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ENC2000-00011
CITY OF CAM :>BELL DEPT. OF PUBLIC WORKS 70 North First Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERNIIT (for working witl~ ~he pubtic fight-of-way) Permit expires' in 12 monroe/- Application Day-- Application expires in 6 months -- APPLICATION - Applica~on is hereby made for a Public Works Permit/n a~ordanc~ wi~h C~ll Mu~ C~, ~ ~ ~k ~ not ~su~. Applicon F~ ~ ~n~le.) A. Wo~ ~s or~ ~ ~' ~ ' ~ ~ U~li~ ~ l~on cF / ~ C. A~ f~r (4) ~i~ of m ~gin~r~ pl~ showing ~e I~on ~ ~ of ~e wo~, p~ s~l s~ow ~e ~l~on of ~e pm~s~ wo~ m ex~ ~ ~ ~ ~mv~, ~m ~mv~ by ~ C~ ~. ~ p~ ~ ~ p~ of ~ p~. D. ~1 wo~ s~l ~o~ ~o ~e Ci~ of C~II S~ S~ifi~om ~ ~ for ~bl~ Wo~ side; ~ ~e Sp~ ~ovisiom for ~ ~it, Ih~ ~low. F~lu~ ~ ~ide by ~m~ m~fiom P~o~ Sur~im md ~h d~si~. (S~ G~e~ P~t Co~iffom i ~ 2.) ~. ~ CO~CTOR MU~T ~ ~S Pff~ ~ APPRO~ P~S AT T~ ~ ~ MU~ NO~ ~ P~C WO~ D~P~ AT ~T~O DAYS BEFO~ ST Is ~b work ~ing done by ~e pmpc~ owner ~ ~eir own ~id~? y~ ~ Appli~ff~i~ her~y ~r~ by MF~ing ~e~ sig~re m ~ ~t ~ hold ~e Ci~ of C~bell, ~ offi~, ~ md e~loy~ f~. ~e ~ ~s ~om my c~ or de~d for ~g~ rmulfing from ~e work ~ver~ by ~ p~[. . /Z-I g ~, ~ / /. . t ID~ ~cnt .... ~ ~ ~ ~ v~ for ~ SEE. PUBLIC WORXS FEE SCHEDULE FOR CURR~ F~W~ PER.MIT APPLICATION FEE PLAN CHECK DEPOSIT s~cu~.rry ~o~ ~Arr~-t. CON,Wi'RUCTION CASH DEPOSIT ..A~OUNT R~C~PT NO. D~,. forms\pwpermZ/rev. GENERAL P~RMIT CONDITION~ - I. A CONSTRUCTION CASE DEPOSIT is require. Cl~rges will be made against this deposit if there is an emergency call-out, over,ne impection or when City o~dered l~'ricading is required. Any st~.h corn in cxce~s of the deposit will be billed m the Permitme. 2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on d~t~ of writmn a~.cep~an~ by the City. 3. REI~.JND of tile cash deposit balance a~l refund or can~ella~on of the Faithful Performance Surety will be init~ted by the wril~n ncceptnnce of the work by the City. 4. The Permi~e MUST REQUEST IN WR=rl"ING a ~1 ~c~on and ac. cept~nce of the work upon comple~on. Accepnnce by the City will be made in writing to thc Permi~e. $. MAINTAIN ~fe pedesn'ian and vehicular crossings and free access to phvat,, driveways, Ires stops, ~ hydro, ts and water valves. 6. A CONSTRUCTION ~C CONTROL PI.AN and a CONSTRUCTION SCHEDULE is ~luired for ~11 ~ closures, d~tours and street closures. This plan nmst be ~ and APPROVED prior to any ~ closures. 7. The CONSTRUCTION TRAYFIC CONTROL PLAN ~ conform with the C. altrans ~ of Tt'~c Conn'ols for Cons~uc~on and Maint~nanee Work ~.on~s, d~t~d 1990, available at Caln'an~. Trn~c control equipment ~hnl! include Type II fla.~hing arrow sign~ if required. 8. REPLACE IN KIND any damaged or removed exis~g improven~nts, including planting. 9. Sawcut for all PCC or AC removals. All PCC removal~ ~ be to nea~st sco~tn~rk and ~ be doweled to existing improvements. 10. OVERTIM~ INSPECTION PREMrUM will be ~ed against the ca.~h deposit for inspection requir~ outside the hours of 8:00 a.m. to 4:00 p.m. at the curr~nt overtime rnt~, m/nimum one hour charge. I I. SATURDAY INSPECTIONS must be arranged in advance. Saturday/m'pecfion time is cl~rged at the curr~nt overtime ~ wi~ ~ ~ hour minimum. Advance payment for thc es~n~ted ~e is required. 12. Adequate signing and lighted BAKI~.ICADING is required on the job sim. Failure to provide such signing and barricading may result in th~ City's renttn$ such signing and barric~es and cl~rging the cost (including all ¼bor and matori~ls) against the ~ deposit. 13. Compaction t~sting of subgr~de, b~s¢ rock, and ~tsphalt concr~t~ by Perotitme is REQUI~ED unless otherwise stated by the City Engineer. I4. The Contractor or Perrn~tt~¢ will have a SUPERVISORY REPRESENTATIV~ available for con,ct on the project at nil t~ne$ dur~g construction. Cont~ctor or Permit~e shall provide e phone number at which they can be contact~l out~ide the hour~ of $:00 a.m. to 4:00 p.m. 15. No 5'I'OKAGE of n~t~nals or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderl~ne which would creat~ a t~rdous condition to the public. 16. This permit shall not be consn-ued ~s authoriz~ttion for excavation and grading on privat~ property ADJACENT to tile work. or any other work for which a separ~t~ permit rn~y be r~quir~, nor does it relieve the Pcrmitte~ of any obligation to obtain any other permit required by law. 17. This perrn/t does NOT P,.~..EASE the Perrnittee from any liabilities conta/ned in other agreement~ or corm'nets witfi Rle City and any other public agency. 18. This permit is NOT TRA~S~~-. Work must be peffon~ed by the Perrni~ or his designated agent or cont~-,tctor a~ speci~ed thereon. 19. CALL BACK (call out) due to emergencies regarding this permit, .~hall be at thc cur~nt overtime nt~ with a tl~ee (:3) hour m~nln'~m ~r~e per 20. Pursuant to Chapter 14.02 of 8~c C~rnpbell Municipal Code, applicant ~l~n!! not cause to be discharged any mat~ri~l into the municipal storm dr'~n ~st~m other tf~n storm water. Applicant shall aRhcre to the BEST MANAGEMENT PKACTI.CES established by the Santa Clax~ Valley Nonpoint Source Pollution Control Progr~rn. £TI'Y OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right-of-way) Issued ~-:'- ~.'-%?LZ)C'wT' Permit expires in 12 months .~ Permit No.__ X-Ret. -q2 li Application Date -~=~--- ['~%--' 7.. C~c 6.0 Application expires in 6 months APPLICATION - Application is hereby made for a Public Works Permit in ~ccordance with Campbell Municipal Code, Section 11.04. (Applic~ion e,a~pir~ in 6 months i~' th~ permRh l~Ot isSUed. Application Fee is non-refundable.) Utility ~ Ioc~ion IL Nanue of work C. Auach four (4) copies of an engineered plans showing the location and cxte'm of the work, and four (4) copies of the preliminary F.~'s E~timate of work. Thc plans shall show the relation of the proposed work to existing surface and underground improvements. When 'improved by the City F. ngineer, s~d plan becomes a part of D. All work shall conform m the City of C~mpbell S~ndard Specifr.,~iom ~nd Deudis for Public Works Comtrucfion; the General l~mit Condifiom lim~l on the reverse side; and the Special Provisions for this permit, listed below. Failure to ~bide by these conditions and provisiom may result in job shut-down and/or forfeiture of Faithful Performance Sur~ies and cash deposits. (See General Permit Conditions I and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT TI-~ SITE AND MU~T NOTIFY TH~ PUBLIC WORI~ DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING ~ORK.[ NOTICE M~T BE GIVEN TO PUBLIC WORI~ AT LEAST 24 HOURS BEFORE RF,~F~TING ANY WORK. ,,, / Is this work being done by the property owner at their own residence? Yes No The Applicam/Permiuee hereby agrees by affixing their signature m this permit to hold the City of Campbell. its officers, gems and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicam/Permktee hereby ack)]~owledg~hal/~ have t,/ad~")~d understand both the front and back of ~his permit, and fl~-'Y will inform thek conifer, mr(s)of the / (Applicam/~/l~uee) (sign) PE~.,.IA L PROVISIONS ,,..~1. Street shall not be open cut for underground installations. Minimum cuts may be allowed fol' cor~ec{Jo~ts Or ~-xploration holes. 5ach cuts may be so~:ifr, ilv approved by the Inspector prior to cutting. Pavement may be cut for underground installations and must be restored in accordance with the Utilivff Trench Restoration St, mdard D~ils. Me~hod unless otherwise approved by lmpeo, or. Work to be staked by a licensed Land Surveyor or Civil Engimer and two {2) copies of the cut sheets sent to the Pubrsc Works D~partm~nt before st~ting work. Per Section 42 IS of the Government Code this permit is not valid for excavations until Underground Service Alert (USA} lm$ been notif~l ~d the inquiry identifw, afion number Ires been entered .bc'~or~ USA ]va~Ze 1~;800.:2~7~26~0.~ : USA TI.C[~. NO. ~. ~ ~,' . SEE PUBUC WORKS FE~ SCffED~E ~OR C~ ~ ,TY~ -, :~o~;wr ~CE[PT NO, CONS~U~IoN~C~Y FOR FAI~cASH DE~Sff~~C~OR & ~~ . .. ' :" :' ~(~ ~-3 ~ t~ P~ ~CK & INSPE~ON ~ ~~ ~ i~ :\forms\pwpcrmTdrev,6/96 GENERAL PERMIT CONDITIONS 1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made agninst this deposit if there is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A ONE-YEAR MAIN~NANCE PERIOD AND SURETY a~ required. Such period will begin on date of written ~.c~pUtnce by the City. 3. REFUND of the cash deposit balance and refund or cancellation of the F~thful Performance Surety will be inidated by the written accep~nce of the work by the City. 4. The Permittee MUST REQUEST IN WRITING a final inspection and accoptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and street closures. This plan must be REVIEWED and APPROVED prior to any lane closures. ?. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caluans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if sequired. 8. REPLACE IN KiND any damaged or removed existing improvements, including planting. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scorenuu'k and shall be doweled to existing improvements. I0. OVERTI2vIE INSPECTION PREMIUM will be charged against the cash deposit for inspection required outside the hours of 8:00 a.m. to 4:00 p.m. at the current overtime rate, minimum one hour charge. I 1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a three hour minimum. Advance payment for the estimated time is required. 12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's renting such signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is REQUIRED unless otherwise stated by the City Engineer. 14. The Contractor or Permittee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at all limes during consu'uction. Contractor or Permirtee shall provide a phone number nt which they can be contacted outside the hours of 8:00 a.m. to 4:00, p.m. 15. No STORAGE of materials or equipment will be allowed near the edge of pavement, the traveled way, or within ~e shouldedme which would create a hazardous condition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property ADJACENT to the work or any other work for which a separate permit may be required, nor does it relieve the Permi~e of any obligation to obtain any other permit required by law. 17. This permit does NOT RELEASE the Permittec from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is NOT TRANSFERRABLE. Work must be performed by the Permiuee or his designated agent or conunctor as specified thereon. 19. CALL BACK (call out) due to emergencies regarding this permit, shall be at the current overtime rate with a three (3) hour mininmm charge per o~urrence. 20. 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 Clnra Valley Nonpoim Source Pollution Control Program. j:\forms\pwperm2 6/96 SPECIAL PROVISION ~ TO ENCROACHMENT PERMIT ENC 2000-0001IA The purpose of this permit is to install a portable chain link fence upon the sidewalk areas of the west side of Second Street, the south side of Campbell Avenue, and the north side of Orchard City Drive to facilitate demolition of on site private improvements only. The permittee is prohibited from removing any public signage or improvement from within the public right-of-way. The permittee shall install and maintain all fencing, gates, signs, lighted barricades, maintain the public right-of-way free of pollutants, contaminants, soils, debris, loose materials, by vacuum sweeping all public areas surrounding the site to and including all downstream storm drainage facilities. Truck traffic to and from the site for the purposes of deliveries of equipment, supplies or material and/or for the purposes of offhaul of the same shall only use Highway 17, Hamilton Avenue, Winchester Boulevard, Campbell Avenue, Orchard City Drive, Second Street, Campbell Avenue, Civic Center Drive, Winchester Boulevard, Hamilton Avenue and Highway 17. At no time shall construction employees park on any of the residential streets south of Orchard City Drive. 3. Equipment and material storage and employee parking shall be on site only. The Contractor shall submit a traffic control plan to the Engineer for review at least five days prior to beginning of construction. The traffic control plan shall conform to the "1996 Manual of Traffic Controls for Construction and Maintenance Work Zones (including all revisions)," and Section 12, "Construction Area Traffic Control Devices" of the Standard Specifications. The Contractor shall install "No Stopping" signs in areas where the Contractor's work will require restricted parking. Prior to start of work which requires parking restrictions, the Contractor shall request approval to post and maintain temporary "No Stopping" signs at each location where constructions operations will take place. The City will provide the signs for the Contractor's use. The Contractor shall post the signs at least forty eight (48) hours prior to start of the work at a maximum spacing of sixty (60) feet. The signs shall clearly show the date(s) and hours of the parking prohibition. These conditions must be followed by the Contractor in order for the no stopping order to be enforceable. The Contractor shall notify the City of Campbell Police Department immediately after posting the signs at (408) 866-2101. H:\permits\20004)001 IA(mp) Public City of Campbell Works Permit Co~trac~or ~ ha~e th~ plan~ CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 Fax (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right3of-wa~) Permit expires in ~2 montlfff' Application Date Application expires in 6 months APPLICATION. Applicmion is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if file permk is not issued. Application Fee is non-refundable.) Utility trm~ lo~ion s. Naau~ of work Construct 2 storm drain inlets, 11 LF 12" RCP at STA. 2+04, C. Attach four (4) copies of an engineered plans showing the location and extent of the work, and four (4) copies of the preliminary £ngine~'s Estimate of work. The plaits shall show the relation of the proposed work m existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of D. All work shall conform to the City of Campbell Standard Specificalions and Details for Public Works Construction; the General Permit Conditions listed on the reveme side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shut-down 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 RE,gTARTING ANY WORK. , ~print name) Ad,i~s / e~ e) .