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HomeMy WebLinkAboutAgr 2012-05-12 (Ghilotti Construction Company, Inc.)TOWN OF TIBURON TIBURON, CALIFORNIA OWNER-CONTRACTOR AGREEMENT FOR THE 600 Ned's Way Facility THIS OWNER-CONTRACTOR AGREEMENT ("AGREEMENT") is made and entered into this 15~'day of M1 201Z, by and between the TOWN OF TIBURON, municipal corporation, 1505 iburon Boulevard, Tiburon, CA 94920, ("Owner") and Gski L10 trz.- C"q CoMP..SNe • ("Contractor"), whose principal place of business is Z~k6 6N; Avc SanrrA tZ os&c ri 54o } . 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 600 Ned's Way Facility ("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 Il PAYMENT See Section 5-1.7 of the Special Provisions of Contract Documents. Total compensation for the Work shall not exceed $ without prior written authorization from the Owner, and will consist of the Base Bid plusq./A A-1 A RTICI R TIT 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 $1500 per ay, f ach and every calendar day's delay in V/ I yp pr cr m e Aon 3.1 hereof. finishing the work in excess of the number of working Ri hard W. Ghilotti To c owrEx~J YN President TIC 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-I.01A(2) of the Standard Specifications. Contract shall forfeit, as a penalty as set forth in California Labor Code §1775, twenty-five dollars ($25.00) for each calendar day or portion thereof, for each workman paid less than the prevailing rates set forth in the Prevailing Rates Schedules for any work done by any subcontractor under Contractor. ARTICLE V NON-DISCRIMINATION The Contractor hereby agrees to comply with the provisions contained in Section 5-1.1 of the Contract Documents. ARTICLE VI WORKER'S COMPENSATION INSURANCE By my signature hereunder, as Contractor, I certify that I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the perfonnance of the Work of this Agreement. A-2 ARTICLE VII In the event of conflict between the terms of this Agreement and the bid or proposal of said Contractor, then, this Agreement shall control and nothing herein shall be considered as an acceptance of the terms of the proposal conflicting herewith. ARTICLE VIII EXHIBITS T his Agreement includes the following Exhibits, which are attached hereto and incorporated herein by reference: Exhibit A 600 Ned's Way Site Description Exhibit B The Contract Documents (Page x-4) P. Exhibit C Bid Proposal (Pages P! 4-P2$) 0 F15 - IN WITNESS WHEREOF, the parties to these presents have hereunto set their hands the day and year first hereinabove written. APPROVED AS TO FORM: TOWN OF TIBURON By z555;; G%l G~ Town Attorney CONT O w By RichAr alV. Its President Contractor icense No. 644515 Expiration Date: 5-31-14 110111 By Tows Manager A-3 EXHIBIT A 600 Ned's Way Site Description The project site is located at 600 Ned's Way in Tiburon, CA. The Assessor's Parcel Number (APN) of the project site is 058-151-27. The project site is undeveloped and consists of mostly grassy hillside with some trees and shrubs and which slopes downward from Ned's Way to the east. The project is bound by Ned's Way and existing housing to the west, undeveloped hillside area to the north, by AT&T facilities to the east and by existing housing development to the south. A-4 EXHIBIT B 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 BIDDER BUSINESS P.O. BOX N.~ TOWN, STATE, ZIP S R osc~ CA q ~;qD-7 BUSINESS STREET ADDRESS a g-~ C~ t o rtiu~, (Please include even if P. O. Box used) TOWN, STATE, ZIP _ SQ-v~~ a, ~S D7 TELEPHONE NO: AREA CODE ~j - d_a 1 FAX NO: AREA CODE (10) 585 c.V C1 CONTRACTOR LICENSE NO. 