HomeMy WebLinkAboutC-3460(N) - Back Bay Science Center, Bid Package #5 (Rough Carpentry)RECORDING REQUESTED BY AND
WHEN RECORDED RETURN TO:
City Clerk
City of Newport Beach
3300 Newport Boulevard
Newport Beach, CA 92663
Recorded in Official Records, Orange County
Tom Daly, Clerk -Recorder
1111111111iIIIIIIIIIIlii11111111111111111111111!11111JIlilIiIIIIIIIIliiI11NO EEE
2007000591992 04:17pm 10/01/07
106 207 N12 1
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
"Exempt from recording fees �Q
pursuant to Government Code Section 27383"
NOTICE OF COMPLETION
NOTICE IS HEREBY GIVEN that the City of Newport Beach, 3300 Newport Boulevard,
Newport Beach, California, 92663, as Owner, and Gamut Framing, Inc., of Montclair,
California, as Contractor, entered into a Contract on March 1, 2006. Said Contract set
forth certain improvements, as follows:
Back Bay Science Center (C-3460)
Work on said Contract was completed, and was found to be acceptable on
September 25. 2007, by the City Council. Title to said property is vested in the Owner,
and the Surety for said Contract is Fidelity and Deposit Company of Maryland.
fiE W s Director
of ewport Beach
VERIFICATION
I certify, under penalty of perjury, that the foregoing is true and correct to the best of my
knowledge.
Executed on a(p _ o� 00 -7 , at Newport Beach, California.
BY
City Clerk
J))
,Et�r
September 25, 2008
Gamut Framing, Inc
4500 Mission Blvd.
Montclair, CA 91763
OFFICE OF THE CITY CLERK
LaVonne M. Harkless, MMC
Subject: Back Bay Science Center (C-3460)
To Whom It May Concern:
On September 25, 2007, the City Council of Newport Beach accepted the work of
the subject project and authorized the City Clerk to file a Notice of Completion, to
release the Labor & Materials Bond 35 days after the Notice of Completion had
been recorded in accordance with applicable portions of the Civil Code, and to
release the Faithful Performance Bond one year after Council acceptance.
The Labor & Materials Bond was released on November 5, 2007. The Surety for the
contract is Fidelity and Deposit Company of Maryland and the bond number is
08748905. Enclosed is the Faithful Performance Bond.
Sincerely,
r2
LaVonne M. Harkless, MMC
City Clerk
enclosure
3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915
Telephone: (949) 644-3005 • Fax: (949) 644-3039 • www. city. newport-beach.ca.us
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT EXECUTED IN FIVE COUNTERPARTS
BOND NO. 08748905
MASTER FORMAL. GONTRACT Pr]Mf U )l'a8C' 7i�•�. TO"i
And ;s SuNlact To Ad74 t s,
CONTRACT NO. 3460
BID PACKAGE #5 - ROUGH CARPENTRY
BOND NO, 08748905
Premium Is For Contract Term
And sas I� an NiaXd To ntra Adjustment
FAITHFUL. PERFORMANCE BOND
�....., On I=ir►aa Contra,.; Fr:r� - The premium charges on this Bond i$ $ 8,957 - 00
being at the rate of $ 14.40/ $8.70 __ thousand of the Contract price.
WHEREAS, the City Council of the City of Newport Beach, State of California, by motion
adopted, awarded to Gamut Framing, Inc., hereinafter designated as the "Principal", a contract for
construction Back Bay Science CenterContract No. 3460 in the City of Newport
Reach, in strict conformity with the plans, drawings, specifications, and other Contract Documents
maintained in the Public Works Department of the City of Newport Beach, all of which are
incorporated herein by this reference.
WHEREAS, Principal has executed or Is about to execute Contract No. 3460 and the
terms thereof require the furnishing of a Bond for the faithful performance of the Contract;
NOW, THEREFORE, we, the Principal, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND
duly authorized to transact business under the laws of the State of
California as Surety (hereinafter "Surety"), are held and firmly bound unto the City of Newport
Beach, in the sum of ($702,000.00) lawful money of the United States of Arneriaa, said sum being
equal to 100%p of the estimated amount of the Contract, to be paid to the City of Newport Beach, 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
present.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal, or the Principal's
heirs, executors, administrators, successors, or assigns, fail to abide by, and well and truly keep
and perform any or all the work, covenants, conditions, and agreements in the Contract
Documents and any alteration thereof made as therein provided on its part, to be kept and
performed at the time and in the manner therein specified, and in all respects according to Its true
intent and meaning, or fails to indemnify, defend, and save harmless the City of Newport Beach, its
officers, employees and agents, as therein stipulated, then, Surety will faithfully perforrn the same,
in an amount not exceeding the sum specified in this Bond; otherwise this obligation shall become
null and void_
N
As a part of the obligation secured hereby, and in addition to the face amount specified in
this Performance Bond, there shall be included costs and reasonable expenses and fees, including
reasonable attorneys fees, incurred by the City, only in the event the City is required to bring an
action in law or equity against Surety to enforce the obligations of this Bond.
Surety, for value received, stipulates and agrees that no change, extension of time,
alterations or additions to the terms of the Contract or to the work to be performed thereunder or to
the specifications accompanying the same shall in any way affect its obligations on this Bond, and
it does hereby waive notice of any such change, extension of time, alterations or additions of the
Contract or to the work or to the specifications.