~' & ~_P-~' ~-/~--Wm"~ .('C,~-e t,,o/2e 24 HOtm ~-MERGESCy ~LEPHO~ NO. ¢ Is this work being done by the proper'~y owner at their own residence? yes t,~No ' The Applieant/Permiuee 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/pe~ hereby acknowledges that they have read and understand both the front and back of this permit, and they will inform their conU'aomr(s) of the information. (sign) Date SPECIAL PROVISIONS ~1. Street shall not be open oat for underground installations. Mimmum oats may be allownd for conneetinm or exploration holes. Such cuts ~ approved bv the Inspector prior to cumin, Pavement may be cut for underground installations and must be restored in accordance with the Utility Trench Restoration Standard Details, Method 'A' Backfill, unless otherwise approved by Inspecxor. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2)copie~ of thc cut sheets scm to the Public Works Departm~t before starting work. Per Section 4215 of the Government Code this permit ia not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry klentifmaUon number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT PERMIT APPLICATION FEE PLAN CHECK DEPOSIT sEctmrry FOR F^IT~FUL P~om~aNc~a~o~ a ~ma~ CONSTRUCTION CASH DE~S~ ~ L~ P~ ~CK & INSPEC~ON F~ ~ ~ D~ ~. GENERAL PERMIT CONDITIONS 1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against this deposit if there is an emergency call-out, overtimc inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permiuee. 2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date of written acceptance by the City. 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee MUST REQUEST IN WRITING a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. ~5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and street closures. This plsn must be REVIEWED and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. 8. REPLACE IN KIND any damaged or removed existing improvements, including planting. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. I0. OVERTIIVlE INSPECTION pREMIUM will be charged against the cash deposit for inspection required outside the hours of g:00 a.m. to 4:00 p.m. at the current overtime rate, minimum one hour charge. I 1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at. the current overtime rate with a three hour minimum. Advance payment for the estimated time is required. 12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's renting such signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is REQUIRED unless otherwise stated by the City Engineer. 14. The Contractor or Perminee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at all times during consu'uction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of g:00 a.m. to 4:00 p.m. I~. No STORAGE of materials or equipment will be allowed near the edge of pavement, the t~aveled way, or within the shoulderline which would create a hazardous cm~iition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property ADJACENT to the work or any other work for which a separate permit may be required, nor does it relieve the Permit'tee of any obligation to obtain any other permit required by law. 17. This permit does NOT RELEASE the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is NOT TRANSFERRABLE. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. CALL BACK (call out) due to emergencies regarding this permit, shall be at the current overtime rate with a three (3) hour rainimum charge per occurrence. 20. 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 ~han storm water. Applicant shall adhere to the BEST MANAGEMENT pRACTICES established by the S, anta Clara Valley Nonpoint Source Pollution Con~ol Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. D ate j:\forms\pwperm2 6/96 CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERM/T (for worltlng withi~ public H~t~f-way) h~ed il / e~t expires ~ 12 mon~ X-R~f. Application Da~ Application expires in 6 months APPL/CATION. Application is hcr~y m~'le for a Public Wor~ A. Wo~ ~d~s or ~ ~~ ~ ~ work ~ing ~one by ~e p~ owner m ~eir ~n ~id~7 Y~ ~ No ~,' ~y ~ or d~d for ~g~ r~uJ~g from ~e ~o~ ~v~ svsc~L SE'E PUBLIC WORKS FEE SCHEDULE FOR CUSLR.ENT PERMIT APP~CA~0N ~E ~N ~ECK DE~S~ SEC~y FOR FA~ PE~O~C~OR CON~U~ON CA3H P~ ~CK & INSPE~ON ~ G~ENI~RAL PERMIT CONDITION I. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against ~ depo~ if there i~ an emergency c~ll-out, overti~ iltipec~otl or when City ordered barncading is requh'ed. Any such cosl~ tn excess of the deposit will be billed to the Pet~Jtzee. 2. A ONE-YF_AR MAINTENANCE PERIOD AND SLrRL:Ty are required. Such period will begin on date of wr~en ac~pe~e by the CLT. 3. R~FUND of :he cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written accep,.~-e of the work by :he City. 4. The PermUte MUST ILEQUEST IN WRITING a final/nspec~on and acceptance of the work upon completion. Ac.:eptanc~ by the City will be made in writing to the Perrmme. 5. MAINTA/N safe pedestrian and vehicular crossings and free access to private driveways, bns stops, rite hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHF. DULI~ is required for all lane closures, detottrs zed street closures. T1~ plan must be R.E~D and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caltrans Manual of Traffic Controls for Cons~uctinn and Mah~enance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shaft include Type rl flashing arrow signs if requital. 8. ILKPLACE IN KIND any damaged or removed exis~ng improvements, tnclud/ng planting. 9. Sawcut for all ?CC or AC removals. All PCC removals shaft be to nearest scorernark and shall be doweled to existing improvements. 10. OVERTLME INSPECTION PREMIUM will be charged aga~'t the cash deposit for inspection required outside the hours of 8:00 a.m, to 4:00 p.m. at the current ovemme rate, minimum one hour charge. Il. SATL'RDAy INSPECTIONS must be arranged in advance. Saturday inspection ~me is charged at :he current overtime ram with a thr~e hour minimum. Advance payment for :he esnmated ~.te is requLred. 12. Adequate signing and lighted BARRICADING is required on the .fob site. Failure to provide such sign~g and barricading may result in the City's renting such signing and barricades and charging :he cost (including all labor and materials) again~ the ca.sh deposit. 19. Compaction testing of subgrade, base rock, and asphalt concrete by Pennitme is REQ~ unless otherwise stated by the City ~ngineer. 14. The Contractor or PemUttee will have a SUPERVISORY R~?R.ESENTATIV~ available for contact on :he project at all times during constmctinn. Contractor or pern'uttee shah provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 15. No STORAGE of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shouldeHine which would create a hazardous condition to the public. I6. This pe,n~t shall not be construed as authorization for excavation and grading on private property ADJACENT to the work. or any other wortc for which a separate pernut may be required, nor does it relieve the Permi~e of any obligation to obtain any other permit required by law. 17, This permit does NOT RELEASE the Permmee from any l/abilines contained in other agreements or contracts with the City and any other public agency. I8. This per:mt i~ NOT TRANSFERSL-LBLE. Work must be performed by the ?ermittee or his designated agent or con.actor ~s specified thereon. 19. CALL BACK (calI out) due to emergencies regarding this perm/t, shall be at thc current over.ne rate with a three (3) hour m~n~murn charge per occurrenc :. 20. lhsrmanr to Chapter l~t.02 of the Ca. rnpbell Municipal Code, applicant shall not cause to be discharged any mater~a~ into :he municipal storm drain system other than storm water. Applicant shall adhere to the BEST ,'vtA.NAGEMENT PRACTI.CES established by the Santa Clara Valley Nonpoint Source Poltution Control Program. j:\forms\pwperm2 6/96 .CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERM/T (for working within the public fight-of-way) Permit ~xpii'es in'12 montl~' - - APPLICATION - Applica~on is berry made for a Public Works ~ in ancontan~ wiah Campbetl Muni~ C~. ~ 11.~. (~ ~ ~ 6 ~ · ~ ~it ~ ~ ~su~, Applicon F~ ~ ~le.) Utility trench location C. Att~:h four (4) copies of an ~J~ineer~[ plans showin~ the lo~.Jon ~zl ~ of the work. and four (4) ~ies of the p~iznina~ F.n~ne~'s Est~na~ of work. The tt~Planspe~mt.sh~Jl show t~c r~l~ion of thc proposed work t~ existin~ sm't'nc~ ;md u~,.,-~'mmd improvement. W~n approved by the C~/.Bnl~e~, ~ plan becomes a part of D. Ail work s~,Jl ~nfonn to the City of C~rnpbetl Smnd~d Specific~Jons ~ ~ for ~lic Wo~ Co--on; ~e ~ ~ C~ ~ on ~ ~e s~c; ~ ~c Sp~ ~v~io~ for ~ ~it, lh~ ~low. F~u~ m ~idc by ~ ~o~ ~ p~ ~ ~ult ~j~ ~ut~ ~ f~ of F~I P~o~ Su~ ~d ~h d~i~. (S~ G~ ~t Co~fiom I ~ 20 ' S. TH'E CONTRACTOR MUST HAV'E TI'lIS PF_.R. MrT AND APPROVED PLANS AT ~ SI"I~ AND MUST NOTTFY ~ PUBUC WORIr~ D£PAR~ AT LEA.ST TWO D~YS BEFORE STARTING WORK. NO'TICS MUST ~£ GWF_N TO PUBLIC WORKS AT LEA$'T 24 HOUI~S BEFORE RESTARTING ANY WORK. Is this work being done by the property owner at their own r~sidenc~? Yes /No Th~ Applicant/Perrai~e hereby ~ by affixing theh- signature m this permit to hold the City of Can~bell, in office-s, a~ent, s and ~ploy~s fi'~e, safe ~ Ire'ales from any claim or demand for damages resulting from the work ~vered by this permit., Th~ Applicant/Permim..e hereby acknowledges ti'mt ~ey have read and understand both the front and bark of this pgr*m~ and they will inform theh- co~r(s) of thc itfformmion. Saree~ sha~! not be open cut £or underground ha.stall,ions. Mi~mum cu~ may ~ aUow~lfo~ com"t~n'a or exploration holes: ~ c~s: mav be spe~fically SPECIAL PROVISIONS a~roved by t~ Inspector prior m eu~inl,. : .. : Pavemem may be cut for underground installations and must be restored ia ,w.r. ordaac, e with the Utility Trench ':: : : unless o~erwise approved by In.specmr. : . Rmmra6oe $taa:la~l Dem~, M~nd 'A' Ba~:fiIl, 1~' Section 4215 of ~ Government C~e ~ l~'rmk is a~n val~ for e~:av'a~Jons angl Ut~ler~'eund ~ Alert ~) has been m~fied and ~ iaqui~ identificat.i~n U.RA ~ SE'~= PL~BLIC WORXS FEE SCHEDULE FOR C~.N'T lmE, g.~ PERM. IT APPLICATION FEE IH.AN CHECK DEPOSIT SECU'RFI'Y FOR FAITF~"u'L PERFORM. ANChOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CI-/'ECK & INSPECTION FF.~ APPROVED FOR I~SUA~WCE JU~C~IPT NO. j:uorma~pwp~.~rev.6/9~ GENERAL PERMIT CONDITION I. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against this deposit if there is an emergency call-out, overtinz inspection or when City ordered barricading is required. A~y such cos~ in excess of the deposit will be billed to the Petimtzee. 2. A ONE-YEAR ,MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date of writmn acceptance by the C~. 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the writt~ accepm~ of the work by the City. 4. The PcrmJt~e MUST REQUEST IN WRITING a final inspection ~nd acceptnnce of the work upon completion. Acceptance by tile City will be made in writing to the Permi~e. 5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus slops, fire hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PI. AN and a CONSTRUCTION SCHEDULE is mtuired for all lane closu~s, d~murs ami strut closures. This plan must be REVIEWED and APPROVED prior to any lane closures. 7. T'ne CONSTRUCTION TRAFFIC CONTROL PLAN shah conform with the Caltrans Manual of Traffic Conu'ols for Construction ami Maln~nance Work Zones, dated I990, available at Caltrans. Traffic conl~oi equipment shall include Type 1I flasl~g arrow signs if requ~. 8. REPLACE IN KIND any damaged or removed existing improvements, iz~ludi~g planting. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and sl~ll be doweled to existing improvements. 10. OVERTLME INSPECTION PREMIUM will be charged against the cash deposit for im'pection required outside the hours of 8:00 a.m. to 4:00 p.m. at the current overtime rat~, minimum one hour charge. I I. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a tiu~e hour minimum. Advanc: payment for the esurnated time is required. 12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's renting such signing and barricades and charging the cost (including all labor and materials) agaimst the cash deposit. 13. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is REQLrlILED unless otherwise stated by the City 14. The Contractor or perrruttee will have a SUPERVISORY REPILESENTATIVE available for contact on the project at all times during ;onsmiction. Contractor or perrmt~ee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 15. No S-FORAGE of materials or equipment will be allowed near the edge of pavement, the tr, tv¢led way, or within the sboulderline which would create a hazardous condition to the public. 16. This permh shall not be construed as authorization for excavation and grading on private property ADJACENT to the work. or any other work for which a separate perrmt may be required, nor does it relieve the Perrnittee of any obligation to obtain ;my other permit required by law. 17. This permit does NOT RELEASE Re Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. TtUS permit is NOT TRANSFERIL-X,BLE. Work must be performed by the Permit~e or his designated agent or contractor as specified thereon. 