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ENC2011-00016
JAN-31-2011 MON 09;33 AM RED^" Properties West FAX N0, 961? . N~t~ Z CCTI' OF CAMPBI~T~L DEFT. OF PY)AL[C WORKS 70 North First St. Catnpbcll, CA 95006 (40S) 866-2150 Fax (406) 376.0958 ENCROACHMENT PERMIT (for wot'kirtg within the public rigttt-of•way) Issued z~~ ~ ~ ~ Permit Expiration Date ~12 P, O1 ~L 2c1 N-Gaillh Permit No X-Ref. File Application Dace ~ ~ -- Applieation Expiradon Date ll II ~~ rr,, ~f~' APN ~~ .~ APPLICATION - AppGeation is hereby shade for a Public Works Permit in accordaaee with Campbell Municipal Code, Sectiou 11.D4. (AppGCUtirn expires in six (4) months it the per A. Work address Utility trench E. Nawre of wor C. Atuch four (4) topics of an engineered plan showing the locstian and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and underground intprovetments. Wbea approved by the City Engineer, said plan becomes a pan of this permit. U. Att work shall conform to the Ciry of Campbell Seaadard Specifications and Details for Public Works Construction: the Craterd Permit Coaditiats listed un the reverse side: and the Special Provisions for this permit, listed below. Failure to abide by these conditions orb provisi~s may :exult in job shutdown at-d/or forfeiture of Paitltful Perfornunce Sureties and ush depccits. (Sec General Permit Conditions 1 and 2.) E. The Conaacrur muse have thin permit and approved plots at the site and must notify the Public Works Department at least two days before starting work. Notice muse be given to blic W at least 24 hours a restarting any work. ~,, /~ ~ ~ /~~ Name of Applican i C-'~i[•~t~'S Telephonp_~- ~ / °1~ Addravs u _t.:lr t • ~ ~z24 HOUR EMERGENCY TELEP'HgNE Nq. ~t~' ~ " ~~~ U E-Mail Address C fs this work being dace by the property owners at then own residence? '~ Yac No 7'he Appticenvl'ei•mittee~ereby agrees by affixing their signawre to this permit W hold the City of Campbell. in offinerx, sgerttc and employees free, safe gad ILVmirss from any claim or demand for damages rauhiag from the work covered by uric permit. The ApplicanvPermittx hereby acknowb infortaauon. Applicant is advised that u arising out of the conditioo of gay private they have rwd and understand both the front and back of this permit, and they will inform their contractor(s) of the tee of thi ~t, proptrty owns, a property owtta's successors, shall be responsible for my and all damages vents' pubGcrigfftof•way, l,/ ~~ / ~~ // 141 ' (Applicant Permiuee) (sign) Uatc (Iirint Name) Date _l. Street shall not be opera cut for underground itesgliatious; MiniCWm cuts t~gy be allowed fro conncctiats or exploration holes, Such cutx may be speciGallY~t,~nvt~ by dte )ntmctor prior to cutting. _2. Pavemeat may be cur far undergrattnd installations and must be restored in accardaace with the Standard Details Trench Rtstoration tutethod "A" wiless otherwise approved by Inspector. _3. Work to be staked by a liceetsed Laod Surveyor or Civil Engineer and two (2) capics of rite cur sheets sent to the Public Works tkpartmau before startiste, work. ____a. Per Scctiou 42I5 of the Government Cade this permit is not valid for exravationa until Under~ound Swvicc Alert NSA) has bee ~ d and the ;oquiry identification member has bees entered hereon. USA Phone t -800-227.2600, USA TICKET NO. .S• Prior to any work, rho property owner shall execute as Agreemene for Privau ltnprovcmeats in the Public Right-of-Way. which shau he recorded. _b. Public Notification Requirements: 7 SEIc Pllt3Ll(: WORx.~.FY$ SCHEDULE FOR CURRENT' PB6.C A)vf 1 REf'PtPT Nn, PERMIT APPLICATION PEE S 3S~ ~ 7 u PLAN CHECK DEPOSIT' S SECURITY POR PATiHPUL FERPORMANCP~LAeOR de MATERIALS S CONSTRUCTION CASH flEPOSIT 3 PLAN CNP.GIG & INSPECTION FEE ~ x~ _-~~ APPROVED POR ISSUANCE ~__J 2~ f ~~ L~ For City Engitteet Date Penmit Expires 12 Mooths Alta Date of Issuance '~~ ~ ~5 ~~ CI/ JAN-31-2011 MON 09 33 AM REM^" Properties West FAX N0. 961? P. 02 GENERAL PERMY7' CONDITIONS I . a Construction Cash Deposit is'e9nired. Ctttugea will bt made agaitut this deposit if Uu!re is as ctnergatcy call•out, overtime inspccttoa a when City ordered barricading is required. Any such costs is excess of the deposit will be billed to the Peaniaee. 