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 September 14, 2011 and are entitled: TOWN OF TIBURON 600 NEWS WAY FACILITY 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 thus obtained shall be the unit price; (b) (Decimal Errors) If the product of the entered unit price and the estimated quantity is ex by a factor of ten, one hundred, etc., or one-tenth, or one-hundredth, etc. from the entered t discrepancy will be resolved by using the entered unit price or item total, whichever most approximates percentage wise the unit price or item total in the Town of Tiburon's Final Estimate If both.the unit price and the item total are unreadable or otherwise unclear, or are omitted, the bic deemed irregular. Likewise if the item total for a lump sum item is unreadable or otherwise unclf omitted, the bid may be deemed irregular unless the project being bid has only a single item and readable total bid is provided. Symbols such as commas and dollar signs will be ignored and have no mathematical signifi( establishing any unit price or item total or lump sums. Written unit prices, item totals and lump sl be interpreted according to the number of digits and, if applicable, decimal placement. Cents also have no significance in establishing any unit price or item total since all figures are assum( expressed in dollars and/or decimal fractions of a dollar. Bids on lump sum items shall be itel only; if any unit price for a lump sum item is included in a bid and it differs from the item total, tl total shall prevail. The foregoing provisions for the resolution of specific irregularities cannot be so comprehensil cover every omission, inconsistency, error or other irregularity which may occur in a bid. Any 's not specifically provided for will be determined in the discretion of the Town of Tiburon, discretion will be exercised in the manner deemed by the Town of Tiburon to best protect thf interest in the prompt and economical completion of the work. The decision of the Town of ' respecting the amount of a bid, or the existence or treatment of an irregularity in a bid, shall be finz f If this proposal shall be accepted and the undersigned shall fail to enter into the contract and fun 2 bonds in the sums required by the State Contract Act, with surety satisfactory to the Town of Z within 8 days, not including Saturdays, Sundays and legal holidays, after the bidder has receive( from the Town of Tiburon that the contract has been awarded, the Town of Tiburon may, at its determine that the bidder has abandoned the contract, and thereupon this proposal and the acc thereof shall be null and void and the forfeiture of the security accompanying this proposal shall 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 prop principals are those named herein; that this proposal is made without collusion with any other firm, or corporation; that he has carefully examined the location of the proposed work, the a proposed form of contract, and the plans therein referred to; and he proposes, and agrees if this pro; accepted, that he will contract with the Town of Tiburon, in the form of the copy of the contract a hereto, to provide all necessary machinery, tools, apparatus and other means of construction, and b the work and furnish all the materials specified in the contract, in the manner and time therein pre,, and according to the requirements of the Engineer as therein set forth, and that he will take payment therefor the following prices, to wit: P-16 1 TOWN OF TIBURON 600 NEWS WAY FACILITY BID PROPOSAL BASE BID -SCHEDULE The contractor agrees to accept payment, in full therefore, at the following prices: ITEM DESCRIPTION EST. QTY UNIT UNIT PRICE TOTAL PRICE Mobilization (Allowance) Includes Traffic Control, Construction Area 1 Signs, Erosion Control, SWPPP, Temporary 1 LS 60,000.00 60,000.00 Facilities, Field Construction Staking, and Security-Fencing 2 Clearing and Grubbing, Tree Removal, 1 LS Demolition ! _ag5oo------ - _gs00 - 3 Earthwork. Includes Stripping, Stockpiling 1 LS - - Excavation Recompaction, Fine Lot Grading i ~ ~~luw C 3---------------- 4 Class Ij Aggregate Base 250 CY l _ 5 Asphalt Concrete Pavement 170 Tons Li `-o - 2 0 6 Asphalt Edge Restraint g 7 Sawcut Pavement 170 LF ---J---------------- -I~K r:r------------- 8 30" Curb and Gutter 56 LF 1 22-- ~ " 9 6" Vertical Concrete Curb 300 LF . ; 2(0 _ E -7_ g? 10 6" AC Dike 175 LF --H-----------------! -50---------- 11 4" Concrete Sidewalk 3040 SF 12 - Accessibility Ramp 2 LS I 13 Concrete Valley Gutter 50 LF ' - s5-- 2~~0~ 14 Street Signs 3 EA _j 1 ~ 15- Pavement Markings ------1------- LS -1 0 ~5-- i 16 - - - - - - - - - - - Wheel Stops - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6 - - - - - - - - - - - - - - EA - - - - - - - - - - - - -`-"?