19. CALL BACK (call out) due to emergencies regarding this permit, shall be at the ;urrem overtime rate with a three (3) hour mlnirrrum charge per 20. Purruanr to Chapter l~t.02 of the Campbell Municipal Code. applicant shall not cause to be discharged any material into the municipal storm dram system other than storm water. Applicant shall adhere to the BEST ,MANAGEMENT PRACTI.CES established by the Sa.nta Clara Valley Nonpoint Source Pollution Control Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understand all of the above conditions. ~-.~Z_ ~ ~7 ~'~pp~cant . Date j:\forms\pwperm2 6/96 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 Campbell Ventures, Inc. 100 South Murphy, Suite 102 Sunnyvale State: CA Zip: 94086 Refund Deposit 101.2203 Amount: $2,436.00 Amount: 101.540.7448 Amount: Interest Earned $2,436.00 (Exact Amount) Refund Construction Cash Deposit ($2,436) (Finance Dept only) Voucher #: Permit #: ENC2000-00011 Receipt #: 130716 Requested b Approved b~.'~/~~ M~l~elle Quin[~ey Finance Dept Only: Verified by: Date: 05/17/2000 Title: PW Inspector Date: Title: City Engineer Date: Title: Accountin~l Clerk II Date: 05/1612002 05/16/2002 Approved by: Title: Accountant Date: Special :[nstructions For' Handling Check Mail As Is: XX Mail in Attached Envelope: Interim Check: Needed By: Return To: (Name) (Department) Other: f/n: Forms/excel/chkreq Revised 05/00 PI. .C WORKS DEPARTMENT RECEIPT Effective August 1, 1999 tO: City C~erk PUaLIC WOmbS FILE p ..... PROPERTY ADDR~S ~~e~~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ .............................................................................................................................................. ENCROAC~ENT PE~IT ~2 Appli~tion F~ Non-Util ~ E~rmchmem Permit ($236.25) Mi~r E~roachment Permit < $5~ R-I Fint Permit (No F~) Sub~quent Permi~Yr ($105) Utility Encroachment Pe~it Aiieiial/Coll~tor S~t Residential S~er A~ 2203 ~osit - 2 % of ENGR. ~. 2203 Faithful Per~rma~ Securit FPS 2203 ~bor and Mamrials S~urit ~ 2203 Monumenmtion Securit 2203 ~bor an~ Material S~urity 4% of ENGR.EST. Plan Ch~k & l~ction F~ (Non-Utili~) (1~% of ENGR. EST.} 4722 Engr.~t. < S250,~ 02% of ENGR. EST.) ** 220~ En r~ ~ it8% of ENGR. ~T./$30 ~ min. ~722 Utilit ( $i~ ~ Minimum Ch~g~ Per ~tion ($126) .~o~ui~/Pi~li~s up to 5~ F~t ($1.75/fQ A~ve 5~ Li~ F~t ($1.15/fQ ~anholes/Vau m/E~. ($1 lO.25/ea) Pol~ Se~Removal ($1 lO.25/ea) S~t Tr~ Planting/Removal ($1 lO.25/tr~ ** 2203 Utiliw ) 51~,~ Actual C~t + 20% 4722 Strut Tree Planting/Removal Pe~it ($110.25) 47~ Pro~t Plato & S~ificatio~ Pro~t No. 47~ Smnd~d S~ifi~tiom & Derails ($1/Pg $12.50/Bk~ 47~ C~ies of Engi~ring M~s & Pla~ Aerial Plot 24' x 36' Aerial ~int 8 I/2' x 11' Maps and Pla~ 24' x 36' ($5) ~722 Penalties: Failure to restore public im~uvemenm ($1~/C~end~ Day) ~um 4722 Pe~lties: Failure to cori~i u~afe conditio~ ($1~/Calend~ Day) LA~ DE~LOPME~ 4722 ~t Line Adiustment ($5~.50) 4~2 Parcel M~ (4 ~ or ~ss) ($1,125 + $25/~t~ 4722 Fiml Tract M~ (5 or More ~ ($1,450 + S25/~Q 4722 Certificate of Complia~ ($525) 4722 Cenifi~m of Coii~iion ($315) 4722 No~ F~ (~r signature) ($10) 4~2 Va~tion of ~blic S~ & ~menm ($5~.50~ 4722 Assessment ~greffation or R~ionment Fint Split ($5~.50) ~ch Additional ~t ($178.50) 4~1 Storm Drainaffe Ar~ F~ Per Ac~ (R-l, $2~) (Multi-Res, $2,250) (All Other~ ~920 Parkland Dedi~tion F~ (75 %~5% Due U~n Cert. of ~cupa~?~ 4~5 Pos~ge ~AFf'IC 4~8 Inter~tion Turn Counm (Tw~Hour CounQ ($63) 4728 Intersection Turn Counm (a.m. or p.m. ~ ($131.25~ 4728 Traffic Flow M~ ~Daily T~ffic Volum~s~ ~$28.35) 4728: Campbell Traffic M~el (Full S~ A~sment) ($2t362.50) 4728 Campbell Traffic M~el {R~u~ S~ Ass~smenQ ~///) 4271 Truck Petmim ($36.75/trip) 4728 No Parkin~ Sig~ ($1/each or $25/1~) DT~R NAME OF APPLICANT ; erne~ ~on-lnterest ~ing de~siQ h:\forms\ecfrm4.xl ..... 7/13/99 (rap) LERK'$. 0FFII:E ~J.I t ur ..01000130717 TiHE: i0:2!:06 DESCRIPTION AHOUNT EN'GR & SUBDiV FiLI.~ F $7,308.00 TOTAL DUE: $7,308.00 C~C~ NO: 0ii0 TEN~[~g: $7,508.00 DESCRiPTiON A~OUNT TOTAL DUE: $2,436.00 CHECK PA!D: CHECK NO: 0ii0 I~U:~:~- 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 Dubrovnik Associates, Inc. 100 South Murphy, Suite 102 Sunnyvale State: CA Refund Deposit 101.2203 101.540.7448 Interest Earned $1,362.00 Refund Plan Check Deposit ($1362) Amount: Amount: Amount: (Exact Amount) Zip: 94086 $1,362.00 (Finance Dept only) Voucher #: Receipt #: 127817 Requested by: Sye..~i~ Approved by: . Michelle~Qu'i~ney Finance Dept Only: Verified by: Approved by: Title: Title: Permit #: ENC2000-00011 Date: 02/03/2000 PW Inspector Date: City Engineer Date: Title: Accountin~l Clerk II Date: Title: Accountant Date: 05/16/20O2 05/16/2002 $13eciol ]:nst uctions Hondlinq ChecE Mail As Is: XX Mail in Attached Envelope: Interim Check: Return To: Other: (Name) Needed By: (Department) f/n: Forms/excel/cflkreq Revised 05/00 PU 2 WORKS DEPARTMENT RECEIPT Effective August 1, 1999 TO: City Clerk PUBLIC WORKS FILE NO. .,'~-,,~'~,'~' ...................... ~ ~ ~ ect& receipt for the following mon es 435.535.4021 { Proi~et R ...... i;P;ii~:i~;;;;i;;ii .............................................................................................................................................................................................................................. ENCROAC~ENT PE~IT ' 4722 Application Fee ~inor Encr~chment Permit < $5.~ R-I First Permit (No Fee} Subsequent Permit/Yr Utility E<r~hment Permit Arterial/Collector S~eet Residential S~ee~Other Are~ {$236.25} 2203 Plan Check Deposit - 2 % of ENGR. EST. (S5~ rain} 2203 Faithful Performance S~urity (FPS) (1~% of ENGR,EST.) 2203 ~bor and Materials S~urity (1~% of ENGR. EST.) 2203 Monumentation Security (1~% of ENGR.EST.) 2203 C~h Deposit (4% of ENGR.EST.){$5~ min/$10,~ max) 2203 ~bor a~ Material S<urity (1~% of ENGR. ~T.) Plan Check & Insp~tion Fee (Non-Utili~) 4722 Engr. Est.< $250~ (12% of ENGR. EST.) ** 2203 Engr. Est. > $250,~ (Deposit 8 % of ENGR. EST./$30,~ min.)** 4722 Utility < $1~.~ Minimum Ch~ge Per ~tion {$126} Condui~/Pi~lines up to 5~ F~t ($1.75/ff) Above 5~ Line~ Feet ($1.15/fl) Manholes/Vaulm/Etc. ($110.25/~) Pole Se~RemovM {$110.25/ea) Street Tree Planting/Removal {$l 10.25/tree) ** 2203 Utility > $1~,~ Actual Cost 4722 Street Tree Planting/Removal Permit ~$110.25) 47~ Pro~ect Plans & Specifications Project No. 47~ Standard Specifications & Details ($1/Pg $12.50/Bk) 4760 Copies of Enemeermg M~s & Plans Aerial Plot 24' x 36' ($42) Aerial Print 8 1/2~ x Il' ($15) Maps and P[am 24' x 36' ($5) 4722 Penalties: Failure to restore public improvemenB ($1~/Calendar Day} ~Mum c~e Sec.[t.34 ulu} 4722 Penalties: Failure to correct umafe conditions {$1~/Calendar Day} LAND DEVELOPMENT 4722 Lot Line Adjustment ($577.50} 4722 Parcel Map (4 ~u or ~ss) ($1,125 + $25/~t) 4~: Final Tract Ma0 (5 or More ~B) ($1.450 + $25/~t} 4722 Certificate of Compliance {$525) 4722 Certificate of Correction ($315) 4722 Notary Fee (per signatu~) ($I0) ~722 Vacation of Public Streem & E~emenm {$577.50) First Split ($577.50) Each Additional ~t ($178.50) 4721 Storm Drainage Area Fee Per Acre (R-I~ $2.~) {.Multi-Res, $2~250) 4920 Parkland Dedication Fee (75%/25% Due Upon Cert. of ~cupamy) 4965 Postage TRAFHC 4728 Intersection Turn Counm (Two-Hour Count) ($63) 4728 Intersection Turn Coun~ {a.m. or p.m. pe~) ($131.25) 4728 Traffic Flow Map (Daily Traffic Volumes} ($28.35} 4728 Campbell Traffic M~el (Full Sco~ Assessment} ($2,362.50) 4728 Campbell Traffic M~el (Reduced Scope Assessment) ($777) 4271 Truck Perm us ~$36.75/trip) '- OT~R 4728 No Parking Signs {SI/each or $25/I~} AME OF APPLICANT ,~'~. . zZ' CITY OF CAMPBELL, CA PAYOR: DUBROVNIK ASSOCIATE TODAY'S DATE: 02/03/00 ~P~TT~ -iAi TOTAL DUE: tl,362.00 rA~. $i,362.00 CHANu~. ~.00 CITY OF CA)P)ELL~ CA .~r~,,, BY: JUI)YS 010001~ P,4Y'O,~.-' [~UBROgNi~ ASSOCIATE :OD~ .~ DATE: REGtSTER DATE: 02/03/00 TIME: 10:II:44 TOTAL ~UE: CHECK PAID: TE~E~E~ CHA~GE: :386.25 MAY-I5-~2 12: 10P FROM: :6504629062 P: 1 x 1 ~sxamu~ A~ m~e~.x~z oz z~~ ~zzzx~z~ ~-~. ~e~e No..~C~OO0_O~i/ the O~e=(s) of a E~_~ficate. of Deuos' balance (tnclu~ng tnteres~ which ' ~erewi~h to ~e CITY OF ~B~L, ~ecel~ of ~i~h is hereby as~t~ee, fox a good ~d valuable consideratio~, acknowledged~ = ~derstand ~t - ' ~-ce or u~n ~re~cntation of a .... w~ ~Y ac20A ~e 8~ature Of the esSt~ee Wi~ou~ further sign A__CK~OWLEDG~MENT BY Issuer affi~s ~a~ ~ere are no o~er holds on issuer. ~, May i,6, 2002 BY~~~ Donna Beaman Title: Deposit Service N~y O f f i c e r 1easm si~ ~%~w for Si-~tu ..... g~ig~t. Ret~n ~is~_ .re ~nt~catton and as m=~owledgement of yo~ no,ice - '' ~g~e~ ~ Recel~ for Date:___5-/i /,~ ,_ City o~ C~mpbell ' ~ ~' / ~ A , , ~.. ,~ Said assignee hereby releases and relin~lshmm m~l his right, title ~d interest tO said acco~t~ Bald inves~ent ce~ficmte, Bald ~lance ~d all O~er rights in connection ~*rewtth. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ~,~ 0,~- U O~L 0,_., ~ ss. On f')gO~ J~TC/~.~?j ,before me,/~'~/'~/'? Date Name and Title of O~fJcer (e.g., "Jf~ne Doe, Nota~..~lic") personally appeared Name(s) of Signer(s) ' ~'personally known to me [] proved to me on the basis of satisfactory evidence Place Notary Seal Above to be the person('~ whose name(~) subscribed to the within instrument and acknowledged to me that~ executed the same in ~-hi~j~F~ir authorized capacity(i~.~), and that by signature({;) on the instrument the person(Z, or the entity upon behalf of which the person(~ acted, executed the instrument. WITNESS my hand and official seal. 'g ature,~f Notary Public ~/ OPTIONAL the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Descri Document Title or Type of ent: Document Date: Signer(s) Other Than Named Above: Number of Pages: Capacity(les) Claimed by Signer Signer's Name: [] Individual [] Corporate Officer-- Title(s): [] Partner-- [] Limited [] General [] Attorney in Fact [] Trustee [] Guardian or Conservator [] Other: Top of thumb here Signer Is Representing: © 1997 National Notary Association · 9350 De Soto Ave., P.O. Box 2402 · Chatsworth, CA 91313-2402 Prod. No. 5907 Reorder: Call Toll-Free 1-800-876-6827 Cr NFIRMATION OF TIME DEPr' IT FTnanclal Inslitulion: Mid-Peninsula Bar,... Main Office 420 Cowper Street, Paid Alto, CA 94301 Account Name: DBI CONSTRUCTION ASSIGNED TO THE CITY OF CAMPBELL BUSINESS TYPE: Corporation Account Number I Issue Date ~mount ~ Maturity Date 01 08597225 May 16, 2002 j. $23,325.00 12 Months May 16, 2003 Rate Information: This Account is an interest bearing account. The interest rate paid on the entire balance in the account will be 2.00% with an annual percentage yield of 2.02%. The interest rate and annual percentage yield will not change for the term of the account. The interest rate will be in effect until May 16, 2003. Interest begins to accrue on the business day you deposit noncash items (for example, checks). Interest will be compounded daily and will be credited to the account at maturity. Interest on your account will be credited by adding the interest to the principal. The annual percentage yield assumes interest will remain on deposit until maturity. A withdrawal will reduce earnings. Balance Information: We use the daily balance method to calculate the interest on the account. This method applies a daily periodic rate to the principal in the account each day. We will use an interest accrual basis of 365 for each day in the year. You must maintain a minimum balance of $5,000.00 in the account each day to obtain the disclosed annual percentage yield. Limitations: You must deposit $5,000.00 to open this account. You may not make additional deposits into this account. You may not make withdrawals from your account until the maturity date. Time Account Information: Your account will mature on May 16, 2003. If you withdraw any of the principal before the maturity date, we may impose a penalty of the following: Deposits with an or ginal maturity of 30 days to Dp~, e r ' ~P_ald on t.h.e da!.e of w. lthdrawal Deposits with an or gins maturity in ex~-~'' -,~ ~arw_ill.fo_rf..e!,!.a.n .a .m. ount equal, to 30 days interest at the rate be n · . ' ' - .... ,,. ,~ ,,,u,m~ wi, rorte~t an amoun, equal 0 days interest at the re,ge ~;~naglt~ala on [ne aa,e of withdrawal. This account will automatically renew. You will have days affe mat le to withdraw funds w ,hour // ........ I FDIr' I //[~,""~ ~-/ ~ ~ TIME DEPOSIT AGREEMENT- BUSINESS CERTIFICATES (12-17 MONTHS) We appreciate your decision to open a time deposit account with us. This Agreement sets forth certain conditions, rules, and ru es that are s e 'r your Account. Each signer acknowled es that the Account Holder named has placed on de ceil w~th the Rn p cl ~c to Indicated, and has agreed to keep the?u~nds on deoesit until th ................ [P. ' ' uncial Inet tut,on the De ' Account Holder(s) the word "Account" m~_~n~ f ' ' - u w~a~un[ ua,e. As use. q in m~s Agreement he word .... p,,o. slt A.,m, cunt ".we" "us" and "ou~" mean . ..._.=__ t_his ~ime Depos~t. Accoun~'and the word 'A ream " , t . . S yOU, your or y.ours mean the i[em~ (such as checks dra twh2~n--a~c-i-al,=lnstlt .ut?.n' ...Th. is Acco. un[ s effective as of the Issueg Dat=e2nt.~ ~m~e,a.~n,s~h-~ _-I'j .m~ D? .posit Agree. mere, a. nd the words . u!., u,~u~ ,nanc al InS[l~ut'ions oe os,ted I ~ ".¥ '° v,~,u.=~ ut [ne sam we receive credit f as of t~e date of deposit and wll be reflected as such on ~l~r reP~ords, o open the Account. Deposits of foreign currency will be converted to ~Jr.~.