HomeMy WebLinkAboutWhitehawk Construction 2014-08-04 �� �����f �
' AGREEMENT I"�'� �$'-0 q 7
FOR
CALVERT DRIVE &WILLOW AVENUE WATER MAIN REPLACEMENT
Specification No. 13-02
THIS AGREEMENT, made this `7�day of , 20�, by and between the City
�—
of Ukiah, Mendocino County, California, hereinafter called the City and
��TE H�}WK CDNSTRUGj7oN
hereinafter called the
Contractor,
WITNESSETH:
WHEREAS, the City has caused to be prepared in accordance with law, specifications, information
provided in attached appendices and other contract documents for the work herein described and shown
and has approved and adopted these contract documents, specifications and information provided in
attached appendices and has caused to be published in the manner and for the time required by law a
notice to bidders inviting sealed proposals for doing the work in accordance with the terms of this contract
and
WHEREAS, the Contractor, in response to the notice to bidders, has submitted to the City a sealed
proposal accompanied by a proposal guaranty in an amount of not less than 10 percent of the bid price
for the construction of the proposed work in accordance with the terms of this contract and
WHEREAS, the City, in the manner prescribed by law, has publicly opened, examined and canvassed the
proposals submitted and as a result has determined and declared the Contractor to be the lowest and
best regular responsible bidder for the work and for the sums named in the proposal,
NOW, THEREFORE, THIS AGREEMENT WITNESSETH:
Article 1 Work to be Done and Contract Davs Allowed.
That the Contractor shall provide all necessary machinery, tools, apparatus and other means of
construction; shall furnish all materials, superintendence, overhead, expenses, all labor and expenses of
whatever nature necessary for completion of the work in conformity with the Special Provisions and other
contract documents hereto attached and according to such instructions as may be given by the Engineer.
The Contractor shall complete the work within thirty (30) working days. Contract days shall be counted
starting with the 10th day following receipt of notice that the contract has been executed by the City.
Contractor, at his or her option, may begin work prior to start of counting contract days, however, in no
event shall the Contractor start work without giving notification to the Engineer at least 72 hours prior to
the start of work, without obtaining an encroachment permit from the City, or without having submitted
certificates of insurance that have been accepted and approved by the Engineer
Article II. Contract Prices
That the City shall pay the Contractor the prices stated in the proposal submitted by the Contractor, for
complete pertormance of the contract by the Contractor. The Contractor hereby agrees to accept the
59
Calvert Drive&Willow Ave.Water Main Replacement Spec. No. 13-02
prices as full compensation for all material and appliances necessary to the work, for all labor and use of
tools and other implements necessary to execute the work contemplated in this contract; for all loss or
damage arising out of the nature of the work or from the action of the elements, or from any unforeseen
obstructions or difficulties which may be encountered in the prosecution of the work; for all risks of every
description connected therewith; for all expenses of the work, as herein specified; for all liability and other
insurance, for all overhead and other expenses incident to the work; all according to the Appendices, the
Special Provisions, the Details, the instructions and the requirements of the City.
Article III. Labor Discrimination.
Attention is directed to Section 1735 of the Labor Code, which reads as follows:
"No discrimination shall be made in the employment of persons upon public works because of the
race, color, national origin or ancestry, or religion of such persons and every contractor for public
works violating this section is subject to all the penalties imposed for a violation of this chapter."
In connection with the performance of work under this contract, the Contractor agrees as follows:
(a) The Contractor will not willfully discriminate against any employee or an applicant for
employment because of race, color, religion, ancestry, or national origin. The Contractor will
take affirmative action to ensure that applicants are employed and that employees are
treated during employment without regard to their race, color, religion, ancestry, or national
origin. Such action shall include, but not be limited to, the following: emp�oyment, upgrading,
demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of
pay or other forms of compensation; and selection for training, including apprenticeship. The
Contractor agrees to post in conspicuous places, available to employees and applicants for
employment, notices to be provided by the awarding authority setting forth the provisions of
this Fair Employment Practice section.
(b) The Contractor will send to each labor union or representative of workers with which he or
she has a collective bargaining agreement or other contract or understanding, a notice, to be
provided by the awarding authority, advising the said labor union or worker's representative
of the Contractor's commitments under this section, to employees and applicants for
employment.
(c) The Contractor will permit access to his or her records of employment, employment
advertisements, application forms and other pertinent data and records by the Fair
Employment Practices Commission, City of Ukiah or any other appropriate agency of the
State of California designated by the awarding authority, for the purposes of investigation to
ascertain compliance with the Fair Employment Practices section of this contract.
(d) A finding of willful violation of the Fair Employment Practices section of this Contract or of
the Fair Employment Practices Act shall be regarded by the awarding authority as a basis
for determining the Contractor to be not a "responsible bidder" as to future contracts for
which such Contractor may submit bids, for revoking the Contractor's pre-qualification rating,
if any and for refusing to establish, reestablish or renew a pre-qualification rating for the
Contractor.
The City of Ukiah shall deem a finding of wiliful receipt of written notice from the Fair
Employment Practices Act to have occurred upon that it has investigated and determined
that the Contractor has violated the Fair Employment Practices Act and has issued an order
under Labor Code Section 1426 or obtained an injunction under Labor Code Section 1429.
Upon receipt of such written notice from the Fair Employment Practices Commission, the
City shall notify the Contractor that unless he or she demonstrates to the satisfaction of the
awarding authority within a stated period that the violation has been corrected, his or her
pre-qualification rating will be revoked at the expiration of such period.