-r - - - - - - - - T 1 5D - - - - - - - - - - - 17 Storm Drainage Structures 7 EA -~QQ 18 4" HDPE (Incl. Trenching, Bedding, 80 LF Backfill) L P-17 r. ITEM I DESCRIPTION I QEST, UNIT TOTAL TY I UNIT I PRICE I PRICE n 19 6" HDPE (Incl. Trenching, Bedding, 26 LF s ----------Backfll)---------- rjfl _ 20 12" HDPE (Incl. Trenching, Bedding, 516 LF 1 ` Backfill) ~ ~ - gop------- 21 Detention Facility (Excavation, Fill, Outfall) 1 LS 4" 4" SS Lateral, Cleanout, Manhole Entry 1 LS (Incl. Trenching, Bedding, Backfill) -------U------7 Water Service Complete (Incl. Trenching, I i 23 Bedding, Backfill, Copper Piping, Spigots, 1 LS 000- Boxes, etc.) 1 { 7 ~QQ 4" Fireline Complete (Incl. Trenching, r 24 Bedding, Backfill, Fittings, Backflow Device, l ki C 1 LS 3 OCO- 1 12 2 30 - _ _ _ _ - _ - _ _ oc ng) onnections, _B - oQ 25 Modular Building Complete 1 LS ! g_ 26 Transformer Pad w/ Bollards per PGE 1 LS Standards ` 27 Electric-Service (400 amp) Switchboard 1 LS _ 3a a~ ; -------------------t 30O©4 28 : Relay Terminal Cabinet 1 LS 3r i ~o~ 29 Pole Lighting (Including Base) 6 EA I 5Qo©-- 1------------------- 30 00©-- 30 Bollards. Lighted (Including Base) 2 EA I --dam-- E - O`- - 31 Pull Boxes and MT Stubs 3 EA I SDO~ ' Soo 32 4"Power, Comm., and CATV Conduit (Incl. 1 LS 1 ' Pull Rope, Excavation, Backfill) Sheet E3 15 D~~ SD4 O- - 33 5" Power Conduit ( Incl. Pull Rope, 1 LS f - - - Excavation, Backfill) Sheet E3 4 -7 0 oo _ ------------------------3------------------ -7000- 1 " Elect. Conduit ( Incl. Pull Rope, 34 Excavation,Backfll (5)#10 Connections) Sheet E3 - 1 LS CP oaQ 40(00 _ - - Joint Trench (Gas/Electrical) ( Incl. _ _ - 35 Excavation, Conduits, Boxes, Backfill) I LS I Sheet C4 -1- r C) o d 0 _ 10 000- 36 Telephone Sen,iee Complete EA NIC 3W Gemeast ceFyiee Cempk4e EA - NIC 38 Soil Prep.; Mulch; Testing 1 LS 3SDd4 ~ - ' 350~~ 39 Trees (15 Gallons) 19 EA S-7oo-- 40 Tree (36" Box) 1 - EA " 508 `1500_ P-18 ITEM DESCRIPTION `EST. QTY UNIT UNIT PRICE TOTAL PRICE 41 Shrubs (Incl. Driwater Elements) 2800 SF ! Z:~-- - f E 7------------ 42 Hydroseed 27,000 SF 2_() 2)Z q00- 43 Irrigation Complete 1 LS 2lP M~T_ 21oM0_ 44 4'H Chain Link Fencing (Black Vinyl) 190 LF ( 3~ ~~~Q 45 Concrete Stairs 1 LS co~ 1 -70 DD - -------------------t 46 Rock Outfall (Complete) 1 LS 1 ► - < < Z OD- Sheet C8; Incl. Total Pathway Construction, Grading, Retaining Wall, Stairway, Fencing, Drainage Grates, Pavement Markings (paint and, .thermoplastic), Signage, Accessibility 47 Ramp, and all other elements except pathway 1 LS surface, Complete in Place (Bid Item 47 is a Deductible Bid Item } The 'T'own is allowed to deduct at no effect to 1 ! _ other bid items or project) - Decomposed Granite Pathway Surface 48 (Bid Item 48 is a Deductible Bid Item. The 7 CY I ~D- -700 _ Town is allowed to deduct at no effect to other bid items or project) 1 49 Televise existing SS(262 LF) & SD (325 LF) 1 LS i j 2s0~ i _ Z500 50 Flush and repair existing SS and SD 1 LS ' 3 500.00 3 500.00 (Allowance) i , , 51 Comply to Exhibit "D"; Mitigation 1 LS ! Monitoring Program (Section 01 1100) ! (p 4O- TOTAL BASE BID = 1 g 3~ (Qq- 1 Deductive Bid Items: A-1 3/8" minus Teal Green Crushed Rock Pathway Surface (BI #48) A-2 Alternate No. 1 (Sec. 01 23 00) Eliminate one module of Facility (BI#25) A-3 Alternate No. 2 (Sec. 01 23 00) Eliminate two modules of Facility (BI#25) A-4 Alternate No. 3 (Sec. 01 23 00) Eliminate Colored Concrete Finishing (BI#25) A-5 Alternate No. 4 (Sec. 01 23 00) 5,. Eliminate One Operable Partition (BI#25) = Additive Bid Items: AA-1 Telephone Service Complete AA-2 Comcast Service Complete 7 CY Vp _ Z dE~O- 1 LS 2_40oo - 2 yooo- 1 LS ODp- 4~DQ~' 1 LS 450' 450- 1 LS ) coo- 15000 - 1 LS c OC0- i LS P-19 TOWN OF TIBURON 600 NED'S WAY FACILITY BID PROPOSAL NOTES: 1. THE TOTAL BASE BID CALCULATED IN ACCORDANCE WITH THE CONTRACT DOCUMENTS, WILL BE USED TO DETERMINE THE LOWEST BIDDER. 