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ENC2008-00049Apr-07-2008 11:26am From-AZTEC 925 637 16F' T-638 P.003 F-168 ':Print~Forrri" ~ ENCROACHMENT PERMIT Permit No ~ ~ 26o~~GG~ QTY QF CAMPBELL ~ DEPT. of PUBLIC WORKS {for working within the public ~y' X-Ref. Pile 7o North First street right-of• ay) Application Date ^ ~ ° Camplaetl,CA95ooe r ~ ~ ~ Application Ex (ration Date (~ °~ Pn. (ao8fse6-2150 issued APN,~~ Fx. (Q08) 376-095$ p , /// / /~ f7 Permit Ex iaation Date ` ~ ~ ~-(/ (1 APPLICATION -Application Is hereby made for a Publle Works Permit in accordance with Ca pbell Municipal Cade, Section 17 .U4. {Application expires In six {6) months if the permit is not issued. Application Fee lsnon-refundable.) A, work Address or Tract No: ~ (~j0 V f l~C~t rv i !1~ 1'~-J +.~ Uti4ry 7reneh Location: ~ W p ~ ~ (~ ~] i ~.~ B. Nature of Work: ~ X (-mfr! ~ p ~. (~ ~ ~ G r"I O N l=D'~ -~D 1~.s~ 1~l~L~t'~ C. Attach four (4) eoples of an engineered plan showing the location and ex[ent afthe work, and four (4) copies of the preliminary Engineer`s Estimate of work. The plans shall show the relation ofthe proposed work to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public works Construction; the General Permit Conditions listed on the inverse side; and the Spetiai Provisions for this permit, listed below. Failure to abide by these condltior~s and provisions may result in jab shutdown and/or forfefture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and Z.} E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public works at least 24 hours before restarting any work Name of Applkant; (~'~-~-~~ G D N S ~f 47 R- ts'S' S r Telephone: ~ Z;~ ~ ~ ~ ~~~-~ Address: ~ R.t Z~ I !t r+,1 L Yr-A. ~ b f}L7 /r~ I .~~: ~.tw ~ J ~' Irl 1~.1~r ln1 ~ N ) C.sg ~ ~ .~ ~ E-Mail Address: ~ ~~ ~ 4-HOUR EMERGENCY PHONE NUMBER: ~ ~~ ~ ~ 8 S ~ 8 ~ .I Is this work being done by the property owners at their awn residence? r YE5 ~( NO The Appl'~cantJPermit[ee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents, and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The AppllcantlPermittee hereby acknowledges that they have con[rac[or(s) of the information. Applicant Is advised that ~ responsible for any an(d~all dx~+anr+c arising out afthe condition Accepted: ' \ ~ ~~ ~~~ T' end understand both the front and back of this permit, and they will Inform their suance of t is {~fmi property owner, or property owner's successors, shall be private i ov a In the public righyf--way. ,. (Applicant Permittee) V (Sign) Date _' ~ C~ ~~`~~~ [bA.15~SLri ~-iJ'1'~ 1`t~v~~t-L ~ l~l]J'~lV_L~T rContractorl (Print Name) Date ~~~'IAL PROVISIQNS~ ~1. Street shall not be open cut far underground installations" Mlnlmum cuts may be allowed for connections or exploration holes. 