Loading...
ENC2015-00105• 0- CITYOFCAMPBELL DEPT. OF PUBLIC WORKS 70 North First Street Campbell, CA 95008 Ph. (408) 866-2150 Fx. (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right-of-way) Issued 6665 Permit Expiration Date 6 /( / 1 Permit No ENC X-Ref. File Application Date /1 Application Expiration Date 12-1i I APN V16S mo-lci� APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: Utility Trench Location: j 20oo S RAsc.Um A,\i� B. Nature of Work: E—j_ eC 7,L�-� C. Attach four (4) copies of an engineered plan showing the location 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 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 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 Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. The Contractor must have this permit and approved plans atthe 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 Applicant: Address: �. ST l ( ....`TIJL Telephone: �"�Ir_._ ..._..__......_:............_....__...-- --- ......... _.....__.._.. 5 PALA !G.. Lfi11LU/V A 24-HOUR EMERGENCY PHONE NUMBER: I_ l �/%�] /®/ S g Y. p per y owners at t elr own residence? YES NO The Applicant/Permittee hereby agrees by affxing.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 Applicant/Permittee hereby acknowledges that they have read and understand both the front and•back of this permit, and they will inform their contractors) of the information. Applicant is ad -' ed that upon issuance of this permit, property owner, or property owner's successors, shall be. responsible for any and a I amages aris out of / zl/e co�ryd�ion of any private improvements in the public right-of-way. / 7 Accepted: Mail Address: �n l e r /Qpz Is this work bein done b the ro t h Permittee) (sign) (Contractor) (Print Name) 2015— Date e �Y CI.IHL YtiUVIJIUNS: - 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be specifically approved by the Inspector oriorto cuttiDg. . 2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A", unless otherwise approved by the Engineer. 3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4216 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has. been notified and the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO, 5. Prior to any work, the property owner shall execute an Agreement for Private Improvements in the Public Right -of -Way, which shall be recorded. - 6. Public Notification Requirements: ►i SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONSTRUCTION CASH. DEPOSIT PLAN CHECK & INSPECTION FEE, EMERGENCY PERMIT FEE AMOUNT RECEIPT NO. s 3Q,5 Z5S 777 /, APPROVED FOR ISSUANCE "�— ; �L �j 1115 , GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call -out, 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 cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4.. Submit project schedule 10 (ten) days priorto proposed start of work. Special provisions may be required for work within. City facilities and downtown Campbell. 5. 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. 6. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants, and water valves. 7. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours, and street closures. This plan must be reviewed and approved prior to any lane closures. 8. A Construction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. improvements in accordance with City Standards and Specifications at the sole 9. Replace as directed by the City Engineer any damaged or removed expense of the Permittee. 