HomeMy WebLinkAboutGhilotti Construction Company, Inc. 2025-08-29 COU No 2526-088
CITY OF UKIAH
Mendocino County, California
AGREEMENT
FOR
FAIRGROUNDS STORM DRAIN REPLACEMENT
SPECIFICATION NO. 25-02
THIS AGREEMENT,made this 18th day of August ,20 25 ,by and between the City of Ukiah,
Mendocino County,California,hereinafter called the City and Ghiiotti Construction Company,Inc.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 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 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
120 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
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
FAIRGROUNDS STORM DRAIN REPLACEMENT 64 Spec No.25-02
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.
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
FAIRGROUNDS STORM DRAIN REPLACEMENT 1% Spec No.25-02
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) 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. 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.
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
FAIRGROUNDS STORM DRAIN REPLACEMENT 66 Spec No.25-02
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 -q day of lak--sT 20 2 S.
CITY OF UKIAH, MENDOCINO COUNTY, CALIFORNIA
By:
O UKIAH
Attest:
CITY CLERK, CITY OF UKIAH
By: ,ON [Ji .r
TRACTOR �IIO .
G7 dcf1-,J lJd•.,(/ �t�t.
h
Attest: r
Title:
The foregoing contract is approved as to form and legality this. day of L 20�
CIT1kA OR7,'cITY QVUKIAH
FAIRGROUNDS STORM DRAIN REPLACEMENT 67 Spec No.25-02
I I
G H I L 0 T T I
Since ' 1914
10�yEAFIS
GHILOTTI CONSTRUCTION COMPANY,INC.
CORPORATE RESOLUTION TO EXECUTE CONTRACTS
WHEREAS, the Board of Directors (the "Board") of Ghilotti Construction
Company, Inc., a California corporation (the "Corporation") deem it desirable and in the
best interests of the Corporation to authorize the following Officers of the Corporation
for the purpose of executing in the name of the Corporation, all bid documents, contract
documents and contract bonds: Richard W. Ghilotti, Chief Executive Officer; Brian W.
Ongaro, President and Secretary; Ali Yazdi, Executive Vice President of Public Works
and Chief Operating Officer; Irving T. Huie, Chief Financial Officer and Treasurer; and
Thomas Smith, Vice President of Estimating.
NOW, THEREFORE, BE IT RESOLVED, that the Directors hereby approve
and appoint Richard W. Ghilotti, Chief Executive Officer; Brian W. Ongaro, President
and Secretary; Ali Yazdi, Executive Vice President of Public Works and Chief Operating
Officer; Irving T. Huie, Chief Financial Officer and Treasurer; and Thomas Smith, Vice
President of Estimating for the purpose of executing in the name of the Corporation, all
bid documents, contract documents and contract bonds.
RESOLVED FURTHER, that any and all actions taken by Richard W. Ghilotti,
Brian W. Ongaro, Ali Yazdi, Irving T. Huie and Thomas Smith in executing said bid
documents and Bidder's Bonds be, and they hereby are, ratified and approved, and all
such Proposals and all such contracts and bonds and documents are hereby adopted as
binding obligations of the Corporation.
Secretary's Certification
The Secretary of the Corporation hereby certifies that he is the duly elected and
qualified Secretary of the Corporation and certifies that the above is a true and correct
record of a Board resolution that was duly adopted by the Corporation's Board of
Directors at a special meeting, which was duly and regularly called and held in all
respects as required by law and by the Corporation's bylaws, and which was held on July
15, 2021.
IN WITNESS WHEREOF, I have hereto set my hand as such Secretary and
affixed the corporate seal of the said Corporation, this 15'h day of July, 2021.
By: —
Brian W ngaro, Secretary
— Engineering Contractor —
246 GHILOTTI AVENUE-SANTA ROSA,CA 95407.707-585-1221 •FAX:707-585-0129
www.ghilotti.com
STATE CONTRACTORS LICENSE$544515
INDEMNIFICATION AGREEMENT
This Indemnification Agreement is made and entered in Ukiah, California, on August 18 20 25
by and between the City of Ukiah (Ukiah)and Ghilotti Construction Company, Inc. (Contractor).
Contractor is
performing work as per Spec 25-02 Fairgrounds Storm Drain Replacement
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: f� _
FAIRGROUNDS STORM DRAIN REPLACEMENT 68 Spec No.25-02
CITY OF UKIAH
Mendocino County, California
PERFORMANCE BOND
BOND No.
KNOW ALL PERSONS BY THESE PREESNTS:
THAT WHEREAS,the City of Ukiah, organized and operating under the laws of the State of California,(hereinafter
referred to as the"City") has awarded to , (hereinafter referred to as the
"Contractor")an agreement for Contract No. (hereinafter referred to as the"Project").
WHEREAS,the work to be performed by the Contractor is more particularly set forth in the Contract for the Project
dated ,(hereinafter referred to,together with all attachments and exhibits thereto,as
"Contract Documents"), the terms and conditions of which are expressly incorporated herein by reference; and
WHEREAS, the Contractor is required by the Contract Documents to perform the terms thereof and to furnish a
bond for the faithful performance of said Contract Documents.
NOW, THEREFORE, we. , the undersigned Contractor and
.as Surety,a corporation organized and duly authorized to transact business under
the laws of the State of California, are held firmly bound until the City in the sum of
($ ), for which amount well and truly to be made,we
bind ourselves, our heirs ,executors and administrators, successors and assigns,jointly and severally, firmly by
these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Contractor, his or its heirs, executors,
administrators,successors or assigns,shall in all things stand to and abide by,and well and truly keep and perform
the covenants,conditions and agreements in the 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 their intent and meaning; and shall faithfully fulfill all obligations; and shall indemnify and save
harmless the City, its officials, officers, employees, and authorized volunteers, as stipulated in said Contract
Documents,then this obligation shall become null and void;otherwise it shall be and remain in full force and effect.