5ueh cuts J7l:i~~ specifically aoRXpved by the Inspector prior to cutting. ~„2. Pavement may be cut far underground installations and must be restored in accordance with the Standard details "french Restoration Method "A",unless othervvise approved by the Engineer, 3. Work to be staked by a licensed Land Surveyor or Clvll Engineer and two (2) eoples of the cut sheets sent to the Public Works department before starting work 4. Per Section 4215 ofthe GovemmentCadethispermit is notvalid for excavations until Underground Service Alert {USA) has been notified and the inquiry identifieatlon number has been entered hereon. USA Phone; 1-BOi)-227-2600. USA TICKET Nil. ~,„^S. Prior to any work, the property owner shall execute an Agreementfor Private Improvements In the Public Right-of-lNay, which shall be retarded. ~6. Public Notiflca[lon Requlrements:~ 7. SEE PUBLIC WORK~,~~.~~s-KFDULE FOR CURRENT FEES PERMIT APPLICATION FEE PLAN CHECK dEPdSf)' SECURITY FOR FAITHFUL PERFORMANCE/LABOR 8r MAC CONSTRUCTION CASH DEPOSfr /J/ PLAN CHECK i~ INSPECTION FEE APPROVED FOR ISSUANCE AMOUNT 3 I 0 REC IPT N . 5 (~(~ `~~ ~ ~~'~ ~ ~~ V Permit Expires 12 Months Aitcr pate of Issuance Apr-07-2006 11:26am From-AZTEC 925 637 165" T-638 P.004/009 F-168 (, A Construction Cash Deposl[ Is required. Charges will be made against [his deposit if there Is an emergency oll•ou[, overtime inspection or when city ordered barricading is required. Any such costs In excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund or the msh deposit balance and refund or cancellation of She Faithful Performance Surely will be initiated by the wrl[ten acceptance of the worK by the City. 4. The Permittee must request in writing a final Inspection and acceptance of the work upon completion. Acceptance by the City will be made In writing LO Lhe Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to pflvate driveways, bus SLOps, fire hydrants, and water Valves. 6. A Cortstructlon Traffic Control Plan and a Construction Schedule are requited for all lane Closures, detours, and stfeeL close res. This plan must be reviewed and approved prier to any lane closures. 7, A Construction Traffic Control Plan shall conform to the Caltrans Manual of7rafflc Controls for Cons[rudlon and Mlairl[ena~nce Work Zones, dated 1990, avaiiable at Caltrans- Traffic control equipment shall include Type 11 flashing arrow signs if required. e. Replace asdirettedby[heCltyEngineeranydamagedcrremovedimprovementsinaccordancewltllCityStanderdsand''spe[ifitationsatthesole expense of the Permittee. 9. sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scaremark and shall be doweled to existing improvemenu. 10, Prior approval of inspet[or Is required for any work done after normal working hours, on weekends ar holidays and may require reimbursement of inspection costs at the current overtime rate. 11. Adequate signing and barricading is required on the job site. Fellure to provide such signing and barrimding may result in the city's providing signing and barricades and charging the cost {including all labor and materials} against the cash deposit. 12. Compac[lon LesLing of subgrade, base rock, and asphalt concrete by Permittee IS required unless Otherwise stilted by the Clry Engineer. 13. The COn[raG[Or or Permittee will have a Supervisory representative avail0ble for con[act on the project at all Limes during cons[ruc[lon. Contradoror Permittee shall provide a phone number at which they can be contacted outside the hours of S;GO a.m. to 4:00 p.m. 14. No storage of materials or equipment will be allowed nearthe edge of pavemen[, [he [raveled way, ar within the shoulderline which would create a hazardous candi[ian to the public. 