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HomeMy WebLinkAboutGhilotti Construction Company, Inc. 2019-07-05COU #1920-001 CITY OF UKIAH Mendocino County, California AGREEMENT FOR 2019 STREET REHABILITATION PROJECT SPECIFICATION NO. 19-08 THIS AGREEMENT, made this 5th day of iuly , 20 19 by and between the City of Ukiah, Mendocino County, California, hereinafter called the City and Ghilotti Construction Co. hereinafter called the Contractor, WITNESSETH: WHEREAS, the City has caused to be prepared in accordance with law, specifications, drawings and other contract documents for the work herein described and shown and has approved and adopted these contract documents, specifications and drawings 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 Tess 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 Days 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 sixty (60) calendar 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 2019 STREET REHABILITATION PROJECT 55 Spec. No. 19-08 Article II. Contract Prices. That the City shall pay the Contractor the prices stated in the proposal submitted by the Contractor, for complete performance of the contract by the Contractor. The Contractor hereby agrees to accept the 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 Contract Drawings, 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: employment, 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 willful 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. 2019 STREET REHABILITATION PROJECT 56 Spec. No. 19-08 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. (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. (f) (g) 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. 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. Otherwise 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 individuals, 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. 2019 STREET REHABILITATION PROJECT 57 Spec. No. 19-08 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 Rates 3. General Conditions 4. Technical Specifications 5. Proposal 6. Fair Employment Practices Certification 7. Agreement 8. Contract Bonds 9. Contract Drawings and Construction Details 10. Standard Drawings 11. Indemnification Agreement 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 , 20 CITY OF UKIAH, MENDOCINO COUNTY, CALIFORNIA By: CITY MANAGER, CITY OF UKIAH Attest: By: Attest: Title: CITY CLERK, CITY OF UKIAH CONTRACTOR The foregoing contract is approved as to form and legality this day of , 20 CITY ATTORNEY, CITY OF UKIAH 2019 STREET REHABILITATION PROJECT 58 Spec. No. 19-08 INDEMNIFICATION AGREEMENT This Indemnification Agreement is made and entered in Ukiah, California, on July 5th by and between the City of Ukiah (Ukiah) and Ghilotti Construction Company ,20 19 , (Contractor). Contractor is performing work as per the plans and specifications, Spec. No. 19-08, 2019 Street Rehabilitation Project for Ukiah. 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 performance 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 performance 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: 2019 STREET REHABILITATION PROJECT 59 Spec. No. 19-08 CITY OF UKIAH Mendocino County, California FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS, That we the undersigned, AS PRINCIPAL, and AS SURETY, are held firmly bound unto THE CITY OF UKIAH, hereinafter called the "City", in the penal sum of dollars ($ ) for the payment of which sum we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. WHEREAS, the Principal has entered into a certain Contract with the City, dated , 20 a copy of which is hereto attached and made a part hereof, NOW, THEREFORE, the condition of this obligation is such that if the Principal shall in all respects fully perform the Contract and all duly authorized modifications thereof, during its original term and any extensions thereof that may be granted and during any guaranty period for which the Contract provides, and if the Principal shall fully satisfy all claims, arising out of the prosecution of the work under the Contract and shall fully indemnify the City for all expenses which it may incur by reason of such claims, including its attorney's fees and court costs, and if the Principal shall make full payment to all persons supplying labor, services, materials, or equipment in the prosecution of the work under the Contract, in default of which such persons shall have a direct right of action hereupon; and if the Principal shall pay or cause to be paid all sales and use taxes payable as a result of the performance of the Contract as well as payment of gasoline and special motor fuels taxes in the performance of the Contract and all motor vehicle fees required for commercial motor vehicles used in connection with the performance of the Contract, 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 any such modification, extension, or forbearance is hereby waived. IN WITNESS WHEREOF, the aforesaid Principal and