10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. 11. 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. 12: Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by. the City Engineer. 14. The Contractor or Permittee "will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall proyide'a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m. 15. No storage of materials or equipmentwill be allowed nearthe edge of pavement, the traveled way, orwithin the shoulderline which would create a hazardous condition to the public. 16. 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 may be required, nor does it relieve the Permittee of any obligation to obtain any -other permit required by law. 17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. Call back (call out).due to emeregencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 20. Pursuantto Chapter 14.02 ofthe 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 bythe Santa Clara Valley Urban Runoff Pollution Prevention Program. 21. If the public interest requires a modification of, or a departure from the plans and specifications, the City shall have the authorityto 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. 22. Permitttee must provide advance notification to all parties that may be affected bythe permit activities. Notification shall be reviewed bythe City prior to distribution and include dates of work and a contact name and phone number. Applica t shall be responsible for e ring that all those providing services under the applicant are aware and understand all of the above conditions. Gb12-o155 Date' Applicant ~J N Date: Contractor (Print Name) JAFORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.02/14 NOTES 1. APPLICANT TO TRENCH ELECTRIC ONLY 2. APPLICANT IS TO PROVIDE ALL ELECTRIC SUBSTRUCTURES AS SHOWN 3. APPLICANT IS TO PROVIDE MANDREL AND PERFORM MANDREL TEST WITH PG&E INSPECTOR STANDBY 4. THE TOTAL NUMBER OF BENDS INSTALLED IN ANY PRIMARY DUCT RUN SHALL NOT EXCEED 300 DEGREES. THE TOTAL NUMBER OF BENDS IN ANY SECONDARY DUCT RUN IN EXCESS OF 200 FEET SHALL NOT EXCEED 300 DEGREES. ANY SECONDARY DUCT RUN EQUAL TO OR LESS THAN 200 FEET IN LENGTH MAY CONTAIN UP TO A TOTAL OF 315 DEGREES IN BENDS. 5. APPLICANT IS RESPONSIBLE TO ENSURE TRENCHING AND SUBSTRUCTURE INSTALLATION MEET PG&E GREENBOOK STANDARDS. GREENBOOKS ARE AVAILABLE IAT YOUR LOCAL PG&E HEADQUARTERS OR CAN BE FOUND ON THE INTERNET ® WWW.PGE.COM/GREENBOOK �. APPLICANT SHALL INSTALL A NOMINAL 1/2 INCH CONDUIT AND PULL TAPE FROM THE METER SECTION OF THE ELECTRIC PANEL LOCATION TO THE LEGEND — p — INSTALL 3-1/0 A EPR CONC ENCAP PE (25 KV) CABLE IN (1) - 4" PVC PRIMARY DUCT BY APPLICANT —5`A— INSTALL 1 SET 3-1000 & 1-350 XLP 600V) CABLE IN 1 OF (3) - 5" PVC SERVICE DUCTS BY APPLICANT LSJ 3' X 5' X 3'6" PRIMARY ENCLOSURE BY APPLICANT INSTALL TX AS SHONW ON106" X 90" STYLE HE TRANSFORMER PAD BY APPLICANT FIELD CONDITIONS WILL DICTATE PLACEMENT OF PROTECTIVE POSTS ° REQUIRED FOR TRANSFORMER SEE PG&E DOCUMENT 051155 7 COORDINATE # POLE SAFETY FACTOR 3.54 315 8436 26972 POLE SAFETY FACTOR 4.06 16.5 KVA (SC) LOADINGS DISTRICT VD = 4.04 TX SIZE - 5o 7 TELEPHONE SERVICE LOCATION. SEE GREENBOOK FOR FURTHER DETAILS. 