ENC2010-00102Print form
Permit No. ~ ~ z° (L ~ ~ `~~ ~ 2
CITY OF CAMPBELL R-1 ENCROACHMENT PERMIT
DEPT. OF PUBLIC WORKS (Non-engineered work within the public right-of-way) X-Ref File
70 North First Street ($10,000.00 maximum value of work) Application Date 1 I U
Campbell, CA 95008 -7/ Application Expiration ~ ~
Ph. (408) 866-2150 ISSUED: `" Z ~ ~ D Date ._/ I ~ ( I
Fx.1408) 376-0958 Permit Expiration Date: Z I APN `f~~l ~~ b~ Z
APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04.
(Application expires in 6 months if the permit is not issued.)
A. Work Address: 695 KENNETH AVE.
B. Nature of Work: INSTALL NEW SEWER LATERAL
C. Attach three (3) copies of a drawing showing the location, extent and dimensions of the work. The drawing shall show the relation of
the proposed work to existing improvements. When approved by the City Engineer, said drawing become 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 reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and
provisions may result in job shutdown and/or forfeiture of Faithful Performance securities.
NAME OF APPLICANT: ' ~ ~~ ~,5~~~ Telephone: 408-377-9990
Address: ~ 4' S !~~ R~ '(~ C~ r''~fJ C- ~ ~ ~'l ~~v O
E-Mail Address nn~nai CCCDTIr' r S\„ ~~ U` ~~ f ~~ ~ ~j~1~ ~` o ~~
The Applicant hereby confirms that this work is being done by the property owner/applicant at their own re ence.
The Applicant hereby agrees by affixing their signature to this permit to hold the City of Campbell, City of Campbell Redevelopment Agency, its
ofFcers, agents, and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit.
The Applicant hereby acknowledges hat they have read and understand both the front and back of this permit, and that they will inform their
contractor(s) of the information.
7 al ~~
ACCEPTED:
oalicant/Permi ee) (Sign) Date
NOTES: All work shall conform with the attached approved plans and all applicable Campbell Standard Details and Conditions and applicable
insurance requirements.
The Contractor must have this permit and approved plans and must arrange to meet with the Public Works Inspector at the site at least two days
before starting work. Notice must be given to Public Works at least 24 hours before restarting any work.
Per Section 421 S of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the
inquiry identification number (Ticket No.) has been entered hereon. USA Phone: 1-800-227-2600. Ticket No.:
Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all
damages arising out of the design, installation or condition of private improvements in the public right-of-way.
SPECIAL PROVISIONS
1. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way, which shall be
recorded.
2.
3.
SECURITY FOR FAITHFUL PERFORMANCE
R-1 PERMIT FEE
FOR ISSUANCE:
STANDARD
(10096 Of Engr's Est.)
S_~
for City Engineer
Permit Expires 6 Months after Date of Issuance.
NO.
~2/ I~
Date
• r ~ t~l iS ~~/
,~co o® CERTIFICATE OF LIABILITY INSURANCE ~ o5~1M ~ o Yo
PRODUCER (408) 739-8300 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
All Spectrum Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1208 E cirques Ave ALTER -THE COVERAGE AFFORDED BY THE POLICIES BELOW.