60
Calvert Drive&Willow Ave.Water Main Replacement Spec. No. 13-02
(e) The Contractor agrees that should the City determine that the Contractor has not complied
with the Fair Employment Practices section of this Contract, then pursuant to Labor Code
Section 1735 and 1775 the Contractor shall, as a penalty to the City, forfeit for each
calendar day or portion thereof, for each person who was denied employment as a result of
such non-compliance, the penalties provided in the Labor Code for violation of prevailing
wage rates. Such monies may be recovered from the Contractor. The City may deduct any
such damages from any monies due the Contractor.
(� Nothing contained in this Fair Employment Practices section shall be construed in any
manner of fashion so as to prevent the City or the State of California from pursuing any
other remedies that may be available at law.
(g) Prior to awarding the Contract, the Contractor shall certify to the awarding authority that he
or she has or will meet the following standards for affirmative compliance, which shall be
evaluated in each case by the awarding authority:
(1) The Contractor shall provide evidence, as required by the City that he or she has
notified all supervisors, foremen and other personnel officers in writing of the content of the
anti-discrimination clause and their responsibilities under it.
(2) The Contractor shall provide evidence, as required by the City, that he or she has
notified all sources of employees' referrals (including unions, employment agencies,
advertisements, Department of Employment) of the content of the anti-discrimination clause.
(3) The Contractor shall file a basic compliance report, as required by the City. Willfully false
statements made in such reports shall be punishable as provided by law. The compliance
report shall also spell out the sources of the work force and who has the responsibility for
determining whom to hire, or whether or not to hire.
(4) Personally, or through his or her representatives, the Contractor shall, through
negotiations with the unions with whom he or she has agreements, attempt to develop an
agreement which will:
a. Spell out responsibilities for nondiscrimination in hiring, referral, upgrading and
training.
b. Othenvise implement an affirmative anti-discrimination program in terms of the
unions' specific areas of skill and geography to the end that qualified minority workers
will be available and given and equal opportunity for employment.
(5) The Contractor shall notify the City of opposition to the anti-discrimination clause by
indiwduals, firms or organizations during the period of its pre-qualification.
(h) The Contractor will include the provisions of the foregoing paragraphs 1 through 5 in every
first tier subcontract so that such provisions will be binding upon each such subcontractor.
(i) The "Fair Employment Practices Certification" must be completed and signed prior to the
time of submitting the bid.
61
Calvert Drive&Willow Ave.Water Main Replacement Spec. No. 13-02
Article IV. Parts of the Contract.
That the complete contract consists of the following documents, all of which shall be considered a part of
this agreement.
1. Notice to Bidders
2. Wage Scales
3. General Conditions
4. Technical Specifications
5. Proposal
6. Fair Employment Practices Certification
7. Agreement
8. Contract Bonds
9. Appendices and Construction Details
10. Standard Drawings
IN WITNESS WHEREOF, this contract being executed in duplicate and the parties having caused their
names to be signed by authority of their duly authorized office this � day of _Le;GLruw;I ,
20�. �
CITY OF UKIAH, MENDOCINO COUNTY, CALIFORNIA
By:
ANAGER, CITY OF UKIA
Attest:
ITY CLE , CITY OF KIAH��
/
By: �
��ON RA� "
Attest: l��
Title: �i 7�rr v/
N A
The foregoing contract is approved as to form and legality this �' day of !t�gus f 20�.
—v—'
�
CITY ATTORNEY, CITY OF UKIAH
62
Calvert Drive R Willow Ave.Water Main Replacement Spec. No. 13-02
INDEMNIFICATION AGREEMENT
This Indemnification Agreement is made and entered in Ukiah, Cyalifornia, on ,
20_, by and between the City of Ukiah (Ukiah) and ��1'1 �-rY.u,u+� �ll`�'�i.��fid'�
(Contractor).
Contractor is _/,. �/ �q
LOVIS'�'1"kG�iYl CGti �di2Y'1 rive anQ �1 ��aW �YLONbf mL wG(�iif' Iv�A'Ir(
Q (kC.2YYl 2GI ��afL�fl. 'd 2 for Ukiah.
R
As a condition of issuing the work order, attached hereto, Ukiah requires assurance that Contractor will
protect Ukiah from damage or damage claims which arise from its pertormance of the work.
Accordingly, Contractor agrees as follows:
1. Indemnification. Contractor shall indemnify and hold harmless Ukiah and its officers, agents, and
employees from and against any claim, loss, or damage, including the legal and other costs of defending
against any claim of damage or loss which arises out of the Contractor's negligent or wrongful
pertormance under the work order attached hereto, except for claims, losses, or damages resulting from
the sole and exclusive negligence or other wrongful conduct of Ukiah or its officers, agents and
employees.
CONTRACTOR ��
BY:
TITLE of J�/IE�
63
Calvert Drive&Willow Ave.Water Main Replacement Spec. No. 13-02
CITY OF UKIAH
Mendocino County, Califomia
BOND#3929996
FAITHFUL PERFORMANCE BON❑
KNOW ALL MEN BY THESE PRESENTS,
That we the undersigned, wuirFUn�NK coMRTRtI(:TI[)N
AS PRINCIPAL, and
r_oGnT nnnGOireni inici ionnirF rc�nnpnnrv ,
AS SURETY,
are heid firmly bound unlo THE CITY OF UKIAH, hereinafter called the"City", in the penal sum of
ONE HUNDRED FIFTY FIVE THOUSAND SEVEN HUNDRED
SEVENTY DOLLARS AND ZERO CENTS--- doliars($155.770 00 )
for the payment of which sum we bind ourselves, our heirs, executors, administrators, and successors, jointly
and severally
WHEREAS, the Principal has eniered into a certain ConYrecf with the City, dated .0 n Y �7 , 26�,._,_,
a copy of which is hereto attached and made a part hereof,
NOW,THEREFORE,the condition ot this obligation is such that if the Principal shall in ail respects fully
perform the Contract and afl duly authorized modifications thereof, during its original term and any extensions
thereof that may be grartted and du�ing any guaranty period for which the Contract provides, then this
obligation shail be void; otherwise, it shall remain in full force and effect.