°~Cnac~sh INTEREST RATE. The interest rate is the annual rate of interest paid on the Account which does not reflect compounding ("Interest Rate"), and is based upon the interest accrual basis described above. AUTOMATIC RENEWAL POLICY. If the Account will automaticall renew as described above, the princi al amount and all aid earnei has not been withdrawn will automat,call renew on each Maturity ~ate for an identical er,od of tim d nlerest that accounts w I be calculated at the interest/rate then in eft .................. P . . e as t~e ori inal de osit ~ .. Account you must no,if ' . ~u~ ~u, ~ me ae OSl~S o! mat ue i g P. er.re... Interest on renewed , y us dunng the grace period after the Maturity ~te pos [ Amount and term. If you w~sh to withdraw funds from your EARLY WITHDRAWAL PENALTY. You have agreed to kee th f · · · ~eth..e_f..u_n,~.s_from Y.O..ur .Ac.count pr!or to maturity may result i~Pan eearUlndwS on deposit until the M .a?...u,r t_y_ Date of your A. cc. ount An withdraw I ~ ,u,a,[y as specmeo aoove will apply, y Ithdrawal penalty. We w,II consider requests for early ?ithdrawal ~nl~ i~ll~r°~nPt~lt' Minimum Required Penalty. If you withdraw mona within simple interest on the withdrawn funds f .~.~, ........ ?_Y_, . s}x (6) days .afl.er the date of deposit the Mtn m Re uir · · . . · ~-,,~, ,,~, ~a, y w,Horawal s are er ' . ., um q ed penally is seven 7 d amount(s) withdrawn w~lh~n slx 6 da · · ~ ) p mineD, we are re ulred to m o ' ' · ( ) '~Y~' Ygu pay the early withdrawal ,',e(n6~) t,, ~,s, ~a~..,e_r,,e.._ac_h pa. rt,a.I..w~thdrawal: The early w thdrawal ~qenal~,, mo,, ~P~C s--e--l-h-e,~Min-I~um.-Re, quIred-Penalty on the interest has ~, ..... ,-, ...... ,fi; ,L'~ ~..~' '~"~,,,:,g pan or [ne accruea interest on th Account'. .~ -~ ,.,~ ,_,~u,_~_~,,a[, [ne ~n~mum Hequired Penal . .... ~,~,u, wu ~a~e me omerence trom the principal amount of your A~ount. . If your Account has not earned enough interest, or if Excepli.ons. We may I.et you withdraw mona from our · · ~n~[ve. ic~f,~or~uo~s~o=~ I.s.determ!n..e_d.l.ega!ly incom et~Ynt b Z§ouHA%Cr°un' b~l%~, ,.he M..atur, ty Date w,thout an .early.w.i. thdrawal enalty: ( ) e one or .... · ..=--: :-;5~,-,,?m .Acco. un, (I .1-~.) esmblishe~i, accorYdance with ~h~jr~C 4~'~a..tire body ~0~ .comp. et,e,~, J. urlsdlction; or (2~)when ,h'~ )A~cho%]n, is an ,.~.~u; or t,~l when [ne ACCOUnt is a Keo-h Plan 'Keo-h" .......... ,d ,.he m. on_y is paid w thin seven 7 d o . .. IRA or a Keog~ Plan establish~.d nut ..... , ~ .... ~ .~g2 ) "yOU ,oriel[ al least the iniere · - ( ) aye afl.r the Account is grace period ( f any) .... ,. ........~ :~ ucc.. ,~u~ or 26 USC 401, when you reach'aecarned on the wlthdraw..n_funds; or 4) if..!h.e Account is an _.. ge 59 1/2 or become disabled; or (~) wi[nm an applicable RIGHT OF SETOFF. Subject to applicable law we ma exerci ' · nKoe~gohr ~l~,rne~tedr Te~(L~sS~inA(Ccounts) without .n.otice,'for any I~abilily (~ ~leulDtriogfhat n°; So~t~offu?~vShee~rlly. in. teres! a .a!nst any and all of your Accounts excet IRA oth .,k,-*,, ....... g,, and w.h. ether ar. lslng from overdrafts, end ra~.rn~nf, ~..Y~.-L .... er Jolnt..or I.n~iwdual, whether direct or tino~nl wh~h,,. ' set~f~ ~,:¥~'~:. ~r_~e_,,~ccoun[ !s a joint or multiple-partv account. ;.;2/.-;;?~',~u-~' '~.~.lJ~s' ,Da.ns, internments, garnishments, levieCs°~ii;~?,-T;.;;'~;;;.'~:'~..'. -u ........ y ~,u a, Accoums oreach Account H'old~r ...... ~ .... u, ,.utopia-puny account holder authorizes us to ~-~;[r~i;=~;'~,'~,~.~=,~?' OTHER ACCOUNT RULES. The following rules also apply'to the Account. _ ............. u-, Surrender of Instrument. We may require you to endor .Acco.un,.. f you lose this Agreement, "ou a-rea t ...... r.se .a. nd..surrender this Agreement lo us when "ou with ......... · . x u u ~,B. any arriaavi[ or Ios~ instrument or oth r ~ u,a.w runes, transfer or close your harmless from hab~hty, prior to our honoring your withdrawal or request. , e Agreement we may require, and agree to hold us Death of Account Holder. Each Account Holder agrees to no,if us immediately upon the death of any other may hold the funds in your Account until we have received all require~cJocumentation and instructions. Account Holder. You agree that we Indemnity. If you ask us to follow instructions that we believe might expose us to any. claim liability or damages, we may refuse to follow your instructions or may require a bond or other protection including your agreement to indemnify us. Pledge. You agree not to pledge your Account without our prior consent. You may not withdraw funds from your Account until all obligations secured by your Account are sat,st, ecl. DEPOSIT PRO. Var. 8,$2.20.06 Copt, Harland Financial SoluliOn$, Inc, 1996, 2002. All Righl~ Reserved. CA - C.~1. L761 TR-10870 0108597225 SSN/TIN: 77-0471269 TO: DBI CONSTRUCTION ASSIGNED TO THE CITY OF CAMPBELL 100 MURPHY SUITE 102 SUNNYVALE, CA 94068 DATE: May 16, 2002 Customer Copy A~SIGNM~T AND RECEIPT OF INVES~ CERTIFICATE TO CI?Y OF 'CAMPB~.?.?., 70 N. FIR STR~.~T CAMPBELL, CALIFORNIA 95008 (408) 866-2150 I am/We are the owner(s) of a savings account at at its branch office at PaloAlto certificate No. #010783642~ in the names of , California, investment DubrovnikAssociates Inc F~OCityof C~nhe]l and having a present balance of $ 93t300.00 I hereby grant, transfer and assign said account, said investment cert ficate, said balance (including interest which accrues thereon), and all other rights in con~ection therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration, receipt of which is hereby acknowledged, f~r ,the p.u~..~..se of insuring construction described as follows: O~F % i ~ ) TREE F [Mi, ROVE E 'i IN T[.iE 1 C iBiiT-D£- Y. s!ca11~_vdelivered verification of said investment certificata and du~icate of nment and Receipt to said assignee. I understand that assignee can withdraw from said account any time on his signature alone upon presentation of a written order to the issuer. I also understand that I may not withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may act on the signature of the assignee without further inquiry. on sign A. signor print sign Assignor print ACKNOWLEDGEMENT BY ISSUE~ Issuer affirms that there are no other holds on subject account, that subject monies are available, and that the above described~t bas been noted on the Records of said issuer. Date ~ '- / ~- -- O 0 By ( ~'////'~'~ ATTACH Authorized Signature NOTARY Title: ACKNOWLEDGEMENT INSTRUCTIONS TO ASSIGN~R Please sign below for signature identification and as acknowledgement of your notice of Assignment. Return this Assignment and Receipt to the issuer at its address above. Retain one copy of this Assignment and Receipt for your files. City BY ASSIGNEE Said assignee hereby releases and relinquishes all his right, title and interest in and ~o said account, said investment certificate, said balance and all other rights in :onnection therewith. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ~A2~-'/~r ~-¢/~ }SS. On .//74,4-~) ~a~.,';2.~.OO ,beforeme, Name and Title of Officer (e.g., "Jane Doe, Notary Public") personally appeared Name(s) of Signer(s) E~personally known to me ~ 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(les), 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. Wl~SS m~~d official seal. Place Notary Seal Above ?,~ature of Notary Public OPTIONAL Though the information below is not required by/aw, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Number of Pages: Capacity(les) Claimed by Signer Signer's Name: Individual Corporate Officer -- Title(s): Partner -- _- Limited ~_ General Attorney in Fact Trustee Guardian or Conservator Other: Signer Is Representing: Top of thumb here @ 1999 National Notary Association · 9350 De Solo Ave., PO. Box 2402 · Chatswodh. CA 91313-2402 · www. nationalnotary.org Prod. No. 5907Reorder: Call Toll-Free 1-800-876-6827 OF TIME DEPO'" T CO "=IRMATION Financial Institution: Mid-Peninsula Bank 0107836428 420 Cowper Street, Pale Alto, CA 94301 Account Name: DUBROVNIK ASSOCIATES INC. FBO CITY OF CAMPBELL SsNrrlN: 77-0305373 Account Number I Issue Date I Deposit Amount Te,-~ Maturlly Date 0107836428 May 12, 2000 $93,300,00 180 Days November 8, 2000 Rate Information: This account is an interest bearing account. The interest rate on the account is 5.55% with an annual percentage yield of 5.71%. The interest rate and annual percentage yield will not change for the term of the account. The interest rate will be in effect until November 8, 2000. Interest begins to accrue on the business day you deposit noncash items (for example, checks). Interest will be compounded daily and will be credited to the account at maturity. Interest on your account will be credited by adding the Interest to the principal. Balance Information: We use the daily balance method to calculate the interest on the account. This method applies a daily periodic rate to the principal in lhe account each day. We will use an interest accrual basis of 365 for each day in the year. You must maintain a minimum balance of $90,000.00 in the account each day to obtain lhe disclosed annual percentage yield. Limitations: You must deposit $90,000.00 to open this account. You may not make additional deposits into this account. You may not make withdrawals from your account until the maturity date. Time Account Information: Your account will mature on November 8, 2000. If you withdraw any of the principal before the maturity date we may impose a penalty of the following: Deposits with an original maturity of 30 days to one year will forfeit an amount equal to 30 days interest at the rale being paid on the date of withdrawal. The annual percentage yield assumes interest will remain on deposit until maturity. A withdrawal will reduce earnings. This account will automatically renew. You will have 10 days after the maturity date lo withdraw funds without penalty. Member I SIgnature~'rm'T~Tttle of Authorized Financial Institution Signer NON TRANSFERABLE - NON NEGOT,ABLE FDIC F2__ . TIME CERTIFICATE OF DEPOSIT - Business >90,000.00 (180-209 Days) We a p rec'a~ te your decision to open_ a time certificate of deposit account with us. This Agreement setSn def°rthostCertainwith theC°ndFinancialti°ns rateS,lnstitutionand rules, he thatDepositare speci~c~ toyour Account. Each s~gner acknowledges lhat,the A..cco,u..n!. Ho. lde. r n..amD~~ ha,~sP~sC~ ino this ,~-reement the words ""ou", "your" or "yours" ~ t d and has a reedto kee the funds on aeposn until me Ma~un~y a e g Y Amount indica e , g .... P . · ............... ~, ^~,t, nHn~ nncl th~_ word "Aoreement" means th s Time Certificate of nt Ho der s the wore Accoun! means mis lime ueposll ,'~g[eeme-~ ~,u........... .;.- .~ ............... ~eeDa(~Jth~,J~T~Jnt, and t~)"~ords "we", "us" and "our" mean the Financi.a,I Ins.!itutio.n...Thi.s.. A..ccou. nt,is ett.e, ct~v,e_as__ol'_m,e,.[ss^u.e~ ,a~e a~s,.,~v~t~Oo~oOr~l~nen da[re we r~ceive credit for noncash lams (such as checks drawn on otner tlnanclal institutions) aepos[~ea to upu,, i.,lU /~,.,JL, uul,,. ~..~=1~'o ,-~ ~ currency will be converted to U.S. funds as of the date of deposit and will be reflected as such on our records. INTEREST RATE. The interest rate is the annual rate of interest paid on the Account which does not reflect compounding ("Interest Rate"), and is based upon the interest accrual basis described above. I RENEWAL POLICY f the Account wll automatically renew as descr bed above, the pr ncipal amount and all paid earned interest that AUTOMAT C ..... tim as the crt inal de esi, term nterest on renewed withdrawn will automaticall renew on each Matunty Date for an idenbcal penod of e ~]. p ..... · .... ah~cSonu°nttsbew~l? be calculated at the interesFrate then in effect for time deposits of that Deposit Amoum and term. , you wlsn to wltnoraw tunes from your Account, you must notify us during the grace period after the Maturity Date. RLY WITHDRAWAL PENALTY You have agreed to keep the funds on deposit unti the Maturity Date of your Account. Any withdrawal of all or part EA~ ~,,~,..4~ ~ ......... Ar,,-,-,Ho! nri~r tn rn~turitv maY result in an early withdrawal penalty. We will consider requests for early withdrawal and, if granted, t~ j, i~e ~a, i,t~a~.~,l~ e~i.--f i~ d..~ ~)~/~ -w,--il. i ~- p'p-i y- i - ..... Inlmum Re uired Penal, f you withdraw money, within s x (6) days after the date of deposit the Minimum Required Penalty is seven (7) days' · , M . . ,q~ .............. Y,;,-~- If nnrti~l earlv w~thdrawal(s) are permitted, we are required 'to impose the Uin.!mu.m. Requlre..d Pe. nal!y...on !.he simple imerest on ~.e w [~lU/i~.Wll /UllU;~)."-'-- - - ~* . ' - · e more than ,ne M nimum Hequ rea ~'enal[y amount(s) withdrawn within .six (6),.da,ys .aft.er.,.each pa. rtl.al.,wlthdra.~v_'~, in'['ehr~s~a~lny ~hiethAd~:~/ualn~.e~fa,[toYurm~.cYc~unt has not earned enough interest or if th~ You pay the early withdrawa penally oy mrtemng pan or [ne accrueu · ~, ' interest has been paid, we take the difference from the princ pa amount of your Account. lions We ma let ou withdraw money from your Account before the Maturity Date without an early withdrawal penalty: (1) when on.e or mnr~ ~EfXvC~eUP d es ~)r is det~eYrm neYd labially incompetent by a court or other ad. nistrative body of com. pe..t, ent jurisdic, ti.on~; or (.,2_)_w,,_h_en. t_h_e_,,A.c,c;~ou..~Sneadn: ' I IV:Vi--I '-- ' -- ' * C ordance with 26 USC 408 and the money is paia witn n seven [/) aa s at~e~ t.e ~uuuuu~ ,~ u = Ind~wdua Rebrement Account (IRA estabhsed ~n a .c . . . . · - ' h n the Account is a Keo~c~ ~ Plan (Keogh), ,f2~)ou forfeit at least the ,nter .est earned _o_n .t .h_eb,.j ~/z orWl!hdraWnoecome e~sao,eo;f'u' nd.s,, .or or(~)'if'th .e,,~ccounttb)wlmm an appHcao~e~S"an' I~,graceOr a ~.~9~)~h'~l;~n established pursuant 26 USC 408 or USC 401, when you reach age age period (if any). F ETOFF Sub'ect to a plicable law we may exerc se our right of se,off or security interest age nst any and all of your Accounts (except IRA, .R. IGH. T O. S _ _ .. _ J · - P ............ , ..... "-~."