This Faithful Performance Bond shall be extended and maintained by the Principal in full
force and effect for one (1) year following the date of formal acceptance of the Project by the City.
In the event that the Principal executed this bond as an individual, it is agreed that the
death of any such Principal shall not exonerate the Surety from its obligations under this Bond.
IN WITNESS WHEREOF, this instrument has been duly executed by the Principai and
Surety above named, on the 17TH day of MARCH '2006.
GAMUT FRAMING, INC.
Name of Contractor (Principal)
FIDELITY AND DEPOSIT
COMPANY OF MARYLAND
Name of Surety
801 NORTH BRAND BOULEVARD
PENTHOUSE
GLENDALE, CA 91203
BY : - _ ��,
Auffloorrz `-- naturelTitle
MARK SCAR ATELLI, VICE PRESIDENT
BY:
Authorized nt Sig ature
KAREN JEAN HALL, ATTORNEY-IN-FACT
Address of Surety Print Name and Title
800/347-5679 (PHONE)
818/409-2820 (FAX)
Telephone/Fax
NOTARY ACKNOWLEDGMENTS OF CONTRACTOR AND SURETY MUST BE ATTACHED
State of CALIFORNIA
County of SAN DIEGO _
On 3/17/2006
DATE
personally appeared
before me
DEBORAH D. DAVIS, NOTARY PUBLIC
NAME. TITLE OF OFFICER - F_.G., "JANE DOE, NOTARY PUBLIC'
MARK SCARLATELLI, KAREN JEAN HALL
NAME(S) OF SIGNER(S)
® personally known to me - OR - ® proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is,
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
SEP °frtiF (s)
erson DEBORAH D. DAVIS signature(s) on the instrument the p
Yv COMM. #1412744
-� r NOTARYPUBLIC-CALIFORNIA U or the entity upon behalf of which the
i SAN DIEGO COUNTY person(s) acted, executed the instrument.
c,r•FOas My Comm. Exp. APRIL 21, 2007
WITNESS my hand and official seal.
Ne 5193
NOMM OPTIONAL SECTION
CAPACITY CLAIMED BY SIGNER
I rnnugn statute does not, regUVe rhe rso*a ro
fi! data below, do:r.y sc >,ay prove
..V31 UiiCl ,v (Jergnr-rlyinr �t
trie
1 INDIVIDUAL
CORPORATE OFFICERS?
VICE PRESIDENT
TITLE(S)
PARTNER(S) LIMITEu
GENERA!_
! q r T ORNEY-IN-FA.CT
TRUSTEE(S)
GUARDIAN/CONSERVATOR
j O; H E R — ----- ----
SIGNER IS REPRESENTING:
NAME OF FERSON(S) OR. ENTITGJES�
SIGNATURE OF NOTARY
IN OPTIONAL SECTION
THIS CERTIFICATE MUST BE ATTACHED TO TITLE OR TYPE OF DOCUMENT_
THE DOCUMENT DESCRIBED AT RIGHT: ---- -- - - — —
Though the data requested here is not required by law,
it could prevent fraudulent reattachment of this form.
NUMBER OF PAGES _ DATE OF DOCUMENT
SIGNER(S) OTHER THAN NAMED ABOVE
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENT'S: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the State of Maryland, by M. P. HAMMOND, Vice President, and T. E. SMITH, Assistant Secretary, in
pursuance of authority granted by Article VI, Section 2, of the By -Laws of said Company, w set forth on the reverse
side hereof and are hereby certified to be in full force and effect on the date hereof d s nate, constitute and
appoint John G. MALONEY, Helen MALONEY, Mark D. IATARO r n all of Escondido,
California, EACH its true and lawful agent and Attorney -in- ute or, and on its behalf
4
as surety, and as its act and deed: any and all bon o gs o such bonds or undertakings in
pursuance of these presents, shall be as bis om IN ply, to all intents and purposes, as if they
had been duly executed and ace re o I ers of the Company at its office in Baltimore, Md., in
their own proper pep f atto Issued on behalf of John G. Maloney, Helen Maloney, Mark
D. Iatarola, Karen J at r 2.
The said Assistant " es e eby certify that the extract set forth on the reverse side hereof is a true copy of Article VI,
Section 2, of the By- s said Company, and is now in force.
IN WITNESS WHEREOF, the said Vice -President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 12th day of July, A.D.
2004.
ATTEST:
'y�C DfPpsrf
_ o O
P, IE90 ?
t
Sul,
State of Maryland1 ss:
City of Baltimore f
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
LZ'4'_) By:
T. E. Smith Assistant Secretary
M. P. Hammond vice President
On this 12th day of July, A.D. 2004, before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came M. P. HAMMOND, Vice President, and T. E. SMITH, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being
by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid,
and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of
the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
H,�}On
wwc.o awry
w'.uw
POA -F 012-5012
Dennis R. Hayden Notary Public
My Commission Expires: February 1, 2009
RECORDING REQUESTED BY AND
WHEN RECORDED RETURN TO:
City Clerk
City of Newport Beach
3300 Newport Boulevard
Newport Beach, CA 92663
"Exempt from recording fees
pursuant to Government Code Section 27383"
NOTICE OF COMPLETION
NOTICE IS HEREBY GIVEN that the City of Newport Beach, 3300 Newport Boulevard,
Newport Beach, California, 92663, as Owner, and Gamut Framing, Inc., of Montclair,
California, as Contractor, entered into a Contract on March 1, 2006. Said Contract set
forth certain improvements, as follows:
Back Bay Science Center (C-3460)
Work on said Contract was completed, and was found to be acceptable on
September 25, 2007, by the City Council. Title to said property is vested in the Owner,
and the Surety for said Contract is Fidelity and Deposit Company of Maryland.