Surety have executed this instrument and affixed their seals hereto, this day of 20 In the presence of: WITNESS: (SEAL) (Individual Principal) (Business Address) (City/State/Zip Code) 2019 STREET REHABILITATION PROJECT 60 Spec. No. 19-08 WITNESS: ATTEST: ATTEST: (Corporate Principal) (SEAL) (Business Address) (City/State/Zip Code) (Corporate Principal) Affix Corporate Seal (Business Address) (City/State/Zip Code) (Corporate Surety) Affix Corporate Seal (Business Address) (City/State/Zip Code) The rate of premium on this bond is $ per thousand. The total amount of premium charges is $ (The above is to be filled in by Surety Company). (Power of Attorney of person signing for Surety Company must be attached). (CERTIFICATE AS TO CORPORATE PRINCIPAL) certify that 1 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 signature, and that his signature thereto is genuine; and that said bond was duly signed, sealed, and attested to for and in behalf of said corporation by authority of its governing body. Affix Corporate Seal 2019 STREET REHABILITATION PROJECT 61 Spec. No. 19-08 CITY OF UKIAH Mendocino County, California MATERIAL AND LABOR BOND KNOW ALL MEN BY THESE PRESENTS, That we the undersigned, , AS PRINCIPAL, and , AS SURETY, are held firmly bound unto THE CITY OF UKIAH, hereinafter called the "City" in the penal sum of dollars ($ ) for the payment of which sum we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. WHEREAS, the Principal has entered into a certain Contract with the City, dated 20 , a copy of which is hereto attached and made a part hereof, NOW, THEREFORE, the condition of this obligation is such that if the Principal shall in all respects fully perform the Contract and all duly authorized modifications thereof, during its original term and any extensions thereof that may be granted and during any guaranty period for which the Contract provides, and if the Principal shall fully satisfy all claims, arising out of the prosecution of the work under the Contract and shall fully indemnify the City for all expenses which it may incur by reason of such claims, including its attorneys fees and court costs, and if the Principal shall make full payment to all persons supplying labor, services, materials, or equipment in the prosecution of the work under the Contract, in default of which such persons shall have a direct right of action hereupon; and if the Principal shall pay or cause to be paid all sales and use taxes payable as a result of the performance of the Contract as well as payment of gasoline and special motor fuels taxes in the performance of the Contract and all motor vehicle fees required for commercial motor vehicles used in connection with the performance of the Contract, 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 any such modification, extension, or forbearance is hereby waived. IN WITNESS WHEREOF, the aforesaid Principal and Surety have executed this instrument and affixed their seals hereto, this day of 20 In the presence of: WITNESS: (SEAL) (Individual Principal) (Business Address) (City/State/Zip Code) 2019 STREET REHABILITATION PROJECT 62 Spec. No. 19-08 WITNESS: ATTEST: ATTEST: (SEAL) (Corporate Principal) (Business Address) (City/State/Zip Code) (Corporate Principal) Affix Corporate Seal (Business Address) (City/State/Zip Code) (Corporate Surety) Affix Corporate Seal (Business Address) (City/State/Zip Code) The rate of premium on this bond is $ per thousand. The total amount of premium charges is $ (The above is to be filled in by Surety Company). (Power of Attorney of person signing for Surety Company must be attached). (CERTIFICATE AS TO CORPORATE PRINCIPAL) certify that 1 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 signature, and that his signature thereto is genuine; and that said bond was duly signed, sealed, and attested to for and in behalf of said corporation by authority of its governing body. Affix Corporate Seal 2019 STREET REHABILITATION PROJECT 63 Spec. No. 19-08 DIRECTIONS FOR PREPARATION OF PERFORMANCE AND MATERIAL AND LABOR BOND 1. Individual sureties, partnerships, or corporations not in the surety business will not be acceptable. 2. The name of the Principal shall be shown exactly as it appears in the Contract. 3. The penal sum shall not be less than required by the Specifications. 4. If the Principals are partners or joint venturers, each member shall execute the bond as an individual and state his place of residence. 5. If the Principal is a corporation, the bond shall be executed under its corporate seal. If the corporation has no corporate seal, it shall so state and affix a scroll or adhesive seal following the corporate name. 6. The official character and authority of the person(s) executing the bond for the Principal, if a corporation, shall be certified by the Secretary or Assistant Secretary thereof under the corporate seal, or copies attached to such records of the corporation as will evidence the official character and authority of the officer signing, duly certified by the Secretary or Assistant Secretary, under the corporate seal, to be true copies. 