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ENC2019-00231 � A � ov. CA 04CHAR4 CITY ®F CAMPBEL}L Public Works Department January 29, 2020 Mr. Richard Martin Garden City Construction, Inc. 618 S. First St. San Jose, CA 95113 SUBJECT: PERMIT NO. ENC 2019-00231 1070 Dell Ave., Campbell, CA Permit Fee Refund Dear Richard: Enclosed is your refund for the fees paid regarding Permit ENC2019-00231 f you have any questions, please give me a call at (408) 866-2165. ,.S ncerely e\Wahidi City Inspector 70 North First Street • Campbell, California 95008 • TEL 408.866.2150 • FAX 408.376.0958 Teo 408.866.2790 ............................ ........................ .............................. .....................-........... ......................... ....................... ....................................... ........ ................-........... ................. jd CITY OF CAMPBELL VENDOR NO. 10015957 CHECK NO. 277283 AccOr�nt Purchase Oder. &WW k .......... 101.554 4214 CRO12320 23.00 CNCLD PRMT REFUND 101.730 4722 CRO12320 1,148.00 CNCLD PRMT REFUND 10015957 GARDEN CITY CONSTRUCTION VILd V CHECK DATE CHECK No. O CITY-DECAAWBELL WELLS FARGO BANK, N.A. -24 :�Zl..-MONTGOMERY STREET 01/27/20 277283 die" 70 NORTH FIRST STREET T2 1-0 6XJ4BEik CALIFORNIA 95008 SAN FRANCISCO, CA 94104 0 0 AMOUNT *****1, 171 . 00* ' C) AFTER 90 DAYS -n 011CHAVLO VOID 0 > "N PAY THE SUM OF ONE THOUSAND, ONE HUNDRED SEVENTY ONE DOLLARS.- ml I ZERO CENTS TO THE GARDEN CITY CONSTRUCTION ORDER G18 S. FIRST ST. SAN JOSE CA 95113 iin277283110 1: 1210002481: 4 12 M 5 Sli, L 511 .................... ..................................... ................................ .................. ........................................ .........................- .................... ........... ........................... ...................... ............................... ........... ......................................J Z- *See Reverse Side For Easy Opening Instructions* ---------- CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 GARDEN CITY CONSTRUCTION G18 S. FIRST ST. SAN JOSE CA 95113 CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No.: EN C 1 l'Ufl 8 DEPT.OF PUBLIC WORKS (for working within the X-Ref. File 70 North First Street public right-of-way) Application Date Campbell,CA 95008 Ph.(408)866-2150 Issued Oil( , Application Expiration Date Fx. (408)376-0958 V/ ct/ APN '�Z�{ (�/I�3 Permit Expiration Date ( � APPLICATION-Application is hereby made fora 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: ( 0 �.,L L }U B. Nature of Work/Utility A + vC [ S�( �T— �� P6 V Trench Location: 4t CC) ,y N F l I 1 U oy ❑ No Fee Permit for work related to City Project Project Name: 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 workshall conform to the CityofCampbell Standard Specifications and Details forPublic Works Construction;theGeneral 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. 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: MS/n LAC J A I Telephone: Address: Co ' S O .J �S __ n d E-Mail Address: UR E E NCY PHONE NUMBER: !'t►7ct� 'I N������,r eal Ct� r. �"a '''.rrr ��� � - 5 -- S 9 Is this work being done by the property Aners at their own r iidence7 Yes No 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 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 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 damages arising out of improvements completed in the public right-of-way. t Accepted: � (A icant Pe e) (sign) Date SPECIU,,'PROSIONS: ontractor) (Print Name) Date 1. l 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 prior to cutting. _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: _7. :r SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT F RECEIPT NO. q— PERMIT APPLICATION FEE $ 7`T: 27�L PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCEMABOR&MATERIALS $ CONSTRUCTION CASH DEPOSIT $ / PLAN CHECK&INSPECTION FEE $ 1( 2%TECHNOLOGY FEE TRAFFIC CONTROL REVIEW APPROVED FOR ISSUANCE For City Engineer Permit Expires 12 Months After Date of Issuance PUBLIC WORKS DEPARTMENT UTILITY ENCROACHMENT, TRAFFIC & MISCELLANEOUS RECEIPT Effective July 8, 2019 TO: Finance �yy PUBLIC WORKS FILE NO. [—i V C '2 c lq-Oo Z 3 PROPERTY ADDRESS f 0 70 1:�k A,116 Please collect& receipt for the following monies: ACCT. ITEM AMOUNT ENCROACHMENT PERMIT 4722 Utility Encroachment Permit Application Fee $574.00 4722 R-1 Encroachment Permit $234.00 2203 R-1 Faithful Performance Deposit $2,500 4722 Plan Check&Inspection Fee Minimum Charge Per Location $574.00 ►� Conduits/Pipelines up to 500 Feet 3.67/ft Above 500 Linear Feet $1.84/ft Manholes/Vaults/Etc. 230.00/ea Pole Set/Removal $230.00/ea 2203 Street Tree Planting/Removal-Deposit(refundable) $500/tree 4760 Storage Container Permit(valid up to 60 days only) $182.00 4760 Engineering