PujAc W94(s, Director
City of Newport Beach
VERIFICATION
certify, under penalty of perjury, that the foregoing is true and correct to the best of my
knowledge.
Executed on _ &0 , at Newport Beach, California.
BY
City Clerk
November 5, 2007
Mr. Mark Scarlatelli
Gamut Framing, Inc.
4590 Mission Boulevard
Montclair, CA 91763
OFFICE OF THE CITY CLERK
LaVonne M. Harkless, MMC
Subject: Back Bay Science Center (C-3460) - Bid Package #5 (Rough
Carpentry)
Dear Mr. Scarlatelli:
On September 25, 2007, the City Council of Newport Beach accepted the work of
the subject project and authorized the City Clerk to file a Notice of Completion,
to release the Labor & Materials Bond 35 days after the Notice of Completion had
been recorded in accordance with applicable portions of the Civil Code and to
release the Faithful Performance Bond one year after Council acceptance.
The Notice of Completion was recorded by the Orange County Recorder on
October 1, 2007, Reference No. 2007000591992. The Surety for the contract is
Fidelity and Deposit Company of Maryland, and the bond number is 08748905.
Enclosed is the Labor & Materials Payment Bond.
Sincerely,
LaVonne M. Harkless, MMC
City Clerk
cc: Public Works Department
encl.
3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915
Telephone: (949) 644-3005 • Fax: (949) 644-3039 • www. city. newport-beach. ca. us
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT EXECUTED IN FIVE COUNTERPARTS
BOND NO. 08748905
MASTER FORMAL CONTRACT € RIME MI MLUDED IN PEWOMAMTcu nor,TD
CONTRACT NO. 3460
BID PACKAGE #5 - ROUGH CARPENTRY
BOND NO. 08748905
LABOR AND MATERIALS PAYMENT BOND
WHEREAS, the City Council of the City of Newport Beach, State of California, by motion
adopted, has awarded to Gamut Framing, Inc., hereinafter designated as the "Principal," a
contract for constructicBack Bay Science Center Contract No. 3460 in the City of
Newport Beach, in strict conformity with the pians, drawings, specifications and other Contract
Documents in the office of the Public Works Department of the City of Newport Beach, all of which
are incorporated herein by this reference.
WHEREAS, Principal has executed or is about to execute Contract No. 3460 and the
terms thereof require the furnishing of a bond, providing that if Principal or any of Principal's
subcontractors, shall fail to pay for any materials, provisions, or other supplies used In, upon,
for, or about the performance of the worts agreed to be done, or for any work or labor done
thereon of any kind, the Surety on this bond will pay the same to the extent hereinafter set forth:
NOW, THEREFORE, We the undersigned Principal, and,
FIDELITY AND DEPOSIT COMPANY OF MARYLAND duly authorized to transact
business under the laws of the State of California, as Surety, (referred to herein as "Surety") are
held firmly bound unto the City of Newport Beach, in the sum of ($702,000,00) lawful money of the
United States of America, said sum being equal to 100% of the estimated amount payable by the
City of Newport Beach under the terms of the Contract; for which payment well and truly t0 be
made, we bind ourselves, our heirs, executors and administrators, successors, or assigns, jointly
and severally, firmly by these present.
THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal or the Principal's
subcontractors, fail to pay for any materials, provisions, or other supplies, implements or machinery
used in, upon, for, or about the performance of the work contracted to be done, or for any other
work or labor thereon of any kind, or for amounts due under the Unemployment Insurance Code
with respect to such work or labor, or for any amounts required to be deducted, withheld and paid
over to the Employment Development Department from the wages of employees of the Principal
and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code with respect
to such work and labor, then the Surety will pay for the same, in an amount not exceeding the sum
specified in this Bond, and. also, in case suit is brought to enforce the obligations of this Bond, a
reasonable attorney's fee, to be fixed by the Court as required by the provisions of Section 3250 of
the Civil Code of the State of California.
The Bond shall inure to the benefit of any and all persons, companies, and corporations
entitled to file claims under Section 3181 of the California Civil Code so as to give a right of action
to them or their assigns in any suit brought upon this Bond, as required by and in accordance with
the provisions of Sections 3247 et. seq. of the Civil Code of the State of California.
And Surety, for value received, hereby stipulates and agrees that no change, extension of
time, alterations or additions to the terms of the Contract or to the work to be performed thereunder
or the specifications accompanying the same shall in any wise affect its obligations on this Bond,
and it does hereby waive notice of any such change, extension of time, alterations or additions to
the terms of the Contract or to the work or to the specifications.
In the event that any principal above named executed this Bond as an individual, it is
agreed that the death of any such principal shall not exonerate the Surety from its obligations under
this Bond.
IN WITNESS WHEREOF, this instrument has been duly executed by the above named
Principal and Surety, on the 17TH day of MARCH , 2006.
GAMUT FRAMING, INC.