2. ALL BLANKS IN THE BID SCHEDULES, INCLUDING ADDITIVE BID ITEMS AND _ DEDUCTIVE BID ITEMS, MUST BE APPROPRIATELY FILLED IN. 3. TOWN OF TIBURON CAN CHOOSE TO AWARD CONTRACT CONSISTING OF BASE BD AND ANY COMBINATION OF THE ADDITIVE BID ITEMS AND DEDUCTIVE BD ITEMS. Total Base Bid (written) fl rot < i D-r1 Sl'y, kun6(e~ I' 6 1/7 Dollars $(numbers) i , LP $ (9g) Y. By my signature hereunder, as Contractor, I certify that I am aware of the 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 provisions 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. Signature Name Thomas Smith Estimating Managear Company t D~k SAY ) r Ai cy-\ P-20 The Bidder shall list the name and address of each subcontractor to whom subcontract portions of the work, as required by the provisions in Secthe Bidder proposes to Listing of Proposed Subcontractors," of the Standard Specifications an 2-1.054, "Required "General," of the special provisions. and Section 2-1.01, LIST OF SUBCONTRACTO RS Name and Address Description of Portion of Work Subcontracted 'NI~ILa ~rou~h ~e~~-r~ c. c-5 (R) ~k Movr,navt~(~[c-e ~CA- q ~ mar S~u-~~ C~ns~-rc~c: Sam o LLano Rcl ~=per 1, C-~ s y-~ z C_rl 0-n THIS PAGE LEFT BLANK P-?.?. LIST OF REFERENCES No. Name Contact information Project Type L~,s 'I- Project Amount P-23 THIS PAGE LEFT BLANK P-24 (THE BIDDER'S EXECUTION ON THE SIGNATURE PORTION OF THIS PROPOSAL SHALL ALSO CONSTITUTE AN ENDORSEMEATT AND EXECUTION OF THOSE CERTIFICATIONS WHICH ARE A PART OF THIS PROPOSAL) EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION The GHILOTTI CONSTRUCTION COMPANY bidder proposed subcontractor ' 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 Contr4ct Compliance, a Federal Government contracting or administering agency, enc or the former President's Committee on Equal Empto g g y~ yment Opportunity, all reports due under the applicable filling requirements. Note: The above certification is required by the Equal Empto yment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)) and proposed subcontractors only in connection with contracts must be submitted by bidders and subject to the equal opportunity clause. Contracts and subcontracts subcontracts which are from the equal opportunity clause are set forth in 41 CFR 60-1.5. ( which exempt contracts or subcontracts of $10,000 or under are exempt.) (Generally only 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-25 THIS PAGE LEFT BLANK P-2F PUBLIC CONTRACT CODE Public Contract Code Section 10285.1 Statement In conformance with Public Contract Code Section 10285.1 (Chapter 376, Stats. 1985), the bidder hereby declares under penalty of perjury under the laws of the State of California that the bidder has , has not k been convicted 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 blank spaces provided. The above Statement is part of the Proposal. Signing this Proposal on the signature portion thereof shall also constitute signature of this Statement. Bidders are cautioned that making a false certification may subject the certifier to criminal prosecution. Public Contract Code Section 10162 Questionnaire In conformance with Public Contract Code Section 10162, the Bidder shall complete, 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 of law or a safety regulation? Yes No If the answer is yes, explain the circumstances in the following space. NA P-27 Public Contract Code 10232 Statement In conformance with Public Contract Code Section 10232, the Contractor, hereby penalty of perjury, that no more than one final unappealable finding of contempt ol federal court has been issued against the Contractor within the immediately precedii period because of the Contractor's failure to comply with an order of a federal court iA the Contractor to comply with an order of the National Labor Relations Board. Note: The above Statement and Questionnaire are part of the Proposal. Proposal on the signature portion thereof shall also constitute signa: Statement and Questionnaire. Bidders are cautioned that making a false certification may subject the criminal prosecution. A_I)Q 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 awarding 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 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-29 z { THIS PAGE LEFT BLANK P-30 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. 