As part of the obligation secured hereby and in addition to the face amount specified therefore, there shall be
included costs and reasonable expenses and fees including reasonable attorneys'fees, incurred by the City in
enforcing such obligation.
As a condition precedent to the satisfactory completion of the Contract Documents,unless otherwise provided for
in the Contract Documents,the above obligation shall hold good for a period of one(1)year after the acceptance
of the work by the City,during which time if Contractor shall fail to make full,complete,and satisfactory repair and
replacements and totally protect the City from loss or damage resulting from or caused by defective materials or
faulty workmanship. The obligations of Surety hereunder shall continue so long as any obligation of Contractor
remains. Nothing herein shall limit the City's rights or the Contractor or Surety's obligations under the Contract
Documents, law or equity, including, but not limited to, California Code of Civil Procedure Section 337.15.
Whenever Contractor shall be, and is declared by the City to be, in default under the Contract Documents, the
Surety shall remedy the default pursuant to the Contract Documents, or shall promptly, at the City's option:
i. Take over and complete the Project in accordance with all terms and conditions in the Contract
Documents; or
ii. Obtain a bid or bids for completing the Project in accordance with all terms and conditions in the
Contract Documents and upon determination by Surety of the lowest responsive and responsible bidder,
arrange for a contract between such bidder, the Surety and the City, and make available as work
progresses sufficient funds to pay the cost of completion of the Project, less the balance of the contract
price, including other costs and damages forwhich Surety may be liable.The term"balance of the contract
FAIRGROUNDS STORM DRAIN REPLACEMENT 69 Spec No.25-02
price"as used in this paragraph shall mean the total amount payable to Contractor by the City under the
Contract and any modification thereto, less any amount previously paid by the City to the Contractor and
any other set offs pursuant to the Contract Documents.
iii. Permit the City to complete the Project in any manner consistent with California law and make
available as work progresses sufficient funds to pay the cost of completion of the Project,less the balance
of the contract price,including other costs and damages for which Surety may be liable.The term"balance
of the contract price"as used in this paragraph shall mean the total amount payable to Contractor by the
City under the Contract and any modification thereto, less any amount previously paid by the City to the
Contractor and any other set offs by the City pursuant to the Contract Documents.
Surety expressly agrees that the City may reject any contractor or subcontractor which may be proposed by Surety
in fulfillment of its obligations in the event of default by the Contractor.
Surety shall not utilize Contractor in completing the Project nor shall Surety accept a bid from Contractor for
completion of the Project if the City,when declaring the Contractor in default,notifies Surety of the City's objection
to Contractor's further participation in the completion of the Project.
The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Contract Documents or to the Project to be performed thereunder shall in any way
affect its obligation on this bond,and it does hereby waive notice of any such change,extension of time,alteration
or addition to the terms of the Contract Documents or to the Project_
[REMAINDER OF PAGE LEFT INTENTIONALLY BLANK)
FAIRGROUNDS STORM DRAIN REPLACEMENT 70 Spec No.25-02
IN WITNESS WHEREOF,we have hereunto set our hands and seals this day of
2022.
(Corporate Seal)
Contractor/Principal
By
Title
(Corporate Seal)
Surety
By
Attorney-in-Fact
(Attach Attorney-in Fact Certificate) Title
The rate of premium on this bond is perthousand.The total amount of premium charges is
(The above must be filled in by corporate attorney.)
THIS IS A REQUIRED FORM.
Any claims under this bond may be addressed to:
(Name and Address of Surety)
(Name and Address of Agent or
Representative for service of process in
California, if different from above)
(Telephone number of Surety and Agent
or Representative for service of process in California)
FAIRGROUNDS STORM DRAIN REPLACEMENT 71 Spec No.25-02
CITY OF UKIAH
Mendocino County, California
PAYMENT BOND
BOND No.
KNOW ALL PERSONS BY THESE PRESENTS:
WHEREAS, the City of Ukiah ("City") has awarded to ("Contractor/Principal") a
contract (City Agreement No. , dated referred to as the
"Agreement") for the work described as . The Agreement is incorporated by this
reference into this Payment Bond ("Bond"); and
WHEREAS, Contractor/Principal is required to furnish a bond in connection with the Agreement and pursuant to
California Civil Code section 9550;
NOW, THEREFORE, we the undersigned
Contractor/Principal, and ("Surety"), a corporation organized and existing under the
laws of the State of and duly authorized to transact business under the laws of the
State of California, as Surety, are held firmly bound until the City, and to any and all persons, companies, or
corporations entitled by law to file stop payment notices under California Civil Code Section 9100,or any person,
company,or corporation entitled to make a claim on this bond, in the sum of$ ,for
which payment will and truly be made,we bind ourselves,our heirs,executors and administrators,successors and
assigns,jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that if Contractor/Principal,its heirs,executors,administrators,
successors,or assigns,or subcontractor,shall fail to pay any person or persons named in Civil Code section 9100;
or fail to pay for any materials, provisions,or other supplies, used in, upon, for, or about the performance of the
work contracted to be done, or for any work or labor thereon of any kind, or for amounts due under the
Unemployment Insurance Code,with respect to work or labor thereon of any kind;or shall fail to deduct,withhold,
and pay over to the Employment Development Department,any amounts required to be deducted,withheld,and
paid over by Unemployment Insurance Code Section 13020 with respect to work and labor thereon of any kind,
then Surety will pay forthe same,in an amount not exceeding the amount herein above set forth,and in the event
suit is brought upon this bond,also will pay such reasonable attorneys'fees as shall be fixed by the court,awarded
and taxed as provided in California Civil Code Section 9550, et seq.