No modification of the Contract or extension of the term thereof, nor any forbearance on the part of the City
shall�n any way release the Principal or the Surety from liahility hereunder. NoYice to the Surety af any such
modification, extension, or for6earance is hereby waived.
IN WITNESS WHEREOF, the aforesaid Principal and Surety have executed this instrument and affixed their
seals hereto, this 9RTH day of n n v ,20 �n
In the presence of:
WITNES����� ��
JI � .
WHI T ION
(SEAL)
ndividual Principai)
a n anx �8�
(Business Address)
pqi � r.FpRO CA 96073
{City/State2�p Code)
64
Calvert Drive&Willow Ave.Water Main Replacement Spec.No. 13-02
WITNESS:
(SEAL}
(Corporate Principaq
(Business Address)
(City/State/Zip Code)
A'fTEST:
(Corporate Principal) Affix
Corporate
Seal
(Business Address)
( ity/Stat ip Code)
R T ERI � INSU NCE MPP.NY
ATTEST:
ANix
COLLEEN MCHUGH ATTORN�Y-IN-FAC Corporate
$@HI
301 E. 4TH STREET
(Business Address)
CINCINNATI. OHIO 45202
(CitylState2ip Codej
The rate of premium on this bond is$ per thousand.
The totai amount of premium charges is$3 337.00
(The above is to be filied in by SureEy Company). (Power of Attorney of person signing for Surety Company
must be attached).
(CERTIFICATE AS Tp CORPORATE PRINCIPAL)
I, , certify that I am the
Secretary of the corporation named as Principal in the foregoing bond; that
who signed the said bond on behalf of the Principal, was then
of said corporation; that I know his sgnature, and that
his signat�re thereto is genuine; and that said bond was du[y signed, sealed, and attested to for and in behalf
of said corporation by authority of its governing body.
Affix Corporate Seal
65
Calvert Drive&Willow Ave.Water Main Replacement Spec. No. 13-02
CALIFORNIA ALL•PURPOSE ACKNOWLEDGMENT
State of California 1
}
County of ShaSta �
On JULY 25. 2014 betore me, Tina Baughman. Notary Public
Oate Here Inserl Name antl Tllle ot Ne OHIce�
personally appeared Colleen McHugh
Name�s)oI519ner(s)
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is/are subscribed to the
wi hin instrument and acknowledged to me that
he�she/they executed the same in his/hedtheir authorized
�.+nnn�.n...,nnn. capacity(ies), and that by his/hedtheir signature(s) on the
TINA BAUGHMAN instrument the person(s), or the entity upon behalf of
Q � COMM. NO. 1948471 � which the person(s) acted, executed the instrument.
NOTARY pUBLIC�CALIFORNIA 9
� SHASTA COUNTY �
MYCOMMISSIONIXPIRE6 I certify under PENALTY OF PERJURY under the laws
AUGUST 1 S, 201 S of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand official seal.
<
Signa ure
Place Nalary Seal Nbave nelve oi Nata Ic
OPT/ONAL
Though the inlormafion below is not required by law, it may prove valuable to persons relying on fhe document
and could prevent fraudulent removal and reattachment of ihis/orm to anofher document.
Description of Attached Document
Title arType of Document: B�ND
DocumentDate: JULY25 2014 NumberofPages:
Signer(s) OtherThan Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual Olndividual
❑ CorporateOfficer—Title(s): OCorporateOfficer—Title�s):
❑ Pariner—O Limited ❑ General ❑Partner—�Limited ❑General
❑ Attorney in Fact • ' ❑Attorney in Fact • '
❑ Trustee Top oF Ihumb here p Trustee Tap al ihumb here
❑ Guardian or Conservator ❑Guardian or Conservator
❑ Other: ❑Other:
Signer Is Representing: Signer Is Representing:
9200)NellonelNO�aryASSOCiellon•93500eSoloAVe.,P.OBOx2902•Chals}troM,CA91313-2402•www.NallonalNatary.org Ilemq590] Feo�de�CellT011-Free1-800�8]BE827
�r���a�w��i�a�v in��u�aruc€ ���n��n��r�
Administrat{ve Office: 309 E 4TH STREET • CIPICINPIAYI,owia ae2o2 0 51S-3G9.5000 o FdX 519-723-2740
The oumber of persons authorized by
this power of attomey is not more than TWO
Mo.O 14681
pOWER OFATTORN�Y
KNOWALLA9ENBYTHESEPRESENTS: ThattheGREATAMERICANINSURANCECOMPANX,acorporationorganjzedendeXistingundar
and by virtue of the Vaws of the State of Ohio,does hereby nominate,consti[u[e and appoint the petson ot persons nanted beloty,each individyally if moic than
one is named,its true and lawful attomey-in-fact,for it and an its name,place and stead to execute on behalf ofthe said Company,as surety,My and aiF 6onds,
undertakings and wntracis of suretyslilp,ot uthe[w[itten obligazions in the nahae tttecenf;pmvided that the liability of the said Company on any such�ond,
undcrtaking or conVact of sureryship exeeuted undu this authority shall not exceed the limit stated below.