75. 7h(5 permit shall not be construed as authorization forexcavation and grading on priva[e property adjacent to [he work cr any other work forwhich a separate permit may be required, nor does it relieve the Permittee of any obligation to ObLaln any other permit required try law. 16. This pemtit does noL release the Permittee from eny 118bIIILleS Contained in other agreemenu or contrails with the Clry and any other public agency. 17. This permit is not transferable. Work must be performed by the Permittee ar his designated agent or cantraaor as speclFled thereon. 18. Ca11 back (call out) due to emeregencles regarding this permit shall be at Lhe current overtime rate with a three {3) hour minimum charge per occurrence. 74. Pursuantto Chapter 14.02 ofthe Campbell Municipal Code, applicant sha)1 not vase to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere m the BEST MANAGEM>=NT PRACTICES es[ablished by the Santa tiara Vailey Urban Runoff Pollution Preverrtion Program. 20. If the public interes[ requires a modification of, ora departure from the plans and specifications, the City shall have the authority to require orapprove any modification or departure and to specify the manner in which the same is to be made far C""sty-owned or maintained facilities. Zi, Permltttee must provide advance notifita[i0n LO all parties that may he affected by the permit aalvltles. Notification Shrill be reviewed by the City prior to distribution and include dates of work 0nd a contact name and phone number. GENERAL PERMIT CONQITIONS Applicant shaJFrbe responsible for ensuring that ell those providing services underthe applicant are aware and understand all of the above GOnditions. Applicant - ~-~ Date: P~-Z~s~ C~r~S U c.Ti)-n!? S Contraaar {Print Name) ~~~~ o~ pate: J:ReinalWebsitelLand Dev Forms~Encroachment permit STATIC formZ.pdf Rev, (11 /9/05) Apr-07-2006 11:26am From-AZTEC AZTEC CONSTRUCTORS General Contractors • Construction Managers 2021 Omega Road Suite 20Q San Ramon, California 94583 (925) 837-1050 Fax (925) 837-1652 PROdIC[2aw 1"+wo>, Sliw1e120S1 (hoJ~ol 925 637 165 T-638 P.002 F-166 gas ~ r~vv~~ ..~ ..r ..- - $µEET NC. ~ CptCULA7ED SY OATE ~ ~~ ~ CHECKED BY OAYF rut3Llc wvRKS DEPARTMENT UTILITY ENCROACHMENT 8~ MISCELLANEOUS RECEIPT Effective July 1, 2007 TO: City Clerk II ,,.. \\ PUBLIC WORKS FILE NO. ~vC ZOOg- OOOL(q PROPERTY ADDRESS I Pj O ~•I (2Ci I N I~ Please collect & recei t for the followin monies: ACCT. dTEM AMOUNT ENCROA CHMENT' PERMIT I I ncroac men ermi pp Ica Ion ee on- I I Encroachment Permit $300.00 31 v Minor Encroachment Permit < $10 000 ($135.00) R-1 First Permit No Fee Subse uent < $10 i $135.00 Utili Arterial/Collector Street $560.00 Residential Street/Other Areas $310.00 2203 Plan Check De osit 2% of En ineer's Estimate $500 min 2203 Faithful Pertormance Securi FPS 100% of ENGR.EST. * 2203 Labor and Materials Securi 100% of ENGR. EST. * 2203 Monumentation Securi $1000/Monument 2203 Emer enc Construction Cash De osit 4% of En r. Est $500 min/$10,000 max 4722 Plan Check & Inspection Fee (Non-Utility) Engr.Est. < $250,000 (13% of ENGR EST ) 25~ ** 2203 En r. Est. >$250 000 Actual Cost + 20%/Min. $30,000 De osit 4722 Utilit < $100 000 Minimum Charge Per Location ($250.00) Conduits/Pipelines up to 500 Feet ($2.25/ft) Above 500 Linear Feet ($1.35/ft) Manholes/Vaults/Etc. ($125.00/ea ) Pole Set/Removal ($125.00/ea) Street Tree Plantin /Removal $145.00 ** 2203 Utili > $100 000 Actual Cost + 20% ** 4760 Stora a Container Permit $125.00 4760 Pro'ect Plans & S ecifications Pro'ect No. 4760 Standard S ecifications & Details $ 1/P $15.50/Bk 4760 Co ies of En ineerin Ma s & Plans Aerial Plot 24" x 36" $54.00 Aerial Print 8 1/2" x 11" $25.00 Aerial Search Fee $25.00 Ma sand Plans 24" x 36" $12.00 4722 Penalties: Failure to restore ublic im rovements $100/Calendar Da Muni Code Sec. 11.34.010) 4722 Penalties: Failure to correct unsafe conditions $100/Calendar Da 4722 Work Without Permits 4 Times A licable Fee MISCELLANEOUS Other Please S eci *Engineel's Estimate shall be as approved by the City Engineer. NAME OF APPLICANT C C) twl j g- ~'! TOTAL w •• L. Nr'r` S~ O $ NAME OF PAYOR ~C_ C_E~ /J SC.) L: ~ ~}-N"~Tr? PHONE ~Z 6Z ~ S •~~C'i ADDRESS OZ f3+til ~ rJF' 7 ~ +'T (? ?~ c Si~ ~ i37~ ZIP p C ~-( .~ ~j` '~ **Actual Cost Plus 20% Overhead Non-Interest bearin de osit FOR RECEIVED BY ITY CLERK ONLY ~~ Date Rec • *For Plan Check and Cash Deposits, el ow co ~~ nce. Date/Initials J ~FORMB•i~pwrWmbi4UMwvYCM1E Fmm UWY Ewo.C.M ~ we 0]a0 MEV. 1NE) INSURANCE REQUIREMENTS CHECKLIST Permit # ~ G 2008 - a~ °~I CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of--way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: d $1,000,000 per occurrence, and ^ $1,000,000 general aggregate limit applying separately to the project, or .~ $2,000,000 general aggreg to limit. ^ Policy expiration date ~~'~ / Miss , ~ Automotive Liability: --~-~ ^ "Any Auto" checked on certificate ^ $1,000,000 per accident for bodily injury and property damage ^ Policy expiration date Workers' Compensation and Employer's Liability --~. ^ Waiver of Subrogation clause ---~ ^ $1,000,000 per accident for bodily injury or disease ^ Policy expiration date Course of Construction (if required in Special Provisions) ^ Completed value of the project ^ Policy expiration date J ~~~ ~J r~ ~~ j po ~O ~~ ~ ~, ~~'~ ~~ \~ ti.9~-~ Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement -~ o The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. The insurance coverage afforded to the Additional Insured is primary insurance. _-~ ^ Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives". ^ Workers' Compensation Insurance Sheet Submitted ^ For General Contractor ^ For Developer or Owner Acceptability of Insurer(s) ^ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Insurance Certificate Reviewed Initials Date J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev. 03/08) Apr-07-2008 11:26am From-A 925 83 T-638 P.001 F-166 Genera! Contractors AZTEC Design-sued Cansfrucffon Managers CONSULTANTS 1~ACSIMIL~ T3tANS1VIITT,AL 5Ei8)E r TQ ~ ~ ~ 1J PROM; J l) rjS' ~, ~-3 L~ 1~ t-r ~ COMPANY: DATL•: r'nX NUMBER. PnGPS nvcLUntNC COVER; Gf~Q ~ fir; ~ a~~ J PHONE NUMBER: SEN1aER'S Ii.EBL•"RENCE