It is further stipulated and agreed that the Surety of this bond shall not be exonerated or released from the
obligation of the bond by any change,extension of time for performance,addition,alteration or modification in,to,
or of any contract, plans, or specifications, or agreement pertaining or relating to any scheme or work of
improvement herein above described; or pertaining or relating to the furnishing of labor, materials, or equipment
therefor; nor by any change or modification of any terms of payment or extension of time for payment pertaining or
relating to any scheme or work of improvement herein above described; nor by any rescissions or attempted
rescission of the contract, agreement or bond; nor by any conditions precedent or subsequent in the bond
attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or
agreement or under the bond;nor by any fraud practiced by any person other than the claimant seeking to recover
on the bond;and that this bond be construed most strongly against the Surety and in favor of all persons for whose
benefit such bond is give;and under no circumstances shall the Surety be released from liability to those forwhose
benefit such bond has been given, by reason of any breach of contract between the Owner and
Contractor/Principal or on the part of any oblige named in such bond;that the sole condition of recovery shall be
that the claimant is a person described in California Civil Code section 9100, and who has not been paid the full
amount of his or her claim;and that the Surety does hereby waive notice of any such change, extension of time,
addition,alteration or modification herein mentioned,including but not limited to the provisions of section 2819 and
2845 of the California Civil Code.
Any notice to Surety may be given in the manner specified in the Agreement and delivered or transmitted to Surety
as follows:
FAIRGROUNDS STORM DRAIN REPLACEMENT 72 Spec No.25-02
Attn:
Address:
City/State/Zip:
Phone:
Fax:
Email:
IN WITNESS WHEREO,two identical counterparts of this Bond,each of which shall for all purposes be deemed an
original thereof, have been duly executed by Contractor/Principal and Surety above named, on the_day of
202_
(SEAL)
Contractor/Principal
By
Contractor's Representative
Contractor/Principal's Address
City,State,Zip
(SEAL)
Surety
By
Surety's Representative
Surety's Address
City,State,Zip
Telephone Number
NOTE:Signatures of those executing for Surety must be properly acknowledged,The bond must be accompanied
by a properly acknowledged Power of Attorney from the Surety authorizing its agent to bind it to this bond.A copy
of such Power of Attorney must be in file with the City.
FAIRGROUNDS STORM DRAIN REPLACEMENT 73 Spec No.25-02
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 tt appears in the Contract.
3. The penal sum shall not be less than required by the Specifications.
4. If the Principals are partners orjoint 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.
FAIRGROUNDS STORM DRAIN REPLACEMENT 74 Spec No.25-02
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
(Seal)
BY: (Seal)
(Seal)
Surety
FAIRGROUNDS STORM DRAW REPLACEMENT 75 Spec No.25-02
CONTRACTORISUBCONTRACTOR WORKER CLASSIFICATION
The California Department of Industrial Relations(DIR) requires a registration number for all contractors and subcontractors who
perform work on public works projects as defined in Labor Code Section 1720. No contractor or subcontractor may be awarded a
contract, on a public works project, unless registered with the Department of Industrial relations pursuant to Labor Code section
1725.5. Additionally, contractor and subcontractor are required to furnish electronic certified payroll record to the Labor
Commissioner.
Revise and resubmit if changes occur with subcontractors during project.
Project No. Project Title
Prime Contractor(All fields must be completed)
Name of Prime Contractor Prime Contractor's License Number Prime Contractor's DIR Registration N
Mailing Address(Street Number or P.O.Box) city State Zip Code
Prime Contractor's Telephone Number Prime Contractor's Email Addres%
Project Manager(Name) Project Manager's Email Address Project Manager's Phone Number
Prime Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
❑TILE WORKERS
❑Check this box to indicate there are no other subcontractors and agree to report any subcontractors if used
while providing services to City of Ukiah.
Prime contractor is to provide a listing of all sub-contractors who have a direct contractual relationship. (only one
subcontractor can be listed per trade).