10 tL>r KVA LOAD-37.1 v ! O sm 315 8408 28974 ___ POLE SAFETY FACTOR 5.33 ,----------------- - - - _ - L 100i) AMS _ 120/208 V ` 4W 3m SCI 42,000 116 KVA (SC) VD = 3.03 e"!J7QS{J ki!!IICIiIG # 2000 _ _I( I) I I '-I lit p CUST. - t t O _ ^, !O d PHASE -10 �Lp I /d 50 �9 oh 50 Lo 315 8418 28973 I EXISTING OPEN POINT DIFFERENCE IN TENSION v o 6 IN SECONDARY 2� 0 LBS 4 ASCR VS 3-. C ------------------- O O os`Q a 206' 3-2 C 0 190' 3-2 C g 12 KT_-- EAST CAMPBELL ± 125' TO S. BASCOM Nilp. 5 FOOT RADIUS. ALL SWEEPS TO BE -- _ _ .COAICRETED. - - _-- ^d --- a- ------------------------ 3 4 AR 12 KV 3/4 AR 12 KV PT 72 5 oA' POLE SAFETY FACTOR 2. 0 PROPOSED PG&E o !!aa 4 RISER QUADRANT 82' VERIFY WITH PG&E INSPECTOR _ PROJECT CONDITIONS STAMP _�..�..,,.. rl-t- p-, p COORDINATE j) ,'� '• PRIMARY VOLTAGE SECONDARY VOLTAGE \I .. IY)niTeay 120/208 T% SIZE - Is. KVA T O - _ .... ' �..-.. K% VA 30 - 116 T L. F. D - YPE LOADING IIIT-11: 3' X 5' X 3'6" 1- I� IVT PRIMARY ENCLOSURE BY APPLICANT iI t r r. F I TY 1 SAFETY PlE00E t.i , 01",OSED RISER I I areTinnT ND ALL i" Identify - —j- Pele — Area Dbtrlct (per Doc 1072140 and UOIIty ''i_ .:! eweNn To-Tame-aa.r. uAAI �. G i.i t:r f'I OFRA ❑SRA yy LRA I,' - ) Per tie Pewer Line Vlre Prvvenlion FINd .d Guide, tie a p— be ng inetolled m ❑E—pi )ONon E-Wt ❑N/A r 1 , ❑ III ng Non Famnpt Equipment a Fve Area, venfy n SAP Nal the CN 25 hoe been gellwted. i ❑New Business ❑PG&E Malntenonce & Construction :oject Conditions: [:]NONE APPARENT (It p.jmi design change, contact ADE) ❑ CONDITIONS APPLY: []PERMITS ❑ TAILBOARD ❑ OTHER (PrvJde ad Deal mto U.. en Ine bebw) Underground Service Alert Call: TOLL FREE 1-800-227-2600 TWO WORKING DAYS BEFORE YOU DIG OAS CONTLJCTS'IOENRM FOR MIS PROJECT GAS PUTS: Yop/ 3412-V GAL. CAI NTIES IN —ILICE WITH EXCAVATION AT LOC(S} GAS UpNT1E5 IN PRO%INHY WIM C%CAVATION AT LOC(S): Loa. G"( jri iE�i L i C L I ri S l i A LL- E 1 N 5 r,1U- C-i7 R 6 1.e4- i1-4 D 5 i DE V-Al- j_ W w m CD N O °o I"' U fn Z C:)� i Z Q O U U w � /t J LLI 1--t w U w LU E -E m cn m E—( o Q g o Q O � LJ LL. U Q Li r c CD MAP H161N= = a o Q CLASS 3 AREA�- 8" INSUL DIST z d a EiS . 12 KV AREA SC LA EL PATIO 1104 11-: o CL a z < SSD 31193 w a En Cie a u M APPLICANT CHECKLIST x ■ CONTACT UNDERGROUND SERVICE ALERT "USA" AT 1-800-227-2600 (OR "811" BY LANDLINE), AT LEAST 2 BUSINESS DAYS BEFORE EXCAVATION, TO HAVE EXISTING UNDERGROUND UTILITIEDS MARKED IN FIELD ® OBTAIN CITY/COUNTY EXCAVATION PERMIT (IF APPLICANT TO TRENCH) N FOLLOW TRENCH INSTRUCTIONS (IF APPLICANT TO TRENCH) ■ APPLICANT TO BACKFILL IMMEDIATELY AFTER INSTALL. MINIMUM OF 4" OF SAND AND 8" OF NATIVE SOIL DAY OF CONSTRUCTION. ■ HAVE SUFFICIENT SAND ONSITE PRIOR TO FINAL INSPECTION, REFER TO GREENBOOK SECTION 2.3.4 ■ MAINTAIN 3' MINIMUM PARALLEL SEPARATION FROM WET FACILITIES (I.E. WATER, SEWER, STORM), REFER TO UO STANDARD S5453, EXHIBIT B ■ TRENCH MUST MEET PG&E STANDARDS (SHOWN BELOW) AND HAVE 2" OF PG&E APPROVED SAND ON BOTTOM OF TRENCH BEFORE FINAL INSPECTION, ❑ COORDINATE INSTALLATION OF TELEPHONE AND CABLE TV FACILITIES PER THEIR CONSTRUCTION REQUIREMENTS ■ CALL (408) 725-2202 OR FAX (408) 725-7773 FOR PG&E TRENCH INSPECTION — AT LEAST 2 BUSINESS DAYS ADVANCE NOTICE ■ PLUMB GAS HOUSELINE TO NEW LOCATION AND HAVE MUNICIPALITY NOTIFY PG&E THAT GAS HOUSELINE HAS PASSED INSPECTION ❑ GAS METER GUARDS PER GAS STANDARDS AND SPECIFICATIONS MANUAL SECTION J-95 ■ PAYMENT MUST BE RECEIVED BY PG&E, BEFORE CONSTRUCTION WORK CAN BE SCHEDULED 4 TYPICAL JOINT TYPICAL PICTRENCH SERVICE TRENCH GAS R1 � 18 Z o ¢ 12' z ¢ w } MIN, MIN. wOff BACKFILL