HomeMy WebLinkAboutCC Resolution 11604 (Fifth Ave. Storm Drain Impr. at Sun Valley School)RESOLUTION NO. 11604
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN
RAFAEL AWARDING PROJECT FOR FIFTH AVENUE STORM
DRAIN IMPROVEMENTS AT SUN VALLEY SCHOOL TO
MICHAEL PAUL COMPANY, INC. FOR THE AMOUNT OF
$174,003.00
BE IT RESOLVED by the Council of the City of San Rafael as follows:
WHEREAS, on the 13th day of July, 2004, 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:
"FIFTH AVENUE STORM DRAIN IMPROVEMENTS
AT
SUN VALLEY SCHOOL"
PROJECT NO. 11053
In accordance with the plans and specifications therefore on file in the office of said City
Clerk; and
WHEREAS, the bid of Michael Paul Company, Inc. 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 therefore;
NOW, THEREFORE, BE IT RESOLVED by the Council of the City of
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San Rafael, that the bid of Michael Paul Company, Inc. and the same is hereby accepted
at said unit prices and that the contract for said work and improvements be and the same is
hereby awarded to said Michael Paul Company, Inc. at the unit prices mentioned in said
bid.
IT IS FURTHER ORDERED AND RESOLVED that the City Manager
and the City Clerk of said City be authorized and directed to execute a contract with
Michael Paul Company, Inc. for said work and to return the bidders bond upon the
execution of said contract.
RESOLVED, FURTHER, that the Council does hereby authorize the
Public Works Director to take any and all such actions and make changes as may be
necessary to accomplish the purpose of this resolution.
I, JEANNE M. LEONCINI, 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 Council of said City on the 19th day of July, 2004 by the following vote, to wit:
AYES: COUNCILMEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: None
JE NE M. LEONC NI, City Clerk
File No.: 08.02.233
City of San Rafael • California
Form of Contract Agreement
for
Fifth Avenue Storm Drain Improvements
at
Sun Valley School
Project No: 11053
This Agreement is made and entered into this 19th day of July 2004 by and between the
City of San Rafael (hereinafter called City) and Michael Paul Company, Inc.
(hereinafter called Contractor). Witnesseth, that the City and the Contractor, for the
considerations hereinafter named, agree as follows:
II - 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 shown on the plans and described
in the specifications for the project entitled: Fifth Avenue Storm Drain Improvements
at Sun Valley School, 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.
III- Time of Completion
(a) The work to be performed under this Contract shall be commenced after the written
notice to proceed by the City to the Contractor, but no later than July 26, 2004.
(b) The work shall be completed by August 21, 2004 after the date of such notice and
with such extensions of time as are provided for in the General Conditions.
IIII - Liquidated Damages
It is agreed that, if all the work required by the contract is not finished or completed by
August 21, 2004, 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
$1,000 for each and every calendar day's delay in finishing the work past August 21,
2004, as 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 — Early Completion Incentive
It is agreed that, if all the work required by the contract is finished or completed by
August 21, 2004, as set forth in the contract, the City will pay to the Contractor, the
sum of $1,000 for each and every calendar day in finishing the work before August 21,
2004, prescribed above; and the City agrees to pay said early incentive herein provided
for in the contract.
V - 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.
AGREEMENT • 1
NO. ITEM QUANTITY UNITS UNIT PRICE TOTAL PRICE I
1. Site Clearing, Grubbing,
Mobilization, Traffic
Control, Utility
Coordination,
Environmental Controls,
and Temporary Facilities
and Controls
2. Demolition
3. Storm Drain System
a. 48"PVC Pipe
b. 30" PVC Pipe
c. Manhole (UCS
#203, Type B)
4. Headwall
1 LS
@
12,133.00 =
1 LS
@
14,266.00 =
12,133.00
14,266.00
614 LF @ 111 = 68,154.00
49 LF @ 192 = 9,408.00
3 EA @ 15,605.00 = 46,815.00
1 LS @ 23,227.00 = 23,227.00
GRAND TOTAL $174,003.00
VI - 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). On not later than the 15th day of the month, the City shall, after deducting previous
payments made, pay to the Contractor 90% 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.
VII - 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.
AGREEMENT • 2
(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) The 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:
�� 9v
Jeanne M Leoncini Rod ould
City Clerk City Ma agerr
APPROVED AS TO FORM: CON CTOR:
Gary T. Ragghianti
City Attorney for
AGREEMENT • 3
INTERNATIONAL FIDELITY INSURANCE COMPANY
PERFORMANCE BOND — PUBLIC WORK
(BOND ISSUED IN DUPLICATE) Bond No. 0382341
Premium $2,506.00
KNOW ALL MEN BY THESE PRESENTS: That
MICHAEL PAUL COMPANY, INC.
as Principal, and International Fidelity Insurance Comnanv , a corporation organized under the laws of
the State of New Jersey, and authorized to transact a general surety business in the State of California, as Surety, are
held and firmly bound unto
CITY OF SAN RAFAEL
as Obligee in the sum of
*ONE HUNDRED SEVENTY-FOUR THOUSAND THREE AND NO/100THS-------------------------------------------*
Dollars ($ 174.003.00) for the payment whereof, in the lawful money of the United States, said Principal and Surety
bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these presents.
