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HomeMy WebLinkAboutAgr 2009-09-25 (North Bay Construction)TOWN OF TIBURON TIBURON, CALIFORNIA OWNER-CONTRACTOR AGREEMENT FOR THE 2009 Reed Ranch Road and Ridge Road Overlay Project-ESPL-5388(008) THIS OWNER-CONTRACTOR AGREEMENT ("AGREEMENT") is made and entered into this 2sT6 day of 36, L- , 2009, by and between the TOWN OF TIBURON, municipal corporation, 1505 Tiburon Boulevard, Tiburon, CA 94920, ("Owner") and North Bay Construction, Inc. ("Contractor"), whose principal place of business is 431 Payran Street, Petaluma., CA 94952-5908 In consideration of the mutual covenants and agreements set forth herein, Contractor and Owner hereby agree as follows: ARTICLE I CONSTRUCTION Subject to and in accordance with the terms of this Agreement, the Contractor shall do all the work and furnish all the labor, services, materials and equipment necessary to construct and complete, in accordance with the Contract Documents (as hereinafter defined) in a good, workmanlike and substantial manner and to the satisfaction of the Owner, the 2009 Reed Ranch Road and Ridge Road Overlay Project-ESPL-5388(008) ("Project") located in Tiburon, California more particularly depicted on Exhibit A ("the Site"). The Project is that described and reasonably inferable from the drawings and specifications and documents enumerated in Exhibit B, such construction and furnishing of labor, services, materials and equipment and the performance of Contractor's other services and obligations required by the Contract Documents are hereinafter referred to as the "Work." The term "Contract Documents" shall mean this Agreement, and all of the items enumerated in Exhibit B. ARTICLE II PAYMENT See Section 5-1.7 of the Special Provisions of Contract Documents. A-1 ARTICLE III TIME FOR PERFORMANCE Section 3.1 Time of Completion: See Section 8-1.06 of the Standard Specifications and Section 4 of the Special Provisions. Section 3.2 Liquidated Damages: Contractor will pay liquated damages as set forth Section 8-1.07 of the Standard Specifications and Section 4 of the Special Provisions. The Parties acknowledge that time is of the essence in this Agreement and wish to avoid the cost, difficulty and delay of proving the damages caused by delay. Accordingly, the Parties agree that the Contractor shall pay to the Town the sum of $1000 per day, for each and every calendar day's delay in finishing the work in excess of the number of working days prescribed in Section 3.1 hereof. Town of Tiburon North Bay Construction, Inc. OWNER CONTRACTOR ARTICLE IV PREVAILING WAGES The general prevailing rate of per diem wages and the general prevailing rate for holiday and overtime work in this locality for each craft, classification, or type of workman needed to execute this Agreement is that ascertained by the Director of the Department of Industrial Relations of the State of California, copies of which ("Prevailing Rate Schedules") are on file in the Owner's principal office. The Prevailing Rate Schedules shall be made available to any interested party upon request. The holidays upon which rates shall be paid shall be all holidays recognized in the collective bargaining agreement applicable to the particular craft, classification or type of workman employed on the Project. Attention is directed to Section 7-1.01 A(2) of the Standard Specifications. Contract shall forfeit, as a penalty as set forth in California Labor Code § 1775, twenty-five dollars ($25.00) for each calendar day or portion thereof, for each workman paid less than the prevailing rates set forth in the Prevailing Rates Schedules for any work done by any subcontractor under Contractor. ARTICLE V NON-DISCRIMINATION The Contractor hereby agrees to comply with the provisions contained in Section 5-1.1 of the Contract Documents. ARTICLE VI WORKER'S COMPENSATION INSURANCE By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code A-2 which require every employer to be insured against liability for Worker's Compensation or to undertake self insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the Work of this Agreement. ARTICLE VII CONFLICT In the event of conflict between the terms of this Agreement and the bid or proposal of said Contractor, then, this Agreement shall control and nothing herein shall be considered as an acceptance of the terms ofthe proposal conflicting herewith. ARTICLE VIII EXHIBITS This Agreement includes the following Exhibits, which are attached hereto and incorporated herein by reference: Exhibit A The Site Exhibit B The Contract Documents Exhibit C Bid Proposal (Pages P 1-P 14) IN WITNESS WHEREOF, the parties to these presents have hereunto set their hands the day and year first hereinabove written. APPROVED AS TO FORM: By own Attorney TOWN OF TIBURON By Tow anager CONTRACTOR: North Ba Construction, Inc. By ~op Barella Its CEO Contractor's License No. 357560 1✓xpiration Date: 08/31 /10 A-3 EXHIBIT A The Site The public and private rights-of-way located in the Town of Tiburon, California and known as: 1. Ridge Rd, 2. Reed Ranch Rd. A-4 EXHIBIT B The Contract Documents • Project Plans • Standard Specifications • Standard Plans • Special Provisions • Proposal and Contract • Contract bonds(Payment Bond and Performance Bond) • Any supplemental agreement amending or extending the work • Any working drawings, sketches, or instruction clarifying or enlarging upon the work specified • Pertinent portions of any other documents included by reference in the specifications, Standard Specifications or Plans A-5 EXHIBIT C PROPOSAL TO THE TOWN OF TIBURON PUBLIC WORKS DEPARTMENT NAME OF BI BUSINESS P.O. B Y-n TOWN STATE Z P BUSINESS ST SS Q- (P ase inclu a even if P.O. B e j TOWN, STAT , ZIP TELEPHONE NO: AREA C FAX NO: AREA O Z& ~07 loor CONTRACTOR LICENSE NO. t The work for which this proposal is submitted is for construction in conformance with the special provisions (including the payment of not less than the State general prevailing wage rates or Federal minimum wage rates), the project plans described below, including any addenda thereto, the contract annexed hereto, and also in conformance with the California Department of Transportation Standard Plans, dated May, 2006; the Standard Specifications, dated May, 2006; and the Labor Surcharge and Equipment Rental Rates in effect on the date the work is accomplished. The project plans for the work to be done were approved 2009 and are entitled: TOWN OF TIBURON 2009 Reed Ranch Road and Ridge Road Overlay Project-ESPL-5388(008) Bids are to be submitted for the entire work. The amount of the bid for comparison purposes will be the total of all items. The bidder shall set forth for each unit basis item of work a unit price and a total for the item, and for each lump sum item a total for the item, all in clearly legible figures in the respective spaces provided for that purpose. In the case of unit basis items, the amount set forth under the "Item Total" column shall be the product of the unit price bid and the estimated quantity for the item. In case of discrepancy between the unit price and the total set forth for a unit basis item, the unit price shall prevail, except as provided in (a) or (b), as follows: (a) If the amount set forth as a unit price is unreadable or otherwise unclear, or is omitted, or is the same as the amount as the entry in the item total column, then the amount set forth in the item total column for the item shall prevail and shall be divided by the estimated quantity for the item and the price thus obtained shall be the unit price; P-1 (b) (Decimal Errors) If the product of the entered unit price and the estimated quantity is exactly off by a factor of ten, one hundred, etc., or one-tenth, or one-hundredth. etc. from the entered total, the discrepancy will be resolved by using the entered unit price or item total, whichever most closely approximates percentage wise the unit price or item total in the Town of Tiburon's Final Estimate of cost. If both the unit price and the item total are unreadable or otherwise unclear, or are omitted, the bid may be deemed irregular. Likewise if the item total for a lump sum item is unreadable or otherwise unclear, or is omitted, the bid may be deemed irregular unless the project being bid has only a single item and a clear, readable total bid is provided. Symbols such as commas and dollar signs will be ignored and have no mathematical significance in establishing any unit price or item total or lump sums. Written unit prices, item totals and lump sums will be interpreted according to the number of digits and, if applicable, decimal placement. Cents symbols also have no significance in establishing any unit price or item total since all figures are assumed to be expressed in dollars and/or decimal fractions of a dollar. Bids on lump sum items shall be item totals only; if any unit price for a lump sum item is included in a bid and it differs from the item total, the items total shall prevail. The foregoing provisions for the resolution of specific irregularities cannot be so comprehensive as to cover every omission, inconsistency, error or other irregularity which may occur in a bid. Any situation not specifically provided for will be determined in the discretion of the Town of Tiburon, and that discretion will be exercised in the manner deemed by the Town of Tiburon to best protect the public interest in the prompt and economical completion of the work. The decision of the Town of Tiburon respecting the amount of a bid, or the existence or treatment of an irregularity in a bid, shall be final. If this proposal shall be accepted and the undersigned shall fail to enter into the contract and furnish the 2 bonds in the sums required by the State Contract Act, with surety satisfactory to the Town of Tiburon, within 8 days, not including Saturdays, Sundays and legal holidays, after the bidder has received notice from the Town of Tiburon that the contract has been awarded, the Town of Tiburon may, at its option, determine that the bidder has abandoned the contract, and thereupon this proposal and the acceptance thereof shall be null and void and the forfeiture of the security accompanying this proposal shall operate and the same shall be the property of the Town of Tiburon. The undersigned, as bidder, declares that the only persons or parties interested in this proposal as principals are those named herein, that this proposal is made without collusion with any other person, firm, or corporation; that he has carefully examined the location of the proposed work, the annexed proposed form of contract, and the plans therein referred to; and he proposes, and agrees if this proposal is accepted, that he will contract with the Town of Tiburon, in the form of the copy of the contract annexed hereto, to provide all necessary machinery, tools, apparatus and other means of construction, and to do all the work and furnish all the materials specified in the contract, in the manner and time therein prescribed, and according to the requirements of the Engineer as therein set forth, and that he will take in full payment therefor the following prices, to wit: TOWN OF TIBURON 2009 Street Improvement Project (Stimulus) BID PROPOSAL The contractor agrees to accept payment, in full therefore, at the following prices: BID SCHEDULE II ITEM I DESCRIPTION t- I OEST. TY ` UNIT I RUNIT TOTAL ICE I PRICE 1 Traffic Control and Construction Area Signs I LS YD6 2 Mobilization - - I LS - - ---f G - t - - - - - - - 2 0 1 5; x 0 3 Asphalt Concrete 2,100 TON S ~0 ~ '0 0& / 5 4 AC Wedge Grind - 6' Wide (0. IT) 10,000 LF _ - - G 5 - 5 AC Confonn Grind (15' Wide) 400 SY s-- s 6 AC Base Repair (4") - - - - 6200 - SF - 1 Gr ~`p 7 - - Adjust Manhole to Grade 14 EA = 0 8 Adjust SS Cleanout to Grade 3 EA 3 ~ - o 5,0 9 Adjust Monument Cover to Grade 1 I EA 10 Adjust Water Valve to Grade 20 EA 11 Detail 2 Striping (Thermoplastic) 1900 LF 65- ! 12 Detail 22 Striping (Thennoplastic) 2800 LF - - 13 Detail 27B Striping (Thermoplastic) 1100 LF 14 12" White Striping (Thermoplastic) 80 LF - ~o 15 Pavement Markings (Thermoplastic) 250 SF 2 77 ---✓--J---------- 7 16 Install Type A White Non-reflective Marker 96 EA "Y 3 4 17 Replace/Install Blue Marker 6 EA TOTAL BID ~q q3 c/ P-3 Grand Total of - (11%I~Itle)1) IL ) 6A.I- 1-f o y1 "Lf Dollars $(numbers)_ g By my signature hereunder, as Contractor, I certify that I am aware ofthe_provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workmen's compensation or to undertake self insurance in accordance with the provisions of that code, and I will comply with such provi- sions before commencing the performance of the work in this proposal and contract. In the case of any discrepancies between unit prices and totals, the unit price shall prevail. By my signature hereunder I understand and agree that the quantities of work under each item are approximate only, being given for a basis of comparison of proposal, and the right is reserved to the Town to increase or decrease the amount of work under any item as may be required, in accordance with the provisions set forth in the specification of this contract. Signa Namc Coml P-4 The Bidder shall list the name and address of each subcontractor to whom the Bidder proposes to ti subcontract portions of the work. as required by the provisions in Section 2-1.054, "Required L' Proposed Subcontractors." of the Standard Specifications and Section 2-1.01, "General," of the -y provisions. LIST OF SUBCONTRACTORS Description of Portion Name and Address of Work Subcontracted L v fz 14 vs K o A h z k h r ?L AA T .i:-~ , L L- 46 14 V,~,Ljz g~~0 GS'~ os ~aV 12ofu z-2- 4 -t ? 14 7 i o C /--c c-e~ 43 5 3 1 3,3l D VX1 IQ Cr J L r- °C ° '-I C- n q 5`'?, C-) 6 P-5 LIST OF REFERENCES forth Bay Construction,.Inc.. PAST PROJECTS Job name and location: Wilson Avenue Improvements Vallejo, CA Owner of project: City of Vallejo Total value of project: $8.8 million Completion date: Spring 2008 Reference: Allan Panganiban 707/648-4686 Fax 707/648-4691 Job name and location: Eastside Trunk Sewer Rohnert Park, CA Owner of project: City of Rohnert Park Total value of project: $10.1 million Completion date: Summer 2008 Reference: Adrian Clarke, Winzler & Kelly (Const. Manager) 707/523-1010 Fax 707/527-8679 Job name and location: Columbus Parkway Improvements Vallejo, CA Owner of project: City of Vallejo Total value of project: $8.6 million Completion date: Fall 2008 Reference: Fiona Strykers 707/648-4431 Fax 707/648-4691 (THE BIDDER'S E EEC UTIOIV O,' T THE SIGIVA T URE POR TION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSE11EAT AND EXEC UTION OF THOSE CER TIFICA TIOATS WHICH A RE A PA R T OF THIS PROPOSAL) e The big proposed subcontracto. , hereby certifies that he has has not , participated in a previous contract or subcontract subject to the equal opportunity clauses, as required by Executive Orders 10925, 11114, or 11246, and that, where required, he has filed with the Joint Reporting Committee, the Director of the Office,of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contracts or subcontracts of $10,000 or under are exempt.) Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations. Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor. P-7 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the declares bidder hereb under penalty of perjury under the laws of the State of California that the bidder has . ha convicted snot been within the preceding three years of any offenses referred to in that section, including any charge of fraud, bribery, collusion, conspiracy, or any other act in violation of any state or Federal antitrust law in connection with the bidding upon, award of, or performance of, any public works contract, as defined in Public Contract Code Section 1101, with any public entity, as defined in Public Contract Code Section 1100 , including the Regents of the University of California or the Trustees of the California State University. The term "bidder" is understood to include any partner, member, officer, director, responsible managing officer, or responsible managing employee thereof, as referred to in Section 10285.1. Note: The bidder must place a check mark after "has" or "has not" in one of the blankspaces above Statement is part of the Proposal. Signing this Proposal on the signature onion thereof reof. The also constitute signature of this Statement. Bidders are cautioned that making a false certification shall may subject the certifier to criminal prosecution. g Public Contract Code Section 10162 uestionnaire In conformance with Public Contract Code Section 10162, the Bidder shall com lete p under penalty of perjury, the following questionnaire: Has the bidder, any officer of the bidder, or any employee of the bidder who has a proprietary interest. in the bidder, ever been disqualified, removed, or otherwise prevented from bidding on or completing a federal, state, or local government project because of a violation /1a r a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. P-8 Public Contract Code 10232 Statement In conformance with Public Contract Code Section 10232. the Contractor, hereby states under penalty of perjury, that no more than one final unappealable finding of contempt of court by a federal court has been issued against the Contractor within the immediately preceding two year period because of the Contractor's failure to comply with an order of a federal court which orders the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. P-9 Non-collusion Affidavit (Title 23 United States Code Section 112 and Public Contract Code Section 7106) To the TOWN OF TIBURON PUBLIC WORKS DEPARTMENT In conformance with Title 23 United States Code Section 112 and Public Contract Code 7106 the bidder declares that the bid is not made in the interest of, or on behalf of any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid or that anyone shall refrain from bidding; that the bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder, or to secure any advantage against the public body aNA arding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and, further, that the bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged b information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid. Note: The above Noncollusion Affidavit is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Noncollusion Affidavit. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. P-10 DEBARMENT AND SUSPENSION CERTIFICATION TITLE 49. CODE OF FEDERAL REGULATIONS, PART 29 The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, manager: • is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any Federal agency; • has not been suspended, debarred, voluntarily excluded or determined ineligible by any Federal agency within the past 3 years; • does not have a proposed debarment pending; and • has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. If there are any exceptions to this certification, insert the exceptions in the following space. Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action. Notes: Providing false information may result in criminal prosecution or administrative sanctions. The above certification is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Certification. P-11 NONLOBBYING CERTIFICATION FOR FEDERAL-AID CONTRACTS The prospective participant certifies, by signing and submitting this bid or bid and belief that: , to the best of his or her knowledge (1) No Federal appropriated funds have been paid or will be paid, b or on behalf person for influencing or attempting to influence an officer or employee of an Fof the , to any ederal age undersigned a y, a Member of Congress, an officer or employee of Congress, or an employee of a Member al agency, of with the awarding of any Federal contract, the making of any Federal rant the Congress in connection ma loan, the entering into of any cooperative agreement, and the extension continuation, of any Federal or modification of any Federal contract, grant, loan, or cooperative agreement, non, renewal, amendment, (2) If any funds other than Federal appropriated funds have been aid or will influencing or attempting to influence an officer or employee of an Federal a aid to any person for gency Congress, an officer or employee of Congress, or an employee of a Member of Con a Member e gress with this Federal contract, grant, loan, or cooperative agreement, the undersigned o in connection submit Standard Form-LLL, "Disclosure of Lobbying Activities," in conformance with its instructions. This certification is a material representation of fact upon which reliance w aced made or entered into. Submission of this certification is a prerequisite for makin when this transaction was imposed by Section 1352, Title 31, U.S. Code. Any person who fails to fl g or entering into this transaction subject to a civil penalty of not less than $10,000 and not more than $100,000 e required certification shall be for each such failure. The prospective participant also agrees by submitting his or her bid or bid that language of this certification be included in all lower tier subcontracts whi he or she shall require that the subrecipients shall certify and disclose accordingly. ch exceed $100,000 and that all such P-12 I" ~FI DISCLOSURE O /LOBBYING ACTIVITIES ~_UINJFLtlt 1ri1J rUtc~l 1U 1J1~~LU~> LUtil3Y1NCJA( 11y111tJ YUKJI'.a11 lU J1 u.J,A_ l.i~ 1. Type of Federal Action: 2. Status of Federal Action: .3. Report Type: F I a contract ❑ a hid/nffer/annlicatinn a i/aa b. grant b. initial aNvard b. c. cooperative agreement c. post-award d. loan For Mnly; e. loan guarantee yer _ f. loan insurance da4. Name and Address of Reporting Entity 5. If Reporting Entity in Noee, Enter Name and Address Prime Subawardee Tier if known Congressional District, if known 6. Federal Department/Agency: 8. Federal Action Number, if known: 10. a. Name and Address of Lobby Entity (If individual. last name. first name. MI) Congressional Di rict, if known 7. Federal Progr Name/Description: CFDA N mber, if applicable 9. - Al Amount, if known: b Individuals Performing Services (including address if different from No. I Oa) (last name, first name, MI) (attach Continuation Sheet(s) if necessary) 11 12 14. Amount of Payment (ch/ha ly) 13. Type of Payment (check all that apply) S api tied a. retainer b. one-time fee Form of Payment (chec: c. commission a. cash d. contingent fee b. in-kind: specie deferred f. other, specify Brief Description of Seror to be performed and Date(s) of Service, including officer(s), employee(s), o ntacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) if necessary) 15. /nformation ation S eet(s) attached: Yes 11 No 16. Infreque ed through this form is authorized by Title 31 ecti 1352. This disclosure of lobbying reliance Signature: ~~aby e tier above when his transaction was made or ent. his disclosure is required pursuant to 31 U.S.C. print 1\Tame: 1352. nformation will be reported to Congress semy and ill be available fo r public inspection. Any perfails to file the required disclosure shall be subject Title: o a alty of not less than $10,000 and not more than $10 r each such failure. Telephone No.: Federal Use Only: Date: Authorized for Local Reproduction Standard Form - LLL Standard Fonn LLL Rev. 09-12-97 P-13 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of covered Federal action or a material change to previous filing pursuant to title 31 U.S.C. section 1352. The filing of a form is required for such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence, the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last, previously submitted report by this reporting entity for this covered Federal action. 