2. A oue•year maintenance period anti surety are requireQ. Such pettiad will be~ia oa date of written acceptance by the City. 3, Refund of the each deposit balatuc and refund ar Cancelluioa of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City, 4. The Permittee must request in writing a final inspection and acceptance of the wok upon completion. Acceptance by the City will be awde in within jt to the Permittee. S. Maintain safe pedestrian and vehicular crossings and free access tct private driveways, btu stops, firt hydrants and water valves, 6 A Construction Traffic Control Plan and s Construction Schedule are required for au lane closures, datoun and shret closures. This plan must be reviewed and approved prior w any lane ctoaurea. 7. The Coaswctioo TFaffic C.natral Klan shall conform W the Caltraas Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic Wntrel equipment shall include Type lI flasltinm am~w signs if required. R. Replace as d'vected by tlu City Wtglneer any datnlged or removed improvements in accordance with Ciry Standards and Spccitications at rho solo oxpengc of the Permittee. 9. Sawcut for all PCC or AC removals. All PCC removals shall be w ntarest sorxpnark and slt~ll be doweled to esistmg improvements. 0. prior approval of iasp~tor is requued for any work done afar nottnal working hours, on weekends or holidays and may require reimbursement of inspection casts at the cuneat overtime rate. 1 I . Adequate signing and barricading is required on the job sin. Nailurc m provide such signing and barricading may result in the Gry's providing signing and barricades end charging the cost (including all labor and materials) against the cash deposit. 12. Compactiat tcstiug of subgrade. bate rook. and aaphatt rxntcrctc by Pcrmittee is required unless otherwise stated by du City Eagiater. l3. The Contactor ur Ptrraittec will have a supervisory r~epreceatetive available for ctrrttact on the project at all -imes during construction. Contracwr ur Pem»ttee shall provide a phone,wmber m which they un he cdltactod outside the hours Of 8:00 a.m. aD 4:(lt) p.tp. 14. No storage of materials nr eAuiptncnt will be albwed near the edge of pavement, the traveled way. or within the ttwuldalitu which would create a tuzntiats condition to the public. 15. This permit shall not be construed as authorization &n eacavadoll and gtadiug On private pnrperty adjacent to the work or any Other work for which s separntt permit may he required, nor does it relieve the Permittte of any obligation to obtain any other permit regttirod by law. 16. This permit does as release the Permiaec from any liabilities contained in other agreements or contracts with the Ci-y and any other public agency. 17. This permit is not transferable. Work must be ptxfornood by the Permiuee ur his dcsignattxt agent or coavacwr as spu:ifled thereon. t 8, Ca11 back (u-tll ouq due to cmcrgc»cies regarding this permit stun he at the cuttcnt over[i:tu rare with a three (3) hour minimum cluub+e per uccuttencc. t 7. Wrsuans to Chapter 14,02 of the Campbell Municipal Code, applicant shall not ta,uce to be discharged nay material into the municipal storul drain system other than storm wear. Applicant shall alll,ero W the ASST MANAGP.MENT PRACfiCE,S established by the Santa Clara Vaucy Urban Runoff Pollution Preveatinn Program, 20. !f the public interest requiresa mwli6catitx, of, or a departure from, the plans and specifigtioas, the City shall have the uumoriry to require or approve any tnoditteaCOa ~ departure and to spex;ify the manner in which the tame is to be made for Cityowned or maintained facilities. 