Subcontractor 1: (All fields must be completed)
Name of Subcontractor Subcontractor's License Number Subcontractors bIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑CARPENTERS
❑ CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑ SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 2: (AII fields must be completed)
Name of Subcontracto Subcontractor's License Number Subcontractor's DIR Registration Number
Mailing Address{Street Number or P.O.Box) City State Zip Code
Subcontractor's Telephone Number 5ubcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑ SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 3: (All fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractor's DIR Registration Number
Mailing Address{Street Number or P.O.Boa) I City State Zip Code
Subcontractors Telephone Number Subcontractor's Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 4: (All fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Boa) Ci[y State Zip Code
Subcontractors Telephone Number Subcontractor's Email Address Work to ge Performed
Sub-Contractor's Contractor's Worker Classifications (select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑CARPENTERS
❑ CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑ SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 5: (All fields must be completed)
Name of Subcontractor Subcontractor's License Number Subcontractor's DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractor's Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 6: (All fields must be completed)
Name of Subcontractor Subcontractor's License Number Subcontractors UIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
11 TILE WORKERS
Subcontractor 7: (All fields must be completed)
Name of Subcontractor Subcontractors license Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to ge Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑ OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 8: (All fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑ SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 9: (Ali fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractor's Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑ OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑ SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 10: (All fields must be completed)
Name of Subcontractor I Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑A513ESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑ OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑SOUND/COMM ❑SURVEYORS ❑TEAMSTER
11 TILE WORKERS
Subcontractor 11:(All fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications(select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
Cl ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑SHEET METAL ❑SOUND/COMM ❑SURVEYORS ❑TEAMSTER
❑TILE WORKERS
Subcontractor 12:(All fields must be completed)
Name of Subcontractor Subcontractors License Number Subcontractors DIR Registration Number
Mailing Address(Street Number or P.O.Box) City State Zip Code
Subcontractors Telephone Number Subcontractors Email Address Work to Be Performed
Sub-Contractor's Contractor's Worker Classifications (select classifications that apply)
❑ASBESTOS ❑ BOILERMAKER ❑ BRICKLAYERS ❑ CARPENTERS
❑ CARPET/LINOLEUM ❑ CEMENT MASONS ❑ DRYWALL FINISHER ❑ DRYWALL/LATHERS
❑ ELECTRICIANS ❑ ELEVATOR MECHANIC ❑ GLAZIERS ❑ IRON WORKERS
❑ LABORERS ❑ MILLWRIGHTS ❑OPERATING ENGINEER ❑ PAINTERS
❑ PILE DRIVER ❑ PIPE TRADES ❑ PLASTERERS ❑ ROOFERS
❑ SHEET METAL ❑SOUND/COMM ❑ SURVEYORS ❑TEAMSTER
0 TILE WORKERS
Reproduction of Insurance Services Office, Inc. Form
CERTIFICATE OF INSURANCE ISSUE DATE (MMIDDIYY)
CITY OF UKIAH
PRODUCER THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT
AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW.
COMPANIES BEST'S RATING
COMPANY
LETTER A
COMPANY
INSURED LETTER B
COMPANY
LETTER C
COMPANY
LETTER D
COMPANY
LETTER E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY POLICY EFFECTIVE EXPIRATION DATE
LTR TYPE OF INSURANCE NUMBER DATE(NM'DDIYY) (MMIDDIYY) ALL LIMITS IN THOUSANDS
GENERAL LIABILITY GENERAL AGGREGATE $
❑ COMMERCIAL PRODUCTS COMPIOPS AGGREGATE; $
❑ CLAIMS MADE
❑ OCCURRENCE PERSONAL&ADVERTISING INJURY S
❑ OWNER'S&CONTRACTOR'S S
PROT. EACH OCCURANCE
❑ OTHER
FIRE DAMAGE(any one fire) $
MEDICAL EXPENSES(any one person) S
AUTOMOTIVE LIABILITY COMBINED SINGLE LIMIT S
❑ ANY AUTO
❑ ALL OWNED AUTOS BODILY INJURY (per person)
❑ SCHEDULED AUTOS S
0 HIRED AUTOS BODILY INJURY (per accident)
❑ NON-OWNED AUTOS 5
❑ GARAGE LIABILITY PROPERTY DAMAGE
5
EXCESS LIABILITY EACH OCCURRENCE
❑ $
UMBRELLA
❑ OTHER THAN AGGREGATE
UMBRELLA FORM $
❑ WORKER'S COMPENSATION STATUTORY
AND EACH ACCIDENT E
EMPLOYER'S LIABILITY DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
PROPERTY DAMAGE AMOUNT OF INSURANCE
❑ COURSE OF CONSTRUCTION S
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS
THE FOLLOWING PROVISIONS APPLY:
1. None of the above-described polities will be canceled unfit 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 nsurance described above.
4. The City is named a loss payee on The Property Insurance Policies described above it any
5. All rights of subrogation under the Property Insurance Policy listed above have been waived against the Gly.
B. The Worker's Compensation Insurer named above,it any agrees to waive all rights of subrogation against the City for njuries to employees of the insured resulting fromworkfor the City or use of theCity's
premises or facilities.
Reproduction of Insurance Services Office, Inc. Form
INSURER: COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: FORM CG 20 10 1185(MODIFIER)
ENDORSEMENT NUMBER:
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) Location(s)of Covered Operations
or Organization(s)
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.
Signature-Authorized Representative
Address
Phone Number
CG 20 10 11 85 Insurance Services Office, Inc. For Modified
AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT Endorsement No.
FOR City of Ukiah (the"City") Issue Date:
PRODUCER POLICY INFORMATION:
Insurance Company:
Policy No.:
Policy Period:(from) (to)
LOSS ADJUSTMENT EXPENSE 'Included in limits
In addition to limits
Telephone: ( ) 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: ,in which case only the following specific
agreements and permits with the City are covered:
CITY AGREEMENTS/PERMITS
TYPE OF INSURANCE OTHER PROVISIONS
COMMERCIAL
BUSINESS AUTO POLICY
OTHER
LIMIT OF LIABILITY CLAIMS: Underwriter's representative for claims pursuant to this insurance.
Name:
Address:
$ per accident,for bodily injury and property damage
Telephone: ( )
In consideration of the premium charged and notwithstanding any inconsistent statement in the polity to wit ch this endorsement s 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 wish regard to damages and defense of claims arising from the ownership operation.maintenance.use.
loading er 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 Insured's primary coverage Any insurance or self-insurence 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: Nth respect to the interests of the City,Iris insurance shall not be canceled,except after thirty(30)days prior written notice by receipled delivery has been given to the City
4. SCOPE Or COVERAGE: This policy affords coverage at least as broad as:
(1) If primary,insurance Services Office form number CA0001(Ed.1187),Code 1(Aany auto');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 AUTHORIZED Broker/Agent 'L Underwriter
REPRESENTATIVE
City of Ukiah
300 Seminary Avenue I (print/type name),warrant that
Ukiah, California 95482-5400 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 POLICY INFORMATION:
Insurance Company:
Telephone- Policy No,
f 1 -— "—
Pol-cy Period: (from) (to)
NAMED INSURED OTHER PROVISIONS
CLAIMS (Underwriter's representative for claims pursuant to this EMPLOYERS LIABILITY LIMITS
insurance.