4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District if known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks "Subawardee" then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organization level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identification in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant. or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., RFP-DE-90-001. 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influenced the covered Federal action. (b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name and Middle Initial (MI). 11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. 12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature. 14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and, the date(s) of any services rendered. Include all preparatory and related activity not just time spent in actual contact with Federal officials. Identify the Federal officer(s) or employee(s) contacted or the officer(s) employee(s) or Member(s) of Congress that were contacted. 15. Check whether or not a continuation sheet(s) is attached. P-14 16. The certifying official shall sign and date the form, print.his/her name title and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruction, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information. including suggestions for reducing this burden. to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503. P-15 Local Agency Bidder- UDBE COMMITMENT-(CONSTRUCTION CONTRACTS)-EXHIBITS 15-G(1) N(1 I P"* NI,F.ASF. RFFF.R TO INCTRITC'TInNSs ON T14F RFVFR.'PNF. CI1mF nF TNI,4~ GENCY: Town of Tiburon LOCATION: T i ur on,-ma r i n Grp . ~ CA PROJECT DESCRIPTION: 2009 Reed Ranch Rd & Ridge Rd Overlay TOTAL CONTRACT ,-MOUNT: 5 2.8 9 9 3 9 . 0 0 ID DATE: August 10, 2009 IDDER'S NAME: North Bay Construction Inc . IONTRACT UDBE GOAL: 22.4% ONTRACT ITEM OF WORK AND DESCRIP ITEM NO TION - R SERVICES TO BE ert. No. of UDBE D EXPIR AME OF UDBEs DOLLAR AMOUNT . SUBCONTRACTED OR MATERIALS O BE PROVIDED ATION ATE Must be certified on the date bids reopened - include UDBE address nd hone number DBE ; ; 3 and AC Overlay-hauling 7106 illard Environ. 23 01 6 .00 6 _ AC base repair -hauling Ex p. 5 2011 .O. Box 579 _ ron CA 94514 25-634-6850 For Local Agency to Complete: ocal Aeency Contract Number: Total Claimed Partici ation $ 2 3 , 016.0 0 Federal Aid Project Number: Federal Share: p 7.94 ontract Award Date: ocal Aeenc c tif h ll i f y er ies t at a n ormation is complete and accurate. K rint Name Signature ate ocal Agency Representative Area Code) Telephone Number: fB eyPre::ident. Sign _ Au 10 For Caltrans Review: g. , ? 07-7 63_-2891 ~ Date (Area Code) Tel. No. Cindy Orme Person to contact Local Aeency Bidder - UDBE Conunitme t R 3;09 Print Name Signature Date tr t n ( ev ) k _upy - r-ax or scan a copy to the uaitrans District Local Assistance Engineer (DLAE) within 15 days of award. Failure toy ~r send a copy to the DLAE within 15 days of a~Nard may result in de-obli-Ration of funds for this project. RECEI E (2) Copy Include in award package to Caltrans District Local Assistance y (3) Original - Local aeency files AUG 13 2009 P-1L°. TOWN OF TIBURON BUILDING DIVISION Local Agency Bidder- UDBE COMMITMENT-(CONSTRUCTION CONTRACTS)-EXHIBITS NOT PT,FASF. RF.FFR TO TNCTRTTCTION,q ON TNF RFVFRCF. STDF OF THIS, 1 LOCATI PROJECT DESCRIPT N. Y TOTAL CONTRACT AMOUNT: S 5i_ P q 3 pj BID DA BIDDER'S NAM ONTRACT UDBE GOAL: 22.4% I CONTRACT TEM OF WORK AND DESCRIPTION R SERVICES TO BE en. No. of UDBE NAME OF UDBEs DOLLAR AMOUNT ITEM NO. D EXPIRATION Must be certified on the date bids D UBCONTRACTED OR MATERIALS O BE PROVIDED ATE are opened - include UDBE address and hone number BE - For Local Agency to Complete: Local Aeenc,, Contract Number: Total Claimed Pa ti i ti Federal Aid Project Number: Federal Share: r pa c on % Contract Award Date: Local Agency certifies that all information is complete and accurate. Print Name Signature Date Local Agency Representative Area Code) Telephone Number: Sign re of Bidder I ID 1 For Caltrans Review: ate (Area Code) Tel. 'o. Local Agency Bid er - UDBE Commitment (Rev 3!09) Print Name Signature Date I -N, - . vi 3--au a wPy tU u,c ~auiana rnsrnct Local Assistance >rngineer (DLA ) ~~-ithin 15 days of a~vard. Failure to send a copy to the DLAE within 15 days of av and may result in de-obligation of pis project. (2) Copy Include in award package to Caltrans District Local Assistance (3) Original - Local agency files ~f_ )zP~ P-16 INSTRUCTION UDBE COMMITMENTS (CONSTRUCTION CONTRACTS) EXHIBITS 15-G(1) ALL BIDDERS PLEASE NOTE: It is the bidder's responsibility to verify that the UDBE(s) falls into one of the following groups in order to count towards the UDBE contract goal: 1) Black American; 2) Asian-Pacific American; 3) Native American; 4) Women. This information may be submitted with your bid proposal. If it is not, and you are the apparent low bidder or the second or third low bidder, it must submitted and received as specified in the Special Provisions. Failure to submit the required UDBE commitment will be grounds for finding the proposal nonresponsive UDBE is a firm meeting the definition of a DBE as specified in 49 CFR and is one of the following groups: I. Black American 2. Asian-Pacific American 3. Nation American 4. Women The form requires specific information regarding the construction contract: Agency, Location, Project Description, Federal Aid Project Number (assigned by Caltrans-Local Assistance), Total Contract Amount, Bid Date, Bidder's Name, and Contract Goal. The form has a column for the Contract Item Number (or Item No's) and Item of Work and Description or Services to be Subcontracted or Materials to be provided by UDBEs. The UDBE should provide a certification number to the Contractor and expiration date. The form has a column for the Names of UDBE contractors to perform the work (who must be certified on the date bids are opened and include the UDBE address and phone number). Enter the UDBE prime's and subcontractors' certification numbers. Prime contractors shall indicate all work to be performed by UDBEs including, if the prime is a UDBE, work performed by its own forces. IMPORTANT: Identify all UDBE firms being participating in the project regardless of tier. Names of the First Tier UDBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. Provide copies of the UDBEs' quotes, and if applicable, a copy of joint venture agreements pursuant to the Subcontractors Listing Law and the Special Provisions. There is a column for the total UDBE dollar amount. Enter the Total Claimed UDBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the UDBE, describe exact portion of time to be performed or furnished by the UDBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); to determine how to count the participation of UDBE firms. Exhibit 15-G (I) must be signed and dated by the person bidding. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Contract Award Date and Federal Share fields.and verify that all information is complete and accurate before signing and sending a copy of the fonn to the District Local Assistance Engineer within 15 days of award. Failure to submit a completed and accurate form within the 15-day time period may result in the de-obligation of funds on this project. District DBE Coordinator should verify that all information is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the fonn. P-17 UDBE INFOICAIATION-GOOD FAITH EFFORTS, EXHIBIT 15-H Federal-aid Project No. ESPL-5388 (008) Bid Opening Date The (Ci!y/Coup of) established an Under-utilized Disadvantaged Business Enterprise (UDBE) goal of -22.4_% for this project. The information provided herein shows that a good faith effort was made. Lowest, second lowest and third lowest bidders shall submit the following information to document adequate good faith efforts. Bidders should submit the following information even if the "Local Agency Bidder - UDBE Commitment" form indicates that the bidder has met the UDBE goal. This will protect the bidder's eligibility for award of the contract if the administering agency determines that the bidder failed to meet the goal for various reasons, e.g., a UDBE firm was not certified at bid opening, or the bidder made a mathematical error. Submittal of only the "Local Agency Bidder - UDBE Commitment" form may not provide sufficient documentation to demonstrate that adequate good faith efforts were made. The following items are listed in the Section entitled "Submission of UDBE Commitment" of the Special Provisions: A. The names and dates of each publication in which a request for UDBE participation for this project was placed by the bidder (please attach copies of advertisements or proofs of publication): Publications Dates of Advertisement B. The names and dates of written notices sent to certified UDBEs soliciting bids for this project and the dates and methods used for following up initial solicitations to determine with certainty whether the UDBEs were interested (please attach copies of solicitations, telephone records, fax confirmations, etc.): Names of UDBEs Solicited Date of Initial Solicitation Follow Up Methods and Dates C. The items of work which the bidder made available to UDBE firms, including, where appropriate, any breaking down of the contract work items (including those items normally performed by the bidder with its own forces) into economically feasible units to facilitate UDBE participation. It is the bidder's responsibility to demonstrate that sufficient work to facilitate UDBE participation was made available to UDBE firms. Items of Work Bidder Normally Breakdown of Items Amount Percentage Performs Item Of (Y/N) Contract P-18 D. The names, addresses and phone numbers of rejected UDBE firms. the reasons for the bidder's rejection of the UDBEs, the firms selected for that work (please attach copies of quotes from the firms involved), and the price difference for each UDBE if the selected firm is not a UDBE: Names. addresses and phone numbers of rejected UDBEs and the reasons for the bidder's rejection of the UDBEs: Names, addresses and phone numbers of firms selected for the work above: E. Efforts made to assist interested UDBEs in obtaining bonding, lines of credit or insurance, and any technical assistance or information related to the plans, specifications and requirements for the work which was provided to UDBEs: F. Efforts made to assist interested UDBEs in obtaining necessary equipment, supplies, materials, or related assistance or services, excluding supplies and equipment the UDBE subcontractor purchases or leases from the prime contractor or its affiliate: G. The names of agencies, organizations or groups contacted to provide assistance in contacting, recruiting and using UDBE fines (please attach copies of requests to agencies and any responses received, i.e., lists, Internet page download, etc.): Name of Method/Date of Results Agency/Organization Contact H. Any additional data to support a demonstration of good faith efforts (use additional sheets if necessary): NOTE: USE ADDITIONAL SHEETS OF PAPER IF NECESSARY. P-19 Local Agency Bidder UDBE COMMITMENT-(CONSTRUCTION CONTRACTS)-EXHIBIT Inclusive of all DBEs including the ITnRFc lictpd at Rid p1-n--A - v V'7sa1 NOTE- PLEASE. RFFFR TO TNSTRIIC'TIONS ON TNF. RFVFR,qF.qIDF OF THIS AGENCY: LOCATION: PROJECT DESCRIPTION: TOTAL CONTRACT AMOUNT: S BID DATE: BIDDER'S NAME: ONTRACT ITEM OF WORK AND DESCRIPTION R SERVICES TO BE BE Cert. No. NAME OF DBEs DOLLAR AMOUNT ITEM NO. D EXPIRATION Must be certified on the date bids BE SUBCONTRACTED OR MATERIALS O BE PROVIDED ATE are opened - include DBE address and hone number For Local Agency to Complete: Local Agency Contract Number: Total Claimed Parti i ti Federal Aid Project Number: Federal Share: pa c on % Contract Award Date: Local Agency certifies that the DBE certification(s) has been verified and all information is complete and accurate. rint Name Signature Date Local Agency Representative Signature of Bidder Area Code Telephone Number: or Caltrans Review: Print Name Signature Date Caltrans District Local Assistance Engineer Date (Area Code) Tel. No. Local Agency Bidder DBE Information (Rev 3;09) rT • . j a~a,i a ~-Vpy iv uic'a,ua,u Ltauict Local Assistance t.nglneer (llLAE) within 15 days of contract execution. Failure to send a copy to the DLAE within 15 days of contract execution may result in de-obligation of funds for this project. (2) Copy Include in award package to Caltrans District Local Assistance (3) Original - Local agency files P-20 INSTRUCTION UDBE COMMITMENTS (CONSTRUCTION CONTRACTS) EXHIBITS 15-G(2) SUCCESSFUL BIDDERS The form requires specific information regarding the construction contract: Agency, Location. Project Description. Federal Aid Project Number (assigned by Caltrans-Local Assistance), Total Contract Amount. Bid Date. Bidders Name, and Contract Goal. The form has a column for the Contract Item Number (or Item No's) and Item of Work and Description or Services to be Subcontracted or Materials to be provided by DBEs. The DBE should provide a certification number to the Contractor and expiration date. The DBE contractors should notify the Contractor in writing with the date of the decertification if their status should change during the course of the contract. The form has a column for the Names of DBE certified contractors to perform the work (must be certified on the date bids are opened and include DBE address and phone number). Enter DBE prime and subcontractors certification number. Prime contractors shall indicate all work to be performed by DBEs including work performed by its own forces if a DBE. IMPORTANT: Identify all DBE firms participating in the project--including all UDBEs listed on the UDBE Commitment form (Exhibit 15G(1)), regardless of tier. Names of the First Tier DBE Subcontractors and their respective item(s) of work listed should be consistent, where applicable, with the names and items of work in the "List of Subcontractors" submitted with your bid. There is a column for the total DBE dollar amount. Enter the Total Claimed DBE Participation dollars and percentage amount of items of work submitted with your bid pursuant to the Special Provisions. (If 100% of item is not to be performed or furnished by the DBE, describe exact portion of time to be performed or furnished by the DBE.) See Section "Disadvantaged Business Enterprise (DBE)," of the Special Provisions (construction contracts); to determine how to count the participation of DBE fines. Exhibit 15-G (2) must be signed and dated by the successful bidder. Also list a phone number in the space provided and print the name of the person to contact. Local agencies should complete the Contract Award Date, Federal Share, Contract and Project Number fields, and verify that all information is complete and accurate before signing and sending a copy of the form to the District Local Assistance Engineer within 15 days of contract execution. Failure to submit a completed and accurate form within the 15-day time period may result in the de-obligation of funds on this project. District DBE Coordinator should verify that all information is complete and accurate. Once the information has been verified, the District Local Assistance Engineer signs and dates the form. P-21 C-~~TY OF DATA UNIVERSAL NUMBERING SYSTEM (D-U-N-S) NUMBER Submit this form with the Executed Contract. If you fail to submit your D-U-N-S Number, the Department will not approve the contract CONTRACT NUMB CONTRACTOR N STREEI":J~~ 1 CIT~- STATE: ZIP CODE: C D-U-N-S Number: Contact Name: N,)t Telephone No: '1"(.)'7- '11 O--> P-22 BUYS NESS ADDRESS (D-U-N-S Number Location): companying this proposal is (\-OTICE: 1.