Name of Contractor (Principal)
FIDELITY AND DEPOSIT
COMPANY OF MARYLAND
Name of Surety
801 NORTH BRAND BOULEVARD
PENTHOUSE
GLENDALE, CA 91203
Address of Surety
800/347-5679 (PHONE)
818/409-2820 (FAX)
Telephone/Fax
BY: 1 --
MARK SCARLATELft , VICE PRESIDENT
Signature
KAREN JEAN..HALL, ATTORNEY-IN-FACT
Print Name and Title
NOTARY ACKNOWLEDGMENTS OF CONTRACTQR AND SURETY MUST BE ATTACHED
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of CALIFORNIA
County of SAN DIEGO
On 3/17/2006 before me.
DATE
DEBORAH D. DAVIS, NOTARY PUBLIC
NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC'
personally appeared MARK SCARLATELLI, KAREN JEAN HALL
NAME(S) OF SIGNER(S)
j personally known to me - OR - ❑ 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 ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
_ - capacity(ies), and that by his/her/their
DEBORAH D.DAVIS signature(s) on the instrument the person(s),
COMM. #1412744
th I t't
OPTIONAL SECTION
CAPACITY CLAIMED BY SIGNER
Though statute does not require the Notary to
fill in the data below, doing so may prove
invaluable to persons relying on the document.
® INDIVIDUAL
® CORPORATE OFFICER(S)
VICE PRESIDENT
TITLE(S)
PARTNER(S) ® LIMITED
® GENERAL
Q ATTORNEY-IN-FACT
® TRUSTEE(S)
® GUARDIAN/CONSERVATOR
® OTHER:
Y NOTARY PUBLIC -CALIFORNIA (D or e en y upon behalf of which the —
SAN DIEGO COUNTY person(s) acted, executed the instrument.
c4hF F" My Comm. Exp. APRIL 21, 2007
-��— SIGNER IS REPRESENTING:
WITNESS my hand and official seal. NAME OF PERSON(S) OR ENTITY(IES)
SIGNATURE OF NOTARY
OPTIONAL SECTION
THIS CERTIFICATE MUST BE ATTACHED TO TITLE OR TYPE OF DOCUMENT
THE DOCUMENT DESCRIBED AT RIGHT:
NUMBER OF PAGES DATE OF DOCUMENT
Though the data requested here is not required by law,
it could prevent fraudulent reattachment of this form.
SIGNER(S) OTHER THAN NAMED ABOVE
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the State of Maryland, by M. P. HAMMOND, Vice President, and T. E. SMITH, Assistant Secretary, in
pursuance of authority granted by Article VI, Section 2, of the By -Laws of said Company, w set forth on the reverse
side hereof and are hereby certified to be in full force and effect on the date hereof d s nate, constitute and
appoint John G. MALONEY, Helen MALONEY, Mark D. IATARO r n all of Escondido,
California, EACH its true and lawful agent and Attorney -in- ute ° ; or, and on its behalf
as surety, and as its act and deed: any and Al bon ° gs o such bonds or undertakings in
pursuance of these presents, shall be as bi om Il ply, to all intents and purposes, as if they
had been duly executed and ac the re o i ers of the Company at its office in Baltimore, Md., in
their own proper pep f o issued on behalf of John G. Maloney, Helen Maloney, Mark
D. Iatarola, Karen J=, at r 2.
The said Assistant es e e certify that the extract set forth on the reverse side hereof is a true copy of Article VI,
Section 2, of the By- s said Company, and is now in force.
IN WITNESS WHEREOF, the said Vice -President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 12th day of July, A.D.
2004.
ATTEST:
�p DEPOSE
_ o ;
State of Maryland
City of Baltimore ss.
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
T. E. Smith Assistant Secretary
M. P. Hammond Vice President
On this 12th day of July, A.D. 2004, before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came M. P. HAMMOND, Vice President, and T. E. SMITH, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being
by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid,
and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of
the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
o�aA
POA -F 012-5012
Dennis R. Hayden Notary Public
My Cominission Expires: February 1, 2009
EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND
"Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice -President, or any of the Senior
Vice -Presidents or Vice -Presidents specially authorized so to do by the Board of Directors or by the Executive Committee,
shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident
Vice -Presidents, Assistant Vice -Presidents and Attorneys -in -Fact as the business of the Company may require, or to
authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations,
policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in
the nature of mortgages,... and to affix the seal of the Company thereto."
CERTIFICATE
I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify
that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that
the Vice -President who executed the said Power of Attorney was one of the additional Vice -Presidents specially authorized
by the Board of Directors to appoint any Attorney -in -Fact as provided in Article VI, Section 2, of the By -Laws of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the
Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on
the 10th day of May, 1990.
RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically
reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or
hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and
binding upon the Company with the same force and effect as though manually affixed."
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company
this 17TH day of MARCH , 2006
Assistant Secretary
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
MASTER FORMAL CONTRACT
CONTRACT NO. 3460
CONTRACT
THIS AGREEMENT, entered into this 1St day of March, 2006, by and between the CITY OF
NEWPORT BEACH, hereinafter "City," and Gamut Framing, Inc., hereinafter "Contractor," is
made with reference to the following facts:
WHEREAS, City has advertised for bids for the following described public work:
MASTER FORMAL CONTRACT
BACK BAY SCIENCE CENTER, BID PACKAGE #5 — (ROUGH CARPENTRY)
Contract No. 3460
WHEREAS, Contractor has been determined by City to be the lowest responsible bidder and
Contractor's bid, and the compensation set forth in this Contract, is based upon Contractor's
careful examination of all Contract documents, plans and specifications.