$ (Each Accident)
Name:
$ (Disease-Policy Limit)
Address:
$ (Disease-Each Employee)
Telephone: f 1
In consideration of the premium charged and notwithstand-ng 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 nsurance shall not be canceled,except after thuty,30j 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 age nst the City,its officer,officials, employees, and volunteers for
losses paid under the terms of this pol cy whrch arise from the work performed by the Named Insured for the City.
Except as stated above nothing herein shall be he'd to we ve alter or extend any of the limits cond lions agreements,or exclusions of the policy to which this endorsement is
attached.
ENDORSEMENT HOLDER
CITY AUTHORIZED t: Broker/Agent ` Underwriter
City of Ukiah REPRESENTATIVE
300 Seminary Avenue t (print/type name),warrant that 1
have authority to bind the above-mentioned insurance company and by my
Ukiah, California 95482-5400 signature hereon do so bind this company to this endorsement.
Signature
(original signature required)
Telephone:f Date signed:
Premium$6,795.00
Premium is for Contract Term Executed'n Duplicate
and is Subject to Adjustment
Based on Final Contract Pnce.
CITY OF UKIAH
Mendocino County,California
PERFORMANCE BOND
BOND No. 070227448
KNOW ALL PERSONS BY THESE PREESNTS:
THAT WHEREAS,the City of Ukiah,organized and operating under the laws of the State of California,(hereinafter
referred to as the "City")has awarded to Ghilotti Construction ComEany,Inc. , (hereinafter referred to as the
"Contractor")an agreement for Contract No. 252H88 (hereinafter referred to as the"Project").
WHEREAS,the work to be performed by the Contractor is more particularly set forth in the Contract forthe Project
dated August 18,2025 ,(hereinafter referred to,togetherwith all attachments and exhibits thereto,as
"Contract Documents"),the terms and conditions of which are expressly incorporated herein by reference;and
WHEREAS, the Contractor is required by the Contract Documents to perform the terms thereof and to furnish a
bond for the faithful performance of said Contract Documents.
NOW, THEREFORE, we, Ghilotti Construction Company,Inc. the undersigned Contractor and
Liberty Mutual Insurance Company ,as Surety,a corporation organized and duly authorized to transact business under
the laws of the State of California, are held firmly bound until the City in the sum of
'See Below ($591.204.00 ),for which amount well and truly to be made,we
bind ourselves,our heirs,executors and administrators,successors and assigns,jointly and severally,firmly by
these presents.
'Five Hundred Ninety One Thousand Two Hundred Four&Noll00
THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Contractor, his or its heirs, executors,
administrators,successors or assigns,shall in all things stand to and abide by,and well and truly keep and perform
the covenants,conditions and agreements in the 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 their intent and meaning; and shall faithfully fulfill all obligations; and shall indemnify and save
harmless the City, its officials, officers, employees, and authorized volunteers, as stipulated in said Contract
Documents,then this obligation shall become null and void;otherwise it shall be and remain in full force and effect.
As part of the obligation secured hereby and in addition to the face amount specified therefore, there shall be
included costs and reasonable expenses and fees including reasonable attorneys'fees, incurred by the City in
enforcing such obligation.
As a condition precedent to the satisfactory completion of the Contract Documents,unless otherwise provided for
in the Contract Documents,the above obligation shall hold good for a period of one(1)year after the acceptance
of the work by the City,during which time if Contractor shall fail to make full,complete,and satisfactory repair and
replacements and totally protect the City from loss or damage resulting from or caused by defective materials or
faulty workmanship.The obligations of Surety hereunder shall continue so long as any obligation of Contractor
remains. Nothing herein shall limit the City's rights or the Contractor or Surety's obligations under the Contract
Documents,law or equity, including, but not limited to,California Code of Civil Procedure Section 337.15.
Whenever Contractor shall be, and is declared by the City to be, in default under the Contract Documents,the
Surely shall remedy the default pursuant to the Contract Documents,or shall promptly,at the City's option:
i. Take over and complete the Project in accordance with all terms and conditions in the Contract
Documents;or
ii. Obtain a bid or bids for completing the Project in accordance with all terms and conditions in the
Contract Documents and upon determination by Surety of the lowest responsive and responsible bidder,
arrange for a contract between such bidder, the Surety and the City, and make available as work
progresses sufficient funds to pay the cost of completion of the Project,less the balance of the contract
price,including other costs and damages for which Surety may be liable.The term"balance of the contract
FAIRGROUNDS STORM DRAIN REPLACEMENT 69 Spec No.25-02
price"as used in this paragraph shall mean the total amount payable to Contractor by the City under the
Contract and any modification thereto,less any amount previously paid by the City to the Contractor and
any other set offs pursuant to the Contract Documents.
iii. Permit the City to complete the Project in any manner consistent with California law and make
available as work progresses sufficient funds to pay the cost of completion of the Project,less the balance
of the contract price,including other costs and damages for which Surety may be liable.The term"balance
of the contract price"as used in this paragraph shall mean the total amount payable to Contractor by the
City under the Contract and any modification thereto,less any amount previously paid by the City to the
Contractor and any other set offs by the City pursuant to the Contract Documents.
Surety expressly agrees that the City may reject any contractor or subcontractor which may be proposed by Surety
in fulfillment of its obligations in the event of default by the Contractor.