NUMBER; C ~ ~$ o ~- ~' YOi1R REFFRCNCE Nutvr.BEte ~o vin ~. ~--s-r ~ ~ ~ ^ URG~ENZ' ^ FOR REVIEW ^ PLF,ASS COMMENT ^ PLEASE REPLY ^ TO FALLOW IiY MAJL tvo'T~s~rnt~,rerFU~rc. .S Y ~~ ~ t~ S ~ ~~ ~ 2021 Omega Road, Suite 200, San Ramon, California 94583-1542 PHONE: (925} 837-1050 FAX: (925) 837-1652 Apr-07-2006 11:27am From-A r 925 83 _ T-636 P.005/009 F-166 'Q~'DI~D CERTff=fC ' ` A ~ ,,, ATE Cif Lf~4BIL1~ Y fNSURANCE 3 25I200 ,roaueGR (b59) 486-2400 +c'347C: (6S0) 5943986 THIS CERTtF10ATE IS ISSUED AS A lNATTEI~ OF INFORhRATiPN RiA3e Stz'ategies Company dNLY AND GOHFER.S Nd I~IGWT$ UPdN 7ME CERTIFICATE HdLDER THIS CERTIFICATE DDES NOT AMEl1[D, ExTEND dR 203 Redwood Shores Farkway ALTER TWE CdVERAGE AFFORDi_D 8Y TH£ POLICIES BELdW. Suite 580 Redwood Cit CA_~4065 ~~ lIVSUR>=RSAFFQRDi>uGCdVERAGE NAIC# INSURED INSIIRr:RA-7:n~erataS=tr1 FirE __ _ Aztec CaYtSUlCahC.D7 Aztec COT~EStz'uC~4rs, Tic.; INSURER6'Ndtl4Ad1 L7ai.ou Fire ~Sla.- 2021 pmega Rd. INSUkeRC ~.^~~~- $11~C0 2D0 ~ kNEI]Rr+LD Sall Ramon C:A 94563 iNSURERC' THE POLICIES OF iNSURANG[ I.ISTkD Fl£t_QW HAVE BE£N ISSUED TO THE INSURED NAMEA ABGvE POk'fNE POLICY PERIQO INDYCAI'tU. NOTWITHSTANDING ANY REflU1rZtMENT, TERM OR CONDITION OF .1NY CONTRACT 4R OT~iER bQCUM£Nl' WITH RESPECT TO WIi1CH THLS CkRT[FICATE WIRY sG ISSUED Ort MAY I~£R"l;41N THe INSUFLgNCE AFFORDED $Y ll-tE PDLICrES DESGRI[}EO r1Elz£'IN iS Su6,lECT TO ALL THE TERMS E%CI,USIQNS AND G47NDiT10NS Of' SUCH I~OLtCIES , . Acr, ~r TE LIMI?„~,,,- v IN51k ADD.1. TYPE OFINSURANCE POLICY NNMpER ...,.,,-,...--, POLICY EPFEGTIVL~ OATS MMlOb/ POLICY EXPIRAT14N I]aTt MM1061YY _.._._...,..,,.,~- ~~-~-~~~~-,........,..,..,......... LPAITS OENERALLIAeIUTY -ar -. :rl~#~.:^.,..,-..... s Z, OOD.000 _...._^_ X ~ COn1MLRCrALCEPaERa,I.L_LWHIUT' DAMAGE FORS:Nr~v o- F.t~kaS.Lka1.~,:,4:LkrJS'' ~ ~ + DOA S A ~ C1.,1LUSMADC }: OCCUR 9GL•2000476 01 a1 08 01/01 09 N(f~ F,~,~A~n~n".i .arson S (:7xCludtrd <9C1NAI RAf Y 1 Q D{I O~Q x Y ( _ ~ . N~Sjt{x,,,,.,,. , ....,~,.,._ ,:. __ - - - ..........-........-.......,. GFNIr.RAL E1~.~?,T~....-,. __ 2 , D 0 0 . D 0 Q GEN'L l1GGREiiA7L• L,IMIT'APPLI>=li Pt}:; PRO. P I _SiLI.mL':,Q,Y~.L~Ci~+'~, pOD r app ' ti.,,,_....-.-. '-r...~. ._~-. X P!1 ICY OC _ Au7 6MDBILE L1A&uTY C{)NIpIN1:D t;iNCiLL LIMIT ANY AUTO LG~iilCCiOdBy '" ALL U'NNED AUiJS SGN~OIIIrpAJ'['UE BpULLY INJUnY LPoI'a4171PRy S BQI)II..Y IN.nJriY NCN-OYVIJfD AUTCS {rwr aac,~wnq I-'R4Yf'FLYY UNM1Al~ ( {P+Ar AcCIWlllry CARAGC•~lA>31UTY AUTDOM.Y-S'Ar:f.CII)kNT w _ ANY AUTO ,,. '..'."„",...-.,. At1TD0Y1,Y~ *~~; S R L°XC~Sa`JUMBRELLi4LIABIUTY SES0683~7, 01/D1~D$ 01/OI/09 ,,}.11Gl:I.D':CIJRCi139SiE_ _ ].Orpf~0,000 OCCUR ~ L' LArM:+ h1A0(? A£~i~t~.~~.td.r._ ? 1 D , V 0 0 , 0 Q I1 s ...,.-.. _ DECJUCTIgLE .........~..-.. _ ~ p. .NTH ry i WDRItGLt3 COMPCNSariDN ANa - STATU. O rl~l. EMPf.pYER$' LIABILl7Y +WY PROI~RtE'.'OhlPAK'YNFILEiCECUTNE OFFICERlMEMBER D~CLUD[D NF I~ E^CI^ACOII)ENT S - ? I(Yi'4.aJdG;LnVnuw E.L DIBFRF,_ •F ~~~ 5.....,..«.w.~,,._.,,......,....~...._.., SPECIAL PRaVI5H7N~ [snmw DTHER F. L. DIREASF . F"OI.ICY LIM1IIT S PESCRLPriDN Dk DPF_wLTLVNSrLVCa7~QNS7vF~gcL.~SJF.%GLU9IDN~ Aa000 LV iNDOR ;L~nptNTrSpEt~aL PRav151axs Proj ec`.