 194,885.00 ) for which payment well and truly be made we bind ourselves, our heirs,
executors and administrators, successors and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, That if said Principal, his or its heirs, executors,
administrators, successors or assigns, or subcontractors, shall fail to pay any of the persons named in Civil Code
Section 3181, or amounts due under the Unemployment's Insurance Act with respect to work or labor performed
by any such claimant, or for any amounts required to be deducted, withheld, and paid over the Employment
Development Department from the wages of employees of the principals and his subcontractors pursuant to
section 13020 of the Unemployment Insurance Code, with respect to such work and labor, that the Surety or
Sureties herein will pay for the same in the amount not exceeding the sum specified in this bond, otherwise the
above obligation shall be void. In case suit is brought upon this bond, the said surety will pay a reasonable
attorney's fee to be fixed by the court.
PAY71001 CA0202f
In witness Whereof, We have hereunto set our hand and seals this I
day of June 2015
W. R. FORDE ASSOCIATES
Principal
By .
DONALD J. RUSbEfL, INC. GENERAL PARTNER
DONALD J. RUSSELL PRESIDENT
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
By: I—)— K�L,
.TEFF RICKSON , Attorney -In -Fact
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of NAPA
On JUNE 1, 2015 before me, K. M. WILLBACK, NOTARY PUBLIC
Date Here Insert Name and Title of the Officer
personally appeared
JEFFREY D. ERICKSON
Name(V of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person($) whose narne(so is/NKK
subscribed to the within instrument and acknowledged to me that he/j_K&Ztb= executed the same in
his/ka(Umirauthodzed capacity#e*, and that by hisAmdtheb:signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
LLBACK
K. M. WILL
BACK
�BACK
Commission # 205791B
Notary Public - California z
z
M M Napa County z
y CommCornm. Egires Feb 14, 2018
I certify under PENALTY OF PERJURY under the laws
of the State of Califomia that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature, ` �� L?4 c
Signature of Notary Public
Place Notary Seal Above
, OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: —
Document Date:
Number of Pages: — Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name:
• Corporate Officer — Title(s):
• Partner — 0 Limited 0 General
• Individual 0 Attorney In Fact
• Trustee 0 Guardian or Conservator
• Other:
Signer Is Representing:
Signer's Name:
• Corporate Officer — Title(s):
• Partner — 0 Limited 0 General
El Individual 0 Attorney in Fact
E3 Trustee 0 Guardian or Conservator
E] Other:
Signer Is Representing:
. . . . . . . . . .
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
THOMAS O. MCCLELLAN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said
Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby
nominate, constitute, and appoint Jeffrey D. ERICKSON, Robert E. CHOVICK, Michael BOGGES, Clay THOMPSON, Bryan
RICHMOND and Karen M. WILLBACK, all of Napa, California, EACH its true and lawful agent and Attorney -in -Fact, to make,
execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of
such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and
purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE
COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND
SURE'T'Y COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT
COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 14th day of July, A.D. 2014.
ATTEST:
BY
Assistant Secretary
Gerald F. Haley
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
lug, t
8CAL
Vice President
Thomas O. McClellan
State of Maryland
City of Baltimore
On this 14th day of July, A.D. 2014, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS 0.
MCCLELLAN, Vice President, and GERALD F. HALEY, Assistant Secretary, of the Companies, to me personally known to be the individuals and
officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly swom, deposeth and saith,
that helshe is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and
that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instnunent by the authority and direction of the said
Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written,
Maria D. Adamski, Notary Public
My Commission Expires: July 8, 2015
POA -F 016-3343A
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, Attomevs-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies,
recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such
facsimile signature and seal shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY,3WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this __L day of 20�
wo ocioJINS
�.r
EAL
Michael Bond, Vice President
WRFORDE-01 SKERR
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CERTIFICATE OF LIABILITY INSURANCE DATE
(MMIDD
11110� F 6 18/2015
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 License # 0303587 NAME: CONTACT
ISU Sander Jacobs Cassayre Insurance Services PHONE FAX
3200 Villa Lane (AIC, No, Ext): (707) 252-8822 (NO No): (707) 253-8255
Napa, CA 94558 E-MAIL ifacobs.com
ADDRESS: no@sanderj
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Gemini Insurance Company 10833
INSURED INSURER B: West American Ins. Co. 44393
W. R. Forde Associates INSURER C: Houston Casualty Company 42374
984 Hensley Street INSURER 0: STATE COMPENSATION INS. FUND OF CA 35076
Richmond, CA 94801-2117 INSURER E:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE -LISTED BELOWHAVE " 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.