Surety shall not utilize Contractor in completing the Project nor shall Surety accept a bid from Contractor for
completion of the Project if the City,when declaring the Contractor in default,notifies Surety of the City's objection
to Contractor's further participation in the completion of the Project.
The Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Contract Documents or to the Project to be performed thereunder shall in any way
affect its obligation on this bond,and it does hereby waive notice of any such change,extension of time,alteration
or addition to the terms of the Contract Documents or to the Project.
(REMAINDER OF PAGE LEFT INTENTIONALLY BLANK)
FAIRGROUNDS STORM DRAIN REPLACEMENT 70 Spec No.25.02
IN WITNESS WHEREOF,we have hereunto set our hands and seals this 19M day of August
We 2025.
(Corporate Seal) Gh lotti Construction Comw .Inc. - y
ContraZ��
By
0
Title
(Corporate Seal) Liberty Mutual Insurance Company
Surety
r^
Ashley White.Attorney-in-A' t
(Attach Attorney-in Fact Certificate) Title Attomey-In-Fact
The rate of premium on this bond is $12.241$7.40 per thousand.The total amount of premium charges is
g 6,795,00
(The above must be filled in by corporate attorney.)
THIS IS A REQUIRED FORM.
Any claims under this bond may be addressed to:
(Name and Address of Surety) Liberty Mutual Surety Claims
100141h Ave.,Suite 3800
Seattle,WA 96154
(Name and Address of Agent or Melissa DeKoven
Representative for service of process in 2710 Gateway Oaks Drive,Suite 150N
California,if different from above) Sacramento,CA 95833-3505
(Telephone number of Surety and Agent (925)979-6705-Ed Campos
or Representative for service of process in California)
FAIRGROUNDS STORM DRAIN REPLACEMENT 7`. Spec No.25-02
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validi of that document.
State of California
County of Placer )
On August 19, 2025 before me, ]oselynn Campbell, Notary Public
(insert name and title of the officer)
personally appeared Ashley White
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal. w� JOSELYNN CAMPBELL
504808
0.•��us_ NOTARY A PUBLIC?CALIFORNIA
�• PLACER COUNTY 0
1 COMM.EXPIRES NOV.19,2028"
Signature (Seal)
Liberty POWER OF ATTORNEY
M�,itti . Certificate Na 8213388-977aa2
Liberty Mutual Insurance Company
SURETY The Ohio Casualty Insurance Company
West American Insurance Company
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire,that
Derry Mutual Insurance Company is a corporation duty organized under the laws of the Slate of Massachusetts,and West American Insurance Company is a corporation duly organized
under the laws of the Stale of Indiana(herein collectively called the'Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Maggie
Honda-Johnson:Dona Lisa 13uschmanu:Josclynn Campb0l;Edward D.Johnson;Robert D.Laux;Kathy Rung]:Julic A.Shironou;Ashtcy Whitc
al of the city of _ Roseville ___stale of CA each Indmdually if there be more than one named,its true and lawful atlomey-in•fact to make,
execute.seal,acknowledge and deliver,for and on its behalf as surety and as its ad and deed.any and all undertakings,bonds,reeognizances and other surety obligations,in pursuance
of these presents and shall be as binding upon the Companies as lf they have been duly s gned by the president and attested by the secretary of the Companies in thew own proper
persons
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 1801 day of March , 2025 .
Liberty Mutual Insurance Company
P� nNSUR�� �tr lgs&. %NSU.t The Ohio Casually Insurance Company
aJ3`o�Oq''�e°tor �J o}pO4�R6�yt� 4 a"*.oN West American Insurance Company
err 1912 � " 1919 n a 1991 � ✓�,�/�f �_
�`� s ,p o f 1a•�IT 1f {r�
B C
�7 a p� Hl a t� ''M • •a Y' 5
wNathan J.Zangede,Assistant Secretary
to State ofPENNSYLVANIA ss
m Canty of MONTGOMERY
On Ihis 111th day of March 2025 before me personally appeared Nathan J.Zangede.who acknowledged h mself to be the Assistant Secretary of Liberty Mutual Insurance
ih7 Company.Thor Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
m�
a IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written.
.y
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0 ►worm.'vaw0 An 0*0 d Nuhras Teresa Pastella,Notary Public
� This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casually Insurance Company.Liberty Mutual Insurance
EC Company,and West American Insurance Company which resolutions are now in full force and effect reading as folk)ws:
? ARTICLE IV-OFFICERS:Section Q.Power of Attomey. t5
`o m
'�� Any officer or other official of the Corporation authored for that purpose in wilting by the Chairman or the President,and subject to such Imflation as the Cho ninon or the President �
L) may prescribe,shall appoint such aticeneys-in-fad,as may be necessary to act In behalf of the Corporation to make,execute,seal,acknowledge and deliver as surely any and all 7n
co C undertakings,bonds recogn izances and other surety obligations.Such attomeys4r►fac.subject to the Imitations set forth in then respective powers of atlemey,shallhave full 1229
c)
o power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such instruments shall
Z c0i be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or anomey-rn-lad under the provisions of this
article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authedty
ARTICLE XIII-Execulfon of Contracts:Section S.Surely Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,
shall appoint such atlomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,
bonds,reeognizenhces and other surely obligations.Such adomeysdn•fact subject to the limitations set forth In their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company.authorizes Nathan J.Zangerte,Assistant Secretary to appoint such
attomeys-io-fad as may be necessary to ad on behalf of the Company to make,execute.seal,acknowledge and deliver as surety any and all undertakings,bonds,recogmzances and
other surely obligations.