N�� Address Limitok'Power
BOTH OF BQTN
COLLEEN McHUGH BOBETiE WINTON REDDING, $10QUOO,pQ0.Q0
CALIFORNIA
Thts Pnwer ofAttomey revokes aIl pr�vious powers issued op behalf of the attomey(s}in-fact named above.
.[I�W[TNESS wH&REOP the GR6AT AMERICAN INS[7RANCE COMPANY has caused these presents to be signa.d and attested�y its appropriate
officers ae�d its co'rporat�seal hereunw affixed tbis 20TH day of JANUARY• 2012 .
, ptt�� GREATA.M&RICAN INSURANCE COMPANY
� '
�tr •g . ,
•�+., �� .--�-.�_ ` -
Avsmnt&cnmry DiroviondSenfoz VlnPrealden�
STATE OF On;O,COL7N7'Y OF HA&IILTON-ss: onNO c.krrcwr+fensn-2+os)
pn��;, 20TH day of dANUARY , 2012 befose me personally appeared DAVID C.KITCHIN,to me
known,being dulp swom,deposes and says that he cesides in Cincinnati,Ohio,ihat he is a Divisional Senior Yce PresidenC of the Bond DiVision of Grea[
American Insurance Compang the Company described in and which executed the above instrumcnt;t6at he knows Ute seal of the said Cbm�uny;Nat the seal
affixed W the said inswment is such coiporate seal;that it was so affixed by authority of his office under the By-Laws of said Company,and d�at be�igned his
name[hereto by like authoriry.
KAflEN L.SHOSNEIM
,� ''s, NDTARYPUBUC SfA7E0FOH10
;�• AIYCOAMMBlIOq�11PINE802-2b18
This Power ofAttomey is granted by authority of the following resolu6ons adopted by the Boazd of DicecWrs of GreatAmerican I��sur�ccCompany
by unanimous written consentdated June 9,2008.
RESOLVED: That the DNisional Prestdent,the severa��ivisiorwl Senio>�ce Presidents,Divtslonai�ce PresldenGS and DivtsoenlAssislant�ce
Presidenfs,or any one oJthem,be and hereby is aulhorized j�'om fime to ttme,!o appoint one or mom Attorneys-in-Fvct to execute on behaFJof the Company,
as surery,arry and all bonds,undertakings and conhacts ofsuretyship,or othe�written obligahons in the nature thereof,'to p'escrrbe their respective duties and
the respective limits of their aulhorlry;and to revoke arry such appointment at arry trme.
RESOLVEp FURTNER: Thai the Compa�ry seai and Ihe signature of any of[he aforenaid o,�cers qnd any SecreWry or Assisfam Secretary of the
Comparry may be q�"ieed by jacsimfle to any power ofattorney or certhcate ofeiUrer given jor the e�cution of arry bond, undertaking,contract ofsureryship,
or Other wriften o6llgafton in the nahve thereof,such signanrre and sea!when sa used betng I+ereby adopted by the Company as the origrnaCygnahrre ofsuch
officer and the origina[seal ajthe Company,to be valid and btnding upon Jhe Company with the same jorce and e�'ect as thovgh mtmually a,�'iced
CERTIFICATION
1,STEPHEN C,BERAHA,Assistant Seccetary of GreatAmerican Insurance Cbmpany,do heceby ce[tify that the foregoing PowaofAttomey and
the Resolutions of the Boazd of Direcrois oE3une 9,2008 have imt been ievoked and aze�w in full fwce eMI effZct_
Signedandsealedt6is Z�� dayof �UL,�-� � z(��1� '
;y�•.�M'�...
��1�
AssurantSecremry
51029PC(d/71)
CITY OF UKIAH
Mendocino County, California
BOND#3929996
PAYMEtJT BOND
KNQW ALL MEN BYTHESE PRESENTS,
That we the undersigned, WHITEHAWK CONSTRUCTION
AS PRINCIPAL, a�d
QRFAT AMFRICAN INSURANCE COMPANY
,AS SURETY,
are held firmly bound unto THE CITY OF UKfAH, hereinafter called the"City" in the penal sum of
ONE HUNDRED FIFTY FIVE THOUSAND SEVEN HUNDRED
SEVENTY DOLLARS AND ZERO CENTS-- dollars($155.770.00 )
for the payment of which sum we bind ourselves, our heirs, executors, administrators, and successors,
joinUy and severally.
WHEREAS,the Principal has entered into a certain Contract with the City, dated JULY 17 2014 ,
a copy of which is hereto attached and made a part hereof,
NOW,THEREFORB,the condition of this obiigation is such that and if the Principal shaA make full payment
to all persons supplying labor, services, materials,or equipment in the prosecution of the work undar the
Contract, in default ot which such persons shali have a direct right of action hereupon; and if the Principal
shall pay or cause to be pafd all saies antl use taxes payable as a result of the perfortnance of the Contract
as well as payment of gasolfne and special motor fuels taxes in the pertormance of the Contract and all
motor vehicle fees required for commercial motor vehicies used in cronnection with the perfonnance of the
Contract, and if the Principal shall fully satisfy all claims, arfsing out of the prosecution of the work under
the Contracf and shall fully indemnify the City for all expenses which it may incur by reason of such ctaims,
includi�g its attorney's fees and court costs, then this obligation shall be void; otherwise, it shall remain in
full force and effect.