INR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LT , I I , RpTrm
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,DOO
CLAIMS -MADE X OCCUR X VCGPD21674 04/01/2015 04101/2016 DAMAGE TO RENTED
PREMISES (Ea occurrence) S 50 000-
MED EXP (Any one person) S 5,000
PERSONAL & ADV INJURY S 1,00010001
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
POLICY X PRO-
JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000
Deductible S 5,000
COMBINEDSINdff LIMIT - S 11 1 ,00 000 - 0, 1
AUTOMOBILE LIABILITY (Ea accident)
B X ANY AUTO BAW1655976085 04101/2015 0410112016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) S
AUTOS AUTOS fi
HIRED AUTOS
NON OWNED PROPERTY DAMAGE S
AUTOS (Per accident)
X UMBRELLA LIAB ...X
OCCUR EACH OCCURRENCE S 5,000,000
C EXCESS LIAR CLAIMS -MADE H15XC5032701 04/0112015 04101/2016 AGGREGATE S 5,000,000
DED RETENTION $. ..... . ... -S
_wOkkERS COMPENSATION PER OTH,
AND EMPLOYERS'LIABILITY IN X STATUTE ER
D ANY PROPRIETOWY
PARTNER/EXECU7ME 767625814 10101/2014 1010112015 E.L. EACH ACCIDENT S 1,000,000
OFFICER/MEMBER EXCLUDED? Y
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE S
Ifes
DESCRIPTION describe under
S6RIPTI N OF OPERATIONS beIow E.L. DISEASE - POLICY LIMIT .. S
DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: Multi -Use Pathway Repairs, City Project No. 11256
When required by written contract the City of San Rafael, its officers, employees, agents and volunteers are included as Additional Insured per policy form
CG2010 04/13 attached. Coverage is Primary/Non-Contributory per policy form CG2001 04/13 attached.
30 days notice of cancellation except 10 days for non -pay. Auto 30 day cancellation endorsements attached. GL 30 day cancellation endorsement applies
(forthcoming from carrier). WC 30 day cancellation applies it was issued at policy inception 2013 and per State Fund is automatically renewed each year but a
new endorsement cannot be generated.
........ . . . . . . . . ..aa......_ ---- - - -
CERTIFICATE HOLDER CANCELLATION
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
City of San Rafael
P.O. Box 151560
San Refaelr,CA 94915-1560
1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
Policy: VCGP021674
Insured Name: WR FORDE ASSOCIATES
CG 20 0104 13
Effective Date: 04/01/2015
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured
under your policy provided that:
(1) The additional insured is a Named Insured under such other insurance; and
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not
seek contribution from any other insurance available to the additional insured.
CG 20 01 04 13 1 of 1
Policy: VCGP021674
Insured Name: WR FORDE ASSOCIATES
CG 20 10 04 13
Effective Date: 04/0112015
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
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Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in
the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such
additional insured will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than
service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the
covered operations has been completed; or
CG 20 10 04 13 1 oft
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or
organization other than another contractor or subcontractor engaged in performing operations for a principal as a part
of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of
Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the
additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 20 10 04 13 2 of 2
COMMERCIAL AUTO
CA 88 63 09 12
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ N.CAREFULLY.
AMENDMENT OF CANCELLATION PROVISIONS
Any bann or provision of the Cancellation Conditions of the policy or any endorsement amending orreplac-
ing such Conditions is amended bythe following:
A. If we uanoa| this policy for any reason other than nonpayment of pn*mium, we will notify the person or
organization shown in the Schedule below. In no event will the notice to the person or organization
scheduled below exceed the notice to the first named insured.