- City of Campbell- Comc a>3c i~ rilimad ne addi.Ci.oaal ix>,aurad with reapsct to Gsneral Liabi.l i,Cy i$os Iz.': t;a,aYYCatI CG;L D' 10 31 2:a] tM rmc vi raa b +' ltt y 5 F2 pn Contract, CennzrA ~, L'1 Obil,lty COV#rTA{3e3 YD ,priLTLdi^f {pgY AL'LtiCl'1@d ZCB-A~O~ 7.?. O5I! . T~ HO BtipULP ANY OF THE A[~DVE D>=SCRIk3En pCUCre:; tS8 CANCELLEn 9EFURE 7HE CcamCa6t [7(PIP:ATIDN OATS THEREOF, 1'FIG 163UIN4 IN9U1'iGR WIU, -ENEQlh49R~-91D MAIL 1900 S ~Otkl Slue Ot ~ ~ DAYS WRITTEN NbTLCE 7t7 THE CERTIRCATE HOLDER NAIprEp 7p THE L,fiFT ~- Sau ~7oseq, CA 957.12-411D ~-^ - F 9eL,IRATION oR LIAPI AUTHDR]2E0 REPRESENTATiVG ,.. ~,_ :r M1r_ri;iG1 C::.>:istian/yfAF -~•._r,-:''~° •c~...,«=Y ..~.~~.._:_..'~; __;.. ACORD 25 (20Dif08) __..._..._ ..._. INS025 tolon, gyn., SH AG4RD CORPORATION 'f 988 Puyu, 1 W i Apr-OT-2006 11:27am From-A. 925 63 T-638 P.006/009 F-168 kMPaRTANT it the certificate holder Is an ADDl710NA~ tNSURED, the policy{fes) must be endorsed. A statement on this Certificate does not Confer rights tD the ~ertifiCate holder in lieu pf such endorsement(s). If SUBROGn7tON 15 WA1V[D, :.ubj~ct is the terms and conditions of the policy, certain pclicius may require an endorsement. A statement on this Certificate does not confer rights to the Ce1-tlficate hokdar in lied of such endorsement(s). DISCI..AIAAER The CeR15Caia of lnsuranae an the reverse silo of this form [floes not canstltutp a contract betw~zen the +ssuing insurer(s}, authorized representative 4r producer, and khe certificate holder, nor does it affirmatively or ner,~.atlvely amend, extend br alter the coverage aPfarded by the policies fisted thereCn. {--` ACORD 25 {24p1148) PL4t7 2012 f 115425 ta~ias~ cAn Apr-07-20D8 11:2Tam From-A. •~ 925 83 __ T-638 P.007/009 F-168 scr_-i~7E ~, ~I~'ISR~t_rt~~r~,mr 'P'C?WcY ~ ,i:~.`em {'.ocwrl4Er+;s, u,c l~l''kl,'• F'kp,p~DrTrSf~~BN-R?d'ts~i TY~4~ ~~IG~S9~~:~~Ff. 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Pn nr a$cy Y+r ail.e!h+ca ~cMr rrf i.,ta patiq, wt'+ICh k ~:n~rC+6Etr e~ by ya~.r !'nr P!sp .+W~1irJon~N ul»sr>•ac:' if utf4cir ~~:;rl urro' u.t{,t: Ire-~u:v~~~:~ ~tl rn~rt,~a~~s ~;r thw'+4ruut,~ f:.sieznlra" :~•:.~{ NON TRANSFERA$LE ~ ~ ~ I ~ ~ Ss7• • L'tir~~~N'~7.~E.. ~ , . 09TY OF ~CA'MPB~E•~:~L., ~C:A~ • The person, firm or carporaUon nametl below Is grantetl tnls huslnsss I~cenee pursuant to me provkions of the Ciry Business License Ominances to onganu'in, carry on or Contlunr me huS~ndSS. irSOC, cnIIn10, iboirSSiUn, ~:xnibiuon or m•cupaliun d~~,cribr~i'Drauw Issuance al I~CansC ~; nor an enpurvrulant, nor rortlACapnn•o1 rgmpllance with other 4o]lnarrcos or Irrv~r;. nor an as;unncc ttkil the propasotl use is ~n oomfnrmanco wdh the Ciry itlninp ropulatrons. This Iicbnsc is issuotl withauS,rbrpflca110n 111x[ the 11CenB~u h; BUbject to' of cxampt from licensing by the Siste al Callfom~a. CITY h7HSY bt NOYtFIt?0 OF ANV CHANOE IN OWNERSHIP. LOCAYIDN OR CLOSURE. OWIV~l~ a~~.;~~~ A~T'EC CQNSUL.TAN'I'S X021 orIEG~1 Rp ',~"l!:[TE. ~k~~~a SAN RANIQI~I GA 945~8~ ~IDSfNES~ ~~CA'}f'8~fhl ~Q~l ~lMEG~a RT3 SIJ I TE #~OQ SAN RAI'70N CA 5'45$ ~~DE ~I~ASS&~9~AT9~9r9 3.799A COIVTRC7R-SPECI(~l.. TRADE ISSUE RATE: EY,PIFiATI©N •DATE. ~C~''a"Y•S~ TAX .