No modification of the Contract or extension of the term thereoF, nor any forbearance on the part of the City
shall in any way release the Principal or the Surety from liability hereunder. Notice to the Surety of eny
such modification, extension, or forhearance is hereby waived.
IN WITNESS WHEREOF, the aforesaid Principal and Surety ha�e executed this insirument and affixed
their seais hereto, thiS 25TH d3y Of JULY ,20�_.
In the presence of:
1�RII N S: � WHIT T N
��' � (SEAL)
di idual Principal)
P.O. BOX 181
(Business Address)
p�LO CEDRO.,�({,,Q�073
(City/State/Zip Code)
66
Calvert Drive&Willow Ave.Water Main Replacement Spec.Na. 13-02
wirrress:
(Corporate Principal)
(Business Address)
(CirylstalelZip Code)
AT7EST:
(Corporate Principal) Affix
Seal
(Busineu Address)
(City/Statel ip Code)
G E T A E C SU E CO PANY
ATTEST: G
x
(Co�porate Surety) C rporar.e
COLLEEN MCHUGH ATTORNEY-IN-FACT geai
301 E.4TH STREET
(Business Address)
CINCINNATI OHIO 45202
(City/State/Zip Code)
The rate of premium on this bond is$ per thousantl.
The total amount of premium charges is$3.337.00
(The above is to be filled in by Surety Company). (Power of Attomey of person signing for Surety
Company must 6e atfached).
(CERTIFICATE AS TO CORPORATE PRINCIPAI)
�, , certify that I am the
Secretary of the corporation named as P�incipai in the fo�egoing bond; that
, who signed the said bond on behalf of the Principal,
was then
of said corporation;thai I know his signature, and
that
his signaiure thereto is genuine; and that said bond was duly signed, sealed, and attested to for and in
behalf of safd corporation by authority of its go�erning body.
Affix Corporate Sea
67
Calvert Drive &Wiilow Ave.Water Main Replacament Spec.No. 13•02
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of California 1
County of Shasta �
On JULY 25. 2014 betore me, Tina Baughman. Notary Public
Dale Here Insetl Name antl Tllle ol Ihe Oflice�
personally appeared Colleen McHugh
Neme(s)ol SlgneKs)
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(sj is/are subscribed to ihe
wi�h\ in instrument and acknowiedged to me that
w�N� helshe/they executed the same in his/herftheir authorized
�N TINA BAUGHMAfV capacity(ies), and that by his/her/their signature(s) on the
COMM. NO. 1948471 � instrument the person(s), or the entity upon behalf of
Q � NOTARY PUBLIC-CALIFORNIA p Which the person(s) acted, executed the instrument.
o SHASTACOUNTY
MY COMMISSION EXPIRE6
� AUGUST 15, 2015 I certiiy under PENALTY OF PERJURY under the laws
vwvvwwv�n
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand an ffi ' sea.
Signature
Place Nolary Saal Above netva v�Nate ubllc
OPTIONAL
Though the in/ormation 6elow is not requi�ed by law,it may prove valuable to persons relying on fhe document
and cou/d p2vent fraudulent removal and reattachment of this(orm to another document.
Description of Attached Document
Title orType af Document: B�N�
Document Date: JULY 25, 2014 Numberof Pages: .
Signer(s) OtherThan Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
O CorporateOfficer—Title(s): ❑CorporateOfficer—Title(s):
❑ Partner—p Limited ❑General ❑Partner—O Limited ❑ General
❑ Attorney in Fact • ' ❑Attorney in Fact • '
❑ TfUSt22 Tap oi Ihumh here ❑Trustee Top ol thumb here
❑ Guardian or Conservator ❑Guardian or Conservator
❑ Other: ❑Other:
Signer Is Representing: Signer Is Representing:
�2001NetlanalNO�aeyASOCiellan•9350oe5o�oAVe.,P.0.0oz2402�Cha�svoM,CAe131&2402•www.NallonalNotary.org Ilem#59W Reortler.CallT011-Free1�800E�Ffi621
f3REAT AMERICAN INSURANCE CAMPANI(0
Administretive Office: 301 E 4TH STREET • CINCINNATI,OHIO 45202 � 513-369-5000 • FAX 573-723-2740
The number of persons authorized by
this power of attorney is not more than TWO
No.O 14681
POWER OFATTORNEY
KNOWALLMENBYTHESEPRESENI'S: ThattheGREATAMERICANINSURANCECOMPANY,awrporationorganizedandewstingunder
and by virtue of the laws of the State of Ohio,does hereby nominete,constitute and appoint the person or persons named below,each individueliy if more than
oce is named,its[rue and lawful attomey-in-facy for i[and in its name,place and s[ead to execute on behalf of the said Company,as surety,any and all bonds,
undertakings and contracu of suretyship,or other written obligations in the naNre thereof;provided that the liabiliry of the said Company on any such 6ond,
undertaking or conVac[of suretyship executed under[his au[hority shall mt exceed the limi[s[ated below.
Name Address Limit of Power
BOTH OF BOTH
COLLEEN McHUGH BOBETTE WINTON REDDING, $100,U00,000.00
CALIFORNIA
This Power of Attomey revokes all previous powers�ssued on behalf of the attomey(s)-in-fact named above.
IN W I1NES5 WIIEREOF the GREAT AIvIERICAN INSURANCE COMPANY has caused thue presents to be signed and atcested by its appropriate
ofiioz�s and iis rr;rpora[e seal hereunto affized this 20TH day of JANUARY 2012 .