21. Per,r,ietee mwt provide advance notificstioq to all partiex that may be affected by the permit activities. Notification shall be reviewed by City prior to distribution and include daces of work and a contact name and phone aerobe. services under du applicant are aware of and undcrsland all of the above conditions. Contractor (Print Name) ~ _y.i/ Date -~" ~e ~~ l~formslpwpum Rev, l 1!9/05 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT & TRAFFIC RECEIPT Effective July 1, 2010 ` G ~ o I PUBLIC WORKS FILE NO. ~~ ~ 2_ ~ I `'~` ~ TO: City Clerk ~~ -- /-/--7---- ---L--- --------- PROPERTY ADDRE S' v_V_? ~~- J~`"~-11 ~' _ Please collect & recei t for the followin monies, ACCT. ITEM LAND DEVELOPMENT` AMOUNT - 4 22 ncroac ment ermit A lication Fee Non-Utilit Encroachment Permit $350.00 Minor Encroachment Permit <~~o,ooo $200.00 -j Initial R-1 Permit N/C I Subse uent R-1 Permits within Two Year Period $200.00 ___-_. _' 2203 Plan Check De osit 2% of En ineer's Estimate $500.00 min _ __ Utility and R-1 Permits no deposit required _ _ _ ____- 47221 Gradin & Draina e Plan Review Single Family Lot $250.00 __ _ _ Site < 10 000 s.f. $750.00 I _ Site >_ 10 000 s.f. < Acre $1.000.00 _ ~ -- Site ? 1 Acre $1.500.00 ! __ Plan Check & Ins ection Fee (Non-Utility) ___ - ~ S "`2203. En r. Est. u to $250 000 14% of En ineer's Estimate I ____ _ 4722 En r. Est. ?$250,000 Actual cost +20% Admin Overhead - ___ (Min $35 000 Deposit)' ~ _ _ _ 2203' Emer enc Cash De osit __ 4% of Engr. Est." ($500 min/$10.000 Max) ! ___ ____ 2203. Faithful Performance Security (FPS) 100% of ENGR. EST.' ___ - Labor and Materials Security _ 2203. 100% of ENGR. EST _ 4721 Storm Drainage Area Fee Per Acre R-1 $2 120.00 __ - -- - IF- -- ~, -- - (Multi-Res $2 385.00) __________. ~_ _ (All Other $2,650.00) '~ _ 4722 P cel Map (4 Lots or Less 4722 Final Tract Map (5 or More Lots) r $3 600.00 + $80/lot -_____ __-___ $4 400.00 + $108/lot __ _ 2203 Monumentation Securit 100% of ENGR. EST. _ __ ______ 49201 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) __ i _ __ _ 4722 Lot Line Ad ustment $1,400.00 _ __ _ _____ 47221 Vacation of Public Streets & Easements $2,250.00 l _-__ _ 47221 Certificate of Com liance $1 700.00 ___ ~ _ 4722. Certificate of Correction $500.00 ___ ___ ~_ _ 4722' A eal Filin Fee $200.00 ! ___ - ---~ 4722 - Notary Fee (per signature) $10.00 _ 4722, Assessment Segregation or Reapportionment __ First Split $800.00-_ _ ~ __ Each Additional Lot $250.00 ._ _ 511.7424 j TRAFFIC 4728! Postage Traffic Flow Ma Dail Traffic Volumes '~ $34.00 ___ 4728 Si nal Timin Information $72.00/Hr 4271 I Truck Permits $16.00/per trip 4728 MISCELLANEOU No Parking Signs S $1/each or $25/100 'i I Other (Please Specify) - `Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. ;-'7~~ "Actual Cost Plus 20°~o Overhead (Non-Interest bearing deposit) TOTAL $ / ~~ ~ NAME OF APPLICANT~_gr~_MQ~JI I~i~S~~UYv~ ' U PHONE ~lo~- ~~ ~'~ ~~ ~cao~ N~c~t~c~Uy~ NAME OFPAYOR ~Q~~~ ADDRESS - ~ ~~`~ ~~'c~y~ ~~ // ~~~~M ~~-~4 ZIP ~ cc , '~-T- i FOR RECEIVED ~~ CITY CLERK ONLY - ~' :Date '~ ~ ~~-Recei t# L.J "`For Plan Check;and Cash Deposits,<send ye low copy to Finance. ' Date/ initials ~E~ j, 1 LU I I FINANCE DEPT. i,FOaMS~re,.,o~aieswo~n~~~so-eeveweoem~ Form ~~e oeveioomem i rarer io-i ~ rke~ o5n m LEllFlICRTE ~CIT~~ 0~ CRt~~'SCLL O1DDD'"s~~D9 kECt='B BY : 7 RZ MAYOR: M i~R550l~~41 TDL~AY'5 BATE: D~I1fii1 1~,^0 REGISTER BATE: D2ii1~~11 TIi~E: ~~.~~ Ai'#DIlidT BESCRIPTIDN g-~i:G=.DD E{~GR g 5~4I~BI4= FILI'tdG ~ Ct~ST IB: ErdC2Dii-~~DDiS ~'s5D.00 E~GR ~ SDFiLiIV FILING ~ C!!5T iB: 339u 5 5R5GDM R3JE ~iDD-^____-- ~?DO.DD TDTAL BLIE: ~iDD.DD CH€Ck: pALB: CHECK ND: X03 viDD.DD TENBEREB: ~.CD CHRNGE; INSURANCE REQUIREMENTS CHECKLIST Permit # ~y~~~ ! J - r~~^ ~~ (~- # Cc' (~~ ;~~ ~=7 /-~~;~~~~~1 C~~ 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: ^ $1,000,000 per occurrence, and ^ $1,000,000 general aggregate limit applying separately to the project, or $2,000,000 general aggre ate limit. ^ Policy expiration date '~~~~ ~ Automotive Liability: ~ "Any Auto" checked on certificate $1,000,000 per accident for bodil injury and property damage ^ Policy expiration date c~ ~~~~ ~I ~ W~kers' Compensation and Employer's Liability 1,,~ Waiver of Subrogation clause $1,000,000 per accident for bodily injury or disease ^ Policy expiration date ~ f I ~ ~ Course of Const ction (if required in Special Provisions) ^ Complete value of the project ^ Policy piration date Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement 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 Acce abilit 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. ^ Campbell Business License # Insurance Certificate Reviewed Date ^ Copy of Insurance Certificate placed in tickler file one month prior to expiration. J:\FORMS\Templates\Insurance Requirements\Insurance Requirements Cklist.doc (Rev 05.10) ACORD CERTIFICATE OF LIABILITY INSURANCE TM. DATO2;;~2011YYY' PRODUCER Phone: 877-71 LEWIS Fax: (877) 715-3947 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ISSAC LEWIS & ASSOC. INSURANCE SERVICES LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P O BOX 7504 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SAN JOSE CA 95150 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~~ 1 Z " ~ ~ ~ ~ ~ INSURERS AFFORDING COVERAGE NAIC # A enc Lic#: OD08434 INSURED INSURER A: Geminl InSUranCe Com an EXTREME BACKHOE SERVICES, INC. INSURER B: Allied Insurance Grou _ C/O RICK LEWIS INSURER C: 9900 GUIBAL COURT CA 95020 GILROY INSURER D: , INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER ~~ POLICY EFFECTIVE DATE MtNDD/VV POLICY EXPIRATION DATE MM/DD/VV LIMITS GENERAL LIABILITY VCGP 017670 i 08/26/10 08/26/11 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea xcurence) $ 50,000 CLAIMS MADE OCCUR MED. EXP (Any one person) $ 1,000 A PERSONAL & ADV INJURY $ 2~000~OQQ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 PRO- POLICY JECT LOC AUT OMOBILE LIABILITY ACP 7804685699 09/29/10 09/29/11 ~ COMBINED SINGLE LIMIT X ANY AUTO I (Ea accident) ~, i $ 1,000,000 X ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ i PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS! UMBRELLA LIABILITY ~ EACH OCCURRENCE $ OCCUR ~ CLAIMS MADE ~ AGGREGATE $ i $ DEDUCTIBLE ~ i $ RETENTION $ g WORKERS COMPENSATION AND i WC STATU~ OTHER TORY uMITS EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT _ $ OFFICER/MEMBER EXCLUDE09 E.L. DISEASE-EA EMPLOYEE $ If yes, deecrlbe under SPECIAL PROVISIONS below E.L. DISEASE-POLICY LIMIT $ OTHER: I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS SEE SUPPLEMENTAL CERTIFICATE INFORMATION CERTIFICATE HOLDER GANGELLATION CITY OF CAMPBELL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATTN: DEPT. OF PUBLIC WORKS EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. 70 NORTH FIRST STREET CAMPBELL, CA 95008 A i AUTHORIZED REPRESENTATIVE h ttent on: ACORD 25 (2001/08) Certificate # 5785 ©ACORD CORPORATION 1988 POLICY NUMBER: VCGP 018751 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY Name of Person or Organization (Additional Insured): CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA 95008 SCHEDULE Location of Covered Operations Bodily Injury and Property Damage Liability Premium Basis Cost Rates (Per $1000 of cost) Total Advance Premium Advance Premium (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 1. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization (called "additional insured") shown in the Schedule but only with respect to liability arising out of: A. Your ongoing operations performed for the additional insureds) at the location designated above; or B. Acts or omissions of the additional insureds) in connection with their general supervision of such operations. 2. With respect to the insurance afforded these additional insureds, the following additional provisions apply: A. Exclusions b., c., g., h.(1), j., k., I. and n. under COVERAGE A -BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I -Coverages) do not apply. B. Additional Exclusions. This insurance does not apply to: (1) "Bodily injury" or "property damage" for which the additional insureds) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insureds) would have in the absence of the contract or agreement. such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insureds) at the site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. (3) "Bodily injury" or "property damage" arising out of any act or omission of the additional insureds) or any of their "employees", other than the general supervision by the additional insureds) of your ongoing operations performed for the additional insured(s). (4) "Property damage" to: (a) Property owned, used or occupied by or rented to the additional insured(s): (b) Property in the care, custody, or control of the additional insureds) or over which the additional insureds) are for any purpose exercising physical control; or (2) "Bodily injury" or "property damage" occuring after: (c) Any work, including materials, parts or equip- (a) All work, including materials, parts or equipment ment furnished in connection with such work, furnished in connection with which is performed for the additional insureds) by you. CG 20 09 10 93 Copyright, Insurance Services Office, Inc., 1992 Certificate # 5785 POLICY NUMBER: VCGP 017670 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ THIS CAREFULLY ADDITIONAL INSURED PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This insurance is primary for the person or organization shown in the schedule, but only with respect to liability arising out of your work or that insured by or for you. Other insurance afforded to that insured will apply as excess and not contribute as primary to the insurance afforded by this endorsement. All other endorsement provisions, conditions and exclusions of this insurance shall remain unchanged and apply to the additional insured and described below. SCHEDULE ADDITIONAL INSURED CONTRACT/PROJECT CITY OF CAMPBELL 1859 Bucknall & 145 Fulton, Campbell, ATTN: DEPT. OF PUBLIC WORKS CA 95008 70 NORTH FIRST STREET CAMPBELL, CA 95008 NAMED INSURED EXTREME BACKHOE SERVICES, INC. C/O RICK LEWIS 9900 GUIBAL COURT GILROY, CA 95020 ALL WORK IN PUBLIC RIGHT-OF-WAY. CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS AS RESPECTS LIABILITY PER CG 2009 Certificate # 5785 SUPPLEMENT TO CERTIFICATE OF LIABILITY INS #5785 FEB 11 11 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPLMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITIONAL INSUREDS AS RESPECTS LIABILITY FORM CG 203710. THE INSURANCE AFFORED TO ADDITIONAL INSURED IS PRIMARY IN RESPECT TO AUTO LIAIBILITY AND GENERAL LIABILITY. RE: INSURED'S WORK/SERVICEA T 663 EL PATIO DRIVE, CAMPBELL, CA 95008. ALL WORK IN PUBLIC RIGHT-FO-WAY c;ertincate n 5itt5 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (2001/08) Certificate #5785 Applied >Snderwriters 2/11/2011 11:55:52 AM PAGE 1/001 Fax Servez WI~tICER3 COMPENSATION AND ENPLOYER$ LIABILITY INSURANCE POLICY WAIVER OFOUR RIGHTTO RECOVER FROM OTHERS ENDORSEMEtY1' we o~ a3 os We have the right to rerxnrer our payments from anyone liable for an injury covered by this policy, We wil not enforce our right against the person or organ¢ation named !n the Schedule, but this waiver appiaa only with respect to bodily injury arising cut of the operations described in the Schedule where you are required by a written contract io obtain this waiver from us. This endorsement shall net operate directly ar indirectly m benefit anyone not named in the Schedule. The prema~m for th is endorsement i3 shown in the Schedule. Schedule ~. (~ Specific UVaiver Name of person or argan¢ation: city of Calspbell ~a ~aortn Yi:.t st: Campbell, cA ssoae () Blanket Waiver Atry person orarganization forwhomthe Named Insured has agreed by written contract to furnish this waiver. 2. Operatbrts: 663 El eatio Cautipbeil, Cd 95006 3. Premium 150 The premiurn charge for this endorsement shall be of the premium developed on payroll in contraction with work perfiormed far the above person(s) or organization(s) arising cut of the operations rtescrr~ed. 4. Minimum Premium 5. Advance Premium This endortaement d~anges the polity to vurrich R ~ etbched end is eftecive on the date Issued unless oche nwise stated. Endoraemantt3fective 06/01/30 P'otlcy No. 46-007286-O1-Od Erdor~merrtNa. 12 insured lwttTe~ 78ac]Choe Sesviae, Inc. Premium S 150.00 Insurance Company Califoien].a lasu=a2SOr Company Z' d 6~~9-8b8-80ti Coun6erorlgned by - •. `saolnaag aoy~oe8 auaaatx~ d6~~Z L l• L l• 1. 9a~ Applied (Jnderwriters 2/11/2011 11:45:30 AM PAGE 1/001 Fax Server rl,~g--3~b -0958 ACQRD CERTIFICATE ~F LIABILITY INSURANCE ° aaiiii2 i~ vaoaucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AO Iaeurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10825 Old ]!dill Rd HOLDER- THIS CERTIFICATE DOES NOT AINEND, E7fTEND OR Clma6a, 1bC 68159 ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. (877) 234-9920 INSURERS AFFORDING COVERAGE NAIC F INBURED INSUReaA:Ca1i£ornia Ineuralnoe Co. 38865 £atralale Baekhce Service, Inc . INSUgCR B 99Q0 Guibsl Ave INS UREA C: Gilroy, CA 95020 INSURER D: CTL 1273 594563 INSURER E L:U V E HACit ti THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NClTYUITHSTANIDI NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHE R DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOPOED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL 7FIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. T DD TYPEDPIN9UIIANCE POUCYNUMBER POUCYEFFEC DA LILY E7IPIRATI DATR_ LIMITS GENERAL LIAB4ITY EACH OC CURANCE S COMMERCIALGENERALLIABIUTY MSES Eaooaaen i 6 CLAIMS MAOC ^OCC VR MED EXP (any ons _non I • S i PERSO L V NJURY GENERAL AGGREGATE S GEN'L AG3RE4ATE UMT APPLICS PE PROOL'CTS • COMP.OP AGG S POLICY ~- LOC AIR OM4 BILE LIAB ILJTY ANY AUTO C OMBINEp SINGLC LIMB (Ea aeddsn) 9 ALL OW,VED AUTOS EDGILY INJURY SCMEDULEOAVTOS {Anpdsan) S HIRED AUTOS BC 71LY I M,IUAY NON~^WNEDAUTOS IPrramidem) S PROPERTYQAMAGE { Par aaoi dmt) S OARAG£ LIABILITY - ALRO ONLY • °A ACCIDENT S ANY ALlTD OThIEF. THAN £A ACC S AUTD ONLY: A00 8 ExCE3TilWIBRELLA UABRITY EAC4000UREIrCE S OCCUR ~ CUIMSMAOE AGGREGATE S S DE9UCTrBLE f PETENTION i S WDRKERS COMPEN6AT10N AND EMPLOYERS' 1JABIUTY Ili!' • A ANY PFIOPFBE70RfPARTNER'EXECUTIV! 96-ao7266-0~-06 06/01!10 O6/Ol/11 F.L. EACH ACCIDENT f 1,0OO~OQO OFFICEWMEM:ER CKCLUOED? ~ E.L. DISEASE • EA EMPLGYEE S 1 OOO OOO II yy~~ desor~br tuner SPECIALPRDYEpDMS `~de.r C.L DISEASE -POLICY LIMB t 1, OOO, OOO OTHER DC9CR1 PTION OF OPERATWNS! LOCATIONS! VEHICLF9 / EXCLUBIONB AD DED BY ENDORSEMENT 19PFCML PROYISJON9 License # 770170. [t£; 663 £1 Patio Campbell, CA 95008 -- Waiver o£ Subrogation in Favor of City of Campbell relative to xork pezfoza+~i undes coat=act. City O£ Caslpbel2 70 North Firet St Campbell, CA 95006 Attn: Public works ACORD 25 (2001148) ~~d SHOt.LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATETMEREDF. ME193UING INSURER YALL ENDEAVOR TO MAIL ~o DAY9 WtiITTEN hOTICF TO THE CERTIFICATE MOLDER NAMED TO THE LEfT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABFLITY OF ANY KIND UPON THE iNSURlR, IT8 AGENTS OR REPRESENTATIVES; AUTHDRRED REPRESENTATI ~ ~,/~/ ~~/~"fe~ "'- '' OD78336 6b~9-8t~8-80b yr nsrVnV VV HYV KA ItV1Y 19St! 'saoinaag aoL{~oe8 aLUaa;x~ dZg;Z ~ ~ ~ ~ ~ qa~ ~ ''?'1- '7 t ~~ 3 g ~~ ~"~!~ ACQRD CERTIFICATE OF LIABILITY INSURANCE DAT ~ NlDDlYVIl17 a ~ PRaoucER THIS CERTIFICATE IS ISSUED AS A f1AATTER OF INFORMATION AV Insurance S®rvicea ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO Box 3646 HOLDER. THIS GERTIFICATE DOES NOT AMEND, EXTEND OR Omaha, N8 66103-0696 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (877) 234-4420 ENSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:CalifOSni8 Insurance Co. 38865 &ztreme BaCkh08 .g erviC@, Inc. INSURER B: 9900 Guibal Ave INSURER G: Qilroy, CA 95020 INSURER D: CTL 1273 542851 INSURERS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOGUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN kS SUBJECT TO ALL THE TERMS EXCLUSIONS , AND CONDITIONS OF SUCH POLICIES. AGGREGATE LfMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE POLICr NUMBER I TE O T M! LIMBS GENERAL LUUIILITY ~ EACH OCCURANCE $ COMMERCIAL GENERAL LIABIUTY A PREMISES fEa oceurenoa $ CLAIMS MADE ^OCCUR MEDEXP one rsan $ PERSONAL$ADVINJURY 5 GENERAL AGGREGATE S GEN'L AGGREGATE UMR APPLIES PER ' PR6- PRODUCTS - COM'PlOP AGG S POLICY LOC AU TOMOBILE IJABILITY 1.NE D BINDLE LIMIT eMB ( S ANY AUTO ~ 8 E ALL OWNED AUTOS BO DILY I NJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS I NON-0WNED AUTOS BODILY INJURY (PeraccideM) I S PROPERTY DAM G A E S (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIOENT S ANY AUTO ! OTHER THAN ~ ACC S ~~ AUTO ONLY: ACaG S I EXCESSlUMBRELLA LIABILITY EACH OCCURENCE $ OCCUR ~ CLAIMS MADE AOOREGATE 5 S DEOLIC7IBLE E RETENTION S WORKERSCOMPENSATWNAND EMPLOYERS' LIABILITY ~ X 3 A ANY PROPRIETOR/PARTNERIE)(ECUTIVE 46-007286-D1-06 O6/Ol/10 06/01/11 E. L. EACH ACCIDENT S1, 000, 000 OFFICERrMEMBER EXCLUDED? It yyes, deeathe under E.L. DISEASE-EA EMPLOYEE 51,000,000 SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMB SI, OOO, 000 OTHER I DESCRIPTION Of OPERATIONS (LOCATIONS! VEH ICLE9 /EXCLUSIONS ADDED BY ENDORSEMENT 13 PECULL PROVISIONS License # 770170_ All Operatiofls. City Of Campbell 70 North First St Campbell, CA 95008 Attn: Public works SMDULD ANY OF THE ABOVE DESCRIBED POLICIEB BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE 186URXi INSURER MALL ENDEAVOR TO NAIL ~o DAYS WRD7EN NOTK:E TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON FHE INSURER, IT8 AGENTS OR REPRESEMATIVES AUTNORQEA R!!PRESEN7ATTV _~,~.~-~-~ OD7833b CSI RcUFiU CORPORATION 1988 L'd 6~ti9-8~8-80b 'seoinJeg eoy~{oe8 ewes}x~ Rg9:60 L L L L qe~ State O! California ~~,., CONTRACTORS STATE LICENSE BOARD coawmc ACTNE LICENSE na,~~ ,,m,.,~„~.77a17o «,., CORP ..,:,_,..~...,< EXT'REME BAGKHOE SERVICES 1NC ~.~. ~•~•~•~• 09130/2011 ~la~.a Z'd 6~b9-8~8-80b 'seoin.ieg eoy~{oeg ewe~~x3 e9q~60 6 L 6 ~ qe~ Policy Number: VCGP018751 CG 2037 10 O1 Insured Name:EXTREME BACKHOE SERVICES INC Number: 23 Effective Date: 08/26/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT Location And Description of Completed Operations: COMMERCIAL PROJECTS ONLY, INCLUDING APARTMENTS Additional Premium:0.00 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II -Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations hazard". CG 2037 10 OI Page 1 of t Policy Number: VCGP018751 CG 2010 10 O1 Insured Name:EXTREME BACKHOE SERVICES INC Number: 24 Effective Date: 08/26/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person Or Organization: AS REQUIRED BY WRITTEN CONTRACT; COMMERCIAL PROJECTS ONLY, INCLUDING APARTMENTS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II -Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after; (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be perforn~ed by or on behalf of the additional insureds) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 10 01 Page 1 of t Policy Number: VCGP018751 VE 0224 06 06 Insured Name:EXTREME BACKHOE SERVICES INC Number: 25 Effective Date: 08/26/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION-INCLUDING PRODUCTS-COMPLETED OPERATIONS (AMENDED) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE For a flat fully earned additional premium of 0.00 Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT Job No.: RESIDENTIAL PROJECTS ONLY (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused by your ongoing and completed operations perforn~ed for that insured. With respect to the insurance afforded to these additional insureds, the following exclusions are added: 2) Exclusions a) This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" that has been completed by or for you prior to the Policy Period. "Your work" will be deemed completed at the earliest of the following times: (1) When all of the work called for in your contract has been completed. VE 0224 06 06 Page 1 of 2 JAN-31-2011 MON 09 33 AM F X Properties West FAX N0, 9„ ~ ,. ... . . y, ~ -~ ~..~ w z ~*+ ?~ tR ~ ~g °" $o ~ R~ x C ~ ~ ~' --: f x , ~ y ~ _ 1 ~ P~ A ~ ~ ~ ~ r~ ti ~~~~ ~ ~~ Q - y ;y ~ '~ n {t •~ ~, w w '~ ~ ' Z ~ ~ ~ r. D C "i "' ~ Nf ^i ~ f .~ n ,i a v~ 0~ d~ A O r ~ O» .: ~ a A N A• > ~~ ~ ? 70 7 ~ ~1 +:._ 4 fA ' O~• ,Q ~ r f a ~~~~ , n c d b A ~. ~% j Z ~ A JI c a ~ ~. [ ..,~ ;~ r ~ ~• ~ ~ ~; ... ~ ~ ~ ~ ~ , .~ ~ N ~ .:a b . qq ,' ~ a ~.- n ~•~0 1~ ~ ~~ ~ o '~Oi 'w' ~ .~ 70 n S ~ a N ~ ~ ~ ~ ~ ~ •~1 ~ ~ .i n ~ '• -.. ~3~••03 ~ .. A i ~ ~ ;• ~ h z N ~ ~ "\ E ~ P, 03 Applied Underwriters 2/11/2011 11:45;30 AM PAGE 1/001 Fax Server ~-l~'~-3~b~0958 ~4CDRD CERTIFICATE OF LiABIi.iTY INSURANCE ° az ai'~ / PgORUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AD Iaeurance Servieea OMLY AND CONFERS NO RIGHTS t1PON THE CERTIFICATE 10825 Old [dill Rd HOLDER. THIS GERTIFIC/lTE DOES NOT AMEND EXTEND OR oesal.a, NT 68159 , ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (8 77) 239-9 920 INSURERS AFFORDING COVERAGE NAIC ~ ENSURED INSUREpA;Cali£ornia Insurance Co_ 38665 B XtreRle Ssckhoe Service, Ina. INSURER B: 9900 Guibal Ave il INS UREA C: G roy, CA 95020 INS UREA D: CTL 1273 5-09563 INS~JR~p E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ENSURED NAMED ABOVE FOR THE POLICY PERIOD ;NDICATED . NOTWITH STANDI Nfi ANY REQUIREMENT, TERM OR COND ITION OF ANY CONTRACTOR OTHE R DOCUMENT W RH RESPECTTO WHfC H THIS GERTI FICATE MAYBE ISSUED OA MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 3S SUBJECT TO ALL TF~ TFAMS EXCLUSIONS , AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOUVN MAY HAYS BEEN RERUCED BY PAID CLAIMS. IN$R Tq OD q TYPE OP INSURANCE PDUCY NUNBEA P Y £ IVE 4 MNFD DlY LILY I N DAT LNAITS GENERAL LIABILITY EACH DCCUAANCE S COMMEFiCIAI GENERAL LIAEIUTY MISES Ea S CIAIMS MADE ~CCCUR MEO EXP a arr an $ PE BADVINJURY GENEi AL AOGAEQATE GENLAGGAEGATEUMITAPPLIESPE D' , ~ S PRODUCTS-CCMP/OPAG~". S POLICY ~ LOC AUT OSOBILE LIAR WTY COIJBINEO SINGLE LIMB S ANYA'JTO {Eaaoodanl) ALL OwNEO AUTCS URY SCHCDULEDAUTCS (Pe`pnsmj S MIAEp AUTOS DO OILY IMlUAY NDN•pWNED AUTCS (Pn amident) S P ROPEF.TY DAUNGE P S j rr ao~idmt) WRAGE LIABLJTY AUT3 ONLY • EA ACCIDE N7 S ANY AUTO OTHER THAN PA ACC S 4UT~D O N LY: AGG S EXCESS/UMRAELLA LIAEIUTY I EACHGCCUAENCE S OCCUR Q CLAIMSMADE AGGREGATE S S oEDUCTIeLe s RETENTION s ~ WORKEi~ COMPEN$AT10N ANO ' ~ }~ CHIP LOYERS UABIUTY A ANYPROPRIETORlPARTNERfEXECUTivE Or•FIOERIMEMBER EKCLVDED? 46-007286-01-06 06/01/10 06/01/11 E.L.EACY.ACCIOENT L 1,0011,000 H desabe vn2er E.L. DISEASE • EA ENPLOYEE S 1 ODO 11QQ SPECIAL PROVSSIONS blow E.L. DISEASE • POLICY LIMIT S 1, 000, D00 OTHER DESCRiPTlDN # OPERATIONS! LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDDpSBYIENT f SPECIAL PROVISIONS License 9 770170. RE- 663 Sl Patio Campbell, CA 95006 -- U7aiver of Subrogation in favor of City of Campbell relative to Work pezformed undez contract. ..Cr..•,~....~ .,..r ,~~., - - ---- - SHOULD ANY Of THE AsCVE QESCRIBEO POLICIES 8E CANCELLED BEFGRE THE EXPIAATION~ City O£ Caa~bell 70 Rorth First St DATETHEREDF,TffEtSSWNCINSURERYYILLENDEAVORTOrIAIL 3o OAYSYVgITTENNDTICE CaR~bell, CA 95006 TO THE CERTIPICATE HOLOCP NAMED TO THE LEfr, BUT PAILURE TO DO 50 SItALL IMPOSE NO OBLIGATION pR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGCNTS OP Attn: Public works REPpESCNTATIVES AUTHORIZED R2PAESE NTATi~ /' ~~ I G ~r-~""" •' OD78336 er•_nen x r~rvturmt ~ wcvxU CORPORATION 1988 L'd 6~t~9-8~8-80~ 'seainaag aoy~{oe8 auaaa~x~ d68~Z L L L L L qa~ Policy Number: VCGP018751 VE 0224 06 06 Insured Name:EXTREME BACKHOE SERVICES INC Number: 25 Effective Date: 08/26/2010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION-INCLUDING PRODUCTS-COMPLETED OPERATIONS (AMENDED) This endorsement modi .fees insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE For a flat fully earned additional premium of 0.00 Name of Person or Organization: AS REQUIRED BY WRITTEN CONTRACT Job No.: RESIDENTIAL PROJECTS ONLY (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability caused by your ongoing and completed operations performed for that insured. With respect to the insurance afforded to these additional insureds, the following exclusions are added: 2) Exclusions a) This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" that has been completed by or for you prior to the Policy Period. "Your work" will be deemed completed at the earliest of the following times: (1) When all of the work called for in your contract has been completed. VE 0224 06 06 Page 1 of 2 JAN-31-2011 MON 09;33 AM F X Properties West FAX N0. 9' ~ •~ •7ri ~ O '. ~ nD ~ ~ ~ D is -' NSA r. O a ;; 3~ c c 3 a~ A;~ ~ `~ c a -1 _ ~ $~ ~ c r g• ~ o ~ ~ 3 `+ ~ ~~ n ~ m oo y D ~ a .~ - - ~ N 1 ~ r' A ~ ~ O T. r ~ .~i ~ ~ i.. ~ '' 4 ~ ~' y l~ ~ y C7 ~ ~ .. ~ ~'~ ~ ~ ~ „ ~ ~ - O~ m ~o oLm -i r m~~~ O a F ~~ ~ m m ~ a j . ~ ~ C. a O `~ . i r.. 4. c4i a ~ ~ ~: ' n 3 ~ ..: z ~ ~ ~ p .v~•~ u N ~ ~ ~ ~ .5 W JI ~ a ''. ~. a .~ ;, . m a ¢ ~., M ~~ 3N?® ~ ~ ~ ~gQ~ ~ N q~q '~ ~ . ~ 9 a~ 3 ,,,~ ~ O -~ n y 1f { ~ ~C ~, A p J ~ p 1'-1 ~ ~ ~ ~ , A, ` N ~ ~ 0.A ~'` 4 g ~ Q ~ R ~ ~ ~ ~ ~ Ir O a IM ~ i A' ~ y ~ ~ ~~ ~•~ ~ ~ ~~ , ~~ /"~ 1 r1 Y s r O' j t, 1 0 ~ ' ~ N ~ C ~ ~ ~ t' `~ n ~ ~ ~ ~ I ~ ~ O ~. }.".1~ ~ 1 ~ 7 P. 03 JAN-31-2011 MON 09;34 AM F X Properties West FAX N0. 9' '-~. G~ ~_ r~ .. y ~ry ~ ~~ O 1° `^~ ~° ~ I~ ~I I I `" a }a-~ ~ ^ ~ ~ z ~ ~ ? ~ C1 ~ y? f7 N ~. ¢ -. ,.. N f .-~ r y o a c c~ ~ p- ~ A N c . ~ ., m~ o 0 3 m ,_ ' ~ -~ ~. o a 3 ,~.. K: ? ~ o_i _ '*~c' ? ~ ~ ~; r ap ; ' _ a r`, 3 ~ ~ ~~ ; .D e ~ _ f. 3 y ~ . . 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