NOW, THEREFORE, City and Contractor agree as follows:
A. CONTRACT DOCUMENTS The complete Contract for the Project includes all of the
following documents: Notice Inviting Bids, Instructions to Bidders, Proposal, Bidder's Bond,
Non -Collusion Affidavit, Faithful Performance Bond, Labor and Materials Payment Bond,
Permits, General Conditions, Standard Special Provisions and Standard Drawings, Plans
and Special Provisions for Contract No. 3460, Standard Specifications for Public Works
Construction (current adopted edition and all supplements) and this Agreement, and all
modifications and amendments thereto (collectively the "Contract Documents"). The
Contract Documents comprise the sole agreement between the parties as to the subject
matter therein. Any representations or agreements not specifically contained in the
Contract Documents are null and void. Any amendments must be made in writing, and
signed by both parties in the manner specified in the Contract Documents.
B. SCOPE OF WORK Contractor shall perform everything required to be performed, and
shall provide and furnish all the labor, materials, necessary tools, expendable equipment
and all utility and transportation services required for the Project.
All of the work to be performed and materials to be furnished shall be in strict accordance
with the provisions of the Contract Documents. Contractor is required to perform all
activities, at no extra cost to City, which are reasonably inferable from the Contract
Documents as being necessary to produce the intended results.
C. COMPENSATION As full compensation for the performance and completion of the
Project as required by the Contract Documents, City shall pay to Contractor and Contractor
accepts as full payment the sum of ($702,000.00).
This compensation includes:
(1) Any loss or damage arising from the nature of the work,
(2) Any loss or damage arising from any unforeseen difficulties or obstructions in the
performance of the work,
(3) Any expense incurred as a result of any suspension or discontinuance of the work, but
excludes any loss resulting from earthquakes of a magnitude in excess of 3.5 on the
Richter Scale and tidal waves, and which loss or expense occurs prior to acceptance of
the work by City.
D. NOTICE OF CLAIMS Unless a shorter time is specified elsewhere in this Contract, before
making its final request for payment under the Contract Documents, Contractor shall submit
to City, in writing, all claims for compensation under or arising out of this Contract.
Contractor's acceptance of the final payment shall constitute a waiver of all claims for
compensation under or arising out of this Contract except those previously made in writing
and identified by Contractor in writing as unsettled at the time of its final request for
payment.
E. WRITTEN NOTICE Any written notice required to be given under the Contract
Documents shall be performed by depositing the same in the U.S. Mail, postage prepaid,
directed to the address of Contractor and to City, addressed as follows:
CITY
City of Newport Beach
Public Works Department
3300 Newport Boulevard
Newport Beach, CA 92663
Attention: Stephen G. Badum
(949) 644-0000
CONTRACTOR
Gamut Framing, Inc.
4590 Mission Blvd
Montclair, CA. 91763
Attention: Mark Scarlatelli
(909) 517-3333
F. LABOR CODE 3700 LIABILITY INSURANCEContractor, by executing this Contract,
hereby certifies:
"I am aware of the provisions of Section 3700 of the Labor Code which requires every
employer to be insured against liability for Workers' Compensation or undertake self-
insurance in accordance with the provisions of the Code, and I will comply with such
provisions before commencing the performance of the work of this Contract."
G. INSURANCE Insurance is to be placed with insurers with a Best's rating of no less
than A:VII and insurers must be a California Admitted Insurance Company.
Contractor shall furnish City with original certificates of insurance and with original
endorsements effecting coverage required by this Contract. The certificates and
endorsements for each insurance policy are to be signed by a person authorized by that
4
insurer to bind coverage on its behalf. All certificates and endorsements are to be
received and approved by City before work commences. City reserves the right to
require complete, certified copies of all required insurance policies, at any time.
Contractor shall procure and maintain for the duration of the contract insurance against
claims for injuries to persons or damages to property, which may arise from or in
connection with the performance of the work hereunder by Contractor, his agents,
representatives, employees or subcontractors. The cost of such insurance shall be
included in Contractor's bid.
1. Minimum Scope of Insurance
Coverage shall be at least as broad as:
a) Insurance Services Office Commercial General Liability coverage "occurrence"
form number CG 0002 (Edition 11/85) or Insurance Services Office form number
GL 0002 (Edition 1/73) covering Comprehensive General Liability and Insurance
Services Office form number GL 0404 covering Broad Form Comprehensive
General Liability.
b) Insurance Services Office Business Auto Coverage form number CA 0002 0287
covering Automobile Liability, code 1 "any auto" and endorsement CA 0029 1288
Changes in Business Auto and Truckers Coverage forms - Insured Contract.
c) Workers' Compensation insurance as required by the Labor Code of the State of
California and Employers Liability insurance.
2. Minimum Limits of Insurance
Coverage limits shall be no less than:
a) General Liability: $1,000,000.00 combined single limit per occurrence for bodily
injury, personal injury and property damage. If Commercial Liability Insurance or
other form with a general aggregate limit is used, either the general aggregate
limit shall apply separately to this project/location or the general aggregate limit
shall be twice the required occurrence limit.
b) Automobile Liability: $1,000,000.00 combined single limit per accident for bodily
injury and property damage.
c) Workers' Compensation and Employers Liability: Workers' compensation limits
as required by the Labor Code of the State of California and Employers Liability.
