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ENC2015-00157
CITY OF CAMPBELL "' DEPT. OF PUBLIC WORKS 70 North First Street Campbell, CA 95008 Ph. (408) 866-2150 Fx. (408) 376-09SS ENCROACHMENT PERMIT (for working within the public right-of-way) Issued 5/it I ( C. Permit Expiration Date 5 A�( 7 1 X-Ref. File 0 1 Application Date 0 S Application Expiration Date APN 021 3, 005?i 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.: 136 & 40 Railway Avenue Utility Trench Location: WA, I B. Nature of work: Frontage improvements (curb, gutter, sidewalk replacement & new driveway) 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. Ali 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 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 Applicant: [RanAriko Telephone: 408.568.9650 Address: 1090 Camino Ramon, San Jose, CA 95125 j E-Mail Address: 24-HOUR EMERGENCY PHONE NUMBER: RYAN.ARWO&AMAlt.. col)►l- , t{OS- 15(a- ouzo Is this work being done by the property owners at their own residence? r-1 YES F The Applicant/Permittee 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 resuiting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the frontland back of this permit, and they will inform their contractor(s) of the information. Applicant is advised that upon issuance of this permit, property owner, or property owner's successors, shall be responsible for any and all da5ui"s arising oo o�the condition of any private improvements in the public right-of-way. , Accepted: z (Applicant Permittee) (sign) Date M/ /, An 4 {I v t (Contractor) (Print Name) Date SPECIAL PROVISIONS: 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 —y the Inspector prior to cutting. __Z2. 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: 7 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 a000nxxn ono icu ianirF RECEIPT NO. '00 0 t S Ail e] fj S��t/IG ENCRO-t-rnMENT PERMIT ISSUANCE CHECK LIS1 -` n City of Campbell Encroachment P rmit No. ENC 2,01 S �S I Department of Public Works Tract No. t� � Address: �W'i �V) Mujm &Ea ,-- ITEMS REQUIRED FOR PERMIT APPLICATION: I. F%- Encroachment Permit Application complete, with applicant signature and date (front and back) .� - Recei t Number & Date to I 2._flPermit Application Fee paid $ 3�,S p ZS©l �� .� LS 3. AP!> Plan Check Deposit Paid (2% of Engineer's Estimate, $500 min) $ 500 .co Receipt Number -ZIS`j 1AA - It i 4. � Grading Plan Review Fee paid $ 0 , C£O - Receipt Number & Date SSCI 5. fsCity Engineer's Estimate Completed and Submitted 6. Four (4) Sets of Street Improvement Plans 7. Four (4) Sets of Grading and Drainage Plans 8. Check Lists (Grading and Drainage, Street Improvement) ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS 9. Plan Check & Inspection Fee: Engineer's Estimate (EE) = $ JS yLk5`L z 00 ; if EE is <$250,000, then fee is 14% of EE. If EE > $250,000, fee is Actual Cost + 20%. $35,000 minimum deposit. Amount Receipt No. & Date��ri� I?a�l 1S 10. yo- 11.01k 12._V$, Security for Faithful Performance and Labor and Materials, 100% each of En ineer's Istimfte, supplied or paid. Amount $ 1 � "LK`_ Form CfhW Receipt No. & Date' Solis — Security for Monumentation Amount $ Receipt No. & Date Construction Emergency Cash Deposit: 4% of Engineer's Est ate. ($ 00 mini um 10,000 maximum) Amount $ &b Receipt No. & Datte1 % 119`L0 �® `(� 13.f2eStorm Drainage Area Fee Amount $ 1 Receipt No. &Date ®� 14.Kk Street Improvement Agreement signed and notarized (proof of ownership submitted) 15. Right of Way Documents Completed and Fees Paid. 16. All other Public Works requirements listed in the Conditions of Approval of the development. 17. Other Fees, Payments, Deposits Amount $ ,/K—Covenant Receipt No. & Date 18. QCSWPPP + NOI 19. C3 Certification 20. �Agreement 21. Geotech Letter 22. Storm Water Management Plan Soli 5 f4Gr-�_ ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: 23. Contractor's signature added to the permit application (front and back) 24. Contractor's City of Campbell Business License # 25. Worker's Compensation Insurance Information Sheet received from Contractor. 26. Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. 27. One mylar set and six (6) or less sets of off -site plans signed by engineer, stamped APPROVED FOR CONSTRUCTION. _Contractor, Inspector PW Superintendent (Service Center) EP File LD File _Signals & Lighting Supervisor (Service Center) 28. Permit signed by City Engineer. 29. INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. ENC2015-00157 PROPERTY ADDRESS 36 & 40 Railway Avenue Please collect & receipt for the following monies: ACCT. ITEM AMOUNT LAND.DEVELOPMENT 4722 Encroachment Permit Application Fee Non -Utility Encroachment Permit Major >_$10,000 $395.00 Minor Encroachment Permit <$to,000 $225.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $225.00 Inspection Fee Minimum Charge per Location $390.00 Street Tree Planting/Removal N/C 2203 $500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2% of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot $275.00 Site < 10,000 s.f. $825.00 Site _> 10,000 s.f. < 0.5 Acre $1 105.00 Site >_ 0.5 Acre $1,655.00 4722 NPDES Review C3 Requirements For projects not required to submit numeric sizing $160.00 For projects required to submit numeric sizing Impervious Area 10,000 S . Ft to 1 Acre $690.00 Impervious Area 1 Acre or more $900.00 4722 For projects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non -Utility) 4722 Engr. Est. < $260,000 14% of Engineer's Estimate $2,595.88 2203 En r. Est. >_$250 000 and :5$500 000 $35 000 + 8% of Engineers Estimate 2203 2203 En r. Est. >$500,000 $55 000 + 7% of Engineers Estimate Emergency Cash Deposit 4% of En r. Est* $500 minl$10,000 Max $741.68 2203 Faithful Performance Security FPS 100% of ENGR. EST.* $18,542.00 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2 120.00 (Multi -Res $2 385.00) All Other $2 650.00 $477.00 4722 Parcel Ma 4 Lots or Less $3 930.00 + $85/lot 4722 Final Tract Ma 5 or More Lots $4 775.00 + $116/lot 2203 Monumentation Security 100% of Ci 's Monumentation Estimate 4920 Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment Includes Certificate of Compliance $1 856.00 4722 Vacation of Public Streets & Easements $2 480.00 4722 Certificate of Compliance $1 840.00 4722 Certificate of Correction $550.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee(per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $877.00 Each Additional Lot $275.00 511.7424 MISCELLANEOUS Postage Other (Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $22 356.56 NAME OF APPLICANT / 1` X,, i z NAME OF PAYOR Gn.. I I-) PHONE ADDRESS l ZIP�l'O r' FOR RECEIVED Eff CITY CLERK ONLY \ '° Date Receipt # "'-'<• `''' `" ''"` J.AL.McM Chock Cam.rta.\l-Spafic P,.j-b Acme Pig YmP-,-s .UW A-3L -W- PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. ENC2015-00167 PROPERTY ADDRESS 36 & 40 Railway Avenue Please collect & receiDt for the followinq monies: ACCT: "I AMOUNT LAND.DEVELOPN 4722 Encroachment Perm ifVpncati6n'Fee Non -Utility Encroachment Permit Major a$10,000 $395.00 $395.00 Minor Encroachment Permit <sio,000 225.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $225.00 Inspection Fee Minimum Charge per Location $390.00 I Street Tree Planting/Removal N/C 22031 22031 ($500 per Tree Planting Deposit Required) $500.00/tree Plan Check Deposit 2% of En-gineees Estimate §500.00 min $500.00 Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot $275.00 Site < 10,000 s.f. $825.00 Site z 10,000 s.f. < 0.5 Acre $1,105.00 Site a 0.5 Acre $1,655.00 4722 NPDES Review (C3 Requirements) For protects not required to submit numeric sizing $160.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $690.00 Impervious Area 1 Acre or more $900.00 4722 For projects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non -Utility) 4722 Enqr. Est. < $250,000 14% of Engineers Estimate 2203 - Enqr. Est. 2t$250,000 and 5$500,000 $35,000 + 8% of Engineers Estimate 2203 Engr. Est. >$500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Enqr. Est.* ($500 min1$1 0,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 (Multi -Res $2,385.00) All Other '0' L2ffll),00) 4722 . 8,51lot lTract iMlap(b�or 4722 Final More Lots ) $4,775.UU + $1161lot 2203 . Monumentation Security 100% of CitV's Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (Indudes Cerfificate of Compliance) $1,856.00 4722 Vacation of Public Streets & Easements $2,480.00 4722 Certificate of Compliance $1,840.00 4722 Certificate of Correction $550.00 4722 Document Recording Fees 15.00tfirst page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet, 4722 Appeal Filing Fee $200.00 4722 N Fee(per signature) $10.00 4722 Assessment —Reapportionment First Split $877.00 Each Additional Lot $275.00 511.7424 MISCEL - - Postage OUS" Other (Please Specity) .Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $895.00 NAME OF APPLICANT Ryan Ariko._ NAME OF PAYOR Ryan Ariko PHONE 408.568.9650 ADDRESS 1090 Camino Ramon, San Jose, CA ZIP 95125 FOR RECEIVED BY. CITY CLERK ONLY c Date:: Reeipt#' H. J.�, C�C-S, - Sp- P-j� JUL %»h, y0L N- Date: July 8, 2015 Site Address: 36 & 40 Railway Avenue CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 10/14 ":ENGINEER'S ESTIMATE FOR';' " LAND DEVELOPMENT PROJECTS For File No(s): PLN2014-258/BLD2015-00496 ENC. No. ENC2015-00157 Estimated Cost of Improvements $18,542 ITEM NO. DESCRIPTION QTY UNIT UNIT PRICES FOR PROJECT AMOUNT < $250 K > S250 K $ AMOUNT I. DEMOLITION/CLEARING 1. CLEARING & GRUBBING 0 LS $2,000.00 $1,500.00 $ - 2. SAWCUT P.C.C./A.C.(UP TO 6") 76 LF $6.10 $4.10 $ 463.60 3. P.C.C. REMOVAL 0 SF $4.00 $3.00 $ - 4. CURB AND GUTTER REMOVAL 76 LF $7.05 $3.45 $ 535.80 5. MEDIAN REMOVAL 0 SF $5.25 $2.65 $ - 6. DEMOLISH EXISTING INLET/PLUG RCP'S 0: EA $1,800.00 $1,200.00 $ II. STORM DRAINAGE 1. 12" R.C.P. (CLASS V) 0 LF $210.00 $180.00 $ 2. 15" R.C.P. (CLASS III) 0 LF $225.00 $195.00 $ 3. 18" R.C.P. (CLASS III) 0 LF $240.00 $210.00 $ \ 4. 24" R.C.P. (CLASS III) 01 LF $260.00 $240.00 $ 5. 30" R.C.P. (CLASS III) 0 LF $280.00 $260.00 $ 6. T.V. INSPECTION (12") 0 LF $1.25 $0.80 '$ 7. STD. DRAINAGE INLET (C.C. DETAIL 5) 0 EA $2,800.00 $2,300.00 $ 8. FLAT GRATE INLET (C.C. DETAIL 6) 0 EA $1,620.00 $1,275.00 $ 9. STD MANHOLE (C.S.J. DETAIL D-11) 0 EA $5,000.00 $4,000.00 $ 10. STD MANHOLE (C.S.J. DETAIL D-12) 0 EA $6,500.00 $6,000.00 $ IL BREAK AND ENTER M.H./D.I. 0 EA $1,000.00 $835.00 $ III. CONCRETE IMPROVEMENTS 1. SIDEWALK 354 SF $12.00 $8.00 $ 4,248.00 2. DRIVEWAY APPROACH 136 SF $14.00 $10.00 $ 1,820.00 3. CURB AND GUTTER 76 LF $45.00 $35.00 $ 3,420.00 4. VALLEY GUTTER 0 SF $20.00 $15.00 $ - 5. CURB RAMP 0 EA $1,800.00 $1,500.00 $ 6. TYPE 13-1 CURB 0 LF $34.00 $29.00 $ 7. TYPE AI-B3 CURB 0 LF $20.00 $17.00 $ 8. COBBLESTONE MEDIAN SURFACE 0 SF $20.00 $15.00 $ 9. P.C.C. DRIVEWAY CONFORM 0 SF $8.20 $6.30 $ 10. A.C. DRIVEWAY CONFORM 0 SF $5.25 $4.40 $ J:\LandDev\Plan Check Comments\1 - Specific Projects - Active Project in Progress\Railway Ave. 36\Street Improvements\EngEst (Rev. 03/081page 1 of 4 Date: July 8, 2015 Site Address: 36 & 40 Railway Avenue CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 10/14 rNGINEEIZ'S°ESTBiUtlAE FORS , . LAND DEVELOPMENT PROJECTS.' For File No(s): PLN2014-258BLD2015-00496 ENC. No. ENC2015-00157 Estimated Cost of Improvements $18,542 ITEM NO. DESCRIPTION QTY UNIT UNIT PRICES FOR PROJECT AMOUNT < $250 K > $250 K $ AMOUNT IV. PAVEMENT 1. ASPHALT DIGOUT AND REPLACE CF $5.80 $4.10 $ 2. PAVEMENT WEDGE CUT (6) 0 LF $5.00 $2.65 $ 3. PAVEMENT GRINDING 0 SF $0.95 $0.63 $ 4. PAVEMENT FABRIC (PETROTECH) 0"- SY $2.30 $2.10 $ 5. ASPHALT CONCRETE (TYPE A) 0 T $210.00 $150.00 $ 6. AGGREGATE BASE (CLASS 2) 0 T $80.00 $40.00 $ 7. SLURRY SEAL (TYPE II) 0 SF $0.25 $0.20 $ 8 AC REMOVAL/OFFHAUL/DISPOSAL 0 CF $14.00 $12.00 $ V. TRAFFIC SIGNALS/LIGHTS I. DETECTOR LOOP (6' ROUND) 0 EA $520.00 $347.00 $ 2. DETECTOR LOOP (6' x 30') 0 .. EA $752.50 $62625 $ 3. DETECTOR LOOP (6' x 50') 0 EA $1,042.00 $868.30 $ 4. ELECTROLIER 0 EA $4,000.00 $3,500.00 $ 5. 1 1/2" RIGID CONDUIT 0 LF $10.40 $8.20 $ 6. 2" RIGID TRAFFIC SIGNAL CONDUIT 0 LF $19.70 $15.05 $ 7. CONDUCTOR 0 LF $0.85 $0.65 $ 8. PULL BOX (NO. 3 1 /2) 0 EA $347.00 $278.00 $ 9. TRAFFIC SIGNAL PULL BOX (NO. 5) 0 EA $463.00 $405.25 $ 10. PULL ROPE 0 LF $0.57 $0.57 $ VI. STRIPING AND SIGNS I. REMOVE PVMT. MARKINGS (PAINT) 0 SF $2.65 $1.60 $ 2. REMOVE PVMT. MARKINGS (THERMO) 0 SF $3.70 $3.40 $ 3. REMOVE PVMT STRIPING 0 LF $1.50 $1.00 $ 4. STRIPING DETAIL 9 0 LF $3.00 $2.00 $ 5. STRIPING DETAIL 22 0 LF $3.00 $2.00 $ 6. STRIPING DETAIL 29 0 LF $4.00 $3.00 $ 7. STRIPING DETAIL 32 0" LF $4.00 $3.00 $ 8. STRIPING DETAIL 37 (THERMO) 0 SF $5.00 $3.50 $ 9. STRIPING DETAIL 38 (THERMO) 0 SF $5.00 $3.50 $ 10. STRIPING DETAIL 39 0 LF $5.00 $3.00 $ J:\LandDev\Plan Check Comments\1 - Specific Projects - Active Project in Progress\Railway Ave. 36\Street Improvements\EngEst (Rev. 03/081yage 2 of 4 Date: July 8, 2015 Site Address: 36 & 40 Railway Avenue CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Revised 10114 ENGINEER'S ESTIMATE=FOR LAND DEVELOPMENT PROJECTS For File No(s): PLN2014-258BLD2015-00496 ENC. No. ENC2015-00157 Estimated Cost of Improvements $18,542 ITEM NO. DESCRIPTION QTY UNIT UNIT PRICES FOR PROJECT AMOUNT <$250 K > $250 K $ AMOUNT 11. LIMIT LINE 0 LF $6.00 $4.50 $ 12. CROSSWALK, 12" WHITE 0 LF $6.00 $4.50 $ 13. PAVEMENT MARKINGS (PAINT) 0 SF $3.25 $2.50 $ 14. PAVEMENT MARKINGS (THERMO) 0 SF $6.60 $5.05 $ 15. PAVEMENT MARKER (NON-REFL.) 0 EA $5.20 $3.50 $ 16. PAVEMENT MARKER (REFLECTIVE) 0 EA $6.95 $4.75 $ 17. TYPE K MARKER 0 , EA $109.50 $92.50 $ 18. TYPE N MARKER 0 EA $109.50 $92.50 $ 19. SALVAGE ROAD SIGN 0 EA $99.00 $87.35 $ 20: RELOCATE ROAD SIGN (W81 ON NEW POST) 0 EA $115.75 $99.00 $ 21. INST. RD. SIGN ON EXIST. POLE 0 EA $231.55 $168.50 $ 22. ROAD SIGN WITH POST 0 EA $347.30 $277.85 $ 23. INSTALL 1226S SIGN WITH POST 0 EA $350.00 $252.60 $ 24. STANDARD BARRICADE 0 " LF $19.50 $15.75 $ VII. LANDSCAPING 1. IRRIGATION, PLANTING WORK 0 SF $8.00 $7.35 $ 2. PRUNE TREE ROOTS 0 - EA $147.35 $115.75 $ - 3. TREE REMOVAL 1 EA $684.10 $526.25 $ 684.10 4. ROOT BARRIER (12") 1 LF $21.05 $10.50 $ 21.05 5. ROOT BARRIER (18") 0 LF $26.30 $15.80 $ - 6. STREET TREE l EA $447.30 $342.05 $ 447.30 7. STREET TREE (36" BOX) 0 EA $710.40 $589.40 $ - 8. TOP SOIL BACKFILL 0 CY $26.30 $22.60 $ 9. IRRIGATION 0 LS $1,368.25 $710.40 $ VIII. MISCELLANEOUS 1. PEDESTRIAN BARRIER 0 LF $86.85 $69.45 $ 2. CHAIN LINK FENCE (6) 0 LF $17.35 $13.70 $ - 3. RAISE MISC. BOX TO GRADE I EA $315.75 $210.50 $ 315.75 4. RAISE MANHOLE TO GRADE .0 EA $421.00 $364.45 $ - 5. INSTALL MONUMENT BOX 0 EA $1,500.00 $900.00 $ J:\LandDev\Plan Check Comments\1 - Specific Projects - Active Project in Progress\Railway Ave. 36\Street Improvements\EngEst (Rev. 03/0&yage 3 of 4 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEERING DIVISION Date:, July 8, 2015 Site Address: 36 & 40 Railway Avenue ITEM NO. DESCRIPTION QTY UNIT 6. MEDIAN BACKFILL 0 CY PREPARED BY: REVIEWED BY: , APPROVED BY: a Revised 10114 For File No(s): PLN2014-258/BLD2015-00496 ENC. No. ENC2015-00157 Estimated Cost of Improvements $18,542 UNIT PRICES FOR PROJECT AMOUNT < $250 K I > $250 K $ AMOUNT $22.10 $19.70 $ - SUBTOTAL $ 10% MOBILIZATION, CONSTRUCTION $ TRAFFIC CONTROL/PHASING, $ CONSTRUCTION STAKING, $ CONSTRUCTION TESTING $ 10% CONTINGENCY $ 10% SECURITY ENFORCEMENT TOTAL FAITHFUL PERFORMANCE SECURITY $ USE THIS AMOUNT FOR SECURITY 11,955.60 1,195.56 1,000.00 1,000.00 1,000.00 1,195.56 $1,195.56 18,542.28 J:\LandDev\Plan Check Comments\1 - Specific Projects - Active Project in Progress\Railway Ave. 36\Street Improvements\EngEst (Rev. 03/ORage 4 of 4 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. ENC2015-00157 PROPERTY ADDRESS 36 & 40 RailAgyjA,yenue Please collect & receipt for the following monies: AMOUNT, 472Z Encroachment Permit APplication Fee Non -Utility Encroachment Permit Major >_$10,000 $395.00 395.0 Minor Encroachment Permit <sio,coo $225.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $225.00 Inspection Fee Minimum Charge per Location $390.00 Street Tree P [anti ng/Remova I N/C 22031 ($500 perTree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposi s; Estimate $500.00 min $500.00 Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot 275.00 Site < 10,000 s.f. $825.00 Site 2: 10,000 s.f. < 0.5 Acre $1,105.00 Site z 0.5 Acre $1 655.00 4722 NPDES Review (C3 Requirements) For projects not required to submit numeric sizing $160.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to I Acre $690.00 Impervious Area 1 Acre or more $900.00 4722 For projects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee (Non -Utility) 4722 Enqr. Est. < $250,000 14% of Encilneer's Estimate 2203 Enqr. Est. Z$250,000 and :5$500,000 $35,000 + 8% of Engineers Estimate 2203 Engr. Est. >$500,000 $55,000 + 7% of F=njjneers Estimate 2203 Emergency Cash Deposit 4% of Enqr. Est.* ($500 min/$10,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 . . (Multi -Res $2,385.00) All Other2 00) 4722 Parcel Map (4 Lots, or L2L) $3, 930.00+ KE 4722 Final Tract Mal) (5 or More Lots $4,775.00 +'tl 16/lot 2203 Monurnentation Security Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment (Includes Certificate of Compliance) $1,856.00 4722 Vacation of Public Streets & Easements $2,480.00 4722 Certificate of Compliance $1,840.00 4722 Certificate of Correction $550.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $1 00/sheet 4722 Filing Fee $200.00 4722 ..-_.Appeal Notary Fee $10.00 4722 Assessment Segregation Reapportionment First Split $877.00 Each Additional Lot $275.00 5117424 MI -SC ELA Postage EOUSi', �7.:d I Other (Please Specify) .Engineers Estimate shall be as approved by the City Engineer and shall include all items of work. TOTAL $895.00 NAME OF APPLICANT Ryan Ariko NAME OF PAYOR Ryan Ariko PHONE 408.568.9650 ADDRESS 1090 Camino Ram , San Jose, CA ZIP 915 125 FOR RECEIVED` CITY CLERK ONLY liatei 4 Rece i Ot �4 d,� '0. Overland Contracting Inc. CHECK 35102696 VOUCHER NUMBER INVOICE NUMBER INVOICE DATE AMOUNT DISCOUNT NET AMOUNT 074119 w w w w w w w CR070915182622100 07/09/15 895.00 0.00 895.00 w w w w w w w ��r a w w w w w w w w w Total: 895.00 0.00 895.00 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR NOTICE OF RELEASE OF RECORDED STREET, IMPROVEMENT AGREEMENT Encroachment Permit # ENC2015-00157 Property Address 36 & 40 Railway Ave. Date Street Improvement Agreement recorded 8/31/15 Date of Final Acceptance Letter: 2/8/17 Date of One -Year Maintenance Acceptance Letter: 2/27/18 All deposits refunded (Date of last refund) 2/27/18 Inspector's Encroachment Permit file merged with Main Permit File Date Permit archived in Permit Plan 2/27/18 Processed by: Reviewed By: Reviewed by: S 7 /( Inspector Land Development Engineer Date Check Request Submitted to Finance for Recording Feed Date Notice of Release sent for recording: JAJoAnnaT\Deposit refunds\CHECKLISTS\Rai1way36 SIA Release.doc (Rev. 10/11) S Recording Requested By: City of Campbell And When Recorded Return To: City Clerk City of Campbell 70 N. First Street Campbell, CA 95008 23893625c�ive® Regina A 1 comendras APR i 8 2018 Santa Clara County - Clerk -Recorder 03/23/2018 08 :17 AM 11 Y CLERK'S OFFICE Titles: 1 Pages: 2 Fees: 21.00 Taxes: 0 Total: 121.00 ■IIIM&FRIVali4ift" fk011#1PMU1111M,11111 APN: 412-09-007, 412-09-008, (Space Above This Line For Recorder's Use Only) ADDRESS:36 & 40 Railway Ave., Campbell, CA 95008 NOTICE OF RELEASE BY CITY OF CAMPBELL NOTICE IS HEREBY GIVEN concerning the real property located in the City of Campbell, Santa Clara County, California, and described specifically as follows: 36 & 40 Railway Avenue, Campbell Avenue, Campbell, CA. That whereas, FLOAT STATION LLC, a California Limited Liability Company, entered into a Street Improvement Agreement with the City of Campbell, recorded August 31, 2015, Document# 23067511, in the Office of the County Recorder, County of Santa Clara, State of California. That, whereas, said conditions of said Agreement have been met to the satisfaction of the City. That, Now Therefore Float Station LLC is hereby released from all requirements contained in the agreement recorded August 31, 2015, Document #23067511, in said County Recorder's Office. IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City .Clerk, who are duly authorized by Ordinance 2059 adopted September 20, 2005. ATT ST: Wendy t7od, City Clerk (Attach Notary Acknowledgment) CITY Amy Olay City Engir. Dated: V i of Campbell CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validityof that document. State of California ` 1 County of �_y\�Ct On 6&Ck)(0_V,, �_, ;� C)� % before me, D > c:,-- �l��c..J �V �D\�� Date y� Here Insert Name and Title of the Officer personally appeared iN\�--i ` )�C:"�!) Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. JOANNTHOMASON Commission # 2110789 z -ea Notary Public - California n z ' y Santa Clara County My Comm. Expires May9, 2019 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature _ OPTIONAL of Notary Public Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: DocumentDate: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual o Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: ©2017 National Notary Association Number of Pages: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Other: Signer is Representing: TO BE RECORDED WTIHOUT FEE SECTION 6103 GOVERNMENT CODE 9.T THE REQUEST OF CITY OF CAMPBELL Recording Requested by: City of Campbell When recorded mail to City Clerk City of Campbell 70 North First Street Campbell, CA 95008 DOCUMENT: 23067511 REGINA ALCOMENDRAS SANTA CLARA COUNTY RECORDER Recorded at the request of City Pages: 9 Fees.... * No Fees Taxes... Copies.. AMT PAID APN: 412-09-007, 412-09-008 (Space Above for Recorder's Use Only) Address: 36 & 40 Railway Avenue, Campbell, CA 95008 STREET 1WROVEMENT AGREEMENT RECITALS RDE # 025 8/31/2015 11:15 AM THIS AGREEMENT, identified by File No(s). PLN2014-258, is entered into this �i;'� day Of " � t" � 2015, by and between FLOAT STATION LLC, A CAL] FO A LIMITED LIABILITY' COM[PANY,hereunder referred to as "Owner," and the CITY OF CAMPBELL, a municipal corporation of the County of Santa Clara, State of California, hereinafter referred to as "City." On March 24, 2015 the Planning Commission granted conditional approval to allow the establishment of a health spa and an addition and remodel to an existing one-story commercial building at that certain real property described in Exhibit A attached hereto and incorporated as though fully set forth herein, and commonly known as 36 & 40 Railway Avenue, which property is hereinafter referred to as "said real property." TERMS AND CONDITIONS Now, therefore, in consideration of the above referenced approvals, and in satisfaction thereof, the parties to this Agreement shall comply with the following terms and conditions: (1) The Owner