7. The current power-of-attorney of the person signing for the surety company must be attached to the bond. 8. The date of the bond must not be prior to the date of the Contract. 9. The following information must be placed on the bond by the surety company: a. The rate of premium in dollars per thousand; and b. The total dollar amount of premium charged. 10. The signature of a witness shall appear in the appropriate place attending to the signature of each party of the bond. 11. Type or print the name underneath each signature appearing on the bond. 12. An executed copy of the bond must be attached to each copy of the Contract (original counterpart) intended for signing. 2019 STREET REHABILITATION PROJECT 64 Spec. No. 19-08 CITY OF UKIAH Mendocino County, California DEFECTIVE MATERIAL AND WORKMANSHIP (MAINTENANCE) BOND KNOW ALL MEN BY THESE PRESENTS, That we, , as PRINCIPAL and , as SURETY, are held and firmly bound unto the City of Ukiah as Obligee, in the penal sum of (5 PERCENT OF THE FINAL CONTRACT AMOUNT) to which payment well and truly to be made, we do bind ourselves, our and each of our heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents. WHEREAS, the said Principal entered into a Contract with the City Of Ukiah dated for WHEREAS, said Contract has been completed, and was approved on the day of NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall guarantee that the work will be free of any defective materials or workmanship which become apparent during the period of one (1) year following completion of the Contract, then this obligation shall be void, otherwise to remain in full force and effect, provided however, any additional warranty or guarantee whether expressed or implied is extended by the Principal or Manufacturer only, and the surety assumes no liability for such a guarantee. Signed, sealed, and dated this day of , 20 (Seal) BY: (Seal) (Seal) Principal BY: (Seal) (Seal) (Seal) Surety 2019 STREET REHABILITATION PROJECT 65 Spec. No. 19-08 Reproduction of Insurance Services Office, Inc. Form ISSUE DATE (MM/DD/YY) CERTIFICATE OF INSURANCE CITY OF UKIAH PRODUCER THIS AMEND, COMPANY LETTER COMPANY LETTER COMPANY LETTER COMPANY LETTER COMPANY LETTER CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. COMPANIES BEST'S RATING A B INSURED C D E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTAVDING 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MIWDD/YY) EXPIRATION DATE (MMDD/YY) ALL LIMITS IN THOUSANDS GENERAL LIABILITY ❑ COMMERCIAL ❑ CLAIMS MADE ❑ OCCURRENCE ❑ OWNER'S & CONTRACTOR'S PROT ❑ OTHER GENERAL AGGREGATE $ PRODUCTS COMP/OPS AGGREGATE $ PERSONAL & ADVERTISING INJURY $ EACH OCCURANCE $ FIRE DAMAGE (any one fire) $ MEDICAL EXPENSES (any one personl $ AUTOMOTIVE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS ❑ NON -OWNED AUTOS ❑ GARAGE LIABILITY COMBINED SINGLE LIMIT $ BODILY INJURY (per person) $ BODILY INJURY (per accident) $ PROPERTY DAMAGE $ EXCESS LIABILITY ❑ UMBRELLA ❑ OTHER THAN UMBRELLA FORM EACH OCCURRENCE $ AGGREGATE $ 0 WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY STATUTORY EACH ACCIDENT $ DISEASE - POLICY LIMIT $ DISEASE - EACH EMPLOYEE $ PROPERTY DAMAGE 0 COURSE OF CONSTRUCTION AMOUNT OF INSURANCE _ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THE FOLLOWING PROVISIONS APPLY: 1. None of the above-described policies will be canceled until after 30 day's written notice has been given to the City at the address indicated below. 2. The City. its officials, officers, employees, and volunteers are added as insureds on all Liability Insurance Policies listed above. 3. It is agreed that any insurance or self-insurance maintained by the City will apply in excess of and not contribute with. the insurance described above. 4. The City is named a loss payee on The Property Insurance Policies described above, if any. 5. All rights of subrogation under the Property Insurance Policy listed above have been waived against the City. 6. The Worker's Compensation Insurer named above, if any, agrees to waive all rights of subrogation against the City for injuries to employees of the insured resulting from work for the City or use of the City's premises or facilities. Reproduction of Insurance Services Office, Inc. Form INSURER: POLICY NUMBER: ENDORSEMENT NUMBER: COMMERCIAL GENERAL LIABILITY FORM CG 20 10 11 85 (MODIFIED) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Location(s) of Covered Operations City of Ukiah, its officers, officials, employees and volunteers 300 Seminary Avenue Ukiah, CA 95482 If no entry appears above, information required to complete this endorsement will be shown in Declarations as applicable to this endorsement. 