Maps& Plans Aerial Plot 24"x 36" $36.00 Map Research(includes max of two 24"x36"copies)$36.00 Maps and Plans 24"x 36" $36.00 4722 Penalties: Failure to restore public improvements $100/Calendar Day(Muni Code Sec.11.34.010) 4722 Penalties: Failure to correct unsafe conditions $100/Calendar Day 4722 Work Without Permits 2 Times Applicable Fee TRAFFIC 4728 Traffic Flow Map(Daily Traffic Volumes) $35.00 4728 Traffic Control Plan Review Minor(Lane Closures) $230.00 Major(Detours) $918.00 4728 Signal Timing Information $230 per hour 4271 Truck Permits $16.00 per trip/Annual$90 per year 47281 No Parking Signs $1 each MISCELLANEOUS 554.4214 Technology Enhancement Fee 2%of total permit fees iJr� 511.74241 Postage r Other(Please Specify) TOTAL ® � I - U O NAME OF APPLICANT 6 I) Z�6-A--' C )�-Y f ,(>C_ /L NAME OF PAYOR/ G AADGM C-1 7 COS—S�' I�J� J a'G n PHONE 7 VZ �Z9 ?X ADDRESS /�N �T DSc C/�ZIP I l� PAID FOR RECEIVED BY10 FINANCE. (f SEP 1 7 2019 USE ONLY Date Receipt o CAMPBELL J:Tees\Receipt.Utility Encroachment&Misc 19-20.xis CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT Fee Refund Encroachment Permit#: ENC 2019-00231 Name: Garden City Construction Property Address: 1070 Dell Ave. Date of Final Inspection: On File: Bonds CD Cash Fee Refund, Permit Canceled $1,170.96 Other overdue deposits to be released (Description): Processed by: `l A ministrator Reviewed by: I/j C ' C a D inspector Reviewed by: ,16 1-0?_0 Land Development Engineer J:VoAnnaT\Deposit refunds\CHECKLISTS\Dell 1070.Fee Refund.doc(Rev. 10/11) Vendor# (Finance Use Only) City of Campbell v Check Request 7 To: Finance Director Check Payable To. 'Garden City Construction (35 Characters) .Address-Line 1: 618 S.First St. (35 Characters) ` Line 2: (35 Characters) , i City: San Jose State: CA Zip: 95113 Description: Fee Refund,Permit Canceled (25 characters) Invoice Number: Permit#ENC2019-00231 Receipt#282794i 9117/19 Total Amt Payable: $1,171.00 (Exact Amount) Account Number: 101.554.4214 Amount: $ 23.00 Account Number: 101.730.4722 Amount: $ 574.06 Account Number: 101.730.4722 Amount: $ 574.00 i i Purpose: Permit Fee Refund,Permit Canceled i Requested by: Syed WahidiTitle: Inspector / Date Approved by:. Title: Sr.Engineer- Roger Storz Date ` Interim Check: Iinstructions For Check Needed By: Mail As Is: Mail in,Attached Envelope: Return To: JoAnna Public Works (Name) (Department) Other: Vendor i# i do 1 J q,5? (Finance Use Only) City of Campbell - Check Request To: Finance Director RECEIVED Check Payable To: Garden City Construction (35 Characters) JAN 1 S 2020 Address-Line 1: 618 S. First St. (35 Characters) CITY OF CAMPBELL FINANCE DEPARTMENT Line 2: (35 Characters) City: San Jose State: CA Zip: 95113 Description: Fee Refund,Permit Canceled (25Characters) Invoice Number: Permit#ENC2019-00231 Receipt#282794,9/17/19 Total Amt Payable: $1,170.96 (Exact Amount) Account Number: 4722 Amount: $1,148.00 Account Number: 554.4214 Amount: 23 Purpose: Permit Fee Refund,Permit Canceled Requested by: Syed Wahidi Title: Inspector Date Approved by: VTitle: Sr.Engineer ` �ZO Roger Sto D to Interim Check: Instructions For c Needed By: Mail As Is: Mail in Attached Envelope: Return To: _ Public Works (Department) Other: - - J \\honouliuli\profile_data$\joannat\Desktop\My Forms\Check Requests\Dell 1070 Dellee Refund(Rev.03/08) Online Receipt Detail Page 1 of 1 a u 6 Home ` - _ New �� b Open OK- Back Documents Favorite, I Delete � _ ...�.;..�.W:.v...kaaa«.�:..•--.�.m..»..,.�u..vs,-....W..,.:.:...._........,a..v...�.r......._.u_...:._. ... .u.:.-.,_z.......ra.aa�.«..::,.vva.. .....n..:, "i .r.n..:.,,.u.�v...e;..,,...e..w.--.�..,.*..«.;�:r ..n__„�.;u:;.:.._...m.........i...:�..:�..vne f 1 Number 0100028 4 219 Reg No Ol Batch No R0911 Cash 0,00 Reference Date E/ 7120W]Payor [GARDEN CITY 7CNSTRU Check 1,171.00 14592 f: Credit I Other 0,00' Total 1,111,00 r i Rev Code Description 'Customer ID Amount I 1 i 4722 ENGR&SUBDIV FILING FEES ENC2019.00231 574,001 4722 ENGR&SUBDIV FILING FEES 1.000 574,ff 4214. PERMIT TRACKING SFTVr�R,FEE 1070 DELL AVE 23 00 } 1 j http://potomac/gas2.32/wa/r/plus/finplus50 1/23/2020 S ~ Vendor# (Finance Use Only) City ®f Campbell - Check Request To: Finance Director Check Payable To: Garden City Construction (35Characters) Address-Line 1: 618 S.First St. (35 Characters) Line 2: (35Characters) City: San Jose State: CA Zip: 95113 Description: Fee Refund, Permit Canceled (25 Characters) Invoice Number: Permit#ENC2019-00231 Receipt#282794,9/17/19 Total Amt Payable: $1,170.96 (Exact Amount) Account Number: 101.554.4214 Amount: $ 22.96 Account Number: 101.730.4722 Amount: $ 674.00 Account Number: 101.730.4722 Amount: $ 574.00 Purpose: Permit Fee Refund, Permit Canceled Requested by: Syed Wahidi Title: Inspector Date Approved by: Title: Sr. Engineer Roger Storz Date Interim Check: Instructions For Check Needed By: Mail As Is: Mail in Attached Envelope: Return To: JoAnna Public Works (Name) (Department) Other: C:\Users\robertoa\AppData\Local\Microsoft\WindowsUNetCache\Content.Outlook\BFF20WYW\Dell 1070 Del.Fee Refund.wvected(Rev.03/08) Vendor# (Finance Use Only) City of Campbell ® Check Rewest To: Finance Director Check Payable To: (35 Characters) Address-Line 1: (35 Characters) Line 2: (35 Characters) City: State: Zip: Description: P/ � Characters) Invoice Number: ��.