%SERT THE I!-ORDS "CASH(S " "CASHIERS CHECK. " "CERTIFIED CHECK. " OR "BIDDER'S BOA D. "AS THE CASE :1141' BE.) mount equal to at least ten percent of the total of the bid. names of all persons interested in the foregoing proposal as principals are as follows: IMPORTANT NOTICE If bidder or other interested person is a corporation, state legal name of corporation, also names of the president, secretary, treasurer, and manager thereof, ifa copartnership, state true name offirm, also names ADDENDA- This Proposal is sub -n' ed with respect to the changes to the contract included in addenda number/s (Fill in addenda numbers if addenda have been received and insert, in this Proposal, any Engineer's Estimate sheets that were received as part of the addenda.) By my signature on this proposal I certify, under penalty of perjury under the laws of the State of California, that the foregoing questionnaire and statements of Public Contract Code Sections 10162, 10232 and 10285.1 are true and correct and that the bidder has complied with the requirements of Section 8103 of the Fair Employment and Housing Commission Regulations (Chapter 5, Title 2 of the California Administrative Code). By my signature on this proposal I further certify, under penalty of perjury under the laws of the State of California and the United States of America, that the Noncollusion Affidavit required by Title 23 United States Code, Section 112 and Public Contract Code Section 7106; and the Title 49 Code of Federal Regujidtions, Part 29 Debarment anQ Suspension Certification are true and correct. Date: e >6- Business Addre Place of B iness Place of Reside P-23 Licensed in conformance with an act providing for the registration of Contractors, License No.(~ --fT (00 Classification(s) EXECUTED IN 3 ORIGINALS TOWN OF TIBURON SAMPLE PERFORMANCE BOND (To Accompany Contract) Bond No. 105261124 PREMIUM: $1,450.00 WHEREAS, the Town of Tiburon, acting by and through the Department of Public Works, has awarded to Contractor NORTH BAY CONSTRUCTION, INC. , hereafter designated as the "Contractor", a contract for the work described as follows: 2009 REED RANCH RD. AND RIDGE RD. OVERLAY; ESPL 5388(008) AND WHEREAS, the Contractor is required to furnish a bond in connection with said contract, guaranteeing the.faithful performance thereof. NOW, THEREFORE, we the undersigned Contractor and Surety are held firmly bound to the Town of Tiburon in the sum of $ Two HUNDRED EIGHTY NINE THOUSAND NINE HUNDRED THIRTY* dollars $289f939.00 to be paid to said Town or its certain attorney, its successors and assigns: for which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, successors or assigns, jointly and severally, firmly by these presents. *NINE AND 00/100 THE CONDITION OF THIS OBLIGATION IS SUCH, That if the above bound Contractor, 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 foregoing 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 intent and meaning, and shall indemnify and save harmless the Town of Tiburon, its officers and agents, as therein. stipulated, then this obligation shall become and be null and void; otherwise it shall be. and remain in ftall force and virtue. IN WITNESS WHEREOF, We have hereunto set our hands and seals on this 15TH day of SEPTEMBER , 20 09 . Correspondence or claims relating to this bond should be sent to the surety at the following address: TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA 100 CALIFORNIA ST. STE. 300 NORTH F( CON RUCTION, INC. BY: JOHN $ RELLA, CEO Contractor TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA Name Surety (SEAL) 441 L1 By : ey-in-Fact PAUL RAMATICI SAN FRANCISCO CA 94111 NOTE: Signatures of those executing for the surety must be properly acknowledged. APPROVED AS TO - ` ANN DANFORTH TOWN ATTORNEY TOWN OF TIBURON A-8 CERTIFICATE OF ACKNOWLEDGEMENT State of California, Town of Tiburon On this day of appeared in the year 20 before me a notary public in and for the Town of Tiburon, personally , known to me to be the person whose Attorney-in-fact name is subscribed to this instrument and known to me to be the attorney-in-fact of and acknowledged to me that he/she subscribed the name of the said company thereto as surety, and his/her own name as. attorney-in-fact. (SEAL) *SEE ATTACHED* Notary Public A-9 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of SONOMA On 9/15/09 Date personally appeared. before me, CHERYL GRIGGS, NOTARY PUBLIC Here Insert Name and Title of the Officer PAUL RAMATICI Name(s) of Signer(s) CHERYL, GRIGGS Z COMM. #1821982 n U NOTARY PUBLIC - CALIFORNIA ;p Z SONOMA COUNTY My Comm. Expires Nov. 9. 2012 Place Notary Seal Above who proved to me on the basis of satisfactory evidence to be the person(g) whose name(g) is/ao subscribed to the within instrument and acknowledged to me that he/she/tom executed the same in his/Kr/tbi5ir authorized capacity(iiA, and that by his/W/tlyei"r signature(p) on the instrument the person(,s), or the entity upon behalf of which the person acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official eal. Signature 0, jt~t t Signature of Notar Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer- Title(s): ❑ Partner - ❑ Limited ❑ General 13 Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer -Title(s)- 0 Partner - ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: 111= - - - - - - - - - = = = = = = = = = - = _ = = = = = = = _ = = = = = = = = = = _ = - - - - - - - - - - - - - - - - - - - - - - - - - - - - CALIFORNIA ALL-PURPOSE III I11 CERTIFICATE OF ACKNOWLEDGMENT uI nI nI I11 State of Cali ornia ul 111 111 III County of Sonoma ul ul I11 ul 111 On September 16, 2009 before me, Garnet Ward, Notary Public, I11 111 11' personally appeared John Barella III nl ul 111 nl who proved to me on the basis of satisfactory evidence to 111 m 111 be the person(s) whose name(s) ism subscribed to the 111 m within instrument and acknowledged to me that 111 I11 heAsheilthey executed the same in his authorized 111 111 capacity (ies), and that by his signature(s) on the 111 instrument the person(s), or the entity upon behalf of 111 III which the person(s) acted, executed the instrument. I" ul m III 111 I certify under PENALTY OF PERJURY under the laws 111 111 111 of the State of California that the foregoing paragraph is I11 nl true and correct. ul 111 GARNET WARD 111 III Commission * f 800539 - Notary Public - California WITNESS my hand and official seal. "I Sonoma County III I11 Comm. Expires Jun 5, 2012 I11 I11 I11 Signature III I11 Signature of Notary Public ~ I11 III III OPTIONAL I11 Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent III 111 fraudulent removal and reattachment of this form to another document. I11 III 111 Description of Attached Document 111 uI 111 Title or Type of Document: Performance Bond ul ul 111 Document Date: September 15, 2009 Number of Pages: 2 111 I11 111 Signer(s) Other Than Named Above: III 111 111 Capacity(ies) Claimed by Signer 111 nl ul nl m I11 Signer's Name: John Barella Signer's Name: III III ❑ Individual ❑ Individual I11 I11 a Corporate Officer - Title(s): CEO ❑ Corporate Officer - Title(s): III I11 ❑ Partner - ❑ Limited ❑ General ❑ Partner - ❑ Limited ❑ General 111 I11 ❑ Attorney-in-Fact ❑ Attorney-in-Fact I11 I11 ❑ Trustee ❑ Trustee 111 III ❑ Guardian or Conservator ❑ Guardian or Conservator I11 111 ❑ Other: Top of thumb here ❑ Other: Top of thumb here III I11 I11 I11 I11 Signer is Representing: Signer is Representing: I11 I11 North Bay Construction, Inc. III I11 I11 III = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = ~11 EXECUTED IN 3 ORIGINALS BOND NO: 105261124 PREMIUM INCLUDED IN TOWN OF TIBURON PERFORMANCE BOND SAMPLE PAYMENT BOND (Section 3247, Civil Code) WHEREAS, The Town of Tiburon, acting by and through the Public Works Department, hereafter referred to as "Obligee", has awarded to Contractor NORTH BAY CONSTRUCTION, INC.