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" arising out of "your work" performed for that insured. Modifications to ISO form CG20 10 1185: The insured scheduled above includes the insured's elected or appointed officers, officials, employees and volunteers. This insurance shall be primary as respects the insured shown in the schedule above, or if excess, shall stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event, any other insurance maintained by the Insured scheduled above shall be in excess of this insurance and shall not be called upon to contribute with it. The insurance afforded by this policy shall not be canceled except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subdivision (b) of Section 2782 of the Civil Code. CG 20 10 11 85 Insurance Services Office, Inc. For (Modified) Signature -Authorized Representative Address Phone Number AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT FOR City of Ukiah (the "City") Endorsement No. Issue Date: PRODUCER Telephone: ( ) POLICY INFORMATION: Insurance Company: Policy No.: Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE ` Included in limits E In addition to limits ❑ Deductible ❑ Self Insured Retention (check which) of $ NAMED INSURED APPLICABILITY. This insurance pertains to the operation and/or tenancy of the named insured under all written agreements and permits in force with the City unless checked here C in which case only the following specific agreements and permits with the City are covered: CITY AGREEMENTS/PERMITS TYPE OF INSURANCE COMMERCIAL __. BUSINESS AUTO POLICY 11 OTHER OTHER PROVISIONS LIMIT OF LIABILITY $ per accident, for bodily injury and property damage CLAIMS: Underwriter's representative for claims pursuant to this insurance. Name: Address: Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the polity to which this endorsement is attached or any endorsement now or hereafter attached thereto, it is agreed as follows: 1. INSURED: The City, its officers, officials, employees and volunteers are included as insureds with regard to damages and defense of claims arising from. the ownership operation, maintenance, use, loading or unloading of any auto owned, leaded, hired or borrowed by the Named Insured, or for which the Named Insured is responsible. 2. CONTRIBUTION NOT REQUIRED: As respects work performed by the Named Insured for or on behalf of the City. the insurance afforded by this policy shall: (a) be primary insurance as respects the City, its officers, officials. employees and volunteers; or (b) stand in an unbroken chain of coverage excess of the Named Insureds primary coverage. Any insurance or self-insurance maintained by the City, its officers, officials, employees. and volunteers shall be excess of the Named Insured's insurance and not contribute with it. 3. CANCELLATION NOTICE: With respect to the interests of the City. this insurance shall not be canceled, except after thirty (30) days prior written notice by receipted delivery has been given to the City. 4. SCOPE OF COVERAGE: This policy affords coverage at least as broad as: (1) If primary, insurance Services Office form number CA0001 (Ed. 1/87), Code 1 (Aany auto i; or (2) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding section (1). Except as stated above nothing herein shall be held to waive, alter or extend any of the limits, conditions, agreements or exclusions of the policy to which this endorsement is attached. ENDORSEMENT HOLDER CITY City of Ukiah 300 Seminary Avenue Ukiah, California 95482-5400 AUTHORIZED Broker/Agent II Underwriter ❑ REPRESENTATIVE 1 (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date signed: WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY SPECIAL ENDORSEMENT FOR City of Ukiah ( the "City") Endorsement No. Issue Date: PRODUCER Telephone: ( ) POLICY INFORMATION: Insurance Company: Policy No. Policy Period: (from) (to) NAMED INSURED OTHER PROVISIONS CLAIMS: (Underwriter's representative for claims pursuant to this insurance. Name: EMPLOYERS LIABILITY LIMITS $ __ (Each Accident) $ (Disease - Policy Limit) Address: $ (Disease - Each Employee) Telephone: ( ) In consideration of the premium charged and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, it is agreed as follows: 1. CANCELLATION NOTICE: This insurance shall not be canceled, except after thirty (30) days prior written notice by receipted delivery has been given to the City. 2. WAIVER OF SUBROGATION: This Insurance Company agrees to waive all rights of subrogation against the City, its officer, officials, employees, and volunteers for losses paid under the terms of this policy which arise from the work performed by the Named Insured for the City. Except as stated above nothing herein shall be held to waive, alter or extend any of the limits, conditions, agreements, or exclusions of the policy to which this endorsement is attached. ENDORSEMENT HOLDER CITY City of Ukiah 300 Seminary Avenue Ukiah, California 95482-5400 AUTHORIZED - Broker/Agent I Underwriter _ REPRESENTATIVE 1 (print/type name), warrant that I have authority to bind the above-mentioned insurance company and by my signature hereon do so bind this company to this endorsement. Signature (original signature required) Telephone: ( ) Date signed: