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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 �� b 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) 1.A1:vi•<SCE J. Covr(I_ CC;rnn� Ki 3n ,r 1:?x1143 z ':= 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 u Top of thumb here 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 LO) ZtoI +e Top of thumb here 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 LA`l.l Lo;C.E J. COY11E k :crT1Jl155i0n =1r 1231143 idcicfry Putri?c - Coliicmke Qjjfv'��"s:,.=Trr:,•�:r�e.•cr"�•,;.r :.._ .,,- r.,:��c�.:,."�°+c•`S"r 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 LO) ZtoI +e Top of thumb here 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