Authorization-By unanimous mnsent of the Comparrys Board of Directors.the Carhpany consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company wherever appearing upon a certified copy of any power or attorney issued by the Company in connection with surety bonds,shall be valid and binding tow the Company with
the same face and effect as though manually affixed.
1,Renee C.Llewefyn.the undersigned.Assistant Secretary,The Ohio Casually Insurance Company.Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify,that the origmna power of attomey of which the foregoing is a full,Inle and cared copy of the Power of Attorney executed by said Companies,is in full force and affect and
has not been revoked.
IN TESTIMONY WHEREOF,I halve haeu1110 set my hand and affixed the seals of said Companies this 190% day of August 2025
ttleiJ It 1NSV A 1NSt!
�J��rany�yn y,!•oaro�r� �4*tP*���yC+
12 1919 Aa-
CHO 1991 n c, � ; y• a° sp ��rva+�D� rs ^roux ra B Renee C.O� + hhP 3N1 r �� 3M • AN LI yn,Assistant Secretary LMS•12873 LMnC OCZC WA1C WO Ca 02/24
Premium Included
Executed in Duplicate
CITY OF UKIAH
Mendocino County,California
PAYMENT BOND
BOND No. 070227448
KNOW ALL PERSONS BY THESE PRESENTS:
WHEREAS, the City of Ukiah ("City") has awarded to Ghilotti Construction Company,Inc. ('Contractor/Principal") a
contract (City Agreement No. 2526-088 , dated August 18 — , 2025 , referred to as the
"Agreement") for the work described as 'See Below . The Agreement is incorporated by this
reference into this Payment Bond("Bond?);and
'Fairgrounds Stonn Drain Replacement(Spec 2"2,COU No.252"88)
WHEREAS,Contractor/Principal is required to furnish a bond in connection with the Agreement and pursuant to
California Civil Code section 9550;
NOW, THEREFORE, we Ghrlottr Construction Company.Inc. the undersigned
Contractor/Principal, and Liberty Mutual Insurance Company("Surety"), a corporation organized and existing under the
laws of the State of Massachusetts , and duly authorized to transact business under the laws of the
State of California, as Surety, are held firmly bound until the City, and to any and all persons, companies, or
corporations entitled by law to file slop payment notices under California Civil Code Section 9100,or any person,
company,or corporation entitled to make a claim on this bond,in the sum of$ 591,204.00 _ ,for
which payment will and truly be made,we bind ourselves,our heirs,executors and administrators,successors and
assigns,jointly and severally,firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that if ContractorlPrincipal,its heirs,executors,administrators,
successors,or assigns,or subcontractor,shall fail to pay any person or persons named in Civil Code section 9100;
or fail to pay for any materials, provisions,or other supplies,used in,upon,for,or about the performance of the
work contracted to be done, or for any work or labor thereon of any kind, or for amounts due under the
Unemployment Insurance Code,with respect to work or labor thereon of any kind;or shall fail to deduct,withhold,
and pay over to the Employment Development Department,any amounts required to be deducted,withheld,and
paid over by Unemployment Insurance Code Section 13020 with respect to work and labor thereon of any kind.
then Surety will pay for the same,in an amount not exceeding the amount herein above set forth,and in the event
suit is brought upon this bond,also will pay such reasonable attomeys'fees as shall be fixed by the court,awarded
and taxed as provided in California Civil Code Section 9550,et seq.
It is further stipulated and agreed that the Surety of this bond shall not be exonerated or released from the
obligation of the bond by any change,extension of time for performance,addition,alteration or modification in,to,
or of any contract, plans, or specifications, or agreement pertaining or relating to any scheme or work of
improvement herein above described;or pertaining or relating to the furnishing of labor,materials,or equipment
therefor;nor by any change or modification of any terms of payment or extension of time for payment pertaining or
relating to any scheme or work of improvement herein above described; nor by any rescissions or attempted
rescission of the contract, agreement or bond; nor by any conditions precedent or subsequent in the bond
attempting to limit the right of recovery of claimants otherwise entitled to recover under any such contract or
agreement or under the bond;nor by any fraud practiced by any person other than the claimant seeking to recover
on the bond;and that this bond be construed most strongly against the Surety and in favor of all persons for whose
benefit such bond is give;and under no circumstances shall the Surety be released from liability to those for whose
benefit such bond has been given, by reason of any breach of contract between the Owner and
Contractor/Principal or on the part of any oblige named in such bond;that the sole condition of recovery shall be
that the claimant is a person described in California Civil Code section 9100,and who has not been paid the full
amount of his or her claim;and that the Surety does hereby waive notice of any such change,extension of time,
addition,alteration or modification herein mentioned,including but not limited to the provisions of section 2819 and
2845 of the California Civil Code.
Any notice to Surety may be given in the manner specified in the Agreement and delivered or transmitted to Surety
as follows:
FAIRGROUNDS STORM DRAIN REPLACEMENT 72 Spec No.25.02
Attn: Liberty Mutual Surety C aims
Address: 10014th Ave„Suite 3800
City/State/Zip: Seattle,WA 95154
Phone: (206)473.6210
Fax: (866)547.4880
Email: HOSCL@Libertymutual.com
IN WITNESS WHEREO,two identical counterparts of this Bond,each of which shall for all purposes be deemed an
original thereof, have been duly executed by Contractor/Principal and Surety above named, on the?'day of
August 2025 ,
Ghilotti Construction Company,Inc. (SEAL)
Contractor/Principal
By
C&Iractor'llimpresentative
246 Ghilotti Avenue
ConlractorlPrincipal's Address
Santa Rosa,CA 95407
City,State,Zip
L;be,ly Mutual Insuranoe Company (SEAL)
Surety
Surety's ReprestHnlative
Ashley White,Attorney-In-fact
175 Berkeley Stress
Surety's Address
Boston,kti102116
City,Stale,Zip
Ed Campos-(925)979-6705
Telephone Number
NOTE:Signatures of those executing for Surety must be properly acknowledged,The bond must be accompanied
by a properly acknowledged Power of Attorney from the Surety authorizing its agent to bind it to this bond.A copy
of such Power of Attorney must be in file with the City.