Q z 39' MIN. 3' 28' MIN, BACKFILL N q C T 51' MIN, o SAND 12' Z M ¢ 4' COVER MIN. 6' M]N,, 5 GJ4' SAND © 2' 4 SAND 2' Is N Y 0 0 DO Z W 0 SAND 2 GREENBOOK PG. 2-11 GREENBOOK PG. 2-8 PER UO STANDARD S5453, EXHIBIT B 30' MIN TO 5 ELEC METE t 75' 66' PR 48' BUILDING CORNER 6' MIN. TO INSIDE _ BUILDING CORNER TRIC 12' MIN. TO OUTSIDE BUILDING CORNER ELECTRIC O METER 10' MI CATIONS 36' 36' ENCLOSURE MAXIN.. MIN. EFERRED MIN. SERVICE TEE/HOUSELINE FINISHED GRADE 26 MINIMUM SEPARATION AND CLEARANCE REQUIREMENTS G I T T I C I S P MINIMUM COVER G GAS — 1 12" 17' 12" 1 6" I 24"; 30" in street T TELEPHONE 12" — 1" 1" 12" 12 24"; 30" in street T TELEPHONE (DB) 1" 12" 12 24"; 3C" in street C CAN 1" — 12' 12" 24"; Z' in street S ' ELECTRIC SECONDARY 112"1"— 12 12" — 3 24"; 30" in street P ELECTRIC PRIMARY 12 1,2" S' — 30"; 36" in street SL STREETLIGHT 12 12" 1"1 3" 24"; 30" in street N THE MINMUM CLEARANCES DO NOTAPPLY TO FIXED WINDOWS THAT ARE NOT DESIGNED TO OPEN. LENGTH EXISTING PIPE 36' 36' SERVICE TEE/ 10, MIN. MIN. HOUSELINE 5' LENGTH X 4' WIDTH STEEL PIPE. BUILDING �_ GAS RISER GRADE 18" UNDER STEEL PIPE. VENT GAS RISER GAS VENT lz' UNDER PLASTIC PIPE. GREENBOOK PG. 2-29 ELECTRIC SERVICE RACEWAY GREENBOOK PG. 2-30 GREENBOOK PG. 2-8 COMBUSTION 36' MIN, 36' MIN,COMBUSTION EXHAUST FAN EXHAUST FAN PAD -MOUNTED TRANSFORMERS,. ALL ELECTRIC EQUIP, AND 26 WIRING (E.G„ CENTRAL AIR, COMBUSTION GAS REGULATOR EXHAUST FAN) COMBUSTION AIR-INTAKE VENTS VENT 9a AIR-INTAKE VENTS 8' MIN. L METER SERVICE TEE/HOUSELINE GREENBOOK PG. 2-31 GASRI8' MIN. EST: John Gambucci C0: ADE: John Gambucci Applicant Trenching Checklist SD: NOTSUPV: Erin Straub '2000 S BASCOM AVE CAMPBELL OTHER: REP: Serino Ponce OTHER: u REP: Applicant Copy SHT: SHEETS I? SCAnone OOIE"14/15 ' PACIFIC GAS AND ELECTRIC COMPANY P� 31111912 REV. PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT Effective July 1, 2014 TO: City Clerk PUBLIC WORKS FILE NO, i� C 2-ej+5 - C.)Cj I b 5 PROPERTYADDRESS Please collect & receipt for the following monies: . .:: A W11l11. 11.IT �-OACHMENT. PERMIT . 4722 Utility Encroachment Permit Application Fee $385.00 R-1 Encroachment Permit N/C Emergency Permits $110.00 Plan Check & Inspection Fee Minimum Charge Per Location $385.00 Conduits/Pipelines up to 500 Feet $2.70/ft Above 500 Linear Feet $1.60/ft Manholes/Vaults/Etc. $170.00/ea Pole Set/Removal $170.00/ea A70-(1 C+.,.-,,,,, (`—+oi— [D—if $156.00 _ 4760 Project Plans & Specifications r-lu cU\ 1w. 4760 Standard Specifications & Details $J/Pq $15.50/Bk 4760 Enqineering Maps & Plans _ Aerial Plot 24" x 36" $61.00 Aerial Print 8 1/2" x 11" %29.00 Map Research includes max of two 24"x36" copies) $29.00 _ Maps and Plans 24" x 36" $14.00 _ 4722 Penalties: Failure to restore public improvements $100/Calendar Da Muni Code Sec. 11.34.010) 4722 Penalties: Failure to correct unsafe conditions $1o0/CalendarDay 47221 Work Without Permits 4 Times Applicable Fee TRAFF..IC . '. NUM...41 4728 Traffic Flow Map (Daily Traffic Volumes $35.00 _ 4728 Signal Timing Information $73 Der hour 4271 Truck Permits $16.00 Dertri 4728 No Parking Signs $1 each or $25/100 MISCELLANEOUS 511.7424 Postage Other Please Specify) TOTAL l "I Q NAME OF APPLICANT � `'�� " f C NAME OF PAYOR > A H F— PHONE(�-(SI 2-7/ S q�(© ADDRESS 1(D� I-�V<��iY��� � � cA ZIPq. FOR RECEIVEDBY CITY CLERK ONLY Date` ID is Receipt # Al JUN 01 2015 CITY OF CAMPSf=l-li- J:\FORMS\TemplalesWdministralive\Receipt