shall provide, construct and install- at his/her own proper cost and expense, street improvements as described in Section 11.24.040 of the City Code within 12 months from the date first mentioned hereinabove provided, however, that in the computation of said 12 month period, delays due to, or caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of the Owner or his/her successors shall be excluded. (2) If the Owner fails to complete the work required by this Agreement within the said 12 mnnt}i tneriOd� the riiZ�� after D ving teH (1 ill days riff nntir_,e to the Owner, Or his/her successors, may construct and/or install. said improvements and recover the full cost and expense from the Owner, or his/her successors. J:U.andDcvlFormsl2. AGREEMENTS - PIA S[A DEF SIA Maintenance Reimbursement DevelcpmenMpecifie Agreements - Sueet mprovand DeferredlWord Document of AgreementslRailway 36 S1.doc (Revl1/13) STREET IMPROVEMENT PLANS (3) The Owner, shall cause to be prepared at his/her cost and expense street improvement plans for the construction and installation of said improvements prior to such construction or installation. Said plans shall be submitted to the City Engineer for examination and approval.. (4) All of said improvernents embraced in this Agreement shall be constructed and installed in accordance with the plaits approved by the City Engineer and shall be made under the inspection and to -the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and all applicable plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes. Upon completion and acceptance of the improvements by the City, the Owner, shall provide reproducible as - built plans to the City Engineer. PLAN CHECK AND. INSPECTION FEE (5) Prior to approval of the plans by :the City Engineer pursuant to Section (3) of this Agreement, Owner, or his/her successors, shall pay the City for plan checking of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in .accordance with Resolution No. 10494 as adopted by the City Council on May 3, 2005, or as may subsequently be adopted by the City Council. FAITHFUL PERFORMANCE SECURITY_ (6) The Owner, or his/her successors, shall file with City, prior to beginning construction, security acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure full and faithful performance of the construction of all the aforementioned improvement work. Said security shall guarantee that Owner, and his/her successors, will correct any defects which may appear in said improvement work within one (1) year from the date of acceptance of the work by City and pay, for any damage ,to other work resulting from the construction thereof, as well as pay the cost of all labor and materials involved. This security shall remain in effect until one (1) year after date of final acceptance of said improvements by City. Said security amount may be reduced by the City Engineer in his/her sole discretion after the date of final acceptance to not less. than twenty-five (25) percent of its full value. (7) Upon final. release of said security by City, the obligations of Owner, and his/her successors, contained in this Agreement shall be considered null and void, except as otherwise provided by applicable law, or Sections 12 or 13 of this Agreement. J:\LandDev\Forms\2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement Development\Specific Agreements - Street Improv and Deferred\Word Document of Agreements\Railway 36 SI.doc Rev 11/13 2 FORMATION OF A SPECIAL ASSESSMENT (8) The Owner, when called upon by City to do so, shall execute a petition for the formation of any special assessment district created pursuant to any special assessment act as provided in the Streets and Highways Code of the State of California created for the purpose of constructing and/or installing any or all of said improvements. Owner, or his/her successors, shall participate in and become a part of any special assessment district as described in Section (8) of this Agreement. (9) The Owner's, or his/her successors' obligations contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district shall be considered to satisfy those obligations. RIGHT-OF-WAY ACQUISITION (10) Owner at his/her own cost and expense, shall acquire any easement and right-of-way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans. It is provided, however, that in the event eminent domain proceedings are required for the purpose of securing said easement and right-of-way, Owner, shall .deposit or cause to be deposited with City a sum covering the - reasonable market value of the land proposed to be taken and to be included in said suxia shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and costs, engineering and other incidental costs shall be deposited with the City. (11) The Owner, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his/her own cost and expense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation lines within or without the boundary of said real'property. 110113213412VNIAMIDINKI. (12) The Owner, and his/her successors, to the fullest extent permitted by law, shall indemnify, defend and hold the City of Campbell, its agents, employees, attorneys, officers, officials and assignees harmless from any and all claims, actions, causes of action, liabilities, damages, losses and expenses, including, but not limited to, attorneys' fees, arising out of, or resulting from, or alleged to arise out of or result from any negligent or intentional act or omission (including misconduct) of said Owner, or his/her successors, or any subcontractor; or anyone directly or indirectly employed by him, or anyone for whose acts any of them may be liable in the course of performance of the Agreement, except for any claims, actions, causes of action, liabilities, damages, losses and expenses proximately caused by the sole negligence or willful misconduct of the (13) The Owner, and his/her successors, shall also indemnify, defend and hold the City of J:\LandDov\Forms\2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement Development\Specific Agreements - Street Improv and Deferred\Word Document of Agreements\Railway 36 SI.doc Rev 11113 Campbell, its agents, attorneys, employees, officers, officials, and assignees harmless against and from any and all claims, actions, causes of action, liabilities, demands, losses, lawsuits, judgments, damages, costs and expenses (including, but not limited to, attorneys' fees ' and court costs, whether incurred at -trial, appellate or administrative levels) which the City of Campbell may incur or suffer, or to which the City of Campbell may be subjected resulting from, or alleged to result from the failure of Owner, or his/her heirs, assignees, successors, grantees, agents, employees, subcontractors, or anyone performing services under him, to fulfill any of the obligations imposed under this Agreement, except for any claims, actions, causes of action, liabilities, judgments, damages, costs and expenses proximately caused by the sole negligence or willful misconduct of the City. (14) The Owner and his/her successors shall also indemnify, defend and hold harmless the City, its agents, officers and employees from any claim, action, or proceeding against the City or its agents, officers or employees to attach, set aside, void or annul an approval of the City, its City Council, Planning Commission, Community Development Director, Public Works Director, Building Official, City Engineer, or other such City official concerning a subdivision, which action is brought within the time period provided for in California Government Code Section 66499.37. (15) In the event that this contract is subject to California Civil Code section 2782(b), the foregoing indemnity provisions shall not apply to any liability for the active negligence of the City. The foregoing indemnity provisions are intended to fully allocate all. risk of liability to third -parties. No other rights of indemnity or contribution shall exist between the parties in law or in equity. The provisions set forth in this section shall survive the termination of this Agreement. (16) The City will promptly notify the Owner of any claim, action or proceeding to attack, set aside, void or annul any approval concerning a subdivision of said real property, and will cooperate fully in the defense. (17) Owner and his/her/its successors shall maintain insurance for injuries to persons or damage to property conforming to the following specifications: A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office (ISO) CGL form CG 00. 01 11 85; and 2. ISO form G0009 11 88 Owners and Contractors Protective Liability r' rage r'ntrerage nor operations of Designated Contractor; and hovel .1 orn—Vvfv v 1 v 3. - Course of Construction. Insurance covering all risks of loss; and 4. ISO CA 00 0106 92 including symbol 1 (Any Auto); and J:1LandDeviFormsl2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement DevelopmentlSpecific Agreements - Street Improv and Deferred\Word Document of AgreementslRailway 36 SI.doc Rev 11/13 4 5. Workers' Compensation insurance as required by the Labor Code of the State of California and Employer's Liability insurance. B. Minimum Limits of Insurance Owner shall maintain limits no less than: 1. General Liability: $1,000,000 combined single, limit per occurrence for bodily, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. 3. Workers' Compensation and Employer's Liability: Workers' Compensation limits as required by - the Labor Code of the State of California and Employer's Liability limits of $1,000,000 per accident. C. Deductible and Self -Insured Retention Any deductibles or self -insured retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self -insured retention as respects the City, its agents, officers, attorneys, .employees, officials and volunteers; or the Owner shall procure a bond guaranteeing payment of losses related to investigations, claim administration, and defense expenses. D. Other Insurance Provisions The policies are to contain, or be endorsed to contain, the following provisions: 1. General Liability and Automobile Liability Coverage: a. The City, its agents, officers, attorneys, employees,' officials and volunteers are to be covered as insureds as respects'. liability arising out of activities related to this Agreement performed by or on behalf of the Owner, products .and completed operations of the Owner, premises owned, occupied or used by the Owner, or automobiles owned, leased, hired or borrowed by the Owner. b. The Owner's insurance coverage shall be primary insurance as respects the City, its agents, officers, attorneys, employees, officials and volunteers. Any insurance or self-insurance maintained by the City, its agents, officers, attorneys, employees, officials and volunteers shall be excess of the Owner's insurance J:\LandDev\Forms\2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement Development\Specific Agreements - Street Improv and Deferred\Word Document of Agreements\Railway 36 S1.doc Rev 11/13 5 and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its agents, officers, attorneys, employees, officials, and volunteers. d. The Owner's insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. C. Coverage shall not extend to any indemnity coverage for the active negligence of the City in any case where an agreement to indemnify the City would be invalid under Subdivision (b) of Section 2782 of the California Civil Code. 2. Workers' Compensation and Employer's Liability Coverage: The insurer shall agree to waive all rights of subrogation against the City, its agents, offiicers, attorneys, employees, officials, and volunteers for losses arising from work performed by the Owner for the Cite. 3. Course of Construction Coverage: Course of Construction policies shall contain the following provisions: (a) the City shall be named as loss payee; and (b) the insurer shall waive all rights of subrogation against the City. 4. All Coverages: Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. E. Acceptability of Insurers Without limiting Owner's indemnification provided hereunder, Owner shall take out and maintain at all times during the life of this contract, up to the date of acceptance of the work by the City, the policies of insurance listed in Paragraphs 12 through 16 of this Agreement. insurance is to be issued by an issuer with a current A.M. Best Rating of A:VII and be authorized to transact business in the State of California, unless otherwise approved by the City. F. Verification of Coverage Owner shall furnish the City with certificates of insurance evidencing coverage required by this clause. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates are to be on forms provided by the City. Where by statue, the City Workers' Compensation related forms cannot be used, equivalent forms approved by the insurance Commissioner are to be substituted. All certificates are to be received and approved by the City before work commences. J:\LandDev\Forms\2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement Development\Specific A reements - Street Improv and Deferred\Word Document of Agreementsaailway 36 SI.doc Rev 11/13 n G. Subcontractors Owner shall include all subcontractors as insured under its policies or shall furnish separate certificates by each subcontractor. All coverage shall be, subject to all of the requirements stated herein. MUTUAL BENEFIT COVENANTS BINDING ON HEIRS ASSIGNEES SUCCESSORS AND GRANTEES OF OWNER (18) It is acknowledged that the provisions of this Agreement constitute covenants for the improvement of the subject real property for the mutual benefit of Owner's property, commonly known as 36 & 40 Rahway Avenue, and the City's property, commonly described as Railway Avenue where it adjoins Owner's property. These covenants shall be considered to affect rights in the above -described real properties, and shall be binding on the heirs, assignees, successors, grantees and agents of the Owner to said real property. UNVESTED INTERESTS (19) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. BREACH OF CONTRACT (20) The City, upon breach any of the terms, conditions, or covenants of this Agreement by the Owners, shall be entitled to recover from the Owner, in addition to any other relief available in law or equity, all costs and compensation incurred in attempting to obtain enforcement of the Agreement, including reasonable attorneys' fees and court costs. ENTIRE AGREEMENT BINDING (21) This is the entire Agreement between the parties, and there are no representations, agreements, arrangements or understandings that are not fully expressed herein. This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement, binding on all parties. _ PRELIMINARY PLANS (22) Owner shall provide and constrict public street improvements per preliminary plans titled "STREET IMPROVEMENT PLANS — OFFSITE — 36 & 40 Railway Avenue" which are subject to approval by the City Engineer, prepared by nterra group. 3:\LandDev\Forms\2. AGREEMENTS - PIA SIA DEF SIA Maintenance Reimbursement Development\Specific Agreements - Street Improv and Deferred\Word Document of Agreements\Railway 36 Si.doc Rev 11/13 7 IN WITNESS WHEREOF, said City has caused its .name to be affixed by its Public Works Director and City Clerk, -who are duly authorized by Ordinance 2059 adopted September 20, 2005, and said Owner has caused his/her name to be affixed the day and year first above written. FLOAT STATION LLC, A CALIFORNIA LINUTIED LIABILITY COMPANY A f% By: Ryan Ariko, its Owner 1090 Camino Ramon San Jose, CA 95125 CITY OF CAMPBELL Todd Capurso, Public Works Director City of Campbell (Notary Acknowledgment for above signator(ies) MUST be attached.) Attest: " I)a Wendy )N o d, AQtmg City Clerk J:\LandDe%AFbrms\2. AGREEMENTS - PIA SIA. DEF SIA Maintenance Reimbursement Development\Specific Agreements - Street Improv and Deferred\Word Document of. Agreem.ents\Railway 36 SI.doc Rev 11/13 8 CALIFORNIA ALL-PURPOSE ACKmOWLEDGMSHT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) County of On 5� before me, Here Ins Dateert Name a d Title of th Officer personally appeared Name(s) of Signer(s) to be the person(s) whose name(s) is/are who proved to me on the basis of satisfactory evidence the same subscribed to 'the within instrument and that b his/herd/their to me sign ature(s) on the nstrum nt he pe on(s), his/her/their authorized capacity(ies), a Y or the entity upon behalf of which the person(s) acted, executed the instrument. _ OP PERJURY under the laws JOANN THOMASON Commission * 2110789 a -d Notary PUMIC - U110mia z Santa clua Courity MY Comm. Expires Ma 9 201A I certify under PENALTY of the State of California that the foregoing paragraph is true and correct. WITNESS Signature and official seal. of Notary Public Place Notary Sea! Above OPTIONAL r7pleting this of Though this section is opti reattachment of this form to pan unintended docuon can deterlment. the document or fraudulent Description of Attached Document Title or Type of Document: 13 lip � �c3;.\.,1c�� Document Date: Number of Pages: Signer(s) Other Than Named A +ove: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Si ner is Representing: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: G4'• G rvr`,..4�``.`.:_.`�4�'. �. �,4�`.4�__,4�•`�`�-`�.`�. �.4`..`�.`�4 �4�_✓14�ti.�4'✓4�4��4�✓.4v`v4�.`✓%�ti4'er4v4�✓.4�✓%:�. Associationwww.NationaiNotary-org pi all®l IE-oss Certificate of Acknowledgment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of 1 On ! 3G Z�, t 5 before me,31WIMt 1 -Ib (1c personally appeared A k" h V who proved to me on the basis of satisfactory evidence to be the person(s) whose namels) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph i� WALTER CROCE true and co ect. Commission # 2084757 Notary Public - California z WITNES y han '-rand. ffrcial sE. z Santa Clara County a My Comm. ExFires Oct 31, 201 B S;gtt� !3rC�t t�strx Fu::iia: OPTIONAE INFORMATION Afthoi-1�yli i'he _, Tiofnnati6ri in i17'"SE=CitJi2 is 1?!3i r glflrf'-d bV 184:', k couhd f:,n&vgn f fraudu?em If-'-C'n aen'd :eaiffa'chr?i5iii 0111 ri715 air, irJW'C:£IQn-&7>'it to rr, tmaml. S: rued, docf1,•T'f3nt and rti q j) ot/6 ilse ul to p EFrz3'Si nso.;: i;e aiiach--:.3 LT(`curi"Pen1 Description of Attached Document The preceding Certificate of Acknowledgment is auffached to a document titled/for the purpose of containing � pages, and dated The signer(s) capacity or authority is/are as: ❑ Individual(s) ❑ Attomey-in-fact ❑ Corporate Officer(s) ❑ Guardian/Conservator . ❑ Partner-LimifedlGeneral ❑ Trustee(s) ❑ Other: representing: a s Method of Signer Identification Proved to me on the basis of satisfactory evidence: ❑ form(s) of identification E! credible witness(es) Notarial event is detailed in notary journal on: Page # Entry # Notary contact: I Other T ^ ❑ Additional Signer ❑ Signer(s) Thumbprints(s) Vendor # (Finance Use dnly) Cit lof Carn" P -Check Request �- To: Finance Director Check Payable to: Santa Clara County Recorder: (35 Charact6rs) Address - Line 1: East Wing,,First Flodr. (35 Chafra-c-ters) Line 70 West Hddding Street (35'Characters) City: San Jose §.tafe: CA Zip: 95110 Description: -(25 6araqters) Invoice Number: Invoice Date: Total Amt Payable: (Exact Amount) Account Number: Amount; Account Number: -101.740.7427 Amount: Purpose: Recording do"n. SAO# Requested by: Q\ "title: Approved pproved by: Titld�. Date: � � sera -tructi6nsons',For H�andfm Check, Mail As id - Mail in Attached Envelope:, Interim Check: Needed By: 'fluj - I (Department) J:VoAnnanCheck RequestsTheck Requestrecording.xIs (Rev. 03108) CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2015-00157 Name: Ryan Arilo Property Address: 36 & 40 Railway Ave. Date of Final Inspection: On File: Bonds CD Cash Faithful Performance: $ 4635.50 Labor and Material: $ Construction Cash Deposit to be released: Other overdue deposits to be released (Description): Processed by: Z t3 1d (� Admi trator Reviewed by: Inspector Reviewed by: -2�1 0 'kb Land Development Engineer J:\JoAnnaT\Deposit refunds\CHECKLISTS\Railway36&402.doc (Rev. 10/11) OF cA4� 4, A� 9F C, •UKCHAR9� CITY of CAMPBELL Public Works Department February 27, 2018 Ryan Arils® 36 Railway Ave. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2015-00157 36 Railway Ave., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Ryan: The City of Campbell has made the final inspection ®f the subject Public Works ithpr®vemeuts and finds that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. The remaining 25% of your Faithful Security Deposit in the amount ®f $4,635.50 is gel®sed, sifipagly, SyW Wahidi -Public work-s Iytspmor 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866.2790 G�_....................... ..... _._...... _...._ .......- -- ............ _..._......... - - .... CITY OF CAMP13ELL VENDOR NO. 100:14240 CHECK NO. 266639 I I I I I i I I I I I i 10014240 FLOAT STATION LLC I z• 'I I I I II I I I r'y L 4 Encroachment Permit Final Sign Off Encroachment Permit # C Go 15 Address: Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% V 75 �'nmmontc zsofo L1, Cn 3S s" v of C44 Ok CHAA� CITY OF CAMPULL Public Works Department February 8, 2017 Mr. Ryan Ariko C/O Float Station, LLC. 1090 Camino Ramon San Jose, CA 95008 . SUBJECT: PERMIT NO., ENC 2015--00157 36 & 40 Railway Ave. FINAL INSPECTION AND. ACCEPTANCE Dear Ryan: The City of Campbell has made a final inspection of subject Public.Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit.begins on February 1, 2017. The permittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. 75% of your Faithful Security. Deposit in the amount of $13,906.50, your Construction Cash Deposit in the amount of $741.68 and your Plan Check Deposit for $500.00, are now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2165. Sincerely, Sys ahidi Public works Inspector Cc: Inspector file Permit # ENC 2015-00157 nno 27A nosy . rnn doR 96C)'1790 To: Finance Director Check. Payable To: Address - Line 1: Line 2: City: Description: Account Number:' Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Refundable. Deposit Check Request Float Station; LLC.. : 36 Railway Ave. State: CA Zip: 95008 Campbell ENG 2015-00157 101.2203 Amount: $4,635.55 101.2203 Amount: 101.540.7448 Amount: - - Interest Earned (Finance Dept only)' 15148.1,8 (Exact Amount) .Remaining 25%.of FPS Deposit Refund Permit.#: ENC 2015,00157 -Receipt #: Date: ReceiptM. ' 25§640, Date: 7/30/2015 Requested by: — Title: Inspector' Date: Syed Wa . . Approved by: Title: Sr.Engineer Date: Roger Storz Finance Dept Only: - Verified by: Title: Accounting Clerk'II Date: Approved by: Title: Accountant Date: Special Instructions . or Handling Check mall AS IS:, mail in Attached Envelope: Interim l;necK: Needed By: Return To: JoAnna Thomason, Public Works Other: Please return check to JoAnna f/n: Forms/exceVchkreq - Revised 05/00 CITY of CAMPBELL Public Works Department February 8, 2017 Mr. Ryan Ariko C/O Float Station, LLC. 1090 Camino Ramon San Jose, CA 95008 SUBJECT: PERMIT NO. ENC 2015--00157 36 & 40 Railway Ave. FINAL INSPECTION AND ACCEPTANCE Dear Ryan: The City of Campbell has made afinal inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins on February 1, 2017. The permittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. 75% of your Faithful Security. Deposit in the amount of $13,906.50, your Construction Cash Deposit in the amount of $741.68 and your Plan Check Deposit for $500.00, are now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2165. Sincerely, Sy ahidi Public works Inspector Cc: Inspector file Permit # ENC 2015-00157 70 North First Street • Campbell, California 95008-1436 • TEL 408.866.2150 • FAX 408.376.0958 • TDD 408.866,2790 GEOFORENSICS INC. Consulting Soil Engineering 561-D Pilgrim Drive, Foster City, CA 94404 Phone: (650) 349-3369 Fax: (650) 571-1878 File: 215119 August 4, 2015 Mr. Ryan Ariko 1009 Camino Ramon San Jose, CA 95125 Subject: Railway Avenue Property 36 and 40 Railway Avenue Campbell, California REVIEW OF GRADING AND DRAINAGE PLANS Dear Mr. Ariko: This letter has been prepared to document that we have reviewed the plans prepared for the construction of the new parking area proposed for the site. Plans Reviewed We were provided with eight sheets of drawings to review. The grading and drainage plans were prepared by Nterra Group, and are dated June 24, 2015. These drawings were identified as sheets 1 through 8. Plan Review Comments We have reviewed the above -listed plans for their conformance with the geotechnical recommendations and parameters provided in our report (dated July 16, 2015), and good geotechnical engineering practice. Based upon our review, we have the following comments/changes: Sheet 4 - It would be prudent to specify the Class II AB (baserock) and the upper 6 inches of underlying subgrade both be compacted to a minimum of 95 percent of their Maximum Dry Density. Comment 1 - All the current drain rock surfacing the parking area will need to be removed prior to placement and compaction of the baserock on the soil subgrade. In general, these plans appear to have been prepared in substantial conformance with the intents of the recommendations within our report and good geotechnical engineering practice. The aforementioned comments/changes are relatively minor in extent. Therefore, alterations may be made as red -line changes at the city or as field changes. These items will need to be observed and tested by our office in the field. File: 215119 August 4, 2015 These plans may be submitted to the building department without further review by our office. It is the addressee's responsibility to provide this letter to the proper building officials, design professionals, and contractors. Delays and additional expenses may result if the proper people are not notified of our comments. Should you have any questions, please contact the undersigned. Respectfully Submitted; GeoForensics, Inc. Daniel F. Dyckman, PE, GE Senior Geotechnical Engineer, GE 2145 Bernard A. Atendido Field Engineer 0�p pf ESS/Ot oF CPO-,� cc: 2 to addressee 1 to Nterra Group (attention: Bryan Carrera) (via email: bryan@nterragroup.com) 2 TO NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 FLOAT STATION LLCi 36 RAILWAY AVE CAMPBELL CA 95008 Ref undnble .Deposit Check Request.:: To -Finance, Director .,'. ' Check• Payable To ,Mai -Station, LLC. Address - -Line 1 36'Raili*i iy,AVe., , Line 2 'City ..: Campbell. .° -State:.-'CA Zlp:''•9500'8 • ' ..,' _ . ,. Descriptlon .°.. .. ENC2015 00157'; Accounf.Nurnber.: 1012203 Nmount $15148..18 AccountNdmbe"r: _ 101:2203 .... Amount Account Number _'_ 01:540.7448: .: ... Amounf - - "(Finance-Deptonly); - - ': lnterest.Earned - :, (Finarice Dept,00ly)' Total Payable: _ l n r. _(Exact Amount) ,• . " Purpose: Various degoslt refunds. Permit#R 'ENC.201.5-001'57;:'... Receipt # .: -. , •259369::;($500cQ0) .; _Date .7/l0/2015 ?? ' ($1;4,648 18) , ' Date 7/30/2015 - TltlRequesteer Date Ro e :Storz Approved by Tltle ~City Engineer- Date . A ay.' _ F_.InancbMept Only Verified by Tltle Accounting Clerk:;ll bate Approved by Title :Accountant .:.; Date - SpecInstructions For Handling Check dnaiiAs)Is:'• .. _�.'Marr:1n Att 'cneq-;;Envelope: "inidrim i necK: Needed By: ' Return To: JoAnna=Thomason Public WorksUPEC Other: Please return check to JoAnnd�'_" W. '•- - -' `.fln:Torms/&cellrhkreq . - Revisedb5/00:•. ' • ' - CITY OF CA14PBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTA14CE LETTER Encroachment Permit#: ENC 2615-00157 Name: Ryan Arilo Property Address: 36 & 40 Railway Ave. Date of Final Inspection: On File: Bonds CD Cash Faithful Performance: $ 18,542.00 (7 i1�', 8€�ti5~ Labor and Material: $ Construction Cash Deposit to be released lr$V 1,66 Other overdue deposits to be released (Description): Plan check Deposit 5-00 WH - Processed by: Ad m i n taftr`a`Go r Reviewed by: Inspector Reviewed by: -I�� �-X� `x ��1a' I l Land DeveljpmentEng\eneer JAJoAnnaT\Deposit refunds\CHECKLISTS\Railway36&40..doc (Rev. 10/11) 0 Encroachment Permit Final Sign Off Encroachment Permit If Q\;C 2G 15 - Cc f 5 7 Address: 3 C -140 Izabk--koy *' Date of Final Inspection and Acceptance: 211117 Inspected by: OK to release deposits: 100% 75% oa Comments: Ft3vd M C\e< SRO �zv,-- 25r PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. ENC2015-00157 PROPERTY ADDRESS 36 & 40 Railway Avenue Please collect & receipt for the follo%A;ing monies: AMOUNT,: ACCT. ITEM LAND DEVE :PMENT4,' 41ZZ Encroachment Pennit Application Fee Non:ffh�rity Encroachment Permit Malor >_$110,000 $395.00 $395.00 Minor Encroachment Permit <siosoo. $225.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $225.00 Inspection Fee Minimum Charge per Location $390.00 Street Tree Planting/Removal N/C 2203 2203, ($500 per Tree Planting Deposit Required) $500.00/tree Plan Check Deposit 2% of Engineet's Estimate $500.00 min $500.00 Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Farni[V Lot $275.00 Site< 10,000 s.f. $825.00 Site ? 10,000 s.f. < 0.5 Acre $1,105.00 Site a 0.6 Acre $1,655.00 4722 NPDn Review (C3 Requirements) For projects not required to submit numeric sizing $160.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to I Acre $690.00 Impervious Area I Acre or more $900.00 4722 For proiects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee Non-Utilit 4722 Enqr. Est. < $250,000 14% of Engineers Estimate 2203 Enqr. Est. Z$250,000 and s$500,000 $35,000 + 8% of Engineers Estimate 2203 Enqr. Est. >500,000 $55,000 + 7% of Engineers Estimate 2203 Emergency Cash Deposit 4% of Enqr. Est.* ($500 minl$10,000 Max) 2203 Faithful Performance Security (FPS) 100% of ENGR. EST.* 2203 Labor and Materials Security 100% of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 (Multi -Res $2,385.00) All Other $2 650.00 4722 Parcel Map (4 Lots or Less) �$3,930.00 + z05511ot 4722 Fir $4,775.00 + $116110t 2203 Monurnentation Security 100% of City's Monumentation Estimate 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Occupancy) 4722 lot Line Adjustment (Indudes Certificate of Compliance) $1,856.00 4722 Vacation of Public Streets & Easements $2,480.00 4722 Certificate of Compliance $I84000 4722 Certificate of Correction $550.00 4722 Document Recording Fees $15.00/first page $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee. $1 00/sheet, 4722 Appeal Filing Fee $200.00 4722 Notary Fee 'Per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $877.00 Each Additional Lot $275.00 511.7424 MISCELLANEOUS.