~Q # '. 94-6QpS9,97 : . PLEASE~PQST~Int A CONSPICUOLi5'PLACE ,., _ ~<<-- ~:A: ~;~~ ,. - _ ~~CC~~. air, _ s~~.-~~~rs~°~s 1'" ~'..r~.~~~ir;~, z~rt~e~ c~.~s~alt~.zit~, tr« ~ ~ #,~ ~s i~iO~i1~I+I7 ~tt~~~i5 fiiE PC)~Y. 'i "' R~ ~''~" C~~tt~.~'w an ant bum •d Id ~tPLR ~~~~~ nt My p~r~stxt ~ cxgararr tax ~ y°t t-1aa~+sk~ r~~ s ~ aet ~ cr cr+#z~tiaa~ hewer a trr Wff:.rx~ k~ ~ ~ tk' a~sarrt such pater P~~ ber ~ Mtn a~dd~! kt #~t yiawa {~ tea? #P di +~i~ a t fD ~~~t,. ~ii~a tf~~l~i~'? it ~ ~ +~iiC.cntt7~'!~ a~n~4rr~~t~daCit_t ~'.~~': ;,`~ ~~t..~_, i..w.~., ~~ ~, it1 'ri' 'r5'~iJ{:~~a ~.PS (*~~r't.:w= _~ $Y21'L:~S°! ;`uG~~e~s°:1#~~~`. --"~!'~PR ~. ~.: ^R7~ z.n ~;;~., yF~•¢tri s i'l,-,. .~'" e~'~d4S"!II3"~`~h'' ~ °~'t' CN"i4~`" GG 1D 11 ~~(~t~ ~€1r'~1'!CC! ~~ C1?'~Ge, .F ~~ ~~ °~ tsl`'t C". ACORD,~ CERTIFICATE OF LIABILITY INSURANCE aAi12i2o a PRODUCER (650) 486-2400 FAX: (650) 594-3986 Risk Strategies Company d Shores Parkwa 203 R d THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. y woo e Suite 680 Redwood Cit CA 94065 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Interstate Fire and Aztec Consultants INSURER B: Golden Eagle Insurance 2021 Omega Road INSURERC:National Union Fire Ins Suite 200 INSURER D: Travelers Insurance Co San Ramon CA 94583 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, REQUIREMENT , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. A RE ATE LIMIT H WN MAY HAVE BEEN R D ED BY PAID LAIM . INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 E e 50 000 X COMMERCIAL GENERAL LIABILITY nce a occu PREM SES , $ A X CLAIMS MADE ~ OCCUR SGL-1000976 1/1/2008 1/1/2009 MEDEXP An one erson $ eXClud@ PERSONAL & ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 , 000 , 000 POLICY X jECT LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000' 000 X ANY AUTO (Ea accident) B X ALL OWNED AUTOS BA8220675 1/1/2008 1/1/2009 BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ OWNED AUTOS NON (Per accident) - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA A $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EA H RREN E $ 10 , 000 , 000 X OCCUR ~ CLAIMS MADE AGGREGATE $ 1O , 000 , 000 C DEDUCTIBLE BE5o68331 1/1/2008 1/1/2009 $ X RETENTION 10 000 $ WC STATU- OTH- WORKERS COMPENSATION AND I R EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANV PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ D OTNER Rented/Leased QT66054358835 1/1/2008 1/1/2009 Limit 200,000 Equipment DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BV ENDORSEMENTISPECIAL PROVISIONS Issued as Evidence of Insurance. RE: Comcast Permit #ENC 2008-00049. The City of Cambell, the City of Campbell Redevelopment Agency, ifs officers, employees and volunteer are listed as Additional Insured (s) to General Liability coverage as their interest may appear and as per written contract- CERTIFICATE HOLDER CANCELLATION City of Campbell 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~EXI~pKf~~ MyA]ILL 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BIIc AUTHORIZED REPRESENTATIVE Michael Christian/HE /'~' `~''`-"~ ~~"'''f'~"`''~''~""`~"`""" ACORD 25 (2001/08) ©ACORD CORPORATION 1988 ILICr17C ~~,..o~ ..o_ o~,.e ~ ..r ~