The Condition of the foregoing obligation is such that: whereas, the above bounded Principal has entered into a
contract dated July 19. 2004, with the obligee to do the following work, to wit:
FIFTH AVENUE STORM DRAIN IMPROVEMENTS AT SUN VALLEY SCHOOL
PROJECT NO. 11053
as is more specifically set forth in said contract, to which contract reference is hereby made;
Now therefore, if the said Principal shall well and truly perform the work contracted to be performed under said
contract in accordance with the plans and specifications, then the above obligation to be void, otherwise to remain in
full force and virtue.
No right of action shall accrue under this bond to or for the use of any person other than the Obligee named herein.
Signed and sealed this 22ND day of JULY, 2004 .
MICHAEL PAUL COMPANY, INC.
Principal
B01 I (/Vi -_L-'1- S 5 f'N
International Fidelity Insurance Company
Surety
By:��_ L ll
KELLY HOLTEMANN Attorney -in -Fact
State of California
ss.
County of SONOMA
On 7/22/04 before me, LA"6J MCE J. COYNE, NOTARY PUBLIC
Dale Name end Tdle of Officer (e;g., `Jane Doe, Nolary Public")
personally appeared '------ K=Y HOLTEMgN-------------------------
Name(s) of Signer(s)
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Nal-uy public: - C0111fofria
Jy Sonr).,na County
Place Notary Seal Above
® personally known to me
❑ proved to me on the basis of satisfactory
evidence
to be the person(k) whose name(n) is/meK-
subscribed to the within instrument and
acknowledged. to me that hedb4 executed
the same in her/ authorized
capacity, and -that by kk-ziher/ibeim
signature(j) -on -the instrument the person( -x), or
the entity upon behalf of which the person*
acted,, executed the instrument.
WITNESS my hand and official seal.
SIg tura of N ry ubllc
OPTIf OI V'AL
Though the information below is not required by law, if 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: vh&(b ukq,4ANCE BOND
Document Date: JULY 22, 2004 Number of Pages
Signer(s) Other Than Named Above: N/A
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner —❑ Limited ❑ General
IX Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
KELLY HOLTEKANN
Signer Is Representing: IN'T'ERNATIONAL FIDELITY INSURANCE COMPANY
ONE
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0 1899 National Notary Association " 9350 De Soto Ave., P.D. Box 2402 • Chatsworth, CA 81313-2402 • V w ..nationnlnatary.org Prod. No. 5907 Reorder. Call ToIFFrae 1.6060.67"827
INTERNATIONAL FIDELITY INSURANCE COMPANY
PAYMENT BOND — PUBLIC WORK
(BOND ISSUED IN DUPLICATE) Bond No. 0382341
Premium included in Performance bond
KNOW ALL MEN BY THESE PRESENTS: That
MICHAEL PAUL COMPANY, INC.
as Principal, and International Fidelitv Insurance Comnanv . a corporation organized under the laws of
the State of New Jersey, and authorized to transact a general surety business in the State of California, as Surety, are
held and firmly bound unto
CITY OF SAN RAFAEL
*ONE HUNDRED SEVENTY-FOUR THOUSAND THREE AND NO/100THS--------as Obligee in the sum of
-------------------------------*
Dollars ($ 174.003.00) for the payment whereof, in the lawful money of the United States, said Principal and Surety
bind themselves, their heirs, administrators, successors and assigns, jointly and severally, firmly by these presents.
The Condition of the foregoing obligation is such that: whereas, the above bounded Principal has entered into a
contract dated JULY 19. 2004. with the obligee to do the following work, to wit:
FIFTH AVENUE STORM DRAIN IMPROVEMENTS AT SUN VALLEY SCHOOL PROJECT NO. 11053
Now, therefore, if the above bounded Principal, contractor, person, company or corporation, or his or its sub-
contractor, fails to pay any claimant named in Section 3181 of the Civil Code of the State of California, or amounts
due under the Unemployment Insurance Code, with respect to work or labor performed by any such claimant, that the
Surety on this bond will pay the same, in an amount not exceeding the aggregate sum specified in this bond, and also,
in case suit is brought upon this bond, a reasonable attorney's fee, which shall be awarded by the court to the
prevailing party in said suit, and attorney's fees to be taxed as costs in said suit.