( �� ,\��(S�Z� _ Total Amt Payable: 1 `O CA Qp (Exact Amount) �Account Number: Amount: Account Number: ` 3O �—��as Amount:l�• �a Purpose: \D J ��' �—�� a�— -I L, . DO Requested by: JoAnn Thomason Title: Executive Assistant Date Approved by: Title: Date Interim Check: Instructions For Check Needed By: Mail As Is: Mail in Attached Envelojie Return To: JoAnna /` Public Works (Name) / % (Department) � Other: \\honouliuli\profde—data$\joannat\DesktopWy Forms\Check Requests\USE THIS(Rev.03/08) Vendor# (Finance Use Only) i City of Campbell - Check Request To: Finance Director / Check Payable To: Garden City Construction (35 Characters) xI Address-Line 1: 618 S.First St. (35 Characters) Line 2: (35 Characters) I City: San Jose State: CA Zip: 95113 Description: Fee Refund, Permit Canceled (25 Characters) Invoice Number: Permit#ENC2019-00231 Receipt#282794,9/17/19 o Total Amt Payable: $l;I7fHE (Exact Amount) Account Number: Amount: $1,148.00 Account Number: 554.4214 Amount: 23,-0 Purpose: Permit Fee Refund,Permit Canceled Requested by: Syed Wahidi ' > Title: Inspector Date Approved by: Title: Sr.Engineer Roger St4z D$te Interim Check: Instructions For Check Needed By: Mail As Is: Mail in Attached Envelope: Return To: JoAnna Public Works (Name) (Department) Other: \\honouliullprofile_dataS\joannat\Desktop\My Forms\Check Requests0ell 1070 Del.Fee Refund(Rev.03/03) 1/23/2020 AFees Associated With .1 0:48:54AM C7 C E LJ Case ENC2019-00231 FeE� S ta r-t-1--- TYO Date Datd ue,- e Date: -'Dept D Ae6unt Nurnbe Amount" TEFE 7/8/2019 7/7/2020 Technolgy Enhancement F 101.554.4214 JF 9/19/2019 22.96 0.00 AF05 7/8/2019 7/7/2020 PrmtAppFee Utility Encr 101.730.4722 JF 9/19/2019 574.00 0.00 UPMN 7/8/2019 7/7/2020 Utility Min/Pl Ck&lnsp F 101.740.4722 JF 9/19/2019 574.00 0.00 Total Due: $0.00 Page I of I CaseFees..rpt GENERAL PERMIT CONDITIONS 1 The Permittee must provide evidence of insurance and Additional Insured Endorsements as required by the City.Insurance shall be maintained for the duration of the permit work. 2 A Construction Cash Deposit is required.Changes 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. 3. Faithful Performance Surety and Labor and Materials Surety are required. 4. Refund of the construction cash deposit balance and refund or cancellation of the sureties will be initiated by the written acceptance of the work by the City. S. A one-year maintenance period and surety are required.Such period will begin on date of written acceptance by the City.Surety posted shall be equal to 25%of the original Faithful Performance Security. 6. Submit project schedule 10(ten)days prior to proposed start of work.Additional lead time may be required for work within City facilities and downtown Campbell. 7. 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. 8. Maintain safe pedestrian and vehicular crossings and free access to private driveways,bus stops,fire hydrants,and water valves. 9. 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. 10. A Construction Traffic Control Plan shall conform to the most recent version of the California Manual on Uniform Traffic Control Devices(MUTCD). 11. Replace,as directed by the City Engineer,any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee as expeditiously as possible. 12. Sawcut for all PCC or AC removals.All PCC removals shall be to the nearest scoremark and new PCC shall be doweled to existing improvements. 13. Prior approval of inspector is required for any work proposed after normal working hours,on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 14 Work on arterials and collectors may require the use of changeable message boards.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 construction cash deposit. 15. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction.Contractor or Permittee shall 16. provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m.and on weekends. 17 No storage of materials or equipment will be allowed near the edge of the pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 18 This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any otherwork 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. 19. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 20. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 21. Call back(call out)due to emergencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 22 Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water.Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 23 If the public interest requires a modification of,or a departure from the permit,plans,special provisions and/or specifications,the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made. 24 Permittee must provide advance notification to all parties that may be affected by the permit activities.Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and a phone number. 25. Applicant shall remove water from utility vaults in accordance with the requirements of State Water Resources Control Board Water Quality Order WQ 2014-0174- DWQ. Said vault water shall not be discharged into the City of Campbell's storm drain system. See http://www.waterboards.ca.gov/water issues/programs/npdes/utilityvaults.shtml for more information. Applicant is r1lornsuring that 11 t &e providing services under the applicant are aware of and abide by all of the above conditions. /4_ Applicant Date: --� RI Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Permits\Encroachment Permit 5 919 CONSTRUCTION NOTES: * APPLICANT TO TRENCH AND BACKFILL ALL * APPLICANT TO DIG 4418" UNDER GAS FACILITY TAP HOLES * APPLICANT TO REFER TO PG&E GREENBOOK PAGE 2-9 OR 2-12 FOR BELL HOLE AND / OR TRENCH SPECIFICATION REQUIREMENTS * APPLICANT TO HAVE SUFFICIENT SAND ONSITE PRIOR TO FINAL INSPECTION * APPLICANT TO MAINTAIN 3' SEPARATION FROM WET FACILITIES * GAS ONLY TRENCH * PG&E TO ALTER. SERVICE BY INSTALLING 3' OF 1/2a PL.WITH 3/4a NC RISER WITH 3/4" BYPASS TO INSTALL TWO METER MANIFOLD * GAS LOAD: 2 UNITS @ 200 KBTU EA LEGEND: G — EXISTING GAS ———————————— PROPOSED GAS 43309005 N 3474—A4 MLX—NONE SHUTDOWN AREA FDA ESDZONE 02—C MAOP 60 PSIG CAMPBELL 1" = 20' E SUNNYOAKS AVE CA11:811 � a c� R CLD LLJ O STONE WALL #1070 I ASPS PIR SM FW.. �D I ICI I=YE 1 9 FM MTO CALL TWOB sn WORKING IoTO/a%W i G 1/2" PL I G 3' OF 1/2° PL DB DAYS BEFORE YOU DIG TICKET NO, DATE (3/4e STQ HY1 cm r` PROJECT CONDITIONS STAMP Type(s) of Work: New Business J ❑PG&E Maintenance & Construction a rn 4'X4'X18" Project Conditions: I UNDER GAS FACILITY ❑NONE APPARENT (if project design changes, contact ADE) TAP HOLE or `n ❑CONDITIONS APPLY: —J ❑PERMITS ❑TAILBOARD ❑OTHER N� (Provide additional Information on Ilne below) = cV BY: J SIGNATURE,NMIE, CORPORATE Nj,DATE EST: JASON DEOCAMPO CO: ADE: JOHN GAMBUCCI APPLICANT DRAWING SD: SUPV: ERIN STRAUS 1070 DELL AVE NOTIF: 114252257 REP: SAXON CUMMINS OTHER: PLNR: CAMPBELL SHT: SHEETS SCAM: DATE: PACIFIC GAS AND ELECTRIC COMPANY IPM.43309005 REI 1 =20 4 10 2018 k:FCERTI�FICATE CERTIFICATE OF LIABILITY` INSURANCE 09/1DATE M/2019 Y) 09/17/2019 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 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 LIC #IOM77949 1-888-845-2248 CONTACT NAME: McSherry & Hudson, LLC Insurance Services PHONE FAX AIC No Ext: 408-550-2130 (AIC No: 408-550-2119 160 West Santa Clara Street E-MAIL ADDRESS: Suite 715 San Jose, CA 95113 INSURERS AFFORDING COVERAGE NAIC# Charles M. Griswold INSURERA: GEMINI INS CO 10833 INSURED INSURERB: AMERICAN FIRE & CAS CO 24066 Garden City Construction. Inc. INSURER C: TRAVELERS PROP CAS CO OF AMER 25674 618 South First Street INSURERD: STATE COMPENSATION INS FUND 35076 INSURERE: ALLIED WORLD NATL ASSUR CO 10690 San Jose, CA 95113-2808 INSURER F: OHIO SECURITY INS CO 24082 COVERAGES CERTIFICATE NUMBER: 57271110 REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR S D POLICY NUMBER MM/DD/YYYY MMIDDIYYYY A GENERAL LIABILITY X X VCGP024267 01/01/1 01/01/20 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY X X BAA57052883 01/01/1 01/01/20 EOaaB'NEDtSINGLELIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS 1xx NON-OWNED PROPERTY DAMAGE $ AUTOS PeraccdentXComp Ded Coll Ded $ C4XEXCESS UMBRELLA LIAB X OCCUR ZUP-16N40629-19-NF 01/01/1 01/01/20 EACH OCCURRENCE $ 5,000,000 LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ D WORKERS COMPENSATION X 9083157-19 01/01/1 01/01/20 X WCSTATT ER AND EMPLOYERS'LIABILITY TORY L S ER YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' F N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Pollution Li i a.ty - Eac Occ Lima.t 1,000,000 F Scheduled Equipment BXS57052883 01/01/1 01/01/20 $2,500 Ded 1,131,374 F Rented/Leased Equipment BKS57052883 01/01/1 01/01/20 $2,500 Ded 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: G90710 Dell Avenue Market Ready Shell Additional Insured: City of Campbell, its officers, employees and volunteers CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 70 N. First Street AUTHORIZED REPRESENTATIVE az/� Campbell, CA 95008USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD sarahsj 57271110 P5260028UU2 8 ACOKO® DATE(MM/DDIYYYY) � CERTIFICATE OF LIABILITY