3. Deductibles and Self -Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by City.
At the option of City, either: the insurer shall reduce or eliminate such deductibles or
self-insured retentions as respects City, its officers, officials, employees and
volunteers; or Contractor shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses.
4. Other Insurance Provisions
The policies are to contain, or be endorsed to contain, the following provisions:
a) General Liability and Automobile Liability Coverages
City, its officers, agents, officials, employees and volunteers and Construction
Manager are to be covered as additional insureds as respects: liability arising
out of activities performed by or on behalf of Contractor, including the
insured's general supervision of Contractor; products and completed
operations of Contractor; premises owned, occupied or used by Contractor;
or automobiles owned, leased, hired or borrowed by Contractor. The
coverage shall contain no special limitations on the scope of protection
afforded to City, its officers, officials, employees or volunteers and
Construction Manager.
Contractor's insurance coverage shall be primary insurance and/or primary
source of recovery as respects City, its officers, officials, employees and
volunteers and Construction Manager. Any insurance or self-insurance
maintained by City, its officers, officials, employees and volunteers and
Construction Manager shall be excess of the Contractor's insurance and shall
not contribute with it.
iii. Any failure to comply with reporting provisions of the policies shall not affect
coverage provided to City, its officers, agents, officials, employees and
volunteers and Construction Manager.
iv. Contractor's insurance shall apply separately to each insured against whom
claim is made or suit is brought, except with respect to the limits of the
insurer's liability.
v. The insurance afforded by the policy for contractual liability shall include
liability assumed by contractor under the indemnification/hold harmless
provision contained in this Contract.
b) Workers' Compensation and Employers Liability Coverage
The insurer shall agree to waive all rights of subrogation against City, its officers,
agents, officials, employees and volunteers and Construction Manager for losses
arising from work performed by Contractor for City.
c) All Coverages
Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled, rescinded by either party,
reduced in coverage or in limits except after thirty (30) days' prior written notice
by certified mail, return receipt requested, has been given to City.
All of the executed documents referenced in this contract must be returned within ten
(10) working days after the date on the "Notification of Award," so that the City may
review and approve all insurance and bonds documentation.
5. Acts of God
4
Pursuant to Public Contract Code Section 7105, Contractor shall not be responsible for
the repairing and restoring damage to Work, when damage is determined to have been
proximately caused by an Act of God, in excess of 5 percent of the Contract amount
provided that the Work damaged is built in accordance with the plans and
specifications.
6. Right to Stop Work for Non -Compliance
City shall have the right to direct the Contractor to stop work under this Agreement
and/or withhold any payment(s), which become due to Contractor hereunder until
Contractor demonstrates compliance with the requirements of this article.
H. RESPONSIBILITY FOR DAMAGES OR INJURY
City and all officers, employees and representatives thereof, including Construction
Manager, shall not be responsible in any manner: for any loss or damages that may
happen to the Work or any part thereof; for any loss or damage to any of the materials
or other things used or employed in performing the Work, for injury to or death of any
person either workers or the public; or for damage to property from any cause arising
from the construction of the work by Contractor, or its subcontractors, or its workers, or
anyone employed by it.
2. Contractor shall be responsible for any liability imposed by law and for injuries to or
death of any person or damage to property resulting from defects, obstructions or from
any cause arising from Contractor's work on the Project, or the work of any
subcontractor or supplier selected by the Contractor.
3. Contractor shall indemnify, hold harmless, and defend City, its officers and employees
and Construction Manager from and against (1) any and all loss, damages, liability,
claims, allegations of liability, suits, costs and expenses for damages of any nature
whatsoever, including, but not limited to, bodily injury, death, personal injury, property
damages, or any other claims arising from any and all acts or omissions of Contractor,
its employees, agents or subcontractors in the performance of services or work
conducted or performed pursuant to this Contract; (2) use of improper materials in
construction of the Work; or, (3) any and all claims asserted by Contractor's
subcontractors or suppliers on the project, and shall include reasonable attorneys' fees
and all other costs incurred in defending any such claim. Contractor shall not be
required to indemnify City or Construction Manager from the sole negligence or willful
misconduct of City, its officers or employees or Construction Manager.
4. To the extent authorized by law, as much of the money due Contractor under and by
virtue of the Contract as shall be considered necessary by City may be retained by it
until disposition has been made of such suits or claims for damages as aforesaid.
5. Nothing in this article, nor any other portion of the Contract Documents shall be
construed as authorizing any award of attorneys' fees in any action to enforce the terms
of this Contract, except to the extent provided for in H.3, above.
6. The rights and obligations set forth in this Article shall survive the termination of this
Contract.
I. EFFECT OF CONTRACTOR'S EXECUTION Execution of this Contract and all other
Contract Documents by Contractor is a representation that Contractor has visited the
Project Site, has become familiar with the local conditions under which the work is to be
5
performed, and has correlated all relevant observations with the requirements of the
Contract Documents.
J. CONFLICT If there is a conflict between provisions of this Contract and any other
Contract Document, the provisions of this Contract shall prevail.
K. WAIVER A waiver by City or any term, covenant, or condition in the Contract
Documents shall not be deemed to be a waiver of any subsequent breach of the same or
any other term, covenant or condition.