suite 108
Sunnyvale CA 94085_- _-_ INSURERS AFFORDING COVERAGE NAIC #
INSURED INSUReRA:National Fire Ina Of Hartford zoa7e
Glen Gilbert, dba Able Septic Tank Service INSUReRB:Nationwide Mutual Ins Company z3~a7
Able Underground Construction, Inc INSURERC:Companion Property & Casualty lzis7 _ ___
P.~. BOX 24819 INSURERD--- -------_--- .--
Sari aTOS6 CA 95154- INSURER E:
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NSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES OF I
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
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 DO'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPNiATK)N LIMITS
A X UA811]TY 076630503 05/01/2010 j 05/01/2011 EACH OCCURRENCE E 1 000 000
GEN
}( ERAL
RCIAL GENERAL LIABILITY
A / / / / PREMISES a occurtence S __ 300 , 000
COA~
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OCCUR
ADE l X / / / / MED EXP (Any one person) S 5 000
CLAIMS M
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/ / I / / PERSONAL 6 ADV INJURY S _1 , OOO~OOO
I - i / / I / / GENERAL AGGREGATE S 2 000 , 000
-
TE LIMIT APPLIES PER: / / ~ / / PRODUCTS - COMPlOP AOG S 21_000 , 000
I GENT AGGREGA
X POLICY X PRQ ~-, LOC / / I / /
B 1 X AUT OMOBILELIABIUTY ~CPBA7813990430 1 03/31/2010
j 03/31/2011 COMBINED SINGLEUMIT g 1 000 000
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~ }t / / / / (Ee acpdeM) ~ _
-
ANY AUTO -
ALL OVIMED AUTOS / / / / BODILY IN,&1RY S
_ TOS / / / / (~ person) --------
SCHEDULED AU -
HIRED AUTOS / / / / BODILY INJURY s
TOS / / / / (Per accident) - ----- ---
NON-0VNJED AU I -
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-- / / i / / PROPERTY DAMAGE
s
~ ~ (Per accident)
TY / / / / AUTO ONLY - EA ACCIDENT S _ _ __
GA RAGE LU181U
/ / / / OTHER THAN EA ACC S -_,---
- ANY AUTO
i AUTO ONLY: AGG S
LIABIUTY
MBREW / / / / EACH OCCURRENCE S _ __
EXCESS / U -_
_
]CLAIMS MADE
~ / / ~ / / I AGGREGATE S ______
OCCUR L
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~ / / / / $ ---- -
DEDUCTIBLE i ----
C RETENTION S
WORKERS COMPENSATION
A10633
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05/01/2010
05/01/2011
WC STATU- OTH-
X Y I R =
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ANDEMPLOYERS'LU181UTY
R/PARTNERIEXECUTIVE Y / N
T - / / / / E.L. EACH ACCIDENT S 1 , 000 , 000
ANV pROPRIE
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OFFICER/MEMBER EXCLUDED? ~
NH / / ~ / / E.L. DISEASE - EA EMPLOYE S 1 000 000
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(Mandatory in
S Y~CIAL SIB 6ebw j
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/ /
E.L. DISEASE -POLICY LIMIT
S 1 000 000
OTHER / / / /
/ / ~ / /
/ / /
DESCRIPTON Or OPERATK>NS I LOGTIONS /VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECWL PROVISIONS
As zequised by written contract/agreement per attached endozaea~ents (i-140331-8 (Ed. 01/09), AC01020308 the following
is additional insused: City of Campbell, The City of Campbell Redevelopaeent )Agency, its officers, employees and
volunteess.
*Subject to 10 days notice of canaallation for non-payment of premium.
GER I IFIGA 1 t nuluert ---- -
(408) 866-2150 (408) 376-0958 sHOULDANYOFTHEABOVEDESCRIBEDPOUCIESBECANCELLEDBEPORETNEEXPIRATwN
GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Cl ty of Campbell IMPOSE No OBLIGATION OR LIABILITY OF ANY'KIND UPON THE'INSURER, ITS AGENTS OR
70 N 1st Street REPRESENTATIVES.
_- ,~_
AUTHORDfD REPRESENTATIVE _, ~-
~~~~----
C bell CA 95008- ~r~r~ ~AOnASATAII All ..w1.1~ nn n,1
ACORD 25 (2009/01) ~ ~ ......-.........~ ......... ....• -• -• --- • • _. _...-. --~.-_ - __ _- - - _-
INS025 (zaoeot) The ACORD name and logo are registered marks of ACORD
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
This Certificate of Insurance 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 (2009/01-
INS025 r2oo9o~)
BUSINESS AUTO
AC 01 02 03 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO ENDORSEMENT FORM
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. CHANGES FOR TRAILERS AND FARM
EQUIPMENT
1. Under SECTION I -COVERED AUTOS, the
following are added to Paragraph C. Certain
Trailers, Mobile Equipment and Temporary
Substitute Autos:
4. "Trailers" designed to be towed by a pri-
vate passenger type "auto" or a pickup,
panel truck or van if not used for busi-
ness purposes, other than farming or
ranching.