1~ 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-31 % Accompanying this proposal is b PFS ~E) O (Ij (NOTICE: INSERT THE WORDS "CASH($ "CASHIER'S CHECK, " "CERTIFIED CHECK" OR "BIDDER'S BOND," AS THE CASE MAYBE.) In amount equal to at least ten percent of the total of the bid. The 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; if a copartnership, state true name of firm, also names of all individual copartners composing firm; if bidder or other interested person is an individual, state first and last names in full. rhr~ rd W , Ak14. - tom- esi c~en lea ~r.~ -rA &A;1 - SP LC, Licensed in conformance with an act providing for the registration of Contractors, I r-- License No. ~04A 51 j Classification(s) (-<R , C1~ C,)- C.41, -A-L ADDENDA- This Proposal is submitted with respect to the changes to the contract included in addenda 1 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 Regulations, Part 29 Debarment and Suspension Certification are true and correct. Date: Fstimateng Nficanager Business Address ac+j Place of Business 5#-&4K Place of Residence e ~ - _ 'Presa-r~~ P-32 Here CONSTRUCTION • COMPANY • • Corporate Resolution to Execute Proposals Resolved that this Corporation, Ghilotti Construction Company, hereby approves and appoints Richard W. Ghilotti, President of Ghilotti Construction Company, Brian Ongaro; Vice President of Ghilotti Construction Company, Ali Yazdi, VP, General Manager of Ghilotti Construction Company, Stacy L. Magill, Secretary of Ghilotti Construction Company, and Torn Smith, Estimating Manager of Ghilotti Construction Company for the purpose of executing in the name of this corporation, any and all bid documents and Bidder's Bonds. Resolved further, that any and all actions taken by Richard W. Ghilotti, Brian Ongaro, All Yazdi, Stacy L. Magill and Tom Smith in executing said bid documents and Bidder's Bonds be, and they hereby are, ratified and approved, and all such Proposals and bonds and documents are"'hereby adopted as binding obligations of this corporation. I, Stacy L. Magill, Secretary of Ghilotti Construction Company, a corporation incorporated under the laws of the State of California, do hereby certify that the foregoing is a full, true and correct copy of resolutions of the Board of Directors of the said corporation, duly and regularly passed and adopted at a special meeting of the Board of Directors of the said corporation which was duly and regularly called and held in all respects as required by law, and by the bylaws of the said corporation, at the office thereof on the 2" d day of November, 2004, at which special meeting a majority of the board of Directors of the said corporations was present and voted in favor of said resolutions. IN WITNESS WHEREOF, I have hereto set my hand as such Secretary and affixed the corporate seal of the said corporation, this 22nd day of September, 2011. Stacy L. M ill Secretary - Engineering Contractor - 246 GHILOTTI AVENUE • SANTA ROSA, CA 95407 • 707-585-1221 • FAX: 707-585-0129 STATE CONTRACTORS LICENSE #644515 TOWN OF TIBURON PUBLIC I•VORKS DEPARTMENT BIDDER'S BOND We, Ghilotti Construction Company, Inc. as Principal, and Safeco Insurance Company of America as Surety are bound unto the Town/ x)(of Tiburon , State of California, hereafter referred to as "Obligee", in the penal sum of ten percent (10%) of the total amount of the bid of the Principal submitted to the Obligee for the work described below, for the payment of which suln we bind ourselves, jointly and scverally, THE CONDITION OF THIS OBLIGATION IS SUCH, THAT: WHEREAS, the Principal is submitted to the Obligee, for 600 Ned's Way Facility (Copy here the exact description of work, including location as it appears on the proposal) for which bids are to be opened at Tiburon, CA on (insert place where bids will be opened) October 20, 2011 (Insert date of bid operring) NOW, THEREFORE, if the Principal is awarded the contract and, within the time and manner required under the specifications, after the prescribed forms are presented to him for signature, enters into a written contract, in the prescribed forni, in confonnance with the bid, and files two bonds with the Obligee, one to guarantee faithful performance of the contract and the other to guarantee payment for labor and materials as provided by law, then