B. Our obligation to send notice to the person or organization listed inthe Schedule below will terminate
at the earlier of the current policy period expiration or when you no longer have a|ega| or contractual
�
obligation to such person or organization to maintain insurance coverage under epo|ioy which requires
� that such person or organization be notified in the event of cancellation.
SCHEDULE
�
�
1. Name orPerson mrOrganization:
City of San Rafael
� 2. Mailing Address:
2O BOX 1-51560
Sao Rafael, ca 949I5
3. Number Days Advance Notice:
30
All other berms and conditions of this policy remain unchanged
m
u012Liberty Mutual Insurance
GEMINI INSURANCE COMPANY
A STOCK COMPANY
(herein called "die Company")
COMMON POLICY DECLARATIONS
Policy No.: VCGP021674 Renewal/Rewrite of:
Named Insured and Mailing Address
WR FORDS ASSOCIATES
DONALD J RUSSELL INC
WR FORDE CONSTRUCTION CO INC
984 HENSLEY STREET
RICHMOND, CA 94801
VCGP021132
Ca Surplus Lines Tax & Fee Breakdown
Premium: $93,280.00
3.0% State Tax: $ 2,798.40
0.2% Stamp Fee: $ 186.56
Company Fee:
Wholesale Broker Fee:
Policy Period: From 04,01 2015 to 04 01 2016 at 12:01 a.m. Standard Time at the address of the Named Insured as stated herein
THE NAMED INSURED IS: Partnership
BUSINESS DESCRIPTION: GENERAL ENGINEERING CONTRACTOR
AUDIT PERIOD: 0 Annual ❑ Other
IN RETURN FOR THE PAYMENT OF THE PREMIUM AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGES FOR WHICH A PREMIUM IS INDICATED. THIS
PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
Commercial General Liability Coverage Part
$ 93,280
TOTAL PREMIUM $ 93,280
Form (s) and Endorsement (s) made a part of this policy at inception. See attached schedule:
This policy is not binding unless sealed and countersigned by Gemini Insurance Company or its Authorized Representative.
Countersigned On:
3/31/2015
At: Greenwich, Connecticut
0
Authorized Representative
THESE COMMON POLICY DECLARATIONS AND, IF APPLICABLE, THE COMMERCIAL PROPERTY COVERAGE, THE COMMERCIAL GENERAL
LIABILITY DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART (S), FORM (S) AND ENDORSEMENTS, IF
ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBER POLICY
SEE VE 0525 08 11 - Califomia Disclosure Notice
COMMERCIAL GENERAL LIABILITY COVERAGE PART
DECLARATIONS
Policy: VCGP021674 Effective Date: 04/01/2015
Named Insured: WR FORDE ASSOCIATES
LIMITS OF INSURANCE
Each Occurrence Limit
$1,000,000
General Aggregate Limit(Other than Products -Completed Operations)
$2,000,000
Products -Completed Operations Aggregate Limit
$2,000,000
Personal & Advertising Injury Limit
$1,000,000
Damage to Premises Rented to You
$50,000 Any one premises
Medical Payments
$5,000 Any one person
RETROACTIVE DATES
This insurance does not apply to "bodily injury", "property damage" or
"personal and advertising injury" which occurs before the
Retroactive Date, if any, shown here:
NONE
(Enter Date or "NONE" if no Retroactive Date applies
Class Description
99315 Street or Road Construction or
Reconstruction
Advance Premium:
Minimum Term Premium:
Minimum Earned Premium at Inception:
Terrorism Premium:
Total Premium:
Estimated Exposure Premium Basis
$8,000,000 Per 1,000 Gross
Sales
$93,280
100% $93,280
25% $23,320
Terrorism has been rejected by the Insured
$93,280
Rate Premium
$11.660 $93,280
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED
AND THE POLICY PERIOD.
Page 1 of I
f4141 I 101 RN IN 110] a IM ]u(.`!