~,, ~r ~ebt of an,, of you whether loin, or individual, whether direct or contingenl, w. hether n are/rust Accounls wlrrluu~. [iuiH,.;u, 1Mm ~lly ilct~ ~y ',./ ~ 7 Z ~ ....... ' F, eogn p, a ...... ) ....... :_=__ ,~ ...... rrlrnft~ =nHnrc=m,ant'~ nuarantees cans attachments garn snments ,eves, attorneys tee.st or, ! r x si n , eno woe.eT ~t/l~,lll~ I/UIII UvI;~ ....... , VHU ........ ... · t ' ' , ' ' ' now or nereat e e g r mulh lc- art account each jo~n~ or mulbple-party account holder authorizes us to exercise our ngm o~ other obligations, if the account is a joint o 'p P Y , setoff age.st any and all Accounts of each account holder. OTHER ACCOUNT RULES. The following rules also apply to the Account. Surrender of Instrument. We may require you to endorse and surrender this Agreement to us when you withdraw funds, transfer or close your Account. f you lose this Agreement, you agree to sign any affidavit of lost instrument, or other Agreement we may require, and agree to hold us harmless from liability, prior to our honor ng your withdrawal or request. Death of Account Holder. Each Account Holder agrees to notify us immediately upon the death of any other Account Holder. You agree that we may hold the funds in your Account until we have received all required documentation and instructions. Indemnity. f you ask us to follow instructions that we believe might expose us to any claim, liability or damages, we may refuse to follow your instructions or may require a bond or other protect on, including your agreement to indemnify us. Pledge. You agree not to pledge your Account without our prior consent. You may not withdraw funds from your Account until all obligations secured by your Account are satisfied. DEPOSIT PRO, Reg. U.S. PaL & T.M. Of'F. Vet. 8.o4e (c) 2000 CFI ProServicea, Inc. All Rights Reserved, CA - L761 TO: DUBROVNIK ASSOCIATES INC. CAMPBELL 1101 KNICKERBOCKER AVENUE SUNNYVALE, CA 94087 FBO CITY OF DATE: May 12, 2000 INSURANCE REQUIREMENTS CHECKLIST Permit # ~h/C ~"0 - ~YO[ I / CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury, and property damage: $1,000,000 per occurrence, and -n $1,000,000 general aggregate limit applying separately to the project, or $2,000;000 general aggregat.e limit. Policy expiration date ~utomotive Liability: v' o']'-~ "Any Auto" checked on certificate ahtv,l~jhSCgr $1,000.000 per accident for hod'dy igjury and property damage Policy expiration date Y ' ~ Workers' Compensation and Employer s Liability . --1~5 ~ Waiver of Subrogation clause ,~vgvd~ 1~ $1,000,000 per accident fo~; bodily injury or ~sease ,n Policy expiration date ~(~N?,~49~r~~rb Required Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement ~ The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. ~ The insurance coverage afforded to the Additional Insured is primary insurance. N~ Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives". .n Workers' Compensation Insurance Sheet Submitted ~ For General Contractor (_~~' t~ ~ ' ~ For Developer or O~vner Acceptabilitv of Insurer(s) ~ Insurer(s) has current A.M. B~est Rating of A:VII and is authorized to transact business in the State~~ Insurance Certificate Reviewed ~,,~ * r~'-x-~i~ ,~.~/~ate~ Copy of Insurance Certificate placed in tickler file for month of expiration. j:\forms\inscklst (rev 11/99) STATE COMPENSATION INSURANC'E FUND 2RTHOLDER COPY P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF.:WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-01-2003 GROUP: POLICY NUMBER: 1513296-2003 CERTIFICATE ID: 9 CERTIRCATE'E~PIRES: 02-01-2004 02-01=2003/02-01-2004 CITY OF CAMPBELL ATTN: DEPARTMENT OF PUBLIC WORKS 70 NORTH FIRST STREET. CAMPBELL CA 95008 NG JOB: AL NORK ZN PUBLZC R~GHT-0F-NAY This is to certify that we have issued a vali0 Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the empioyer nameo below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 1odays' advance written notice to the employer. We will also give you lO.days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not ameno, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect' to which this certificate of msurance may be issued or may-pertain, the insurance afforded by the policies described herein is subject to ail the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT EHPLOYER'/SLZABZLZTY LZMIT INCLUDZNG DEFENSE COSTS.: $1,OOO,OO0.OO PER:OCCURRENCE. RECEIVED EMPLOYER LEGAL NAME 'OBI CONSTRUCTION:, INC. 1OO S MURPHY AVE STE 102 SUNNYVALE CA 94086 DB1': CONSTRUCTTON, ZNC O1~16-2003 STATE COMPENSATION ISSUE DATE: P.O. BOX 807', SAN FRANCISCO, CA 94101-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE O2-01-O2 RECEivED JAN 2002 ~D~STI~fiON POLICY NUMBER: 1513296 - 02 CERTIFICATE EXPIRES: 02-01-03 NG CITY OF C.AMPBELL dOB: AL WORK ZN PUBLZC ATTN: DEPARTRENT OF PUBLIC WORKS RZGHT-OF-WAY 70 NORTH FIRST STREET, CAMPBELL CA ~$008 This is to certify that we have ~ssued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon lo days' advance written notice to the employer. We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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, ~IDEN~ EMPLOYER~S:: LZAB!LZTY LZMTT TNCLUDTNG DEFENSE COSTS: $1,000, OO0,00 PER OCCURRENCE. EMPLOYER LEGAL N.~E DB! CONSTRUCTZON, ZNC. 100 S MURPHY AVE STE 102 SUNNYVALE CA g4086 DB! CONSTRUCTZON, ZNC 01-17-02 PRINTED: P0408 STATE COMPENSATION INSURANCE FUND : CITY OF ATTN; BEPART~ENT OF PUBLIC WORK5 70 NORTH FIRST STREET. CAMPBELL CA 9.5008 P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE ~i~1)1~/'~_~ POLIOY N~MBERi ~513296 - 01 C£RTIFICATE EXPIRES~~ 02=~01,02 AL NORK TN PUBL'rC RZGHT-OF-WAY RECE/vED This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon lodays' advance written notice to the employer. We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of ~nsurance ~s not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein ,s subject to all the terms, exclusions and conditions of such policies. PRESIDENT EMPLOYER'S LZABILZTY LZMITINCLUDING DEFENSE COSTS: $1,000,O00.OOPER OCCURRENCE. EMPLOYER LEGAL NAME DB! C0NSTRUCTZON, INC. 100 S MURPHY #102 SUNNYVALE CA 94086 DBI CONSTRUCTZON, ZNC PRINTED: 01-17-01 P0408 Ii'" ..... =.11-- SI'ATE P.o. Box 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE N D CERTIFICATE OF WORKERS, COMPENSATION INSURANCE APRIL 24, 2000 ITY OF CAMPBELL ATTN: DEPT oF PUBLIC WORKS 70 NORTH FIRST ST~ET CAMPBELL CA 95008 i / PUBLIC WORK8 ADMINISTRATiON This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of inSUrance maybe issued or may pertain, the insurance afforded by the policies described herein is subject to all the termS~ exclusions and COnditions of such policies, AUTHORIZED REPRESENTATIVE EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000 PER OCCURRENCE. ENDORSEMENT ~2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 04-24-00 IS ATTACHED TO AND FORMS A PRT OF THIS POLICY. THIRD PARTY NAME: CITY OF CAMPBELL EMPLOYER DBI CONSTRUCTION INC 100 S MURPHY #102 SUNNYVALE CA 94086 L APR.~4.~000 9:40AM STATE COMP FIELD SER M0.884 STATE COMPENSATION INS URANCE FUND 6203 San Ignacio Avenue San Jose CA 95119-1525 Fax # (408) $65-7471 or (408)$65-7640 Company: CITY OF CAMPBELL Date: 04-24-00 # of pages 2 Faxg 408~$ 76-0958 From: SA Certificate Dept (408) 363-7740 Message: THiS POLICY IS. IN FORCE HO WE VER 0 UR CER TIF!CA TES OF !JV$ URA NCE AR F~ NO T,, ,.FAX COMPATIBLE. THIS CERTIFICAT. E I$ "NOT VOID" AND_ THE_ [IAIt D C. OP Y OF THE CER T!CA TE IS IN_THE MAIL. ,. .... ,.,~.~.. ,~ ':~ ........ ~" ': '-In~ ~mml~;O~;.,Io the e~p ~r na~ed bel~,~of ~e ~olloy ~e~od . , '',, ' , ," :, , ..... , .... ", ' , ' . ' .... , ...... · , . . ~ ,,' . .,' ': '. . ' ,": , '.~ . · '.. : ': - ' .- ~ s ~e~i~ Is-n~ an ~ra~,~ ,.and doea not ~m~nd, · , ......... ~,:...: .,~ '.~?: .... ., ,, , ......... , . .,., ,,,,,.,,,.,, .. ..... ,, :~, .:, ~,~,, .... . ,, ) ~, ,. ,. ,,~ ~ :.~ .-:,. ,~ ~ '-.:~' ,~ , . . ,., ,..,,.., ?., ,, , ~ ::. , .,', _,., ~.' ,, ' . ~ :, ,:.:. , , , ..,. , ,, , , , ,. , , ,. ,. ',. .... · :, , ,. ,, .. , . . . . , '"':;. '" ' ~ :~:- '. , :. ..:.::~:' ' .:,:.. . .... .. ' ' ' ;.' , , T . ':'.-:.:' , , ,, , .. ; ,, ,.:~,,, ; . ,.-. ,, , ', , , ..'~,, :' ~ , ,.- . ~,.,:,,-~, .', ,' , , ,, , , .~, ",,,,~ ., ..~.. .,.., ..~.~.'~.,,, ,.,.. , , .......... , .~"~"~ ~: ': '[ .... f . ~ '~ ; ~, . ,... :,'~ , ~,,.',' ",',~" ~ · ,, '~ '( ~ ",',".: ",'T' .... ~ ,,,.,~,, . ~ . .,',,,,,,r , ,.. ~,~,,, ,.~:,,,,~: ..~ ~, .,.,,. ,.,,, .. ...... ,. ,,'.,..,,,., ,,~. ',,,'",,',., ". ,~ . , ',,:.,.:' ', ',:, ,,,~.,,, ..,:',.,,: ':, ~. ~.,,,f,, - ,. .... ... , .~.~. -,%- : ............... ..... .... , .... . .. ~ ....,',"~"-. ,... ..... .,.,,,: .,,. ,. . ..... ' : ' ~ '~0~, ~ Q~. , , /~,.,?.,,. ",, ""'"' ",, . . ............. - ' "' , ~,,,, .... ' .~, ' :, ,[00 8~ ~:,. ~lO~.. ........... ~., - · .'. ,,=,.~ ............... , .... .~','~. : .,', . . ...' ,..,:.. . ':,, : , -:' ....., ,.' ,, ~,~ , ......,.., .,,,. :~ ,:"~., :,' : )::",, ... -:- . .~ /' ,~ ~. CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT PHONE (408) 866-2150 FAX (408) 376-0958 FACSIMILE TRANSMITTAL SHEET TO: FROM: Certificate Department Joanne D'Ambrosia COMPANY: DATE: State Comp. Insurance Fund 04/21/2000 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: (408) 363:2~1~ "-I ~c:'-/ I 2 PHONE NUMBER: SENDER'S REFERENCE NUMBER: (408) 363-7740 RE: YOUR REFERENCE NUMBER: Insurance Certificate DBI Construction [] URGENT [] FOR REVIEW [] PLEASE COMMENT XPLEASE REPLY [] PLEASE RECYCLE NOTES/COMMENTS: We have received a copy of the workers' compensation insurance certificate for DBI Construction in connection with a project they will be doing in the City of Campbell. Our f~ ' · insurance requirements or workers compensauon coverage state the insurer shall agree to waive all rights of subrogation against the City. Please revise the certificate to include a waiver of subrogation and fax a copy to us. A copy of the original certificate follows for your reference. Thanks for your help in this matter. Please contact me at (408) 866-2701 if you have any questions. 70 NORTH FIRST STREET, CAMPBELL, CA 95008-1436 STATE ..o. s^. c^ COMPENSATION INSURANCE I=U N D CERT'r,CATE Or WORKE"S, COMPENSAT,ON INSURANCE A~RIL 7, 2000 POLICY NUMBER: 1513296--00 CERTIFICATE EXPIRES: 2/1/01 CITY OF c~BELL ATTN: DEPT. OF PUBLIc WORKS 70 NORTH FIRST STREET CAMPBELL CA 95008 JOB: ALL WORK IN PUBLIC RIGHT-OF-WAY This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000 PER OCCURRENCE. EMPLOYER DBI CONSTRUCTION ZNC. 100 S MURPHY ~102 SUNNYVALE CA 94086 RECEIVED PUBLIC WORKB ADMINIB?R&.FiON STATE c^ COMPENSATION INSURANCE I::U N D CERTIFICATE OF WORKERS, COMPENSATION INSURANCE APRIL 12'2000 r-- CITY OF cAMPBELL ATTN: DEPARTMENT OF PUBLIC WoRKs 70 NORTH FIRST! STREET CAMPBELL, CA 95008 POLICY NUMBER: 1513296-00 CERTIFICATE EXPIRES: 02--01--01 L_ JOB: ALL WORKS IN PUBLIC RIGHT'OF~WAY This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance 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. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000.00 PER OCCURRENCE. EMPLOYER DBI CONSTRUCTION, INC 100 S MURPHY #102 SUNNYVALE, CA 94086 RECE/VED- ,4PI~ 1 4 2,000 ~Ue~'~c W '"trion 11/09/2001 FRI 17:23 FAX 408 297 4949 MICHELETTI & ASSOCIATES ~001/003 M/c heletti & Associates 760 Meridian Way, P.O. 6ox 26620, San Jose, CA 95159 408-292-4900 Fax 408-297-4949 3'o: City of Campbell From: 'Sylvia So / Fax: ~,08-376-0958 Pages: ~ &It: foanne D'Ambrosia Bate'.11/9/2001 Re: ;)BI Construction CC: Attached CeH~cate 11/09/2001 FRI 17:24 FAX 408 297 4949 MICHELETTI & ASSOCIATES ~002/003 ~.~x=£~ THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFOFIMATION ONLY AMD CONFER~ NO RIGHTS UPON THE CERTIFICATE MIC~L~T.~.TTI & ASSOCTAT~ HOLDEF~ TNLR CERtIFICaTE DO~ NOT AMEND. EXT~NO OR P 0 BOX 2669-0 ALTER THE OOVER~GE AFFORDED B~'THE POLIC~.5 BELOW. ~AN JO~E CA 95159 COMPANIES AFFORO~N(~ COVERAGE a GEMINI INS. CONPAN~ DBI CONSTRUCT~0N 2197 SUNNY VISTA DRIVE SAN JOSE, CA 95128 -- ~~) s 50x000 m ~ . CG2010(10~9~) . ~CEL~TION ~OTIC~: lQ DA~ FOR~ N~PA~T OF PREMIX. 11/09/2001 FRI 17:24 FAX 408 297 4949 MICHELETTI & ASSOCIATES ~003/003 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This ~ndorsemeut modifies insurance provided under th,- following: COMMERCL~L GENERAL I-~'~LRILITY COVERAGE PART Name of Per~o~ or Organization: CITY OF CAMPBELL ATTN~ DEPT. OF PUBLIC WORKS ?0 N. FIRb~ ST. CAMPBELL, CA 9~08 (/f no entry appears above, information required to complctc this eudorsemeut will be shown in the Declarations as applicable to this endorsement.) WIIO I$ AN I~$URED (Section n) is amended to include ns an insured the person or organization shown in ~'e 'Schedule, but only with respect to liabilit~ arising out of your oucoing operations performed for that insured. COVERAGE IS ~PI~[MARY BUT ONLY AS SFEC'I~D BY ~ COMMERCIAL GENERAL LIABII.1Ty COVERAGE PROVIDED IN THE POLICY. RE: JOB LOCATION: 200 E. PERMIT #ENC2000_00011CAMPBELL AVE, CAMi~BELL, CA CG 20 10 10 93 Copyright, ~c,e Services Oflie.~ Inc., 1992 AuToMOBILE LIABILITY IDENTIFICATION CARD AMERICAN STATES INSURANCE COMPANY. INDIANAPOLIS, INDIANA POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 01-CE-803083-2 05-18-01 05-18-02 YEAR MAKE OR MODEL VEHICLEI.D. NUMBER 99 FORD RANGER IFTZRI3V6XPBg0308 DB! CONSTRUCTION, IN~. t00 S MURPHY AVE STE 102 SUNNYVALE, CA 94086 PROFESSIONAL INS ASSOC INC (650) 592-7333 BUSINESS AUTO COVERAGE PART DECLARATIONS PAGE BA 1 ITEM ONE -- NAMED INSURED: !