- Attes! - GREAT AMERiCAN INSURANCE COMPP.NY
9l�'.M�
. ��• ' . �
Assls+anl Secrefary �rvisrana(Semar Vice Prcsldrnt
STA7 i OF CHIO,COUNTY OF HAIvIILTON-ss' onwo c.KrrcHiN(an-an-zaasl
Qn this 20TH day of JANUARY , 2012 ,before me personalty appeared DAVID C.KITC}IIN,to me
known,being duly swom,deposes and says that he�esides in Cincinnaty Ohio,that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Compang the Company described in and which executed the above insWment;[hat he knows the seal of the said Company;Ifiat the seal
aflixed to fhe said ins W men[is such colpora[e seal;that i[was so affixed by authority of his office under the By-Laws of said Company,and Iha[he signed his
name there[o by like authority.
,,,, KAHEN L.GROSHEIM
; xoramwreuc ar�o�oria
;�� MYCOMMI8810N�1iPINESO�2418
This Power ofAttorney is granted by authority of the foilowing resoluuons adopted by the Board ofDirectors of Great American Insurance Company
by unammous written consent dated June 9,2008.
RESOLVED: That!he Orv+sronal President,!he several Drvrsionnl Sen+or�ce Presrdenes,Divisional�ce Presrden[s and D�visanlAssislant�ce
Presidents,or any one of them,be and hereby rs aulhorrzed jrom time 7o dme,to appoint one or more Attarneys-rn-Fact to execuJe on behaljoJthe Comparry,
as surery,any and aJl bonds,andertakings and condacts ofsureryship,or other w�uten oblrgations rn the nature thereof,�to psescnbe thev respective duties and
the respectrve Gmits ojtheir puthonty, and to revoke arry such appoin(ment at any teme.
RESOL VED FURTHER� THa[the Company seal and the signafure of arry of the ajoresaid o�j'icers aiuL any Secretary or AssistantSecrefary ojthe
Comparry may be a_Q'ixed by jacsimrle to ary power oJattorney ar cerHficate of euHer given jor[he executian of arry bond, under[aking,contract of svretyshrp,
or othes wriffen oblrga(wn in!he na[ure lhereaf,such signature and sea7 when sa used bemg hereby adopfed by the Company as the orrgina[aignahnz ojsvch
o,Q'icer andlhe origma7 sea7 ojthe Company,ro be valid anA binding upon!He Comparry wi7h the same force andeJ/'ect ns though mareua[[y affaed
CERTIFICATION
I,STEPAEN C.BERAHA,Ass�stant Secre[ary of GreatAmerican Insurance Company,do hereby certify thatthe foregotng PowaofAttomey and
the Resolutions of the Board of DireCtors of June 9,2008 have not been revoked and are now in full force and effect.
Signed and sealed th�s Z� �� day of ��� , z(�`�I
\ '
��
%�.�c
Asslsmnt Secretary
51029AC(4/11)
ACORDM CERTIFICATE OF LIABILITY INSURANCE o;iZ4iZ 4'
PRO�UCER 530.221.2300 FAX 530.221.2030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Nor Cal Pacific Insurance Services ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
LIC #OD08482 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 494249
Redding, CA 96049-4249 INSURERS AFFORDING COVERAGE NAIC#
INSURED Whitehawk Construction INSURERA Security National Insurance Co 19879
PO Box 181 INSURERB EMC Insurance Companies G9165
Palo Cedro, CA 96073 INSURERC State Compensation Ins Fund G35076
INSURER D
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGA7E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DD' rypE OF INSURANLE POLICV NIIMBER POLICY EFFECTNE POLICY E%PIRATION LIMITS
GENERALLIABILITY NA10 5 9 76 701 OG�OL�ZOZM1 OG�OZ�ZOZS EACHOCCURRENCE E ],�OOO�OO
X COMMERCIALGENERALLIABILITY OAMAGETORENTED $ ZOO�OO
CLAIMS MA�E a OCCUR MED EXP(My one person) $ 5�0p
/� PERSONAL 8 A�V INJURY $ 1�OOO�OOO
GENERALAGGREGATE S Z�OOO�OOO
GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ Z�OOO�OO
X POLICV PR� LOC
JECT
AUTOMOBILELIABILITY 4X94698-15 �6��1�2�14 06�01�2015 COMBINEDSINGLELIMIT
nNVnuro (Eaawdenq $ 1,000,00
ALL OWNED AUTOS BOOILV INJURY
X SCHE�ULEDAUTOS (Pe�person) $
B X HIREOAUTOS
BODILY INJURV $
X NON-OWNEDAUTOS (Petaccitlent)
PROPERNDAMAGE $
(Per accitlent)
GARAGELIABILITY AUTOONLY-EAACCIDENT $
HNYAUTO OTHERTHAN �ACC $
AUTOONLY qGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCWR � CLAIMSMAOE AGGREGATE $
$
DEDUCTIBIE $
RETENTION $ $
WORKERSCOMPENSATIONAND 436-860-12 09/O1/2013 09/O1/2014 X WCSTATU- OTH-
EMPLOYERS'LIABILITY E.L EACMACCIDENT $ Z�OOO�OO
� ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED9 E l DISEASE-EA EMPLOYEE $ 1�OOO�OO
Ifyes,tlesuibeuntler ELDISEASE-POLICVLIMIT $ 1 OOO OO
SPECIAL PROVISION$below � �
OTHER
OESCRIPTON OF OPERATONS/LOCATIONS/VEHICLES/E%CLUSIONS ADDEU BY ENDORSEMENT/SPECIAL PROVISIONS
alvert Drive & Willow Avenue Water Main Replacement, Spec. No. 13-02
ity of Ukiah, its officers, officials, employees and volunteers are included as additional insured as
er the attached endorsement.