Named Insured: WR FORDS ASSOCIATES POLICY NO.: VCGP021674
V464
FORM NUMBER End. # TITLE
VE 06 00 06 14
Common Policy Conditions
CG 00 01 12 07
Commercial General Liability Coverage Form
CGLDEC 05 14
Commercial General Liability Declarations
SCHED 03 08
Schedule of Forms
POLCVLTR 03 14
Vela Policy Cover Letter
CMNDEC 03 08
Common Declarations
VE 67 09 03 14
01
Claims Reporting
IL 00 21 09 08
02
Nuclear Energy Liability Exclusion (Broad Form)
VE 05 28 09 13
03
Professional Liability Exclusion
VE 0525 08 11
04
California Disclosure Notice
VE 05 00 09 13
05
Electromagnetic Fields Exclusion
VE 04 94 09 13
06
Lead Exclusion
VE 66 08 09 13
07
Asbestos Exclusion
VE 06 05 04 14
08
Deductible Liability Insurance - Per Occurrence
VE 0446 09 09
09
Occupational Disease Exclusion
CG 21 73 01 08
10
Exclusion of Certified Acts of Terrorism
VE 0106 04 08
11
Exclusion - Trade/Patent Infringement
VE 0192 08 08
12
Wrap Up Exclusion
VE 7902 10 11
13
Service of Suit - State of California
VE 0442 07 09
14
Tainted Drywall Exclusion
CG 2417 1001
15
Contractual Liability - Railroads
CG 21 96 03 05
16
Silica or Silica -Related Dust Exclusion
CG 21 67 12 04
17
Fungi or Bacteria Exclusion
CG 20 01 04 13
18
Primary and Noncontributory - Other Insurance Condition
CG 20 37 04 13
19
Additional Insured - Owners, Lessees or Contractors - Completed
Operations
VE 0586 04 13
20
Additional Insured - Lessor of Leased Equipment - Automatic Status
When Required in Lease Agreement With You
VE 05 88 04 13
21
Premium Basis
CG 20 10 04 13
22
Additional Insured - Owners, Lessees or Contractors - Scheduled
Person or Organization
CG 2147 12 07
23
Employment Related Practices Exclusion
VE 05 72 03 14
24
New Single Family Residential Project Exclusion
VE 05 73 08 13
25
Multi -Family Residential Project Exclusion
SCHED 03 08 Page 1 of 2
FORM NUMBER End. # TITLE
VE 05 910813
26
Condominium Conversion Exclusion
VEDGS2O813
27
New Small Format Multi -Family Residential Project Exclusion
CE}24O4O5OQ
28
Waiver ofTransfer 0oRights ofRecovery Against Others ToUs
VEO485OQ13
29
Punitive Damages Exclusion
VEOG1OU013
30
Radioactive Material orContamination Exclusion
CG242SO413
31
Amendment ofInsured Contract Definition
VE 01 07 10 13
32
Exclusion - Exterior Insulation and Finish Systems
VE 01 841213
33
Designated Construction Pnojnct(a)General Aggregate Limit 'Subject
ToAMaximum Aggregate
VEO681 02 14
34
Subcontractor and Independent Contractor Conditional Amendment of
Deductible
VEO5OGOG14
35
Amendment-PrumiumAudit
VEGG4OOQ14
38
Exclusion - Continuous orProgressive Damage Claims
ENDORSEMENT AGREEMENT
CERTIFICATE HOLDERS' NOTICE
HOME OFFICE
SAN FRANCISCO EFFECTIVE OCTOBER 1, 2013 AT 12.01 A.M.
ALL EFFECTIVE DATES ARE
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
W R FORDE ASSOCIATES
984 HENSLEY ST
RICHMOND, CA 94801
7676258-13
NEW
NA
5-54-99-80
PAGE 1 OF
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THIS POLICY SHALL NOT BE CANCELLED UNTIL,
30 DAYS
AFTER WRITTEN NOTICE OF SUCH CANCELLATION HAS BEEN PLACED
IN THE MAIL BY STATE FUND TO CURRENT HOLDERS OF
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 2, 20133
e---zdez41l
AUTHORIZEDREPRESENTA IVE PRESIDENT AND CEO
SCIF FORM 10217 IREV.1-2012)
1
2065
OLD DP 217