This bond shall inure to the benefit of any person named in Section 3181 of the Civil Code of the State of California so
as to give a right of action to them or their assigns in any suit brought upon this bond.
This bond is executed and filed to comply with the provisions of the act of Legislature of the State of California as
designated in the Civil Code, Sections 3247-3252 inclusive, and all amendments thereto.
Sealed and Sealed this 22ND day of JULY, 2004.
MICHAEL, PAUL COMPANY, INC.
Principal
International Fidelity Insurance Company
Surety
KELLY HTEMANN Attorney in Fact
CALI1'OANEA ALS"'PURPOSE ACKNOWLEDGMENT
State of California
ss.
County of SONOMA
On 7/22/04 before me, LAwRENGE J. COYNE, NOTARY P=C
Date Name and Title of Officer (erg., 'Jane Doe, Notary Public")
personally appeared ------ —KELLY. AOLZEMMN----------- -----------------
ante(s) of Signar(s)
Place Notary Seal Above
® personally known to me
❑ proved to me on the basis of satisfactory
evidence
to be the person(x) whose name(;.) is/mm
subscribed to the within instrument and
acknowledged. to me thathe executed
the same in herbfukK authorized
capacity, and -that by kkdfier/fix
signature(a) fln'the instrument the person(m), or
the entity upon behalf of which the person
acted,, executed the instrument.
WITNESS my hand and lofficial seal.
Sign re of Not�u lic
OPTIONAL
Though the information below is not required by law, if 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: PAYMENT BOND
Document Date: JULY 22, 2004
Signer(s) Other Than Named Above: VA.
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited .❑ General
IX Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
;9�i ; • 4�iU d�iilll
Number of Pages:
Signer Is Representing: INTERNATIONAL FIDELITY INSURANCE COMPANY
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Place Notary Seal Above
® personally known to me
❑ proved to me on the basis of satisfactory
evidence
to be the person(x) whose name(;.) is/mm
subscribed to the within instrument and
acknowledged. to me thathe executed
the same in herbfukK authorized
capacity, and -that by kkdfier/fix
signature(a) fln'the instrument the person(m), or
the entity upon behalf of which the person
acted,, executed the instrument.
WITNESS my hand and lofficial seal.
Sign re of Not�u lic
OPTIONAL
Though the information below is not required by law, if 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: PAYMENT BOND
Document Date: JULY 22, 2004
Signer(s) Other Than Named Above: VA.
Capacity(ies) Claimed by Signer
Signer's Name:
❑ Individual
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited .❑ General
IX Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
;9�i ; • 4�iU d�iilll
Number of Pages:
Signer Is Representing: INTERNATIONAL FIDELITY INSURANCE COMPANY
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0 1999 National Notary Association - 9350 Do Solo Ave_ P.D. Box 24112 - Chatsworth, CA 91313-2492 - v w juttonalnotary.arg Prod. No. 5907 Reorder. Call Toll -Free 9.600-676-6627
Tel(973) 62 - 2tio P( NER OF ATTORNEY
INTERNATIONAL FIDELITY INSURANCE COMPANY
HOME OFFICE: ONE NEWARK CENTER, 20TH FLOOR
NEWARK, NEW JERSEY 07102-5207
KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing
laws of the State of New jersey, and having its principal office in the City of Newark, New Jersey, does hereby constitute and appoint
GORAN G.E. RYN, BONNIE K. FRYMIRE, LAWRENCE J. COYNE, KELLY HOLTEMANN
Petaluma, CA.
its true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety,any and all bonds and undertakings, contracts of indemnity and
other writings obligatory. In the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and
the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE
COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its
principal office.
This Power of Attorney is executed, and may be revoked, pursuant to and by authority of Article 3 -Section 3, of the By -Laws adopted by the Board of
Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting called and held on the 7th day of February, 1974.
The President or any Vice President, Executive Vice President, Secretary or Assistant Secretary, shall have power and authority
(1) To appoint Attorneys -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and
undertakings, contracts of indemnity and other writings obligatory in the nature thereof and,
(2) To remove, at any time, any such attorney-in-fact and revoke the authority given.
Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of said Company adopted at a meeting
duly called and held on the 29th day of April, 1982 of which the following is a true excerpt:
Now therefore the signatures of such officers and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto by
facsimile, and any such power of. attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the Company and any
such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the Company in the future with respect to any
bond or undertaking to which it is attached.
CITY /ayf IN TESTIMONY WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY has caused this instrument to be
signed and its corporate seal to be affixed by its authorized officer, this 31st day of August, A.D. 1998.
/ v SEAL INTERNATIONAL FIDELITY INSURANCE CO
y
904
STATE OF NEW JERSEY '00-01-00 Aor
County of Essex
JEaS
Jli�l/ �a Vice -Pr ident
On this 31st day of August 1998, before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly
sworn, said the he Is the therein described and authorized officer of the INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seal affixed to
said instrument is the Corporate Seal of said Company; that the said Corporate Seal and his signature were duly affixed by order of the Board of Directors of
said Company.