~I CO~TRU~TION, INC. FORM OF BUSINESS: CORPORATION POLICY NUHBER; 01-CE-803083-2 ITEH THO -- SCHEDULE OF COVERAGES AND COV£R£D AUTOS THIS POLICY PROVIDES ONLY THOSE COVERAGES WHERE A CHARGE IS SHOWN IN THE PREMIUM COLUMN BELOW. EACH OF THESE COVEEAOES HILL APPLY ONLY TO THOSE "AUTOS" SHOWN AS COVERED "AUTOS." "AUTOS" ARE SHOWN AS COVERED "AUTOS" FOR A PARTICULAR COVERAGE BY THE ENTRY OF ONE OR MORE OF THE SYMBOLS FROM THE COVERED AUTO SECTION OF THE BUSINESS AUTO COVERAGE FORM NEXT TO THE NAME OF THE COVERAGE. COVERAGES LIABILITY UNINSURED MOTORISTS AUlD MEDICAL PAYMENTS COMPREHENSIVE - EACH COVERED AUTO COLLISION - EACH COVERED AUTO COVERED LIMIT OF AUTO INSURANCE DEDUCTIBLE SYMBOL $ 1,000,000 1 $ 60,000 2 $ 5.000 2 LESSER OF ACTUAL $ 250 7 CASH VALUE GE REPAIR COST ~LESSER OF ACTUAL S 500 7 iCASH VALUE OR REPAIR COST PREMIUM $ 1,089.00 $ 43.00 $ 74.00 S 141.00 l $ 257.00 ESTIMATED TOTAL PREMIUM $ 1,604,00 ITEM THREE -- SCHEDULE OF COVERED AUTOS YOU OWN .................. DESCRIPTION, CLASS CODE, AND OTHER INTERESTS .................... AUTO [ AUTO IDENTIFI- CLASS [ OTHER GARAGE LOC: NO. YR HAKE MODEL BODY { CATION NUMBER COSI NEW CODE mIN'fEREST STATE/TERR 88i ¢¢ ....... I mUCK } ....... LIMITS, DEDUCTIBLES, A~D PREMIUMS ABSENCE OF A DEDUCTIBLE OR LIMIT OF INSURANCE ENTRY IN A COLUMN BELOW MEANS THAT THE LIMIT OF INSURANCE OR DEDUCTIBLE ENTRY IN THE CORRESPONDING ITEM TWO COLUMN APPLIES INSTEAD. AUTO NO. COVERAGES UNINSURED MOTORISTS AUTO MEDICAL PAYMENT COMPREHENSIVE COLLISION LIMIT OF INSURANCE DEDUCTIBLE AUTO PREMIUM TOTAL PREMIUM I955.00 43.00 74.00 141.00 257.00 $ 1,470.00 9-CC(BA) (0797) NORTHERN CALIFORNIA (HARLI) PREPARED 04-2q-01 CM2EO SEQ.0001 IOO'd d6Z:PO IO/~O/II FAX I Date 11/08/2001 I Number ofpases including cover sheet 4 TO: Phone Fax Phone CC: Julie Miller Micheletti & Associates 760 Meridian Wy/PO Box 26620 San Jose, CA 95159 (408) 292-4900 (408) 297-4949 FROM: Phone Fax Phone Joanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 (408)866-2701 (408)376-0958 REMARKS: [] Urgent [] For your review [] Reply ASAP [] Please Comment Re: Insured: DBI Construction Permit No. ENC2000-00011/200 E. Campbell Ave. The certificate of insurance we have in file for the above permit has expired. Please fax and mail a copy of the renewed certificate to us that includes all the same coverage, wording, and endorsements as the origignal certificate A copy of the certificate follows for your reference. Please call me if you have any questions. Thanks for your help in this matter. 04/22/2000 14:53 4~$-736-G205 ',,-,__,--] STATE FARM INSURANCE ~OMPANIES .'~l~J ~ate Fa~ Mutual Automobile h,.aran~ ~mpany 6400 State Fa~ D~e Rohne~ Pa~ CA 94926 PAGE Ol AUTO RENEWAL 1989 FORD BRONCO P(~LIG¥ NUMBEI~,, 325 8686-A2.2-05B JAN 22 2000 to JUL 22 2000 336A -2941 GERA. HARK0 DBA GERA CONSTRUCTION I PR NG R K LN A II,l,,,I,l,ll,.h.lll,,,,Ih,.i,l,l,,I.,ll.ll,,IM.,ll Yeur pre~nlum ie baled on ~hp Poll~wlr~ . . 989 FORD BRON~ ViN 1~EU15N4K~63653 0H3H0Xl 1 DHving Sa~ Re~ Rate Level A~ D~en over 7,500 miles ~nually. (National average i~ 10,000 mi~ ~nu~iy.) D~TE DUE Cove,gee and Limits PLEAIE PAT THIS ~IMC)UNi A Liability Bodily Injury 500,000/1,000,000 Property Damage 50,000 Medical Payments 5,000 Comprehensive 100 Deductible Collwion Emergency Roex~ Service Uninsured Motor Vehicle Bodily Injury 30,000/60,000 Uninsured Motor Vehiofe Property Damage U1 7.30 .61 Amount Due $251.55 Your premium has already been adjusted by the following: Premium Rmdudlonl Principal driver or spouse has at least 49 ye.re of driving Multiset 6 $. q6 experience. No unmarried driver in your household with ieee than 9 ye,re Driving Safety Record 29 5.2(, of driving experlenoe unless rated aa a principal operator of another c_.~..~Callfomia Good Driver 6 2.8 9 in.ured with State Farm. . _.. (:~-~ \ ~ ~ [...~--~-. _..,j,~O~t~mey be eligibfe for additional diaoountl Business use. ~'r~l --~ ~ '-~ I ~l~e~:he enclosed insert for more information. CONVENIENT PAYMENT OPTION: You may use o of State Farm's flits.ate payment plans which divide, your pre.ant premium into hvo separate payments. You may pay one half of the amount due, $125.77, plus a handling oharge of $2.00. The amount due on JAN 22 2000 will be $127.77. The remaining half will be due on MAR 22 2000. We'll mend you a reminder notioe. The following list of drivers ia shown for informational purposes only and doee not extend or expand (=overage beyond that oontained tn this auto,~,ob;;e policy. Our records irldieate the persons Hated below ~Fe the only licensed drivers repo~tecl to MARKO GERA. If the above information is inacourate or in, , to make oorreotions. Your polioy ha. the guaranteed fane' Agent PATRICIA MONEY Telephone (408)399-6669 ;es reveres e/de for tmportant information. =leaee keep this paut for your tecon~. Pr~nArArl Pd('IV 1 1 1 .qq.q Sylvia So DATE (MM/DOb'Y) OORD. CERTIFICA E OF LIABILITY INSURo .NCE 106/26/2000 PRODUCER (408) 292-4900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Micheletti & Associates David J. Micheletti CPCU 760 Meridian Way ~P. O. BOX 26620 San Jose CA 95159- INSURED DBI Construction, Inc. c/o 2197 Sunny Vista Drive ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Navigators INSURER B: INSURER C: INSURER D: t San Jose CA 95128-0 INSURERE: COVERAGES THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYI DATE IMM/DD/YYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ I, 000,000 A X COMMERCIAL GENERAL LIABILITY 99G4562 10/29/1999 10/29/2000 FIRE DAMAGE (Any one fire) $ 50,000 I CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ i, 000 ~. 000 GENERAL AGGREGATE $ 2,0 0 0,0 0 0 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $ i, 000,000 AUTOMOBILE LiAal L~TY ~ -~ ~ ~ ~ ~ ~. ' ~ ~%~r ~.2'''~~?'~ COMBINED(Ea accident)SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS .~ ~ ~ ~%.~ < $ Z~ i ;~ i ~.~ BODILY INJURY ~ ' (Per person) SCHEDULED AUTOS :'" ~:~ ~- ~ ~'~ ~ BODILY INJURY HIRED AUTOS '~ D J%~ ~-~ ~ ~ , ~ .~-~O~ (Per accident} $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ ]OCCUR ~ CLAIMS MADE AGGREGATE $ ___~ DEDUCTIBLE $ I R~TENT;ON $ WORKERS COMPENSATION AND IToRyW"' ~,A, U-LiMiTS I IU~I~' EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE- POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSlLOCATIONS/VEHICLES/EXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Revised All work in public right-of-way. Permit #ENC2000-00011/200 E. Campbell Ten day notice of cancellation for nonpayment of premium. CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: City of Campbell Att: Dept. of Public Works 70 North First Street Campbell CA 95008- ACORD 25-S (7~97) CANCELLATION ~nou~a any or [ne aoove aescnoea pouches De cance.ea De,ore tne aate [nereor, tne ~ssu~n company will mail 30 days wdtten notice to the certificate holder named to the left. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7~97) POLICY NUMBER: 99G4562 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES or CONTRACTORS [Form B] This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees and volunteers Att: Dept. of Public Works 70 North First Street Campbell, CA 95008 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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" for that insured by or for you. Job: All work in public right-of-way. OTHER INSURANCE - Subject to all other terms and provisions of the policy such insurance as provided by this endorsement shall be deemed primary, but only with respect to work performed by or for the Named Insured in connection with the above described contract. CG 20 10 11 85 Copyright, Insurance Service Office, Inc., 1984 ACORD. Sylvia CERTIFICA1 .- OF LIABILITY INSURAhCE PRODUCER (408) Micheletti & Associates David J. Micheletti CPCU 760 Meridian Way P. O. Box 26620 San Jose CA 95159- 292-4900 INSURED DBI Construction, Inc. c/o 2197 Sunny Vista Drive DATE (MMIDD/YY} 04/26/2000 THIS CERTIFICATE IS ISSUED AS A MAI I,-R OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFDRDING COVERAGE i~ I'"' ~"'~ ,,,- .... INSURER A: Navigators m C ~,~ ~ ! V.~D INSURER B: ,NSURERC: APR INSURER D: J3l I~f ,-- aR~,"2..~_ WORKS I San Jose CA 95128-0 INSURERE: r~l~ ........ COVE~GES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFt:C¥iVE POLICY EXPIRATION i I. TR TYPE OF INSURANCE POLICY NUMBER DATE ~MMIDD/YY~ DATE fMM/DO/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 99G4562 10/29/1999 10/29/2000 FIRE DAUAGE (Any one fire) $ 50000 J CLAIMSMADE ~ OCCUR MEDEXP(Anyoneporson) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2 00 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 X I POLmCY [--"-~PRO'JECT [~LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (La accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS LIABiLiTY EACH OCCURRENCE S I OCCUR [~ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE ~ $ RETENTION $ ,, $ I WC STATU- I OTH- WORKERS COMPENSATION AND I I TORY LIMITS ER ____ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSlLOCATIONS/VEHICLESIEXCLUSlONS ADDED aY ENDORSEMENT/SPECIAL PROVISIONS Revised All work in public right-of-way. Permit #ENC2000-00011/200 E. Campbell Ten day notice of cancellation for nonpayment of premium. CERTIFICATE HOLDER I x I ADDITIONAL INSURED; INSURER LETTER: City of Campbell Att: Dept. of Public Works 70 North First Street Campbell CA 95008- %CORD 25-S (7~97) CANCELLATION Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will mail 30 days written notice to the certificate holder named to the left. l...f / ://.., / AUTHOI~ZE~T~e · c ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7/97) POLICY NUMBER: 99G4562 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES or CONTRACTORS [Form B] This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees and volunteers Att: Dept. of Public Works 70 North First Street Campbell, CA 95008 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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" for that insured by or for you. Job: All work in public right-of-way. OTHER INSURANCE - Subject to all other terms and provisions of the policy such insurance as provided by this endorsement shall be deemed primary, but only with respect to work performed by or for the Named Insured in connection with the above described contract. CG 20 10 11 85 Copyright, Insurance Service Office, Inc., 1984 FAX TO: Phone Fax Phone Sylvia S Micheletti & Associates 760 Meridian Way PO Box 26620 San dose, CA 95159 (408) 292-4900 (408) 297-4949 ~ ~ CC: I Date 4/25/00 I Number of pages including cover sheet FROM: doanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone Fax Phone (408)866-2150 (408)376-0958 REMARKS: [] Urgent [] For your review [] Reply ASAP Re: Insured: DBI Construction Permit No. ENC2000-00011/200 E. Campbell~-~h /C)~(F(~[ tsC~ [] Please Comment We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance req~4irements: X 1. We require that the insurance provided to the City be issued by an insurer authorized to transact 0'/ business in the State of California. Navigators Insurance, the general liability carrier, does not ~,)"~ appear on the list we receive from the Department of Insurance which includes all insurers admitted to transact Surety insurance in the state. The cancellation area of the certificate needs to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives" and to change the 10 days notice of cancellation to 30 days notice. A ten day notice is required for cancellation due to non-payment. Copies of the applicable sections of our insurance requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me if you have any questions. Thanks for your help in this matter. ACORD= PROr.,~CER Micheletti & Associates David J. Micheletti CPCU 760 Meridian Way P. O. Box 26620 San Jose CA 95159- INSURED Sylvia o.~ I DATE (MMIDDIYY) CERTIFICA1-' OF LIABILITY INSURANCE 04/06/2000 292-4900 TH,S CERT,F,CATE,S ,SSUED AS A MA. R OF,,FORMAT,O, DBI Construction, Inc. c/o 2197 Sunny Vista Drive San Jose CA 95128-0 ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Navigators INSURER e: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION INSR LIMITS I, TR TYPE OF INSURANCE POMCY NUMBER DATE fMM/DD/YYt DATE iMM/DD/YY) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X I COMMERCIALGENERALLIABILITY 99G4562 10/29/1999 10/29/2000 FIRE DAMAGE (Any one fire) $__ 50000 IcLAIMSMADE E~] OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $ 1000000 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 X I F-1PR°' F-I Loc I POLICY JECT AUTOMOe,.E LIA.,L,TY Hp_..(.;Ei [) COMBINED SINGLE UMIT (Ea accident) $ ANY AUTO -- ALL OWNED AUTOS 1 0 ~00U BODILY INJURY S SCHEDULED AUTOS (Per person) PUBI,IC WORK, S HIRED AUTOS ADMI NISTRATION BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND IToRyWC STATU-LiM!TS I OTH-ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS All work in public right-of-way Ten day notice for nonpayment of premium. City of Campbell CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30 days written notice to the certificate Att: Dept. of Public Works 70 North First Street Campbell CA 95008- ACORD 25-S (7/97) holder named to the left, But failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. ., ....... ,-**, __. · .............. I [ / / I ~'~ - - AUT.OR,ZE~r~ES.~'~'nVE / .~!