5. Farm wagons or farm implements while
being towed by a covered "auto".
B. CHANGES FOR ADDITIONAL NEWLY
ACQUIRED VEHICLES
Paragraph B.2 of SECTION 1 -COVERED
AUTOS is replaced by the following:
2. If Symbol 7 is entered next to a cover-
age in Item Two of the DeGarations, an
"auto" you acquire will be a covered
"auto" for that coverage only if:
a. We already cover at least one "auto"
you own for that coverage or it re-
places an "auto" you previously
owned that had that coverage; and
b. You tell us within 30 days after you
acquire it that you want us to cover
it for that coverage.
The most we will pay for Physical Damage
Coverage for "loss" under this Coverage Ex-
tension is $100,000 per "auto", subject to
the largest deductible applicable to any
"auto" for that Coverage.
or organization qualifies as an "insured" un-
der the Who Is An Insured Provision con-
tained in Section II - LIABILITY
COVERAGE of the Coverage Form
D. REPLACED EXCLUSIONS
The Expected or Intended Injury Exclusion
IN SECTION II -LIABILITY COVERAGE is
replaced by the following:
Expected or Intended Injury
"Bodily injury" or "property damage" which is
expected or intended by the "insured". This
exclusion applies even if the resulting "bod-
ily injury" or "property damage":
a. is of a different kind, quality or degree
than initially expected or intended; or
b. is sustained by a different person, entity,
real property, or personal property than
that initially expected or intended.
E. ADDITIONAL EXCLUSIONS
The following exclusions are added to
SECTION II -LIABILITY COVERAGE:
Damage to Named Insured's Property
Any claim or "suit" for "property damage" by
you or on your behalf against any other per-
son or entity that is also a Named Insured
under this policy.
Abuse or Molestation
"Bodily injury" or "property damage" arising
out of
a. The actual or threatened abuse or mo-
lestation by anyone or any person while
in the care, custody or control of any "in-
sured", or
C. BLANKET ADDITIONAL INSURED
Any person or organization which you have
agreed to name as an additional insured in a
written contract, executed prior to an acci-
dent, other than a contract for the lease or
rental of a vehicle is an "insured" for Liability
Coverage, but only to the extent that person
b. The negligent:
1) Employment;
2) Investigation;
3) Supervision;
4) Reporting to the proper authorities,
or failure to so report; or
AC 01 02 03 08 InGudes copyrighted material of Insurance Services Office, Inc., Page 1 of 3
-with its permission.
AC 01 02 03 08
5) Retention;
of a person for whom any "insured" is or
ever was legally responsible and whose
conduct would be excluded by Para-
graph a. above.
Abuse means an act which is committed
with the intent to cause harm.
Explosives
"Bodily injury" or "property damage" caused
by the explosion of explosives you make,
sell or transport.
Rolling Stores
~~
If a covered "auto is a rolling store, "bodily
injury" or "property damage" resulting from
the handling, use or condition of any item
the "insured" makes, sells or distributes if
the injury or damage occurs after the "in-
sured" has given up possession of the item.
Wrong Delivery of Uquid Products
"Bodily injury" or "property damage" result-
ing from the delivery of any liquid into the
wrong receptacle or to the wrong address,
or from the delivery of one liquid for another,
if the "bodily injury" or "property damage"
occurs after the delivery has been com-
pleted.
Delivery is considered completed even if fur-
ther service or maintenance work, or correc-
tion, repair or replacement is required be-
cause of wrong delivery.
Professional Services
"Bodily injury":
a. Resulting from the providing or the fail-
ure to provide any medical or other pro-
fessional services.
b. Resulting from food or drink fumished
with these services.
"Bodily injury" or "property damage" result-
ing from the handling of corpses.
F. MOTOR HOME CONTENTS COVERAGE
1. For a covered "auto" that is a motor home
the following exclusions are added TO
SECTION I11 -PHYSICAL DAMAGE:
Motor Home Contents
This insurance does not apply to:
a. "Loss" to the covered "auto's" contents,
except equipment usual to trucks or pri-
vate passenger "autos".
b. "Loss" to TV antennas, awnings or ca-
banas.
c. "Loss" to equipment designed to create
added living facilities.
However, these exclusions do not apply if
Miscellaneous Personal Property Coverage
is provided by endorsement to this policy.
G. ACCIDENTAL AIRBAG DISCHARGE
COVERAGE
Under Paragraph B.3.a. of SECTION III -
PHYSICAL DAMAGE, the following is added:
Mechanical breakdown does not include the ac-
cidental discharge of an airbag.
H. PHYSICAL DAMAGE LIMIT OF INSURANCE
Paragraph C. Limit of Insurance of SECTION III
- PHYSICAL DAMAGE INSURANCE is replaced
by the following:
C. Limit Of Insurance
1. The most we will pay for "loss" in
any one "accident" is the lesser of:
a. The actual cash value of the
damaged or stolen property as
of the time of the "loss"; or
b. The cost of repairing or replac-
ing the damaged or stolen prop-
erty.
2. An adjustment for depreciation and
physical condition will be made in
determining actual cash value in the
event of total "loss".
3. The cost of repairing or replacing
may:
a. Be based on an estimate which
inGudes parts fumished by the
original equipment manufacturer
or other sources inGuding non-
original equipment manufactur-
ers and
b. Include a deduction for better-
ment for a part or parts that are
normally subject to repair or re-
placement during the useful life
of the "auto", such as, but not
limited to tires and batteries.
Betterment means the difference
between the actual cash value of a
part immediately before the "loss"
and the cost to replace that part with
a new part.
Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., AC 01 02 03 08
with its permission.
AC 01 02 03 08
I. GLASS REPAIR -WAIVER OF DEDUCTIBLE
Under Paragraph D. Deductible of SECTION III
- PHYSICAL DAMAGE COVERAGE, the follow-
ing is added:
No deductible applies to glass damage if the
glass is repaired rather than replaced.
J. AMENDED DUTIES IN EVENT OF ACCIDENT,
CLAIM, SUIT, OR LOSS
The requirement in Loss Condition 2.a. Duties In
The Even Of Accident, Claim, Suit Or Loss - of
SECTION IV -BUSINESS AUTO CONDITIONS
that you must notify us of an "accident", "claim",
"suit", or "loss" applies only when the "accident",
"claim", "suit", or "loss" is known to
1. You, if you are an individual
2. A partner, if you are a partnership;
3. An executive officer or the employee desig-
nated by you to give such notice if you are a
corporation; or
4. A member, if you are a limited liability com-
pany.
K. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
SECTON IV -BUSINESS AUTO CONDITIONS
- B.2. is amended by the addition of the follow-
ing:
If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we
will not deny coverage under this Coverage
Form because of such failure. However, this
provision does not affect our right to collect addi-
tional premium or exercise our right of cancella-
tion or nonrenewal.
L. AUTOS HIRED OR RENTED BY
EMPLOYEES
If hired or rented "autos" are covered "autos" on
this policy, the following provisions apply:
A. Changes In Liability Coverage
The following is added to the Who Is An In-
sured Provision in SECTION II -LIABILITY
COVERAGE:
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
contract or agreement in that "employee's"
name, with your permission, while performing
duties related to the conduct of your busi-
ness.
B. Changes In General Conditions
Paragraph 5.b. of the Other Insurance
Condition in the Business Auto Coverage
Form is replaced by the following:
For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
"autos" you own:
1. Any covered "auto" you lease, hire, rent
or borrow; and
2. Any covered "auto" hired or rented by
your "employee" under a contract in that
individual "employee's" name, with your
permission, while performing duties re-
lated to the conduct of your business.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
M. EMERGENCY LOCKOUT - PRIVATE
PASSENGER VEHICLES
We will reimburse you up to $50 for reasonable
expense incurred for the services of a locksmith
to gain entry into your covered "auto" of the pri-
vate passenger type subject to these provisions:
1. Your door key or key entry pad has been lost,
stolen or locked in your covered "auto" and
you are unable to enter such "auto" , or
2. Your key or key entry pad has been lost or
stolen and you have changed the lock to
prevent an unauthorized entry; and
3. Original copies of receipts for services of a
locksmith must be provided before reim-
bursement is payable.
All terms and conditions of this policy apply unless modified by this endorsement.
AC 01 02 03 08 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 3
with its permission.
~-
G-140331-B
(Ed. 01 /09)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE (OPTIONAL)
Name of Additional Insured Person(s)
Or Organizations
(As required by written contract/agreement per Paragraph A. below.)
Location(s) of Covered Operations
(As per the written contract/agreement, provided the location is within the "coverage territory" of this Coverage Part.)
(Coverage under this endorsement is not affected by an entry or lack of entry in the Schedule above.)
A. Section II -Who Is An Insured is amended to in the performance of your ongoing operations
for the additional insureds) or
inGude as an additional insured any person(s) or
or
cluded in the
i
"
organization(s), including any person
anization shown in the Schedule above, whom
r n
that is
c, "Your work
~~products-completed operations hazard"
g
o
you are required to add as an additional insured on and performed for the additional insured,
this Coverage Part under a written contract or but only if this Coverage Part provides such
written agreement, provided: coverage, and only if the written contract or
reement requires you to provide
n a
itt
a. The written contract or written agreement was g
e
wr
the additional insured such coverage.
executed prior to:
1. The "bodily injury" or "property damage"; or 2. However, we will not provide the additional
broader coverage or any higher
red an
i
2. The offense that caused the "personal and y
nsu
limit of insurance than the least of those:
advertising injury" a. Required by the written contract or written
for which the additional insured seeks coverage agreement;
under this Coverage Part; and b, Described in 8.1. above; or
b. The written contract or written agreement
operations or your
oin
n c. Afforded to you under this policy.
g
g
pertains to your o
work" for the additional insured(s). g, This insurance is excess of all other insurance
B. The insurance provided to the additional insured is available to the additional insured, whether
primary, excess, contingent or on any other
limited as follows: unless the written contract or agreement
basis
1. The person or organization is an additional
insured only with respect to liability for "bodily ,
requires this insurance to be primary. In that
event, this insurance will be primary relative to
" "property damage," or "personal and
injury insurance which covers the additional insured
ire
,
advertising injury" caused in whole or in part by: as a named insured. We will not requ
n from such insurance if the written
ti
ib
a. Your acts or omissions; or o
u
contr
contract or written agreement also requires that
b. The acts or omissions of those acting on this insurance be non-contributory. But with
ect to all other insurance under which the
your behalf resp
additional insured qualifies as an insured or
righted material of Insurance
des co
l
I Services Office, Inc., with its permission Page 1 of 2
py
u
nc
G-140331-B
(Ed. 01 /09)
era
additional insured, this insurance will be
excess.
4. The insurance provided to the additional
insured terminates when your operations for the
additional insured are complete. But if the
written contract or written agreement specifies a
date until which this insurance must apply, then
this insurance terminates:
a. On the date spedfied in the written contract
or written agreement; or
b. When this policy expires or is cancelled,
whichever occurs first.
C. With respect to the insurance afforded to the
additional insured, the following additional
exclusions apply.