this obligation shall be null and void; otherwise, it shall remain in full force. In the event suit is brought upon this bond by the Obligee and judgement is recovered, the Surety shall pay all costs incurred by the Obligee in such suit, including a reasonable attorneys fee to be fixed by the court. Dated: October 3 , 2011 Ghilotti nstruction Corn ny, Inc. omaS Smith Estima'tirlg Manager Principal Safeco Insurance m f America U,~ t By Jan ilgard, Rtto-in fact P-33 SEE ATTACHED CERTIFICATE OF ACKNOWLEDGEMENT State of California County of _ SS On v before rne, a V, G~- U b (licrc ins •t name an~i title f'tl3e atiicer) personally appeared S who proved to me on the basis of satisfactory evidence to be the personpp) whose name} is af-e- subscribed to the within instrument and acknowledged to me thatp-91 he4&y--executed the same in his it horized capacity(i and that by s zcnltheir signature) on the instnment the person(y), or the entity upon behalf of which the persons) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITN SS my hand and officials Sig u or atary P' blic (Notary Seal) LAURA V. HIDALGO Commission # 1805719 Notary Public - California z Sonoma County My Comm. Expires Jul 30, 2012 a C'k't' +"-)a P-34 e ACKNOWLEDGMENT State of California County of Placer ) On October 3, 2011 before me, Kathy Rangel, Notary Public (insert name and title of the officer) personally appeared Jana B. Pilgard who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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. r,~.rr,rM.Nrf~V E--;- KATHY RANGEL COMM. #1828903 do NOTARY PUBLIC • CALIFORNIA a a - PLACER COUNTY r Commission Expires January 27, 2013 Signature (Seal) Premium is for Contract Term and is Subject to Adjustment Based on Final Contract Price TOWN OF TIBURON 9 dPERFO---?A~NCE BOLD (To Accompany Contract) Bond No. 070013539 Premium $13,698.00 WHEREAS, the Town of Tiburon, acting by and through the Deparhnent of Public Works, has awarded to Contractor Ghilotti Construe ion Company , Inc , hereafter designated as the "Contractor", a contract for the work described as follows: 600 Ned's Way Facility 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 $ One Million Six Hundred Eighty Three Thousand Six Hundred Ninety Four & No/100 dollars $1.683.694.00 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. THE CONDITION OF THIS OBLIGATION IS SUCH9 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 full force and virtue. IN WITNESS WHEREOF, We have hereunto set our hands and seals on this 27th day of April , 2012 Correspondence or claims relating to this bond Ghilotti Co u i n o p ny, should be sent to the surety at the following / "1%011CLIU WT. h f otti address: fes en 1001 Fourth Ave., Safeco Plaza Safeco Insuran m f America (SEAL) Seattle, WA 98154 By : Attorney-in-Fact Jana B. Pilgard NOTE: Signatures of those executing for the surety must be properly acknowledged. ,~S _ T FOR APP OV D ANN DANFORTH TOWN ATTORNEY TOWN OF TIBURON A-8 SEE ATTACHED CERTIFICATE OF ACKNOWLEDGEMENT State of California Town/County of SS On before me, (here insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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 of Notary Public (Notary Seal) A-9 ACKNOWLEDGMENT State of California County of Placer On April 27, 2012 before me, Kathy Rangel, Notary Public (insert name and title of the officer) personally appeared Jana B. Pilgard who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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 kaDZIA A A (Seal) KATHY RANGEL V) COMM. #1828903 0 a.._ NOTARY PUBLIC • CALIFORNIA w PLACER COUNTY Commission Expires January 27, 2013 Premium is for Contract Term and is Subject to Adjustment Based on Final Contract Price TOWN OF TIBURON Bond #070013539 WLRPAYM ENT BOND Premium Included (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 Ghilotti Construction Company, Ir1c. hereafter designated as the "Principal", a contract for the work described as follows: 600 Ned's Way Facility 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 One Million Six Hundred Eighty Three Thousand Six Hundred Ninety Four & No/100 dollars $1.683 694.00 _ 