0ARQ� IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal,
at the City of Newark, New Jersey the day and year first above written.
O NOTARY _
PUBLIC �. L
-i
y�'►'JEAS� A NOTARY PUBLIC OF NEW JERSEY
CERTIFICATION My Commission Expires Nov. 21, 2005
I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify that I have compared the foregoing copy of the
Power of Attorney and affidavit; and the copy bf:the Section of the By -Laws of said Company as forth in said Power of Attorney, With the ORIGINALS ON
IN THE HOME OFFICE OF SAID COMPANY,and that the same are correct transcripts. thereof, and of the whole of the said originals, and that the said Power
of Attorney has not been revoked and is now in full force and effect
IN TESTIMONY WHEREOF., I have hereunto set my hand this 22ND day of JULY, 2004
AssistantSecretary
i
A C OR✓ TM
I 10
VI
r
CERTIFItCA =
OF
LIABILITY
INSU�'INCE
DATE (MM/DD /YYYY)
107/22/04
PRODUCER
USI Northern California
1670 Corporate Circle, #201
P.O. Box 4409
Petaluma, CA 94955-4409
INSURED
Michael Paul Company
1200 Casa Grande Road
Petaluma, CA 94954
THIS CERTIFICATE IS raSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Lexington Insurance Company
INSURER B: Clarendon National Insurance Company
INSURER c: TOPA Insurance Company
INSURER D: State Compensation Insurance Fund of
INSURER E: Firemans Fund McGee
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.
I TR 4D R TYPE OF INSURANCE POLICY NUMBER I+ATE (MCY MFnD/YYE POLICY
MMIDD/YYIN LIMITS
LTR NSR['
A GENERAL LIABILITY 1142691 11/10/03 11/10/04 1 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51 OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
I POLICY n JEC F-1 LOC
B AUTOMOBILE LIABILITY PA101050251 11/10/03 11/10/04
X ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
/ X HIRED AUTOS
X NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
C EXCESS/UMBRELLA LIABILITY XL17447 11/10/03 11/10/04
7 OCCUR FICLAIMS MADE
DEDUCTIBLE
RETENTION S
D WORKERS COMPENSATION AND 315118703 10/01/03 10/01/04
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E OTHER Builders Risk BINDER85349 07/26/04 07/26/05
Including
Earth Clauke&Flood
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Cancellation: Except for ten day notice for non-payment of premium.
RE: Job #11053, Fifth Avenue Storm Drain Improvements at Sun Valley School.
City of San Rafael, its officers, agents and employees are named as
Additional Insureds per the attached GL endorsement.
CERTIFICATE HOLDER CANCELLATION
City of San Rafael, Department
of Public Works
P.O. Box 151560
San Rafael, CA 94915-1560
DAMAGE TO RENTED $50,000
PREMISES (Ea occurrence)
MED EXP (Any one person) $
PERSONAL & ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
PRODUCTS - COMP/OPAGG $1,000,000
COMBINED SINGLE LIMIT $1,000,000
(Ea accident)
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGEI $
(Per accident)
AUTO ONLY - EA ACCIDENT I $
OTHER THAN EA ACC I $
AUTO ONLY: AGG I $
EACH OCCURRENCE $4.000,000
I AGGREGATE $4.000,000
I $
I Is
I I$
XI TH-
TORY LIMITS I IWC STATU- OER
E.L. EACH ACCIDENT 1$1,000,000
E.L. DISEASE - EA EMPLOYEd $1,000,000
E.L. DISEASE -POLICY LIMIT I $1,000,000
$250,000 Ded:$1,000
100°/x, Coinsurance
Replacement Cost
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL jt4 Qj jtX§tMAIL -1 f DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, J�jttj(6Q9tQpRiEx�JO1QXr14DWC
xtoe�oraatze�vsa�a>i€ xerilaxemrxxraetxoc�otcelxorxxacx�totstx�x�axtvxxraxxxx
x A x
UtRIZE BRESENTATIVE
ACORD 25 (2001/08) 1 of 2 #S633221M62774 `--7 R9'97 \�,�ORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (2001/08) 2 of 2 #S63322/M62774
Insured: Michael Paul Company
Policy Number: 1142691 Commercial General Liability
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS (FORM B)
This endorsement modified. insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
NAME OF PERSON OR ORGANIZATION:
Blanket Additional Insured as Required by Written Contract.
(If no entry appears above, information required to complete this endorsement will be
shown in the declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or
organization shown in the Schedule, but only with respect to liability arising out of "your
work" for that insured by or for you.
Primary Insurance: 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.
CG20 10 1185
HOS 5/89