This insurance does not apply to:
1. "Bodily injury," "property damage," or "personal
and advertising mlury" arising out of the
rendering of, or the failure to render, any
professional architectural, engineering, or
surveying services, including:
a. The preparing, approving, or failing to
prepare or approve maps, shop drawings,
opinions, reports, surveys, field orders,
than-:;c; orders or drawings and
specifications; and
b. Supervisory, inspection, architectural or
engi~~eering activities.
2. "Bodily injury," "property damage," or "personal
and advertising inlury" arising out of any
premise°~ or work for which the additional
insured . • specifically listed as an additional
insurea .:,~ another endorsement attached to
this Coverage Part.
~. LIABILOITY CONDITIONSIs amended asGEows:~L
1. The C~ :ies In The Event of Occurrence,
Offen. ,Claim or Suit condition is amended
to a he following additional conditions
applic~a. -; to the additional insured:
G-140331-B
(Ed. 01109)
An additional insured under this endorsement
will as soon as practicable:
(1) Give us written notice of an "occurrence" or
an offense which may result in a daim or
suit" under this insurance, and of any claim
or "suit" that does result;
(2) Tender the defense and indemnity of any
daim or "suit" to any other insurer ores to
insurer whose policy or program app
a loss we cover under this Coverage Part;
(3) Except as provided in Paragraph 6.3 of this
endorsement, agree to make available any
other insurance the additional insured has
for a loss we cover under this Coverage
Part; and
(4) Send us copies of all legal papers received,
and otherwise cooperate with us in the
investigation, defense, or settlement of the
daim or "suit."
We have no duty to defend or indemnify an
additional insured under this endorsement until
we receive from the additional insured written
notice of a daim or "suit."
2. With respect only to the insurance provided by
this endorsement, the first sentence of
Paragraph 4.a. of the Other Insurance
Condition is deleted and replaced with the
following:
4. Otherlnsurance
a. Primary Insurance
This insurance is primary and non-
contributory except when rendered
excess by this endorsement, or when
Paragraph b. below applies.
E. The provisions of the written contract or written
agreement do not in any way broaden or amend
this Coverage Part.
G-140331-B Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 2
(Ed. 01 /09)
GENERAL PERMIT CONDITIONS
1. Payment of a security to insure faithful performance and completion of the work is required. This security is refundable upon
completion of the work and written acceptance by the City.
2. A one-year maintenance period for all work is required. Such period will begin on date of acceptance by the City. It is the applicant's
responsibility to remove and replace unacceptable improvements within the one-year maintenance period.
3, Refund or cancellation 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 work upon completion. Acceptance by the City will be
made in writing to the Permittee.
5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, fire hydrants and water valves,
6. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and
Specifications at the sole expense of the Permittee.
7. Sawcut for all PCC and AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements.
8. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading as specified by the City
Engineer may result in the City's providing such signing and barricades and charging the cost to the Permittee.
9. The Contractor or Permittee will have a supervisory respresentative available for contact on the project at all times during
construction.
10. This permit shall be kept at the site of work and must be shown to any authorized representatives ofthe City of Campbell or any
law enforcement officer upon demand.
t 1. No storage of materials or equipment will be allowed near the edge of pavement, within the traveled way, or within the shoulderline,
which would create a hazardous condition to the public.
12. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other
work for which a separate permit maybe required, nor does it relieve the Permittee of any obligation to obtain any other permit
required by law.
13. This permit does not release the Permittee from any liabilities contained in other agreements or contrails with the City and any other
public agency.
14. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon.
15. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require
reimbursement of inspection costs at the current overtime rate.
16. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum
charge per occurrence.
17. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to
require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or
maintained facilities.
18. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the
municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by
the Santa Clara Valley Urban Runoff Pollution Prevention Program.
Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above
conditions. ~ _
~~~ /~o
Date
J:\FORMS\Templates\Encroachment Permits\R-1 Encroachment Permit STATIC form2.pdf
Rev. 3/10
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