IN WITNESS WHEREOF, the parties hereto have caused this contract to be executed the day
and year first written above.
CITY CLERK
APPROVED AS TO FORM:
A��C_ �--
CITY ATTORNEY
0
CITY OF NEWPORT
A Municipal_QaCpoWl
By:
CONTRACTOR
By.
2
v (Xorpo icer)
Title: Se'lrte-4r-� c;
Print Name:
='jz
Officer)
ALORPM CERTIFICA---" OF LIABILITY INSURAG' -'E DATE 04/14/2006,
PRODUCER (714)979-6543 FAX (/14)549-2943 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wigmore Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2970 Harbor Blvd. #215 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
License #0811959 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Costa Mesa, CA 92626 INSURERS AFFORDING COVERAGE NAIC #
INSURED Gamut Construction Co., Inc. INSURERA: NIC Insurance Co
4590 Mission Blvd. INSURERe Mercury Casualty Com'l
Montclair, CA 91763 INSURERc: American International Spec.
INSURER D: St Paul Travelers 938
INSURER E.
UUVtKAUtS
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.
INSR
ADD'L
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (mmjpptyyj
POLICY EXPIRATIONLTR
LIMITS
GENERAL LIABILITY
SF06CGLOO172800
03/28/2006
03/28/2007
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 50,000
CLAIMS MADE a OCCUR
MED EXP (Any one person) S 5,000
A
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2, 000,000
GEN'L AGGREGATE LIMIT APPLIES PER
_—. --I
PRODUCTS - COMP/OP ATG $ 1 , 000,000
---
pF�UI. I EJC:
POLICY I
--
AUTOMOBILE
LIABILITY
AC11030684
03/21/2006
03/21/2007
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
1,000,000
ALL OWNED AUTOS
X
SCHEDULED
BODILY INJURY $
B
AUTOS
(Per person)
X
HIRED AUTOS
X
NON-OWNEDAUTOS
BODILY INJURY $
(Per accident)
----
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUI O
OTHER THAN EA ACC S
--E
AUTO ONLY : AGG $
EXCESSIUMBRELLA LIABILITY
__i]OCCUR
BE9305751
03/28/2006
03/28/2007
EACH OCCURRENCE $ 4,000,000
❑ CLAIMS MADE
AGGREGATE $ 4,000,000
C
$
DEDUCTIBLE
HX
S
RETENTION S 10,00
$
WORKERS COMPENSATION AND
WC STATU- OTH-
EMPLOYERS' LIABILITY
T T R
E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXE=CUTIVE
OFFICER/MEMBER EXCLUDED?
--
E.L. DISEASE - EA EMPLOYE $
1f yes, describe under
—__--__
E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
HTHED EQUIPMENT
660862X4347
03/28/2006
03/28/2007
$50,000
D
BUSINESS PERSONAL
$12,039
PROPERTY
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
HE CITY, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED PER FORM
LANKET ADDITIONAL INSUREDS - ANF 160(9/2003)
ROJECT: BACK BAY SCIENCE CENTER - CONTRACT # 3460
ANCELLATION NOTICE IS 10 DAYS IN THE EVENT OF NON PAYMENT OF PREMIUM.
CITY OF NEWPORT
PUBLIC WORKS DEPARTMENT
ATTN: SHARI ROOKS
3300 NEWPORT BLVD.
NEWPORT BEACH, CA 92658
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING R WILL X1XCX2X(X? MAIL
30 DAYS WRITTEN NOTICE TO T CERTI CATE HOLDER NAMED TO THE LEFT,
xdGXJkxdM)(kxDx %)0=
AUTHORIZED REPRESENTATIVE
Wigmore Insurance
ACORD 25 (2001/08) /7-/ -,4ACORD CORPORATION 1988
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.\
BLANKET ADDITIONAL INSURED ENDORSEMENT
(EXCLUDING RESIDENTIAL AND HABITATIONAL)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B)
CG 20 10 11 85
Name of Person or Organization: SCHEDULE
Any person or organization that the named insured is obligated by virtue of a
written contract or agreement to provide insurance such as is afforded by this
Policy, provided the Company is notified in writing within 30 days of the
inception of the contract or agreement, or the inception of this policy,
whichever is later.
WHO IS AN INSURED (Section II) Is amended to include as an insured the person or
organization shown in the Schedule, but only with respect to liability arising out of "your work"
for that insured by or for you.
The following additional provisions apply to any entity that is an insured by the terms of this
endorsement:
1. Primary Wording
If required by written contract or agreement: Such insurance as is afforded by this
policy shall be primary insurance, and any insurance or self-insurance maintained by
the above additional insured(s) shall be excess of the insurance afforded to the named
insured and shall not contribute to it.
2. Waiver of Subrogation
If required by written contract or agreement: We waive any right of recovery we may
have against an entity that is an additional insured per the terms of this endorsement
because of payments we make for injury or damage arising out of "your work" done
under a contract with that peron or organization.
3. Neither the coverages provided by this insurance policy nor the provisions of this
endorsement shall apply to' any claim arising out of the sole negligence of any
additional insured or any of their agents/employees.
4. This endorsement does not. apply to any work involving or related to properties
intended for permanent residential or habitational occupancy.
The words "you" and "your" refer to the Named Insured shown in the Declarations.
"Your work" means work or operations performed by you or on your behalf; and materials,
parts or equipment furnished in connection with such work or operations.