10 day notice of cancellation applies to non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANV OF TME ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE
E%PIRATION DATE THEREOF,THE ISSUING INSURER WILI ENUEAVOR TO MAIL
3OY� DAYSWRITTENNOTICETOTHEGERTIFICATEHOLDERNAMEDTOTHELEFT,
C7CY of Ukiah BUTFAILURE HILSUCHNOTICESHALLIMPOSENOOBLIGATIONORLIABILITY
300 Seminary Avenue OFANVKI NTHEINSURER,ITSAGENTSORREPRESENTATIVES.
Ukiah, CA 9 5482-5400 AUTHO IZE PR ATI �
Bobet W
ACORD 25(2001108) FAX: 707.463.6204 OACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement.A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25(2001I08)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ !T CAREFULLY
BLANK�T ADDITIONA,L INaUREDS -
UWNERS, LESSEES Oft CONTRACI"ORS
This entlorsement modifies insurance provided under the following:
COMMERCIAL GENERAI LIA8ILITY COVERAGE PART
SCHEDULE
PoIlcyNUmber: NA7053767ot EndorsementEffective: 06/01/1a 12:Oia.m.
Named lnsured Authorized Representative:
R�CHARD DALE COX {
WHITENAWK CONSTRUCTION ,,..�'
SCHEDULE
Name of Person orOrganization: City of Ukiah, its o�cers, officials,employees and volunteers
Any person or organization thaf the named insured is abligated by virtue of a writfen contract
or agreement fo provide insurance such as is afforded by this po[icy.
Location: CalveA Drive&Willow Avenue Water Main Replacement, Spec. No. 13-02
(If no entry appears above, information required to complete this endorsement will be shown in ihe Declaratio�s as
applicable to this endorsement}
A. Section II—Wfio Is An Irtsured is amended to inciude as an insured the person or organization
shown in the Schedule, but only to the extent that the person or organization shown in the
Schedule is held liable fw your acts a omissions arising out of your ongoing operations performed
forthatinsured.
B. With respect to the insurance affaded to these additional insureds, the following exclusion is
added:
2. Exciusions
This insurence dces not apply to"bodily injury'or"property damage"occurring after:
(1) All work, including materials, paRs or equipment furnished in connection with such work,
on the project(other than service, mainYenance or repairs)to be pertormed by or on
behalfi of fhe additional irisured(s)at the sife of the covered operations has been
completed; or
(2) That portion of'your work"out of which the injury or damage arises has been put to its
intended use by any person or orga�ization other than another contractor or
subconhactor engaged in performing operations for a principal as a part of ihe same
project.
C. The words"you° and"your"refer to fhe Named insured shown in the Declarations.
D. "Your work" means work or operations pertormed by you or on your behalf; and materials, parts or
equipmer�t furnished in connection with such work or operations.
Primarv Wordinq
If required by wriften contract w agreement: Such insurance as is afforded by this policy shall be
primary insurance, and any insurence or self-insurance maintained by the above additional
insured(s)shall be eatcess of the insurance afforded to the named insured and shall not contrlbute
to it.
Waiver of Subroqation
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 ouf of"your work" done under a contract with
that person or organization.
49�0108 0719 May Include Gopyrighted Material of Insurance Services O�ces, Inc. Page 1 of 1
Used with permission
CITY OF UKIAH
MEMORANDUM
DATE: July 31, 2014
TO: David Rapport, City Attorney
FROM: Rick Seanor, Deputy Director of Public Works �1�✓
�
SUBJECT: Calvert Drive and Willow Avenue Water Main Replacement
Specification No. 13-02
Attached you will find the original agreement, bonds, and insurance certificates for the
subject project. I have also attached a copy of the project specifications for your reference.
The insurance documents have been reviewed and approved by Sheri Mannion.
The Contractor for our Calvert Court and WillowAve. water line project submitted only one
original contract for signature. Is this acceptable for signature? Once the contract is fully
executed, I will keep the original as the City's copy and send a photocopy of the contract to
the contractor.
Would you please review these documents and sign where indicated?
Thank you very much for your prompt attention to this matter.
cc: file
� WHITENAW� GONSTRIJGTION
P.O. Sox iSi • Palo Gedro, CA 910013 • (530)541-5944 • Fax 54-5944
License #83i251�A
.r�y as, aoi4 RECEIVED
JUL 2 8 2014
CITY OF UKIAH
Attn: Jazod Thiele DEPT.OF PUBLIC WORKS
City of iJkiah
300 Seminary Ave
Ukiah CA 95482-5400
Re: Contract Bonds, Insurance, Agreement for the
Calvert Dr/LVillow Ave Water Main Replacement Project
Specification No. 13-02
Deaz Jarod:
As requested, enclosed are the following documents for the Calvert Dr/Willow Ave Water Main
Replacement Project:
• � signed cop�s of Agreement
• Payment,Performance, ae��-�vfaantert�ee Bonds
• Insurance certificate's
• Indemnification Agreement
• Business License application with check for$51
Please let us know if you need any other information.