--'. Postage OTAL $895.00 NE 408,568.9650 95125 I Other (Please Specifv) *Engineer's Estimate shall be as approved by the City Engineer a NAME OF APPLICANT Ryan Ariko NAME OF PAYOR Ryan Ariko ADDRESS 1090 Camino Ramon, San Jose. CA A13, w FOR CITY CLERK ONLY RECEIVED BY ( Date t -Receipt 4 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1, 2015 TO: Finance PUBLIC WORKS FILE NO. ENC2015-00157 PROPERTY ADDRESS 36 & 40 Railway Avenue Please collect & receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 4722 Encroachment Permit Application Fee Non -Utility Encroachment Permit Major >_$10 000 $395.00 _ Minor Encroachment Permit <sm000 $225.00 _ Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $225.00 Inspection Fee Minimum Charge per Location $390.00 Street Tree Planting/Removal N/C 2203 $500 per Tree Planting Deposit Required) $500.00/tree 2203 Plan Check Deposit 2% of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading & Drainage Plan Review Single Family Lot $275.00 Site < 10,000 s f $825 00 Site >_ 10,000 s.f. < 0.5 Acre $1 105.00 Site >_ 0.5 Acre $11655.00 _ 4722 NPDES Review C3 Requirements) For projects not required to submit numeric sizing $160 00 For projects required to submit numeric sizing Impervious Area 10,000 S . Ft to 1 Acre $690.00 Impervious Area 1 Acre or more $900.00 4722 For ro"ects sent to Consultant for review Consultant Cost +20% 4722 Additional treatment facilities $300 ea Plan Check & Inspection Fee(Non-Utility) 4722 En r. Est. < $250,000 14% of Engineer's Estimate $2,595.88 2203 En r. Est. >_$250 000 and s$500,000 $35 000 + 8% of Engineers Estimate 2203 En r. Est. > 500 000 $55 000 + 7% of Engineers Estimate 2203 Ernerc lencyCash Deposit 4% of En r. Est." $500 min/$10,000 Max)$741.68 2203 Faithful Performance Security FPS 100% of ENGR. EST.* $18,542.00 2203 Labor and Materials Security 100% of ENGR. EST.* 4121 Storm Drainage Area Fee Per Acre R-1 $2 120.00 (Multi -Res $2,385.00) All Other $2,650.00 $477.00 4722 Parcel Ma 4 Lots or Less $3 930.00 + $85/lot 4722 Final Tract Ma 5 or More Lots $4 775.00 + $116/10t 2203 Monumentation Security 100% of Ci 's Monumentation Estimate 4920 Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Ad"ustment Includes Certificate of Compliance) $1,856.00 4722 Vacation of Public Streets & Easements $2 480.00 4722 Certificate of Compliance $1 840.00 4722 Certificate of Correction $550.00 4722 Document Recording Fees $15.00/first a e $3 ea. Additional 4722 Private Improvement in Public ROW $50.00 4722 Approved Plan Revision Fee $100/sheet 4722 Appeal Filing Fee $200.00 4722 Notary Fee(per si nature $10.00 _ 4722 Assessment Segregation or Reapportionment First Split $877.00 Each Additional Lot $275.00 511.74241 MISCELLANEOUS Postage Other Please S ecif *Engineer's Estimate shall be as approved by the NAME OF APPLICANT // //City Engineer and shall includddee all items of work. TOTAL $22.356.56 ` , J/u'/r� Le NAME OF PAYOR "! - l?/-o PHONE / ADDRESS �' k'/ / / ZIP Gfj�UO r' FOR RECEIVED BY�/- CITY CLERK ONLY �• '" Date � Recei t# J:M—dD.rVI-Clc kCemii—Al-8P nk P,,j-s-A 6P,,jxl 6 P,W—ARNm, A—WT.Te CITY OF C�MP8ELL REM BY: CASHIER O10025?640 REGISTER DATE; 0,7/31j/15 TIME, DO:D0 y��CRIPTION AMOU�T CUST RAILWAY AVE 15-1,17 ENGR � SU8DIV FILING F V21595.8O COT ID-0,."C2815-O8157 REF DEPOSlT - l81 $741.68 COT I1ENC2015-00157 REF DEPOSIT - 101 $|D'542.OU CUST ID�36 8A[LWAY AVE 57 STORM DRAIN FEES FN 2 ---------- $4??.00 lUTAL 0UE: $22,356.56 TENDE8[0: $22,356.56 CHANGE; «.0D MECK : $22,356.56 REF NUM: 6130 �� Fees Associated With ar Pate End Date Tt�ns ep escrip ion Revenue pCDP 7/1/2015 680/2016 Plan Check Deposit 101.2203 }T CASH 7/1/2015 680/2016 Construction Cash Dcposi 101.2203 JT /\F05 7/l/2015 680/2016 9ontAppFeoUtility Eocr 101.730.4722 }7 FPSD 7/1/2015 680/2016 Faithful Perf.Security/De 1012203 JT PCl| 7/1/2015 680/2017 Non-Lti]Plan Ck/{nap< $ 101.740.4722 JT S[)C 7/1/2015 680/2016 StuonDrain Fee ' All Odh 209.715.4721 }7 11/7/201 3:8Vj4PM 7/13/2015 500.00 010 11/7/2016 741.68 0.00 11/7/2016 39510 0.00 11/7/2016 8,542l0 0.00 11/7/2016 2,595.88 0.00 11/7/2016 47700 0.00 Total Due: $0.00 A ®� 1 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/23/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. 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). PRODUCER 11' 5%'"� McGovern Insurance ` 1625 El Camino Real r•� `�, \7 c^ t ; L Belmont, CA 94002i>. , CONTACT NAME: PHONE FAX C No Ext : 650-593-8216 A/c No): 650-594-9130 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# pn `af `\ www.jemins.com \"e�\ (3��� INSURER A: Associated Industries Insurance Company Inc. AXIV 23140 INSURED r�`"\ Duerson Construction, Inc. u co( 213 Spreadin Oak Drive Q\�G�V Scotts Valley CA 95066 INSURER B : Topa Insurance Company A- VII 18031 INSURERC: INSURERD: INSURER E : INSURER F : CA\/FRArFC r1=PTIFIr_AT1= MIIMRFR• znn)QnoT RFVISH)M MIIMRFR- 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIIYYYY LIMITS A ✓ COMMERCIALGENERALLIABILITY ✓ `/ AES1034745 5/15/2016 5/15/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE �✓ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 ✓ POLICY ❑ PRO �✓ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB �/ OCCUR XL6606993-01 5/15/2016 5/15/2017 EACH OCCURRENCE $ 1,000000 ✓ AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Work performed in Public right of way@ 61R,,a'4 way vt_nue C)� TM-0 ermit #Q 009_7f City of Campbell, its officers, employees adn Volunteerare named as addltlonal Insrue `30 day written Notice of Cancellation, except for non -pay of premium which is 10 days. CERTIFICATE HOLDER CANCELLATION City of Campbell Public Works Dept 70 North 1 st Street Campbell CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Steve Suissa ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 30023427 1 DUERS-1 1 16/17 GL, EX I MaryAnn Worman 1 5/23/2016 11:32:05 AM (PDT) I Page 1 of 4 POLICY NUMBER: AES1034745 Duerson Construction, Inc. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Orcianization(s): I Location And Description Of Completed Operations of Campbell, its officers, employees adn volunteers It is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or.liabil- ity allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim, loss or liability which is determined to be solely the result of the additional insured's negli- gence or solely the additional insured's responsibility. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 30023427 1 DUERS-1 1 16/17 GL, EX I MaryAnn Wor— 1 5/23/2016 11:32:05 AM (PDT) I Page 2 of 4 Page 1 of 1 AES 1034745 Duerson Construction, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - BLANKET COVERAGE / PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: All persons or organizations as required by a written Locations as required by a written contract or contract or agreement with the named insured. agreement with the named insured. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" casued, in whole or in part, by: 1. your acts or omissions; or 2. the acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "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 performed by or on behalf of the additional insured(s) at the location 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. Negligence of Additional Insured "bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. Insured 30023427 1 DUERS-1 1 16/17 GL, EX I MaryAnn Woman 1 5/23/2016 11:32:05 AM (PDT) I Page 3 of 4 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contract or lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. 30023427 1 DUERS-1 116/17 GL, EX I MaryAnn Woman 15/23/2016 11:32:05 AM (PDT) I Page 4 of 4