INSURANCE 01/07/2020 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. p IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must 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 LIC #OM77949 1-888-845-2246 CONTACT o0 NAME: M McSherry & Hudson, LLC Insurance Services PHONE 408-550-2130 F oAX A/C No 408-550-2119 IAIC 160 West Santa Clara Street E-MAIL Z ADDRESS: W Suite 715 San Jose, CA 95113 INSURER S AFFORDING COVERAGE NAIC is Charles M. Griswold INSURER A: GE14INI INS CO 10833 INSURED INSURERB: AMERICAN FIRE & CAS CO 24066 Garden City Construction. Inc. 1NSURERC: TRAVELERS PROP CAS CO OF AMER 25674 1010 S. lot Street INSURER6: CYPRESS INS CO 10855 San Jose, CA 95110 INSURERE: OHIO SECURITY INS CO 24082 INSURERF: ALLIHD WORLD NATL ASSUR CO 10690 COVERAGES CERTIFICATE NUMBER: 58289600 REVISION NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDD MMIDD A GENERAL LIABILITY B X: VCGP025255 01/01/2 01/01/21 EACH OCCURRENCE $1,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occur...) ccurrence $50,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000;000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY ' PRO- LOC $ H AUTOMOBILE LIABILITY 8 X BAL57052883 01/01/2 01/01/21 COMBINED SINGLE1,000,000 Ea accident).__-- _ -- - - -- -— - - r - - --- ANY AUTO - - - - - _ - - _-- _ - - - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X'. HIRED AUTOS fix AUTOS Peraccidenl g Comp Ded Coll Ded $ C UMBRELLALUU3 X OCCUR ZUP-16N40629-20-NF 01/01/2 01/01/21 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION $ D WORKERS COMPENSATION X GAWC117403 01/01/2 Ol/Ol/21 X; WCSLIMIT ER AND EMPLOYERS'UTABILRY YIN ANY PROPRIETORIPARTNEEDXECUTIVE NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? .. (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under 11000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Sc e u e Equ pment HMS7052883 —Tf7U1M /01/21 $2,500 Ded 1,186,809 E Rented/Leased Equipment BKS57052883 01/01/2 01/01/21 $2,500 Ded 250,000 F Pollution Liability 0310-0483 01/01/2 01/01/21 Each OCC/Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U mom apace Is required) RE: G90710 Dell Avenue market Ready Shell Additional Insured: City of Campbell, its officers, employees and volunteers CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 70 N. First Street AUTHORIZED REPRESENTATIVE Campbell, CA 95008 62�� USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD earahej 58289600 P5260028002 Policy Number:VCGP025255 CG 20 3710 01 w Insured Name:Garden City Construction,Inc Number: Effective Date:01/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. w ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Name of Person or Organization: Any person or organization when you have agreed in a written and executed contract, prior to an "occurrence",that such person or organization be added as an additional insured on your policy. Location And Description of Completed Operations: "All locations and completed operations for which you have agreed in a written and executed contract prior to an'occurrence." Additional Premium: Included (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your-work" at the location designated and described in the schedule of this - endorsement performed for that insured and included in the "products-completed operations hazard". CG 20 37 10 01 C ISO Properties,Inc.,2000 Page 1 of 1 P5260028002 IIIIIIIIII, g µ Policy Number:VCGP025255 CG 20 10 10 01 w Insured Name:Garden City Construction,Inc Number: Effective Date:01/01/2020 00 o M THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Person(s)Or Organization(s): Any person or organization when you have agreed In a written and executed contract,prior to an "occurrence",that such person or organization be added as an additional insured on your policy. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II- Who is An Insured is amended (1) All work,including materials,parts or to include as an insured the person or equipment furnished in connection organization shown in the Schedule,but only with such work,on the project(other with respect to liability arising out of your than service, maintenance or ongoing operations performed for that repairs) to be performed by or on insured. behalf of the additional insured(s) at B. With respect .to the insurance. afforded, to the. site of .the covered.operations these additional. insureds, the following has-been completed;or exclusion is added: (2) That portion of "your work" out of 2. Exclusions which the injury or damage arises has been put to its intended use by This insurance does not apply to"bodily any person or organization other injury" or "property damage" occurring than another contractor or after; subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties,Inc.,2000 Page 1 of 1 P5260028002 