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 court. This bond shall inure to the benefit of any of the persons named in Civil Code Section 3181 as to give a right of action to such persons or their assigns in any suit brought upon this bond. Dated: April 27 .20 Correspondence or claims relating to this bond should be sent to the surety at the following address: 1001 Fourth Ave., Safeco Plaza Seattle, WA 98154 Ghilotti omr)anv. Inc. Safedolnsurance Company of America Sure (SEAL By : Attorney-in-Fact Jana B. Pilgard NOTE: Signatures of those executing for the surety must be properly acknowledged. APPROVED AS TO FORM ANN DAN FO RTH A-6 TOWN ATTORNEY TOWN OF TIBURON SEE ATTACHED CERTIFICATE OF ACKNOWLEDGEMENT State of California Town/County of SS On before me, (Here insert name and title of the officer) personally appeared , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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 of Notary Public (Notary Seal) A-7 ACKNOWLEDGMENT State of California County of Placer . On April 27, 2012 before me, Kathy Rangel, Notary Public (insert name and title of the officer) personally appeared Jana B. Pilgard who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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. " w KATHY RA GEL Signature (Seal) COMM. #1828903 V o NOTARY PUBLIC a ~ *CALIFORNIA? PLACER COUNTY . Commission Expires January 27, 2013 ti1•WLY.rLYJVL THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5002134 This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. First National Insurance Company of America General Insurance Company of America Safeco Insurance Company of America POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That First National Insurance Company of America, General Insurance Company of America, and Safeco Insurance Company of America are corporations duly organized under the laws of the State of New Hampshire (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, JANA B. PILGARD, ROBERT D. LAUX, KATHY RANGEL, DONA LISA BUSCHMANN, J. BUSCHMANN, SUSAN FOURNIER . . . . . . . . . . . . . . all of the city of ROSEVILLE , state of CALIFORNIA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have,been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 5th day of March , 2012 O CL d ,1131 N Y d C L v~ CD O M d d ~ M W O L L do O ,4; c` d co ~ 0 C E ~ L c O Z v STATE OF WASHINGTON ss COUNTY OF KING On this 5th day of March , 2012 , before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of First National Insurance Company of America, General Insurance Company of America, and Safeco Insurance Company of America, and that he, as such, being authorized so to do, execute 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 have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. By: KID Riley, Nota ublic This Power of Attorney is made and executed pursuant to and by authority of the following By-law and Authorizations of First National Insurance Company of America, General Insurance Company of America, and Safeco Insurance Company of America, which are now in full force and effect reading as follows: ARTICLE IV - OFFICERS - Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Corporation by their signature and executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomeys-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and biding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, of First National Insurance Company of America, General Insurance Company of America, and Safeco Insurance Company of America do hereby certify that the original power of attorney of which the foregoing is a full 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. First National Insurance Company of America General Insurance Company of America Safeco Insurance Company of America By: Gregory W. Davenport, Assistant Secretary a c~ N d c .y C _ C O v~ W d C E 00 Q M O~ d C OE aM No ;t o ~o O C MO ~o C4 E !V ~M C I Oo 0 e- O19 IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 2 7 thday of Ap r i 1 '20 12 r r~ s t = §S j H g e By: 7`~ -4 ~ David M. Carey, Assistant Secretary POA- FNICA, GICAB SICA LMS_12874_012012 - 3 Company ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/30/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A, CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT NAME: Sawyer & Co. Woodruff HONE FAX P o Ex A/C No 88 Rowland Way, Suite 180 4 E-MAIL ADDRESS: Novato, CA 949 5 46 INSURERS AFFORDING COVERAGE NAIC # (415) 878-2 0 INSURER A : Old Republic General Insurance Corporation 24139 INSURED INSURER B : Ghilotti Construction Company, Inc. INSURER C : 246 Ghilotti Avenue R CA 95407 S t INSURER D : an osa, a INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDL N SUBR VD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY A 1 CG37541208 03/31/2012 03/31/2013 EACH OCCURRENCE $ 2,000,000 r X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ CLAIMS-MADE I-xi OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 21000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 RO- 7 POLICY X P LOC F JECT $ A AUTOMOBILE LIABILITY A1CA37541208 03/31/2012 03/31/2013 COMBINED SINGLE LIMIT Ea accident 1,000 000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON-OWNED AUTOS PerOPERTnDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION ' A 1 CW 94681209 04/02/2012 04/02/2013 OTH -V I X WC STATU A AND EMPLOYERS LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Issued for BID Purposes Only. Re: GCI Job #5429 - 600 Ned's Way Facility Project. General Liability additional insured and primary wording endorsement CG 20 10 07 04, CG 20 37 07 04 and CG EN GN 0029 09 06 attached for review, and can be issued upon award of contract. Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. CERTIFICATE HOLDER CANCELLATION Town of Tiburon Attn: Nicholas T. Nguyen 1505 Tiburon Blvd. Tiburon, CA 94920 ACORD 25 (2010/05) LOAN ID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R REE,SE.NTATI \ © 1'988,-12010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered mal kg of ACORD NAMED INSURED: Ghilotti Construction Company, Inc. POLICY NUMBER: AICG37541208 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) Or Organ izations : Locations Of Covered Operations Town of Tiburon Issued for BID Purposes Only. Re: GCI Job #5429 - 600 Attn: Nicholas T. Nguyen Ned's Way Facility Project. General Liability additional insured and primary wording endorsements CG 20 10 07 04, 1505 Tiburon Blvd. CG 20 37 07 04 and CG EN GN 0029 09 06 attached for Tiburon, CA 94920 review, and can be issued upon award of 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 "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ NAMED INSURED: Ghilotti Construction Company, Inc. POLICY NUMBER: AICG37541208 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 Town of Tiburon Issued for BID Purposes Only. Re: GCI Job #5429 - 600 Ned's Attn: Nicholas T. Nguyen Way Facility Project. General Liability additional insured and 1505 Tiburon Blvd. primary wording endorsements CG 20 10 07 04, CG 20 37 07 04 Tiburon, CA 94920 and CG EN GN 0029 09 06 attached for review, and can be issued upon award of contract. 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 in- at the location designated and described in the clude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad- ganization(s) shown in the Schedule, but only with ditional insured and included in the "products-com- respect to liability for "bodily injury" or "property pleted operations hazard". damage" caused, in whole or in part, by "your work" CG 20 37 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 UNIFORM OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): Town of Tiburon Issued for BID Purposes Only. Re: GCI Job #5429 - 600 Ned's 1505 Tiburon Blvd. Way Facility Project. General Liability additional insured and Tiburon, CA 94920 primary wording endorsements CG 20 10 07 04, CG 20 37 07 04 and CG EN GN 0029 09 06 attached for review, and can be issued upon As required by written contract: award of contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV - Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Ghilotti Construction Company, Inc. Policy Number AICG37541208 Endorsement No. Policy Period 03/31/2012 to 03/31/2013 Endorsement Effective Date: Producer's Name: Producer Number: 4A~~HOaRIV REPRESENTATIVE 04,30/2012 DATE CG EN GN 0029 09 06