ANF 160 (9/2003)
Alkt
MERCURY CASUALTY COMPANY 11 END.# 015
This endorsement forms part of the policy shown below, all other terms and conditions of this policy remain unchanged.
Policy No. AC11030684
Effective Date : 04/15/2006 12:01 A.M.
Named Insured GAMUT CONSTRUCTION CO INC
IT IS AGREED AND UNDERSTOOD THAT THE FOLLOWING ARE LISTED AS
ADDITIONAL INSURED ON ALL THE VEHICLES COVERED BY THIS POLICY:
CITY OF NEWPORT BEACH
PUBLIC WORKS DEPARTMENT
ATTN SHARI ROOKS
3300 NEWPORT BLVD
NEWPORT BEACH, CA 92658
THE CITY, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS
PROJECT: BACK BAY SCIENCE CENTER
IT IS AGREED AND UNDERSTOOD THAT THE FOLLOWING ARE LISTED AS
ADDITIONAL INSUREDS ON ALL THE VEHICLES COVERED BY THIS POLICY:
DOUGLAS E BARNHART, INC
14471 CHAMBERS RD #102
TUSTIN, CA 92708
This agreement applies to this policy, or any continuation, renewal or replacement of this policy by the
Named Insured, or the reinstatement within 30 days of any lapse thereof.
UC -44 /1994 Produ
PRODUCER
STATE
COMPENSATION
INSURANCE
FUND
U-RTHOLDER COPY
P.O. BOX 420807, SAN FRANCISCO,CA 94142,-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 04-05-2006
CITY OF NEWPORT BEACH DEPT OF PUBLIC WORKS
ITS OFFICERS AGENTS AND EMPLOYEES
3300 NEWPORT BLVD
NEWPORT BEACH CA 92663-3816
GROUP: 000046
POLICY NUMBER: 0015449-2005-2
CERTIFICATE ID: 5
CERTIFICATE EXPIRES: 11-06-2006
11-06-2005/11-06-2006
THIS CERTIFICATE SUPERSEDES AND CORRECTS
CERTIFICATE # 3 DATED 03-23-2006
JOB:BACK BAY SCIENCE CENTER
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
tTHORI�ZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-23-2006 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
---ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2006-04-05 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
CITY OF NEWPORT BEACH DEPT OF PUBLIC WORKS
EMPLOYER
GAMUT CONSTRUCTION COMPANY, INC
4590 MISSION BLVD
MONTCLAIR CA 91763
(REV.2-05)
SD
[JLM,CN]
PRINTED : 04-05-2006
SD
JUN -13-2006 11:45 FROM: TO:819496443318 P.1/1
Fax #:
CERTIFICATE OF INSURANCE
CHECKLIST
City of Newport Beach
This checklist is comprised of requirements as outlined by the City of Newport Beach.
Date Received: (0 Cl/ Dept./Contact Received From: `.�rt-iX; ek Y
Date Completed: 3 �, Sent to: .n B f .
Company/Person required o have certificate: �} y f �'
GENERAL LIABILITY
A. INSURANCE COMPANY: (C h A n '
B. AM REST RATING (A: VII or greater).-
C.
reater):C. ADMITTED Company (Must be California Admitted).-
Is
dmitted):Is Company admitted in California? Yes n o
D. LIMITS (Must be $1M or greater): What is limit provided? r,? I a ! jy, 6 cc _
E. PRODUCTS AND COMPLETED OPERATIONS (Must include): Is it included? es ❑ No
F. ADDITIONAL INSURED WORDING TO INCLUDE (The City its
officers, officials, employees and volunteers): Is it included? Fn Yes ❑ No
G. PRIMARY & NON-CONTRIBUTORY WORDING (Must be included):
Is it included? �_,Kes ❑ No
H_ CAUTION! (Confirm that loss or liability of the named insured is not
limited solely by their negligence) Does endorsement include "solely by
negligence" wording? ❑ Yes M4110
I. NOTIFICATION OF CANCELLATION: Although there is a provision that requires notification of
cancellation by certified mail; per Lauren Farley, the City will accept the endeavor wording.
II. AUTOMOBILE LIABILITY
A. INSURANCE COMPANY: MeffCtit
B. AM 13EST RATING (A: VII or greater):
C. ADMITTED COMPANY (Must be California Admitted):
Is Company admitted in California? ,,ff Yes ❑ No
D. LIMITS (Must be $1 M min, BI & PD and $500,000 UM): What is limits provided? .L. A.
E. ADDITIONAL INSURED WORDING TO INCLUDE (The City its
officers, officials, employees and volunteers): Is it included? QY s ❑ No
F. PRIMARY & NON-CONTRIBUTORY WORDING (For Waste Haulers only):
Is it included? wor ❑ Yes ❑ No
G. NOTIFICATION OF CANCELLATION: Although there is a provision that requires notification of
cancellation by certified mail; per Lauren Farley, the City will accept the endeavor wording.
rfr, WORKERS' COMPENSATION
A. INSURANCE COMPANY:
B_ AM BEST RATING (A: VII or greater): _
C. LIMITS: Statutory
D. WAIVER OF SUBROGATION (To include):
HAVE ALL ABOVE REQUIREMENTS BEEN MET?
IF NO WHICH ITEMS NEED TO BE COMPLETED?
Is it Included? es ❑ No
C ❑ Yes No
W .L�a N p �r)-ev �-