- , hereafter designated as the "Principal", a contract for the work described as follows: 2009 REED RANCH RD. AND RIDGE RD. OVERLAY; ESPL 5388(008) AND WHEREAS, said Principal is required to furnish a bond in connection with said contract, to secure the payment of claims of laborers, mechanics, material, men and other persons as provided by law. NOW, THEREFORE, we the undersigned Principal and Surety are bound unto the Obligee in the sum of TWO HUNDRED EIGHTY NINE THOUSAND NINE HUNDRED THIRTY NINE AND 00/100--- dollars $289,939.00 for which payment, we bind ourselves, jointly and severally. THE CONDITION OF THIS OBLIGATION IS SUCH, That if said Principal or its subcontractors shall fail to pay any of the persons named in Civil Code Section 3181, or amounts due under the Unemployment Insurance Code with respect to work or labor performed by such claimant, or any amounts required to be deducted, withheld, and paid over to the Franchise Tax Board for the wages of employees of the Principal and his subcontractors pursuant to Section 18806 of the Revenue and Taxation Code, with respect to such work and labor, that the surety herein will pay for the same in an 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 surety will pay a reasonable attorney's fee to fixed by the coin This bond shall inure to the benefit of any of the persons named in Civil Code Section 318 j as to give a right of action to such persons or their assigns in any suit brought upon this bond. Dated: SEPTEMBER 15TH, Correspondence or claims relating to this bond should be sent to the surety at the following address: TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA 100 CALIFORNIA ST. STE. 300 SAN FRANCISCO CA 94111 20 09 NORTH BAY ONSTRUCT ON, INC. BY:~ JOHN LLA, CEO Principal TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA urety (SEAL) Y . By : A rney-in-Fact PAUL RAMAT I C I NOTE: Signatures of those executing for the surety must be properly acknowledged. _x-ytP OV AS TO FORM ANN DANFORTH TO WN A-6 State of California Town / County of. CERTIFICATE OF ACKNOWLEDGEMENT SS On this day of personally appeared in the year 20 before me personally known to Attorney-in-fact me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument as the attorney-in-fact of and acknowledged to me that he/she subscribed the name of the said company thereto as surety, and his/her own name as attorney-in-fact. *SEE ATTACHED* (SEAL) Notary Public A-7 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA County of SONOMA On 9/15/09 Date personally appeared - before me, CHERYL GRIGGS, NOTARY PUBLIC Here Insert Name and Title of the Officer PAUL RAMATICI Name(s) of Signe who proved to me on the basis of satisfactory evidence to be the personal whose nameV) is/ate subscribed to the within instrument and acknowledged to me that he/sue/t40 executed the same in his/Kr/tlir authorized capacity(iiA, and that by his/i eVtWr signature( on the instrument the person(,s), or the entity upon behalf of which the person~zj acted, executed the instrument. \N CHERYL GRIrGS Z COMM, #1821982 O NOTARY PUIJLIC -CALIFORNIA ,'U Z SONOMA COUNTY ' My Comm. Expires Nov. 9, 2012 Place Notary Seal Above certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. Witness my hand and official seal. Signature Ou, Signature of Nota Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Individual ❑ Corporate Officer- Title(s): ❑ Partner - ❑ Limited ❑ General 1:3 Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Number of Pages: Signer's Name: ❑ Individual ❑ Corporate Officer - Title(s): ❑ Partner - ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Top of thumb here 111_ _ _ _ _ _ _ _ _ _ _ _ _ = = = = = _ = = = = = = = = = = _ = _ _ = ~I - CALIFORNIA ALL-PURPOSE 111 I11 CERTIFICATE OF ACKNOWLEDGMENT I11 nl ui u1 nl 111 State of Cali ornia III n1 111 County of Sonoma III m I11 III nl n1 111 On September 16, 2009 before me, Garnet Ward, Notary Public, 111 III personally appeared John Barella 111 nl m III u1 who proved to me on the basis of satisfactory evidence to 111 nl III be the person(s) whose name(s) ism subscribed to the 111 111 within instrument and acknowledged to me that III 111 h executed the same in his authorized 111 111 capacity (ies), and that by his signature(s) on the III 11' instrument the person(s), or the entity upon behalf of 11I which the person(s) acted, executed the instrument. u1 w nl 111 I certify under PENALTY OF PERJURY under the laws m 111 I11 of the State of California that the foregoing paragraph is 111 ul true and correct. ul ul m 111 111 GARNET WARD WITNESS my hand and official seal. Commission * 1800539 l III I11 ie Notary Public - California I11 III 11' Sonoma County - I11 Comm. Ex Tres Jun 5, 2012 Signature I11 111 Signature of Notary Publi III I11 111 OPTIONAL 11' I11 Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent I11 III fraudulent removal and reattachment of this form to another document. III I11 III Description of Attached Document 111 nl 111 Title or Type of Document: Payment Bond 11' nl nl III Document Date: September 15, 2009 Number of Pages: 2 III I11 III Signer(s) Other Than Named Above: I11 III 111 Capacity(ies) Claimed by Signer I11 nl ul nl ul III Signer's Name: John Barella Signer's Name: I11 III ❑ Individual ❑ Individual III III R1 Corporate Officer - Title(s): CEO ❑ Corporate Officer - Title(s): I11 I11 ❑ Partner - ❑ Limited ❑ General ❑ Partner - ❑ Limited ❑ General 111 I11 ❑ Attorney-in-Fact ❑ Attorney-in-Fact I11 111 ❑ Trustee ❑ Trustee III I11 ❑ Guardian or Conservator ❑ Guardian or Conservator 111 Ill ❑ Other: Top of thumb here ❑ Other: Top of thumb here I11 I11 III I11 111 Signer is Representing: Signer is Representing: I11 111 111 North Bay Construction, Inc. I11 III III WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER .im POWER OF ATTORNEY TRAVELERS J Farmington Casualty Company St. Paul Guardian Insurance Company Fidelity and Guaranty Insurance Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company Attorney-In Fact No. 219453 Certificate No. 0 0 2 3 910 2 0 KNOW ALL MEN BY THESE PRESENTS: That Seaboard Surety Company is a corporation duly organized under the laws of the State of New York, that St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc. is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint M. R. Stewart, Paul Ramatici, Cheryl Griggs, and Thomas Griffith of the City of j?etaluma , State of California , their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this day of May 2008 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance' Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company 20th St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company yH\1t1111ry„M .M~••••••••yV GASUq c."