Form Utility Encroachment & Misc 1415 DATE(MMIOD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/20/2017- THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER. THIS CERTIFICATE DOES NOT, AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES S (9 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVBDR PRODUCER, AND THE CERTIFICATEHOLDER. IMPORTANT: If the certificateholderis an ADDITIONALINSURED,the policy(ies)must beendomed. If SUBROGATIOMS WANED,subjectto the termsandconditlonsofthe policyFertainpoliciesmaymquimnendomemenLA statementon thiscertificatedoesnot conferrightstothe cerUFcateholder in lieu of such endorsement(s). CONTACTDINA- ATHEY PRODUCER NAME. ISU INS SERV -'BC ENV BROKERAGE PA/C.HONENE(916) 939-1080 �uc.Na): (916)939-1085 o, rt 1037 Suncast Ln Ste 103 EMAIL ADDRESS: El Dorado H111s, CA 95762 INSURER(S) AFFORDING COVERAGE INSURERA: ADMIRAL, INSURANCE COMPANY INSURER B: STATE COMP. INS. FUND INSURED ENVIRONMENTAL CONTROL ASSOCIATES, INC 3011 TWIN PALMS DRIVE APTOS, CA 95003 INSURER E : NAICY 24856 35076 COVERAGES Ut]ttllr[UAIM Numocrt: ---- ---------- - THIS IS TO CERTIFY THAT 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, - EXCLUSIONSANDCONDITIONSOF SUCH POLICIES. LIMITS SHOWMMAY HAVEBEEN REDUCED BYPAID CLAIMS. E POLICY EFF POLICY EXP LIMITS TYPE OFINSURANCE POLICY NUMBER MMIDDNYYY) IMM/DDNYYY) X COMMERCIAL GENE RAL LIABILITY EACH OCCURRENCE E 1,000,000 CLAIM—E MX OCCUR _ PREMISES Me oc—ce E 50OOO X MEDEXP(Anyonapemon) E 5 000 CONT.POLLUTION FEI-ECC-22900-00 6/01/16 8/01/17 E 1,000,000 A Y LRSONALBADV INJURY GENERAL AGGREGATE E 2, OOO, OOO GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG E 2 , 000 000 X POLICY1:1 JPEEC LOC g OTHER: CFOOMBI�EED SINGLE LIMIT E AUTOMOBILE LIABILITY BODILYINJURY(PB,pefaan) E ANYAUTO BODILY INJURY (Per accident) E ,ALL OWNED SCHEDULED AUTOS 'AUTOS NON -OWNED - PROPERTY DAMAGE (Par accident) E HIRED AUTOS AUTOS - b UMBRELLA LIAR OCCUR EACH OCCURRENCE E AGGREGATE E EXCESS LIAR CLAIMS -MADE _ DED RETENTION E E RKERS COMPENSATION X PER OTH- STATUTE ER NDEMPLOYERS-LIABILITY ' YIN R—ET rE ENT."-, g-6,-.', =,5 0-i�/•1. '-i�/1'f7 E.L. - F- fi... CCIDENT S 1,000,000 B `I--t orr cr nc Eaov r� L� N- A E.L. DISEASE -EA EMPLOYEE S , 1 , 000 , 000 (Mandatoryn NH) E.L DISEASE -POLICY LIMIT 1 000 000 / / If yes. describe under DESCRIPTION OFOPERATIONS below A E&O LIAB. FEI-ECC-22900-00 8/01/16 8/01/17 $1,000,000 OCCURRENCE CLAIMS MADE RETRO: 08/11/93 $2,000,000 AGGREGATE DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (ACORD 101.AddNanal Remarks Schedule, may be ana hed if more apace is'required) , RE: ALL WORK IN THE PUBLIC RIGHT OF WAY - KIRKWOOD PLAZA - - CITY OF CAMPBELL, ITS OFFICERS EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED. THE INSURANCE COVERAGE AFFORDED TO THE ADDITIONAL INSURED. PRIMARY AND NON-CONTRIBUTORY COVERAGE APPLIES. WAIVER OF SUBROGATION APPLIES. WAIVER OF SUBROGATION APPLIES TO THE WORKERS COMPENSATION. 30 DAY WRITTEN NOTICE OF CANCELLATION APPLIES. (BLANKET ENDORSEMENTS ATTACHED)IVC AAIVER TO FOLLOW FROM CARRIER,- CITY OF CAMPBELL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 70 N 1ST STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCEWITHTHE POUCY PROVISIONS. _ CAMPBELL, CA 95008 AUTHORIZED REPRESENTATIVE hr1�ytl 01988-2014 ACORD CORPORATION. All rights reserved. ACORD25 (2014/01) The ACORD name and logo are registered marks of ACORD