FAIRGROUNDS STORM DRAIN REPLACEMENT 73 Spec No.2"2
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 orjoint 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 seat 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.
FAIRGROUNDS STORM DRAIN REPLACEMENT 7 a Spec No.25-02
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of California
County of Placer )
On August 19, 2025 before me, Joselynn Campbell, Notary Public
(insert name and title of the officer)
personally appeared Ashley White
who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) islare
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s)on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal. JOSt�I YNN CAMPBEEL �
. ' r COMPP. #2504808
_!NOTARY PL18LIC-CALIFORNIA
• PLACER COUNTY 0
111`0 ' COMM,EXPIRES NOV.19,2028"
Signature (Seal)
Liberty POWER OF ATTORNEY
Mutual. Liberty Mutual Insurance Company Certificate No: 8213388.977442
SURETY The Ohio Casualty Insurance Company
West American Insurance Company
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the Slate of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts.and Wes[American Insurance Company is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Companiesl,pursuant to and by authority herein set forth,does hereby name,constitute and appoint. ktu�ie
13cndcr-Johnson:I)ona I:isa Buschmann,Joscl nn Cant bell;Edward 1).Johnson,Ruhort D.Laux;KathyRan cl;Julio A.Shironhe;Ashley While
all of the city of Roseville state o1 CA each mdoridualy if(here be more than one named,its true and lawful attorney-in•fact to make,
execute,seal,acknowledge and delver,for and on its behalf as surety and as its act and dead,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance
of these presents and shall be as binding upon The Companies as'd they have been duty signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF,Us Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this_I Sth day of March . 2025 .
Liberty Mutual Insurance Company
P`rNsu �r lNs` P txsuR* The Ohio Casualty Insurance Company
3`c""�'r° °� �Je��"'r�s� a{<PNr°'h'•o�o� West American Insurance Company
1991
61 rd,�yO•�cNu+�a° °�'`N,rr+"c�a Y� NOUN+ +ai!
9jY . *t► �'t'1 + 4� �M • Fa By: C
Nathan J.Zangede,Assistant Secretary
cC Stale ofPENNSYLVANIA ss
d rn County of MONTGOMERY
v On this I Ndh day of March 2025 before me personally appeared Nathan J.Zangede.who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
- Company.The Ohio Casualty Company.and West American Insurance Company.and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
N�
a IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written.
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�02 or N apAy
rdy canrntrcon axpime Arm 2e,2029 By: ..
4 40"e~112e044
von �..PWMO,N,,,A,D i d,Am„n, Teresa Pastella.Notary Public
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company.Liberty Mutual Insurance +}+
Ec Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows:
d ARTICLE IV-OFFICERS:Section 12.Power of Attorney. ;3
�O ME An officer or other official of the Corporation authorized for that y Corpa purpose In writing by the Chairman or the President and subject to such Imitation as the Chairman or the President �
-Z may prescribe,shall appoint such allom eys-in-fad,as may be necessary to act In behalf of the Corporation to make,execute,seal,aduwwledge and deliver as surety any and at
i v undertakings,bonds,recognizances and other surety obligations.Such allomeys-in-fact,subject to the imitations set forth intheir respective powers of attorney,shall have[ul
t power to bind the Corporation by their signature and execution of any such instruments and to at"thereb the seal of the Corporation.When so executed,such instruments shall qI
Zc0i be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the provisions of this
article may be revoked at any time by the Board,the Chairman,Me President or by the officer or officers granting such poorer or authority. [�3
ARTICLE All-Execution of Contracts:Section 5.Surety Bonds and Urdwiakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and suNed to such Imitations as the chairman or the president may prescribe,
shall appoint such attomeysin-tact,as may be necessary to act in behalf of the Company to make,execute,seal,aduhowledge and deliver as surety any and all undertakings,
bonds,mcognizances and other surety obligations.Such atorneys4n4acl subject to the limitations set forth In their respective powers of attorney,shall have full power to bind the
Company by their signature and execution of any such instruments and io attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes Nathan J.Zangede.Assistant Secretary to appoint such
atomeys-n-fact as may be necessary to ad on behalf of the Company to make,execute,seal,acknowledge and deliver as surety arty and all undertakings,bads,recugmzances and
other surety obligations.
Authorization-By unanimous oonsent of the Companys Board of Directors,the Company wrhsents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company,wherever appearing upon a certified oopy of any power of attorney issued by the Company in connection with surety bonds,shelf be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company.Liberty Mutual Insurance Company.and West American Insurance Company do
hereby certify that the original pourer of attorney of which the foregoing is a M.true arid correct copy of the Power of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have hereunha set my hand and affoced the seek of said Companies this 19ih day of August 2025
hNSUp* %-I INS& N INSU�
1912 0� ;1919 b e 1991 e fff��"'•((��
Mcau+dye �,,,,,•+gip rah�'OjxN►aaa By Renee C.Llewellyn.Assistant Secretary
T t h �/! ► 1, M w �
r.MS.12873 LMIC oCIC WAIL MuIR co ooze