~fIRE 6WNh N IN 1NSli y ~tY Aly C o*: .sp a P o sun TY 9 ` gJ s 1~ dYy ~r J ~s dy O: ' 9 JP O OP'P~'Yr W tRPOR '•>4 •._y~<' 4P G,9 Cn (~~O r' n NCORRDItATf9 t. ~~e;es~ 1W i~pNPORgTf-,`"' af! [e 4 i [7 198e O 977 1cv ; m S 7 f • n = a HARTFORD < 3 • HJIRTFbR0. $ < "mo Z 1951 ~..SEAL3 SEALi3' o 96 -Ar ° web +a~ ~r ~y'an~~~HC~ als',•~N~a~-f ' °1.. nmxw * 1 tid « ANA State of Connecticut City of Hartford ss. By: Georg Thompson, enior ice President On this the 20th day of May 2008 before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. W wr 1. My Commission expires the 30th day of June, 2011. tDxur)J4 Marie C. Tetreault. Notary Public 58440-5-07 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 15TH day of SEPTEMBER 20 0 9 . Kori M. Johans Assistant Secretary G I~$U^ NNN\\1G11q„„ <A, SIETY F\P E 4'Wiyy k y, 1 N _'MW. ,(V A ux~ C' OO'P~fr t J ,y G • •f . t P NO Y • .'Go * ! °c O _y... _ 9 Jp 9 v m ►sae7~ FD F• 4 P¢ Q' MVOR ' ! ~p 'L'', c G ~ € ~f~0 ..A~eCi '~v ORPORAT O m `~f' 1982 O 19wC TED 1927 X • ! j a i - f 1c), a HARTFORD. :i `ty ja 195cl+l # a S E f) O i j CONN. O CONN. P r~l+ 1896 ~ OFNE`N ~~yiA,n~ nu\Nix ~G a1S .•AN~a~'f adD ebb +Lr a"' v9`ys ~f AIN To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER t=a'RO® CERTIFICATE OF LIABILITY INSURANCE OP ID SD DATE (MM/DD/YYYY) IiIiiim~ NORBA- 2 09/15/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Don Ramatici Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 551 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Petaluma CA 94953 Phone: 707-782-9200 Fax: 707-782-9300 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins. of PA 1944 INSURER B: Amer. Casualty Co. Reading PA 20427 North Bay Construction, Inc. INSURER C: Endurance American Specialty P.O. BOX 6004 Petaluma CA 94955-6004 INSURER D: INSURER E: 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY GL18 94 951 10/01/08 10/01/09 PREMISES (Ea occurence) $ 100,000 - 7 CLAIMS MADE Fx ]OCCUR MED EXP (Any one person) $ 5 , 0 0 0 X Brd. Fm. PD $25,000 DED. PERSONAL & ADV INJURY $1,000,000 X XCU/Contrct Incl. INDEP. CONTRACTORS INCL. GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X JEPRO- CT LOC Em p. Ben. 1,000,000 AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X X ANY AUTO BUA4000276691 10/01/08 10/01/09 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 A X X OCCUR F-1 CLAIMSMADE BE3219030 10/01/08 10/01/09 AGGREGATE $ 10, 000, 000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY JOTH- X TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WC3 67 94 64 10/01/08 10/01/09 E.L. EACH ACCIDENT $ 1, 000, 000 OFFICER/MEMBER EXCLUDED? L-1 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 OTHER C Pollution Liab. ECC10100319300 10/01/08 10/01/09 Ea. Claim 2,000,000 $10,000. Ea. Claim All Clms 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Operations of the Named Insured for the Certificate Holder. Job: 2009 Reed Ranch Rd. & Ridge Rd. Overlay; ESPL 5388(008) / NBC #1800 Certificate Holder is named as an additional insured per forms attached. 30XCG2010(07/04)LF/CG2037(07/04)LF/CG2404(10/93)CA2048/923186A/WC040361 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TIBURO5 DATE THEREOF, THE ISSUING INSURER WILL4&!8E0kY9R+8 MAIL 30 DAYS WRITTEN Town of Tiburon, its officials NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, employees, agents & contractor I , and Town's Engineer 1505 Tiburon Blvd. R"-'~---,~T"""--' Tiburon CA 94920 A ZED NTATIVE o,~ ate" ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL1894951 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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) Location(s) Of Covered Operations WHERE REQUIRED BY AN "INSURED CONTRACT" Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - 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 "body 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 locations(s) designated above. B. With respect to the insurance afforded to these additional insured, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 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 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. Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insured(s) shall be excess and non- contributory, but only as respects to any claim or liability determined to be the result of the sole negligence or responsibility of the Named Insured and only if required by written contract. CG 20 10 07 04 ISO Properties, Inc., 2004 POLICY NUMBER: GL1894951 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations WHERE REQUIRED BY AN "INSURED CONTRACT" I Information required to complete this schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to described in the schedule of this endorsement include as an additional insured the person(s) or performed for that additional insured and organization(s) shown in the Schedule, but only included in the "products-completed operations with respect to liability for "bodily injury" or hazard". "property damage" caused, in whole or in part, by "your work" at the location designated and Coverage provided by this policy to the Additional Insured(s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insured(s) shall be excess and non- contributory, but only as respects to any claim or liability determined to be the result of the sole negligence or responsibility of the Named Insured and only if required by written contract. CG 20 37 07 04 ISO Properties, Inc. , 2004 POLICY NUMBER: GL 1 89-49-5 1 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: WHERE REQUIRED BY AN "INSURED CONTRACT" (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 ❑ POLICY NUMBER: GL 189-49-51 COMMERCIAL GENERAL LIABILITY CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECTS GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: ALL CONSTRUCTION PROJECTS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes le- gally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in this Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 1 of 2 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents under COVERAGE C (SECTION 1), which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed or abandoned and then restarted, or if the authorized constricting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Limits Of Insurance (SEC- TION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97 POLICY NUMBER: BUA4000276691 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED INSURED This endorsement modifies insurance provided under the Following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective: 9/15/09 Countersigned by: Named Insured: North Bay Construction, Inc. Ounn (Authorized Representative) SCHEDULE me of Person(s) or Organization(s): Town of Tiburon, its officials, employees, agents & contractor and Town's Engineer (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. Named Insured: North Bay Construction, Inc. Policy No. BUA4000276691 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name of Person or Organization: Town of Tiburon, its officials, employees, agents & contractors and Town's Engineer (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement. We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for the injury or damage. This injury or damage must arise out of your activities under a contract with that person or organization. The waiver applies only to the person or organization shown in the Schedule. 923186A 0589 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 10/01/08 forms a part of Policy No. WC3679464 Issued to: North Bay Construction, Inc. By: National Union Fire Ins. of PA We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2 % of the total estimated workers compensation Premium for this policy. (:::;2 01~aft~A 6JK:;~, 1 WC 04 03 61 Countersigned by: (Ed. 11/90) Authorized Representative