Sincerely,
�UZ�� `-� �
Diana Cox
Owner
WHITEHAWKCONSTRUCTION I ��z$-2D1¢ , scorrva��EVeaNK 2700
P.O.BOX 181 _ �. � _ � �a�nf ��' P O BOX,sa � �
PALO�dEDRO,CA 96073' ' : I ,°�S " YREicq,CA'ssos7 � � -
(530)547-5944 � - W �15 s0 s25112i t _ � .
I �a�t � 7/25/2014-,
pre�� �-6ua `
PAY.TOTHE - -I � � ��� �
ORDE.R�OF City�of Ukiah =.- �� IOUA�h� I«�,�IQ Y _ ' - - � "!51 00' -- g
� � . -- -. . - ' T[��y��/�N'�`�Gl. -- - _ -- -. _--- - ��- � - . -�
Fifty-One and 00/100....+«:.........:— -- ---------- —,..:.».»:.:.,...,,,. ..........:..,,�....:,4�......�
. . . � � - _ � . . .-.: -� . , : _ �'..,< - ,'�;D0ILARSB
�, . : , ' . - ' - . . � � -: �. ,� , � ' ,
City of Ukiah. - a
300 Seminary Ave. . ' °
Ukiah CA 95482-,-. _- �
MEMO ' - � ' - . - � J � - '��`
. � - � - ,- _ _ - - - - - '�.[J�1� �L`-" - r.r . . 'g
- _ ' - ' � 0.UTHORIZEDSIGNAlURE I
��'002700��'-. �: i2i106252�' 05���02646���5n:
WHITEHAWK CONSTRUCTION 2700
City of Ukiah 7/25/2014
6000 � Overhead Expenses:6006 � Licens 51.00
SVB-General Checki 51.00
� CITY OF UKIAH
APPLICATION FOR B USI�VESS LICENS�-
For O�ce Use Only: Business License Number Status:A Classificatian: Category:
Business Name: W►�l i fiG � (AW� ��5�"�Lt ��t'$usiness Phone: 5� �.Sy � -S�tiN
In Care of/Name of Owner�) �('„(G� �Alc � ,L Type of Business: l� GLQ i' 'n�(
Le $I StBtUS: check one ������
g ( ��ole Proprietor; O Partner; O Corporation
Business Location:2��� t"qdd� �e��r.� �-Y� �-�t A �' e�� � n'1 CQ�� �_
S.t�Addre#s� � City State Zip
Malliug Address (�ta�sterent): -I'-� 1S��C (�� �G'�p ���,r�;, �� R( ,�' �,
SS# or Fed ID #� - �J� C�- State Contractor Lic. # or Pesticide Applicator's #:� `Z
State Resale#: State ID # or Ca Drivers License#:
Manager's Name, Address and Phone# f�.t. LJopL `� �L ��) PG,�2 CeG�,N f'�k
�^11�'13 53c� -S�-t'���"I`W
Owner/Emergency Contact Information: �Q� _ Cc����_g�Q'��P1�23
Contract Amount or Estimated Gross Receipts for One year: ��Q`�, U�.^i�
(Gross Receipts include the total amount of sale,service or transaction.Exclusions on cover
Number of Copies needed of Certificate: � Average Number of Employees: �'�" _
Please Read Before Signing
Affidavit of Applicant
I hereby certify,under penalTy of perjury,that the foregoing statements contained in this applicarion aze true and conect to the
best of my knowledge and belie£ I understand that the issuing of Business License Certificate indicates registration and
payment of business license tas as required by the City of iJkiah Municipal Code and all amendments thereto. Issuance of a
license is not an endorsement,nor certification of compliance with other ordinances or laws. Business License may be subject
to revocation or citation pending field inspection compliance with Planning, Building and Fire Departrnents.
i
Date and ' ed t iJki i al' ia,This �� Day of ,20�_
Si ature o A icant rint Name and Title
Do Not Write in This Area-For Offue Use Onlv
Amount Collected
Application Processing(No field inspection required with Planning Approval): $10.00
Field Inspection Administrative Fee(Building and F've Inspection Requued): $40.00
Business License Tax(fee based on annual gross receipts-see attached schedule):
Downtown Improvement District Fee(businesses located in DID only):
TOTAL COLLECTED:
� , .. - -
City of Ukiah Business Emergency Contact Form - -
Ciry of Ukiak
300 Seminary Avenue
Ukia/i, CA 95482
(707)463-6202
Situations such as open doors or windows,vandalism, and burglaries often occur and are discovered after usual business
hours. In these instances the L)kiah Police Deparhnent would need the business owner or an employee to respond to assist
with securing the building and contributing necessary information for report purposes. Situations such as odor or smoke
where a business may be jeopazdized,the LTkiah Fire Department would need to reach someone from the Business
Emergency Contact Form for the business to obtain essential information. The purpose for providing this information to the
iJkiah Police and Fire Department is to assist our public safety agencies in locating business owners or a responsible
employee when and if a problem arises.
Please complete and return this Business Emergency Contact Form.
� � e '
S3o �l 5� -O�
� 9YS-m
In an emergency,contact persons in this order:
Name Phone
� = 0 3
�_� S o - Z 7 f
��,�,� 3a S2 -S3
Misc.Information:
Check appropriate boxes below:
❑Yes �No a a p i61e��- ❑Yes �'No
❑ Burglar ❑ Hold Up ❑ Panic ❑ Fire
,, ,.�
i, . „�. e ��z�
NOTE: All this information is con£idential and stored at our dispatch centec This information is not accessible to anyone
other than our public safety employees and is used for emergency purposes only.