IIIIIIIIIII' Policy Number:VCGP025255 VE 01 8412 13 Insured Name: Garden City Construction,Inc M Number: Effective Date:01/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. > z w DESIGNATED CONSTRUCTION PROJECTS(S) GENERAL AGGREGATE LIMIT - SUBJECT TO A MAXIMUM AGGREGATE This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Designated Construction Project(s):All construction projects for which you have agreed in writing in a contract,prior to an occurrence that causes"bodily injury","property damage"or"personal and advertising injury",to provide project specific limits. A. For all sums which the insured becomes legally obligated to pay as damages caused by'occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, whj h can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A,except damages because of"bodily injury"or"property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits"brought;or c. Persons or organizations making claims or bringing"suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. VE 01 8412 13 Page 1 of 2 P526W28W2 g 4. The limits shown in the Declarations foC Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project o General Aggregate Limit. i 5. All payments under this endorsement are'subject to the Maximum Aggregate Limit of: $ 5,000,000 z The Maximum Aggregate Limit is the most we will pay under this endorsement regardless of the number w of Designated Construction Project General Aggregate Limits. The Maximum Aggregate Limit is not available to pay for damages or expenses other than as set forth in the endorsement. B. For all sums which the insured becomes legally obligated to pay as damages caused by"occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-completed.Operations Aggregate Limit,whichever is applicable;and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or"property damage" included in the "products-completed operations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables,the project will still be deemed to be the same construction project.E. The provisions of Section III- Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. VE 01 8412 13 Page 2 of 2 P5260028W2 g Policy: VCGP025255 CG 20 010413 Insured Name:Garden City Construction,Inc M Number: Effective Date:01/01/2020 ow THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - M OTHER INSURANCE CONDITION W This endgxsement modifies insurance provided under the following: Commercial General Liability Coverage Part The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. M1 CG 20 0104 13 1 of 1 P5260028002 I_ g Policy Number:VCGP025255 CG 24 04 05 09 w Insured Name:Garden City Construction,Inc Number: Effective Date:01/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name Of Person Or Organization: Any person or organization you have agreed in a written and executed contract,prior to an"occurrence", that you would provide such person or organization a waiver of transfer of rights of recovery against others to us on your policy. Information required to complete this Schedule,if not shown above,will be shown in the Declarations. -The following is added to Paragraph 8. Transfer — -Of Rights Of Recovery Against Others To Us of Section IV- Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work' done under a contract with that person or organization and included in the' °products-completed 'operations hazard'. This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 C Insurance Services Office,Inc.,2008 Page 1 of 1 P5200028002 Policy Number: BAA57052883 COMMERCIAL AUTO AC 85 43 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. w CALIFORNIA BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM > ' w With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGE INDEX SUBJECT, PROVISION NUMBER ACCIDENTAL AIRBAG .DEPLOYMENT 12 ADDITIONAL`INSURED BY-CONTRACT, AGREEMENT OR PERMIT 3 AMENDED DUTIES,IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 20 AMENDED..FELLOW EMPLOYEE EXCLUSION 5 AUDIO, VIUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 14 BODILY INJURY REDEFINED 24 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 2 EXTRA EXPENSE-BROADENED COVERAGE 10 GLASS REPAIR-WAIVER OF DEDUCTIBLE 16 HIRED AUTO COVERAGE TERRITORY 22 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 6 LOAN /LEASE GAP (Coverage Not Available In New York) 15 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 1 PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) 17 PERSONAL EFFECTS COVERAGE 11 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 8 PHYSICAL DAMAGE.DEDUCTIBLE -VEHICLE TRACKING SYSTEM 13 PRIMARY AND NON-CONTRIBUTORY -WRITTEN CONTRACT OR WRITTEN AGREEMENT 23 "RENTAL REIMBURSEMENT 9 SUPPLEMENTARY'PAYMENTS 4 TOWING AND LABOR 7 TWO OR MORE DEDUCTIBLES 18 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 21 SECTION II-LIABILITY COVERAGE is amended as follows:. N 1. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. _ However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply in excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 7 P5260028002 fa Policy Number: BAA57052883 g Coverage under this provision d. does not apply to "bodily injury" or "property damage" that . occurred before you acquired or formed the organization. w 2. EMPLOYEES AS INSUREDS w SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an"insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is 10 excess over any other insurance available to any "employee". z f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or w agreement in that "employee's" name, with your permission, while performing duties related to the conduct' of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT m SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the following as an"insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such. person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an"insured". However, such person or organization _is an"insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or"property damage" caused by an"accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and N (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which,coverage could,apply,for_. - —defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24,this policy is excess over any other collectible insurance. 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2)and (4)are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations )required because of an"accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" :at our request, including actual loss of earnings up to $500 a day because of time off from work.. 5. AMENDED FELLOW EMPLOYEE EXCLUSION . . _ s In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION If - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of"loss". This coverage is excess over any other collectible insurance. SECTION III-PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III -PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 7 P5260028002 Policy Number: BAA57052883 a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, u, subject to the following limit and deductible: o a. The most we will pay for "loss" in any one "accident" or"loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss'; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like w kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of"loss". 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing , is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or"medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For"light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW)of 10,000 pounds or less. c. For "medium trucks", we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW)of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a. Coverage Extensions, Transportation Expenses of SECTION III -PHYSICAL DAMAGE COVERAGE,is amended to provide a limit of$50 per day and a maximum limit of$1,500. 9. RENTAL REIMBURSEMENT SECTION III -PHYSICAL DAMAGE COVERAGE,A.Coverage,is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred after the first 24 hours following the "accident" or"loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lesser vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 7 P52MO28002 v Policy Number:BAA57052883 's d. This coverage does not apply unless you have a business necessity that other "autos" available for r. your use and operation cannot fill. e. If"loss" results from the total theft of a covered "auto" of the private passenger type, we will pay o under this coverage only that amount of your rental reimbursement expenses which is not already o provided under Paragraph 4.Coverage Extension. h E No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11.B. 10. EXTRA EXPENSE-BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is$1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III.-PHYSICAL DAMAGE COVERAGE,A.Coverage,is amended by adding the following: s If,you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V-DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securi- ties. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III -PHYSICAL DAMAGE COVERAGE,B.Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 13. PHYSICAL DAMAGE DEDUCTIBLE-VEHICLE TRACKING SYSTEM SECTION Ill-PHYSICAL DAMAGE COVERAGE, D.Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the Vehicle is equipped with a vehicle tracking device such as a radio tracking device s or a global position device and that device was the method of recovery of the vehicle. 14. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III -PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c, and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a$100 deductible. © 2018 Liberly Mutual Insurance AC 85 43 06 118 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 7 P5260028002 Policy Number: BAA57052883 _ 15. LOAN/LEASE GAP COVERAGE(Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: 011 k. The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one o "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date z of the "loss"; w b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a"Balloon Loan"; -f. The'dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; i. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss". C. SECTION V-DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan,thereby requiring a large final payment. 16. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 17. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured' b. Legally parked; and c. Unoccupied. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 7 P526UU28W2 Policy Number: BAA57052883 i s The"loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. w This 'provision does not apply to any "loss" if the covered "auto" is in the charge of any person or 00 organization engaged in the automobile business. 18. TWO OR MORE DEDUCTIBLES Under SECTION III - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D.Deductible : z w a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible , it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV-BUSINESS AUTO CONDITIONS is amended as follows: 19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS ,Paragraph B.2.is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 20. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS - - _ -SECTION-IV_-BUSINESS AUTO CONDITIONS', Paragraph A.2.a. is replaced in its entirety by the follow- ing: a. In the event of"accident", claim, "suit" or"loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or"loss" took place; (b) The "insured's" name and address; and (c) The names and addresses of any injured persons and witnesses. **** 21. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS , Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us,is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 22. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS , Paragraph B.7. Policy Period, Coverage Territory , is amended by the addition of the following: L For"autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages is determined in a"suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 6 of 7 p5260028002 Policy Number: BAA57052883 This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. ****23. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- o11 MENT p The following is added to SECTION IV -BUSINESS AUTO CONDITIONS, General Conditions, B.5.Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution M from any other insurance available to an "insured" under your policy provided that: z 1. Such "insured" is a Named Insured under such other insurance; and w 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V-DEFINITIONS is amended as follows: 24. BODILY INJURY REDEFINED Under SECTION V-DEFINITIONS ,Definition C.is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. J © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 7 of 7 P5260028W2 ' s WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed.01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS o We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce 00 our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you o perform work under a written contract that requires you to obtain this agreement from us.) > w The additional premium for this endorsement shall be calculated by applying a factor of 2%to the total manual premium,with a minimum initial charge of$350,then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium(prior to adjustments) AII_CAOperations __ ._ _ �3697.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 01/01/2020 PolicyNo.: GAWC117403 Endorsement No.: Insured:Garden City Construction,Inc. Premium$ Insurance Company: Cypress Insurance Company Countersigned by WC990410C (Ed.01-19) P5260028002 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 01/07/2020 NAME OF INSURED: Garden City Construction. Inc. rn u. O Additional Description of Operations/Remarks from Pape 1: TO 10 M z w Additional Information: Includes: General Liability: Additional Insured per attached forme CG20371001 and CG20101001. Primary and Non-Contributory Wording per attached form CG20010413. Per Project Aggregate form per attached form VE01841213. Waiver of Subrogation per attached form CG24040509. Automobile Liability: Additional Insured and Waiver of Subrogation per attached form CA88100113. Workers Compensation: Waiver of Subrogation per attached form 10217 (REV. 7-2014). 0 SUPP(05/04)