~ ! ~ ./. ,/: c ACORD CORPORATION '1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7/97) POLICY NUMBER: 99G4562 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- OWNERS, LESSEES or CONTRACTORS [Form B] This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees and volunteers Att: Dept. of Public Works 70 North First Street Campbell, CA 95008 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) 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" for that insured by or for you. Job: All work in public right-of-way. OTHER INSURANCE - Subject to all other terms and provisions of the policy such insurance as provided by this endorsement shall be deemed primary, but only with respect to work performed by or for the Named Insured in connection with the above described contract. CG 20 10 11 85 Copyright, Insurance Service Office, Inc., 1984 Company Profile Results Page 1 of 2 Company Profile nsurance NAVIGATORS INSURANCE COMPANY 123 WILLIAMS STREET NEW YORK, NY 10038 800-496-2901 Service of Process JAMES R. WOODS LEBOEUF, LAMB, GREENE & MACRAE ONE EMBARCADERO CENTER STE 400 SAN FRANCISCO CA, 94111 Reference Information NAIC #: NAIC Group #: Date admitted in Califomia: License Status: Company Type: State of Domicile: 42307 0510 October 22, 1987 UNLIMITED-NORMAL P&C NEW YORK Lines of Insurance Authorized to Transact This company is authorized to transact business within the following lines of insurance. For an explanation of any of these terms, please refer to our glossary_. FIRE MARINE PLATE GLASS LIABILITY BURGLARY SPRINKLER AUTOMOBILE AIRCRAFT MISCELLANEOUS Company Complaint Information http://www2.insurance.ca.g~v/iXpress/cdi--pr~~~es/C~mpPr~~~es/Resu~ts.dm~?eid=6854 04/27/2000 APR-~ ~ 15:J8 FR~M:MICHE~ETTI ASSOC SJ 1408~9T4949 ,~ T0:408_~0958 PAGE:O1 Micheletti & Associates PO Box 26620 Sen Jose, CA 9515,9 Phone 408/292-4900 Fax 408/297-4949 FAX TRANSMITTAL FROM: RE: Suzlnne Stewart of PI #, InGludlng thle page:' ~ i Number g ~ (If yeM de not reMve legible eepl# or the tntll nun?lair:of ptew, plelle Mlphone ImmedllMY J ~~,~ ~,, ,..,_z CITY OF CAMPBELL Public Works Department June 4, 2003 DBI Construction 100 South Murphy, Suite 102 Sunnyvale, CA 94086 SUBJECT: PERMIT NO. ENC2000-00011 LOCATION: 200 E. Campbell Avenue ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE Dear DBI Construction: The City of Campbell has made the final one-year maintenance inspection of subject Public Works improvements and find that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Please find attached your Certificate of Deposit which we are returning to you. Sincerely, Syed Wahidi Public Works Inspec~r cc: Permit ENC2000-00011 Public Works/Maintenance Division Mid-Peninsula Bank, 420 Cowper Street, Palo Alto, CA 94301 H:\word\permitsL2000_l 1 acc(jd) 70 North First Street - Campbell, California 95008-1436 . TEl. 408.866.2150 . FAX 408.376.0958 - TI)l) 408.866.2790 CITY OF CAMPBELL Public 'XYdorks Department June 17,2002 Campbell Ventures, Inc. and Dubrovnik Associates, Inc. 100 South Murphy, Ste. 102 Sunnyvale, CA 94086 SUBJECT: PERMIT NO.: ENC 2000-00011 LOCATION: 200 E. Campbell Ave. FINAL INSPECTION AND ACCEPTANCE (REVISED) Dear Campbell Ventures, Inc. and Dubrovnik Associates, Inc.' 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 began as of May 15, 2002. 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. Checks representing your Construction Cash Deposit of $2,436.00 & plan check deposit of $1,362.00, plus any interest due, are enclosed. A certificate of deposit representing your security for the maintenance period has been received and we have already returned your certificate of deposit for faithful performance/labor and materials. If you have any questions, please call me at (408) 866-2168. Sincerely, Syed Wahidi Public Works Inspector Enclosures CC: Suspense- 11 months Permit #_ENC2000-00011 Inspector File Mid-Peninsula Bank, 420 Cowper Street, Palo Alto, CA 94301 H:\WORDh°ERMITSX2000_00011 finREV 70 North First Street · Campbell, California 95008-1423 · TEL 408.866.2150 - F;,X 408.376.0958 · TDD 408.866.2790 CITY OF CAMPBELL CAMPBELL, CA. 101. 540 7448 101 2205 CR05162002 CR05162002 :,,',col"IiI 194 72 436 00 INTEREST EARNED REFUND DEPOSIT WARRANT NO. 94704 00003307 CAMPBELL VENTURES I NC REMI]-FANCE ADVICE-PLEASE DETACH BEFORE BANKING CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 VOID AFTER 90 DAYS 1.1-35 1210 AMOUNT BANK OF AMERICA WARRANT NO. CAMPBELL OFFICE CAMP.ELLAVE. 94704 CAMPBELL, CA. 95008 DATE 06/03/02 c74704 *****2,630.32** TO PAY TWO THOUSAND, SIX HUNDRED THIRTY-DOLLARS & 52 CAMPBELL VENTURES INC 1(:)(:) S MURPHY STE i SUNNYVALE CA 94086 CITY OF CAMPBELL CAMPBELL, CA. 101. 540 744~ 101 2203 I'.Jll' | Ill -' I!1] I |~]~1 -' · 1,362. O0 WARRANT NO. 94713 INTEREST EARNED REFUND DEF'OSIT 0C)C)(}5308 DUBROVNIK ASSOCIATES INC REMI~ANCE ADVICE-PLEASE DETACH BEFORE BANKING CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 VOID AFTER 90 DAYS 11-35 1210 AMOUNT BANK OF AMERICA WARRANT NO. CAMPBELL OFFICE E. CAM,SE',A E. 94713 CAMPBELL, CA. 95008 DATE 0&/05/02 04715 ****'1,486.15'* TO PAY ONE THOUSAND, FOUR HUNDRED EIGHTY SIX DOLLARS DUBROVNIK ASSOCIATES INC 1(.](} S MURPHY STE 1(}2 SUNNYVALE CA 94(}86 o~ .cA~ ~' CITY OF CAMPBELL Public ~'orks Department Date: May 28, 2002 TRANSMITTAL FROM THE PUBLIC WORKS DEPARTMENT TO: FROM: SUBJECT: Donna Beaman, Deposit Service Officer Mid-Peninsula Bank 420 Cowper Street Palo Alto, CA 94301 Joanne M. D'Ambrosia, Principal Clerk ENC 2000-00011 200 East Campbell Avenue, Campbell, CA. We are forwarding the following: Copy of Assignment and Receipt of Investment Certificate and Confirmation of Time Deposit in the amount of $23,325.00, in connection with the above permit, for your records. Principal Clerk Enclosure 70 .North First ?~[reer · Camvbell California 95008-i 436 · TEL 408.866.2150 · $^X 408.376.0958 . TDD 408,866.2790 Syed Wahidi From: Sent: To: Subject: Vince Huppe Friday, January 18, 2002 8:56 AM Syed Wahidi RE: Stoddard's Project Syed, on 2nd street use London plane trees on Orchard City Drive use Ornamental pear trees, on Campbell Ave. use Chinese hackberry tree. Vince ..... Original Message ..... From: Syed Wahidi Sent: Thursday, January 10, 2002 2:09 PM To: Vince Huppe Subject: Stoddard's Project Contractor needs to know the type of trees to be installed around Stoddard's. 4 new trees on 2nd Street, 2 on Orchard City Drive, and 1 on Campbell Ave. Tree wells already done. can meet with you any time at the site. Thanx, Syed ~' A U.S. CONCRETE COMPANY 790 STOCKTON AVE. PLANT #1 SO. SAN FRANCISCO PLANT #9 - ~ STOCKTON AVE. PLANT #2 HAYWARD PLO, · #1 ! ,..~':ENS LANE PLANT #3 OAKLAND PL~, #12 CAPITOL PLANT #5 WALNUT CREEK PLANT # 14 REDWOOD CITY PLANT #8 BRENTWOOD PLANT #15 /~.IN OFFICE: 755 STOCKTON AVE., PHONE: (408) 293-6272 ~'~ SAN JOSE, CA 95126 FAX (408) 294-3162 INSPECTOR COPY PLEASANTON PLANT # 17 ELK GROVE PLANT #21 RIO UNDA PLANT #22 LINCOLN PLANT #24 CAMERON PARK PLANT #25 WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following descdbed commodity wos weighed, measured or counted by a weighmasl'er whose signature is on this certificate, w~o is a recognized authority of accuracy, as prescribed ~¥ Cha~ter ? (commencing with Section 1 ~?0C)) of Division ,5 of the Colifomia Business and Pro~essions Code, odministemd ~¥ the Division of ~easurement Standards of the California Department of Food and Agriculture. / ' ' / ' Delay L:~xplanation / Were Cy ers~aken~. 10-5 Start Discharge 10-6 Finish Disch. 10-9. leave Job Site 10-10 Arrive Plant · ,'. 'I, · '. SEE BACK SIDE for Property Damage Release ADDITIONAL WATER ADDED TO THIS CONCRETE WILL REDUCE ITS STRENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK. SEE ADDITIONAL DELIVERY~T~,RMS BELOW. Water added to this load at the request of ,~ FULL LOAD I 3/4 LOAD 1/2 LOAD 1/4 LOAD I GALS GALS GALS GALS TRUCK NO. LOAD SIZE / UNIT MIX CENTRAL CONCRETE SUPPLY CO.. INC. - DEPUTY WEIGHMASTER Drum Rev. CT.-ST. Finish LOAD SIZE / UNIT LOAD RECEIVED BY X tf any action at law or in equity is necessary to enforce or interpret the terms of this agreement the prevalthg party shall be entffied to rel~onable affomey's fees and cosls in addition to any other relief to whieh he may be en~ibed. SLUMP USE PLANT TICKET NO. r I ~iEd~UE CUSTOME: NO 'O 'q J~B NO , ~.../' DATE ~)RDER NO. CUM. QUANTITY TOTAL ORDER PRODUCT CODE STAND-BY TIME PRODUCT DESCRIPTION ~':,. , :,t':.. t "- COD AMOUNT WARNING: INJURIOUS TO EYES, CAUSES SKIN iRRITATION. READ WARNING ON REVERSE SIDE BEFORE USING. This Product Contains Portkmd Cement :I. 043440 January 22, 2001 CITY or CAMPBELL Public '~7orks Department Jim Bariteau San Jose Water Co. 1265 S. Bascom Avenue Campbell, CA 95008 RE: 200 E. Campbell Avenue - Stoddard's - Utility Installation Dear Mr. Bariteau: Please be advised that the City of Campbell has approved the installation of utilities in Second Street by conventional trenching (City Standard Method A Trench Restoration) for the above referenced project. Given that the City's recent street maintenance project on Second Street consisted of a rubberized cape seal surface treatment, as opposed to a resurfacing or street reconstruction structural treatment, open trenching for installation of the water service will be allowed. Thank you for your concern and assistance in maintaining the quality of Campbell's streets. Please do not hesitate to contact me if you have any questions or need additional information. Sincerely, Michelle Quinney City Engineer cc: Nick Gera, Property Owner Lynn Penoyer, City of Campbell Land Development Manger Geoff Bradley, City of Campbell Senior Planner bcc: Alan Hom, Ph/ Inspector J:\MQ\Utility Companies\SJWC-Stoddmd~.doc 70 North First Street · Campbell, California 95OO8-1423 . TEt. 408.866.2150 · Fax 408.3760958 - TDD 408.866.2790 A U.S. CONCRETE COMPANY 790 STOCKTON AVE. PLANT # 1 SO. SAN FRANCISCO PLANT #9 · STOCKTON AVE. PLANT #2 HAYWARD PL' #1 ! ~. ,~ENS LANE PLANT #3 OAKLAND PLA,.. #12 CAPITOL PLANT #5 WALNUT CREEK PLANT # 14 REDWOOD CITY PLANT #8 BRENTWOOD PLANT # ! 5 MAIN OFFICE: 755 STOCKTON AVE., PHONE: (408) 293-6272 SAN JOSE, CA 95126 FAX (408) 294-3162 WEIGHMASTER CERTIFICATE PLEASANTON PLANT # 17 ELK GROVE PLANT #21 RIO LINDA PLANT #22 LINCOLN PLANT #24 CAMERON PARK PLANT #25 1152358 THIS IS TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. Delay Explanation / Were Cylinders Taken? SEE BACK SIDE for Properly Damage Release ADDITIONAL WATER ADDED TO THIS CONCRETE WILL REDUCE ITS STRENGTH. ANY WATER ADDED IS AT CUSTOMER'S RISK. SEE ADDITIONAL DELIVERY TERMS BELOW. Water added to this Icad at the request of FULL LOAD 3/4 LOAD 1/2 LOAD 114 LOAD GALS GALS GALS TRUCK NO. I LOAD SIZE / UNIT MIX CENTR~AL COI~CRETE ~UI?~LY ~(~1, Jl~C. - DEPUTY WEIGHMASTER GALS SLU. M,~ USE PLANT TICKET NQ. CUSTO ~Mi,,~ N~.,~P.O. Drum Rev. CT.-ST. Finish LOAD SIZE / UNIT TOTAL ORDER LOAD RECEIVED BY If any action at law or in equity is necessa~ to enforce or interpret the terms of this agreement the prevallng party sha~l be entitled to reasonable attorney's fees and costs in addition to any other relief to which he may be entitled. DATE ORDER NO. LOAD NO. PRODUCT DESCRIPTION DRIVER L,', i:i , PRICE COD AMOUNT STAND-BY TIME WARNING: INJURIOUS TO EYES, CAUSES SKIN IRRITATION. READ WARNING ON REVERSE SIDE BEFORE USING. This Product Contains Portland Cement 1152358 SPECIAL PROVISION 5 TO ENCROACHMENT PERMIT ENC 2000-0001IA The purpose of this permit is to install a portable chain link fence upon the sidewalk areas of the west side of Second Street, the south side of Campbell Avenue, and the north side of Orchard City Drive to facilitate demolition of on site private improvements only. The permittee is prohibited from removing any public signage or improvement from within the public right-of-way. The permittee shall install and maintain all fencing, gates, signs, lighted barricades, maintain the public right-of-way free of pollutants, contaminants, soils, debris, loose materials, by vacuum sweeping all public areas surrounding the site to and including all downstream storm drainage facilities. Truck traffic to and from the site for the purposes of deliveries of equipment, supplies or material and/or for the purposes of offhaul of the same shall only use Highway 17, Hamilton Avenue, Winchester Boulevard, Campbell Avenue, Orchard City Drive, Second Street, Campbell Avenue, Civic Center Drive, Winchester Boulevard, Hamilton Avenue and Highway 17. At no time shall construction employees park on any of the residential streets south of Orchard City Drive. 3. Equipment and material storage and employee parking shall be on site only. The Contractor shall submit a traffic control plan to the Engineer for review at least five days prior to beginning of construction. The traffic control plan shall conform to the "1996 Manual of Traffic Controls for Construction and Maintenance Work Zones (including all revisions)," and Section 12, "Construction Area Traffic Control Devices" of the Standard Specifications. The Contractor shall install "No Stopping" signs in areas where the Contractor's work will require restricted parking. Prior to start of work which requires parking restrictions, the Contractor shall request approval to post and maintain temporary "No Stopping" signs at each location where constructions operations will take place. The City will provide the signs for the Contractor's use. The Contractor shall post the signs at least forty eight (48) hours prior to start of the work at a maximum spacing of sixty (60) feet. The signs shall clearly show the date(s) and hours of the parking prohibition. These conditions must be followed by the Contractor in order for the no stopping order to be enforceable. The Contractor shall notify the City of Campbell Police Department immediately after posting the signs at (408) 866-2101. H:\permits\2000-00011A(mp) City of Campbell Department of Public Works ITEMS REQUIRED FOR PERMIT APPLICATION: __ Applicant section complete Applicant signature and dqt. e (front and back) '-z~-'"~- t~.2)Permit Application Fee~ Sgg-5.A)0 paid - Receipt Number ~Y' L~q,c~:__A k.o · 7..--~-e.o Engineer's Estimate Submitted .~, ~ "-L:-~-- ~o Plan Check Deposit Paid;(2 % of Engineer's Estimate, $500 min) Receipt Number ,ROACHMENT PERMIT ISSUANCE CE K LIST Encroachment Permit No.k~i'4, C-,~c_'>c x._., --~.~"XD l I Tract No. Address:""Zc-:~?d'_~ ~'F, 'C'~4.~t~%~w_:L.-~- - 2~--x-~t~'' '2_-- %- oo Five Sets of Improvement Plans Submitted ITEMS REOUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS Plan Check & Inspection Fee: If Engineer's Estimate < $25.0,000, then 12% of Engineer's Estimate. If Engineer's Estimate > $250,000, then Actual Cost + 20%. (Deposit of 8% of En~.¢er!s_E.sti_mate required; $30,000 minimum deposit). Amount $"1'"~ O~-,-C:~ Receipt No.- ~~i ...... . Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount $ ~g;~"~%~ f-~--o~>, O._~, Form I.D. # Security for Monumentation Amount $ Receipt No. Construction Emergency Cash Deposit: 4 % of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount $"~ ~--, C~,~_~ Receipt No../_.~'~ ?~/~ i"~ Storm Drainage Area Fee Amount $ ~---~:-~ Receipt No. Worker's Compensation Insurance Information Sheet Received for Applicant. ~.~/o.,,,'~,~/ ~- ';}" All other Public Works requirements listed in the Conditions of Approval of the development. Other Fees, Payments, Deposits Amount $ Receipt No. ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: Contractor's signature added to the permit application (front and back) Worker's Compensation Insurance Information Sheet received from Contractor. slzt V/c"r(_,~rt'fficate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped APPROVED FOR CONSTRUCTION. __ Permit signed by City Engineer. WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\word\forms\pmtcklst rev. 4/97 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 200 E. CAMPBELL AVE. - STODDARD'S AND CITY Date: 05/03/2000 ENCROACHMENT PERMIT NO. ENC 2000-00011 APPLICATION NO. S 98-01, UP 98-01 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT I. SURFACE CONSTRUCTION MOBILIZATION 1 LS $ 2,000.00 $ 2,000.00 CONSTRUCTION TRAFFIC CONTRO LCONTROIdPHASING I LS $ 2,000.00 $ 2,000.00 CONSTRUCTION STAKING I LS $ 500.00 $ 500.00 CONSTRUCTION TESTING I LS $ 750.00 $ 750.00 Il. DEMOLITION/CLEARING 1. CLEARING & GRUBBING LS 2. SAWCUT P.C.C./A.C.(UP TO 6') 524 LF $4.50 $3.00 $2.00 $ 1,572.00 3. P.C.C. REMOVAL 377 SY $30.00 $23.00 $10.00 $ 8,671.00 4. CURB AND GU'I'FER REMOVAL 1601 LF $6.00 $3.00 $2.00 $ 480.00 5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA $300.00 III. STORM DRAINAGE 1. 12' R.C.P. (CLASS V) 40 LF $60.00 $40.00 $20.00 $ 1,600.00 2. 15' R.C.P. (CLASS IID LF $65.00 $48.00 $38.00 3. 18' R.C.P. (CLASS III) LF $70.00 $60.00 $52.00 4. 24' R.C.P. (CLASS III) LF $80.00 $68.00 $59.00 5. 30" R.C.P. (CLASS III) LF $90.00 $75.00 $65.00 6. ]'.V. INSPECTION (12') 40 LF $1.20 $0.75 $0.60 $ 30.00 7. ;'I'D. DRAINAGE INLET EA $1,600.00 $1,300.00 $1,000.00 C.C. DETAIL 9) 8. FLAT GRATE INLET I EA $1,400.00 $1,100.00 $900.00 $ 1,I00.00 C.C. DETAIL 6) 9. STANDARD MANHOLE I EA $2,000.00 $1,600.00 $1,300.00 $ 1,600.00 C.S.J. DETAIL D-II) INCLUDES FRAME & LID) 10. IBREAK AND ENTER M.H./D.I. EA $700.00 $550.00 $450.00 Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT IV. CONCRETE IMPROVEMENTS 1. SIDEWALK 7575 SF $6.50 $4..50 $2.75 $ 34,087.50 2. DRIVEWAY APPROACH 272 SF $7.50 $5.50 $3.75 $ 1,496.00 3. CURB AND GUTTER 160 LF $22.00 $18.00 $15.00 $ 2,880.00 4. VALLEY GUTTER SF $12.50 $10.00 $8.25 5. HANDICAP RAMP 4 EA $1,200.00 $800.00 $700.00 $ 3,200.00 I 6. TYPE B-I CURB LF $12.00 $9.50 $7.50 7. TYPE Al-B3 CURB LF $15.00 $12.00 $10.00 8. COBBLESTONE MEDIAN SURFACE SF $12.00 I $8.00 $5.00 9. P.C.C. DRIVEWAY CONFORM SF $7.00 $5.50 $4.50 10. A.C. DRIVEWAY CONFORM SF $4.50 $3.75 $3.00 V. PAVEMENT 1. ASPHALT DIGOUT AND REPLACE 160 CF $2.00 $3.50 $2.S0 $ 560.00 2. PAVEMENT WEDGE CUT (6') LF $5.00 $2.50 $1.50 3. PAVEMENT GRINDING 160 SF $0.80 $0.50 $0.35 $ 80.00 4. ~AVEMENT FABRIC (PETRO-MAT) 18 SY $2.00 $1.85 $1.50 $ 33.30 5. ASPHALT CONCRETE (TYPE A) T $80.00 $50.00 $35.00 73.4)(18) (0.33)(0.0775) 6. AGGREGATE BASE (CLASS 2) T $~0.00 $20.00 $12.00 I73.4)(18)(0.92)(0.070) 7. SLURRY SEAL (TYPE ID SF $0.07 $0.06 $0.05 8. SLURRY SEAL (TYPE lid SF $0.11 $0.09 $0.07 VI. TRAFFIC SIGNALS/LIGHTS 1. DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $2~0.00 2. DETECTOR LOOP (6' x 30') EA $650.00 $540.00 $,~0.00 3. DETECTOR LOOP (6' x 50') EA $900.00 $750.00 $640.00 4. ELECTROLIER 41 EA $2,600.00 $2,200.00 $1,800.00 $ 8,800.00 4.5 ELECTROLIER, RELOCATE $1,500.00 $ 1,500.00 5. I I/2' RIGID CONDUIT 234 LF $9.00 $7.00 $5.00 $ 1,652.00 6. 2' RIGID CONDUIT LF $17.00 $13.00 $10.00 7 CONDUCTOR 993 LF $0.70 $0.55 $0.45 $ 546.15 Page 2 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT 8 PULL BOX (NO. 3 1/2) 4 EA $300.00 $240.00 $185.00 $ 960.00 9 PULL BOX (NO. 5) EA $400.00 $350.00 $300.00 VII. ~TRIPING AND SIGNS I. REMOVE PVMT. MARKINGS (PAINT) SF $2.50 $1.50 $I.00 2. :REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40 3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40 4. STRIPING DETAIL 9 LF $1.35 $0.85 $0.35 4.5 STRIPING DETAIL 22 LF $2.25 $1.65 5. STRIPING DETAIL 29 LF $2.25 $1.65 $1.20 6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25 7. STRIPING DETAIL 37 (THERMO) LF $1.85 $1.50 $1.00 8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 $I. 15 9. STRIPING DETAIL 39 LF $1.50 $0.85 $0.45 ' 10. STRIPING DETAIL 40 LF $2.20 $1.70 $I .00 11. LIMIT LINE LF $1.35 $I .05 $0.90 12. CROSSWALK LF $1.35 $1.05 $0.90 13. PAVEMENT MARKINGS (PAINT) SF $2.50 $1.90 $1.60 14. PAVEMENT MARKINGS (THERMO) SF $5.50 $3.80 $2.60 15, PAVEMENT MARKER (NON-REFL.) EA $4.50 $3.00 $2.20 16. DAVEMENT MARKER (REFLECTIVE) EA $6.00 $4.15 $3.15 17. I'YPE K MARKER EA $95.00 $80.00 $70.00 18. TYPE N MARKER EA $95.00 I $80.00 $70.00 19. SALVAGE ROAD SIGN EA $85.00 $75.00 i $65.00 20. RELOCATE ROAD SIGN EA $100.00 $85.00 $75.00 21. INST. RD. SIGN ON EXIST. POLE EA $200.00 $145.00 $110.00 22. ROAD SIGN WITH POST EA $300.00 $240.00 $195.00 23 STANDARD BARRICADE LF $15.00 Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT VIII. LANDSCAPING 1. IRRIGATION, PLANTING WORK SF $8.00 $8.00 2 PRUNE TREE ROOTS EA $125.00 $100.00 $85.00 3. tREE REMOVAL EA $650.00 $500.00 $400.00 4. ROOT BARRIER (12') LF $20.00 $I0.00 $6.00 5. ROOT BARRIER (18') 204 LF $25.00 $15.00 $10.00 $ 3,060.00 6. STREET TREE (24' BOX) 12 EA .5450.00 $325.00 $250.00 $ 3,900.00 7. STREET TREE (36' BOX) EA $700.00 $550.00 $400.00 8. TOP SOIL BACKFILL CY $20.00 $20.00 9 NEENAH R-8814-A TREE GRATE 12 EA $150.00 $ 1,800.00 48' x 36" W/16' ID OPENING IX. MISCELLANEOUS 1. PEDESTRIAN BARRIER LF $7:5.00 $60.00 $50.,00 2. CHAIN LINK FENCE (6') LF $15.00 $11.50 $9.25 3. RAISE MISC. BOX TO GRADE EA $300.00 $200.00 $175.00 4. RAISE MANHOLE TO GRADE EA $400.00 $275.00 $200.00. 5. INSTALL MONUMENT BOX EA $~.50.00 $350.00 $300.00 SUBTOTAL $84,857.95 PREPARED BY: ~~ '~/~ 10% SECURITY ENFORCEMENT FEE $ 8,485.80 REVIEWED BY: TOTAL ESTIMATE FOR FAITHFUL $93,343.75 APPROVED BY: PERFORMANCE SECURITY $93,300.00: *See Section 66499.4 of fl~e Map Act. h:\excel\stoddards200ecamp, xls(mp) Page 4 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 200 E. CAMPBELL AVENUE - CITY PORTION ONLY Date: 05/03/2000 ENCROACHMENT PERMIT NO. ENC 2000-00011 APPLICATION NO. S 98-01 UP 98-01 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT I. SURFACE CONSTRUCTION MOBILIZATION I LS $ 700.00 $ 700.00 CONSTRUCTION TRAFFIC CONTROLCONTROL/PHASING I LS $ 700.00 $ 700.00 CONSTRUCTION STAKING 1 LS $ 175.00 ! $ 175.00 CONSTRUCTION TESTING 1 LS $ 262.50 $ 262.50 II. DEMOLITION/CLEARIING 1. CLEARING & GRUBBING LS 2. SAWCUT P.C.C./A.C.(UP TO 6') 121 LF $4.50 $3.00 $2.00 $ 363.00 3. P.C.C. REMOVAL 14 SY $30.00 $23,00 $10.00 $ 322.00 4. CURB AND GU'I YER REMOVAL 80 LF $6.00 $3.00 $2.0~ $ 240.00 , 5. MEDIAN REMOVAL iF .$4.50 $2.25 $1.25 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA $300.00 III. STORM DRAINAGE 1. 12' R.C.P. (CLASS V) LF $60.00 $40.00 $20.00 2. 15' R.C.P. (CLASS III) LF $65.00 $48.00 $38.00 3. 18' R,C.P. (CLASS III) LF $70.00 $60.00 $52.00 4. 24' R.C.P. (CLASS Ill) LF $80.00 $68,00 $59.00 5, 30' R.C.P. (CLASS lID LF $90.00 $75.00 $65.00 6, T.V. INSPECTION (12') LF $1.20 $0.75 $0.60 7. STD. DRAINAGE INLET EA $1,600.00 $1,300.00 $1.000.00 (C.C. DETAIL 9) 8. FLAT GRATE INLET EA $1,400.00 $1,100.00 $900.00 C.C. DETAIL 6) 9. STANDARD MANHOLE EA $2,000.00 $1,600.00 $1,300.00 C.S,J. DETAIL D-I 1) INCLUDES FRAME & LID) 10. BREAK AND ENTER M.H./D.I. EA $700.00 $550.00 $450.00 Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT IV. CONCRETE IMPROVEMENTS 1. SIDEWALK 263{3 SF $6.50 $4.50 $2.75 $ 11,835.00 2. DRIVEWAY APPROACH SF $7.50 $5.50 $3.75 3. CURB AND GUTTER 80 LF $22.00 $18.00 $15.00 $ 1,440.00 4. VALLEY GU'FI'ER SF $12.50 $10.00 $8.25 5. HANDICAP RAMP 2 EA $1,200.00 $800.00 $700.00 $ 1,600.00 6. '['YPE B-I CURB LF $12.00 $9.50 $7.50 7. rYPE Al-B3 CURB LF $15.00 $12.00 $10.00 8. COBBLESTONE MEDIAN SURFACE SF $12.00 $8.00 $5.00 9. P.C.C. DRIVEWAY CONFORM SF $7.00 $5.50 I $4.50 I0. A.C. DRIVEWAY CONFORM SF $4.50 $3.75 $3.00 V. PAVEMENT 1. ASPHALT DIGOUT AND REPLACE 85 CF $2.00 $3.50 $2.50 ! $ 297.50 2. PAVEMENT WEDGE CUT (6') LF $5.00 $2.50 $1.50 3. PAVEMENT GRINDING 85 SF $0.80 $0.50 $0.35 $ 42.50 4. PAVEMENT FABRIC (PETRO-MAT) 9.5 SY $2.00 $1.85 $1.50 $ 17.58 5. ASPHALT CONCRETE (TYPE A) T $80.00 $50.00 $35.00 (73.4)(18)(0.33)(0.0775) 6. AGGREGATE BASE (CLASS 2) T $40.00 $20.00 $12.00 (73.4)(18)(0.92)(0.070) 7. SLURRY SEAL (TYPE II) SF $0.07 $0.06 $0.05 8. SLURRY SEAL (TYPE III) SF $0.11 $0.09 $0.07 VI. tRAFFIC SIGNALS/LIGHTS 1. ~DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $250.00 2. DETECTOR LOOP (6' x 30') EA $650.00 $540.00 $4a0.00 3. DETECTOR LOOP (6' x 50') EA $900.00 $750.00 $640.00 4. ELECTROLIER 2 EA $2,600.00 $2,200.00 $1,800.00 $ 4,400.00 5. I 1/2' RIGID CONDUIT 146 LF $9.00 $7.00 $5.00 $ 1,022.00: 6. 2' RIGID CONDUIT LF $17.00 $13.00 $10.00 7 CONDUCTOR 438 LF $0.70 $0.55 $0.45 $ 240.90 Page 2 ITEM LINEr PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT 8 PULL BOX (NO. 3 1/2) 3 EA $300.00 $240.00 $185.00 $ 720.00 9 PULL BOX (NO. 5) EA $400.00 $350.00 $300.00 VII. STRIPING AND SIGNS 1. REMOVE PVMT. MARKINGS (PAINT) SF $2.50 $1.50 $1.00 2. REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40 3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40 4. STRIPING DETAIL 9 LF $1.35 $0.85 $0.35 4.5 STRIPING DETAIL 22 LF $2.25 $1.65 5. STRIPING DETAIL 29 LF $2.25 $! ,65 $1.20 6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25 7. STRIPING DETAIL 37 (THERMO) LF $1.85 $1.50 $1.00 8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 $1.15 9. STRIPING DETAIL 39 LF $1.50 $0.85 $0.45 10. STRIPING DETAIL 40 LF $2.20 $1.70 $I.00 11. LIMIT LINE LF $1.35 $1.05 $0.90 12. 'CROSSWALK LF $1.35 $1.05 $0.90 13. PAVEMENT MARKINGS (PAINT) SF $2.50 $1.90 $1.60 14. PAVEMENT MARKINGS (THERMO) SF $5.50 $3.80 $2.60 15. PAVEMENT MARKER (NON-REFL.) EA $4.50 $3.00 $2.20 16. PAVEMENT MARKER (REFLECTIVE) EA $6.00 $4.15 $3.15 17. TYPE K MARKER EA $95.00 $80.00 $70.00 18. TYPE N MARKER EA $95.00 $80.00 $70.00 19. SALVAGE ROAD SIGN EA $85.00 $75.00 $65.00 20. RELOCATE ROAD SIGN EA $100.00 $85.00 $75.00 21. INST. RD. SIGN ON EXIST. POLE EA $200.00 $145.00 $110.00 22. ROAD SIGN WITH POST EA $300.00 $240.00 $195.00 23 STANDARD BARRICADE LF $15.00 Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY <: $30 K $30 K to $150 K > $150 K $ AMOUNT ¥III. LANDSCAPING 1. IRRIGATION, PLANTING WORK SF $8.00 $8.00 2 PRUNE TREE ROOTS EA $125.00 $100.00 $85.00 3. rREE REMOVAL EA $650.00 $500.00 $400.00 4. ROOT BARRIER (12') LF $20.00 $I0.00 $6.00 5. ROOT BARRIER (18') 1191 LF $25.00 $15.00 $10.00 $ 1,785.00 6. STREET TREE (24" BOX) 7 EA $450.00 $325.00 $250.00 $ 2,275.00 7. STREET TREE (36' BOX) EA $700.00 $550.00 $400.00 8. TOP SOIL BACKFILL CY $20.00 $20.00 9 NEENAH R-8814-A TREE GRATE 7 EA $150.00 $ 1,050.00 48" x 36" W/16" ID OPENING IX. MISCELLANEOUS 1. PEDESTRIAN BARRIER LF $75.00 $60.00 $50.00 2. CHAIN LINK FENCE (6') LF $15.00 $11.50 $9.25 3. RAISE MISC. BOX TO GRADE EA $300.00 $200.00 $175.00 4. RAISE MANHOLE TO GRADE EA SxRX).00 $275.00 $200.00 5. :INSTALL MONUMENT BOX EA $450.00 $350.00 $300.00 6. MEDIAN BACKFILL CY $19.00 $17.00 $15.50 PREPARED BY: ~'"~"~---~ ~/'::~:~' SUBTOTAl $29,487.98 10% SECURITY ENFORCEMENT FEE $ 2,948.80 REVIEWED BY: TOTAL ESTIMATE FOR FAITHFUL $32,436.77 APPROVED BY: PERFORMANCE SECURITY $32,400.00 *See Section 66499.4 of the Map Act. H: \excel\20OecampbellengesIS_00(mp) Page 4 City of Campbell Department of Public Works .ROACHMENT PERMIT ISSUANCE CB K LIST Encroachment Permit No Tract No. Address: ~.E)O ~ ITEMS REQUIRED FOR PERMIT APPLICATION: Applicant section complete Applicant signature and date (front and back) Permit Application Fee $225.00 paid - Receipt Number Engineer's Estimate Submitted Plan Check Deposit Paid (2% of Engineer's Estimate, $500 min) Receipt Number Five Sets of Improvement Plans Submitted ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then 12% of Engineer's Estimate. If Engineer's Estimate > $250,000, then Actual Cost + 20%. (Deposit of 8% of Engineer's Estimate required: $30,000 minimum deposit). Amount $ Receipt No. Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount $ Form I.D. # __ Security for Monumentation Amount $ Receipt No. __ Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount $ Receipt No. __ Storm Drainage Area Fee Amount $ Receipt No. __ Worker's Compensation Insurance Information Sheet Received for Applicant. __ All other Public Works requirements listed in the Conditions of Approval of the development. __ Other Fees, Payments, Deposits Amount $ Receipt No. ITEMS REO~~6R T-0 is~ANCE6F ENC-RoACHMENT PERMIT: __ Contractor's signature added to the permit application (front and back) Worker's Compensation Insurance Information Sheet received from Contractor. '~ ~j)t~ certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped APPROVED FOR CONSTRUCTION. Permit signed by City Engineer. WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\word\forms\pmtcklst rev. 4/97 - RECEIVE OTY OF CAMPBELL ,,,...cwo..~...,.,,~,~ FEB 0 9 ~000 ENGINEER'S EETIMATE PUBLIC WORKS ADMINI~TRAT, ION ITEM NO. DF. SCRIFT10N MOBILIZATION IONSTRUCTJON T~C OI~OLCOI~OL.~ ~O~U~ON ~G ~RI~ & GR~BING 3. ~.C.C. REMOVAL ~RB A~ G~R ~MOVAL 5. M~IAN REMOVA~ DEMO~H ~ING ~UG ~.V. INSPE~ON (12') 1. ~TG~TEIN~ ~A~AR~ MANNO~ {INCLUDE~ FRAME & LID) DRIVEWAY APPROACH ,, UNIT PRI~ FOR PROJECT AMOUICr QUANTrrlES < $~0 K ~0 K m S1~0 K · Silo K SF DJO.O0t $7f.00 SI.TM $0.75 S1,~0.00 $1,400,00 S1,1~0.00 $1,600.00 S AMOUNT B~ OO $I.~ $1,~.~ 27-J'ua-96 Page 1 of 4 Vo NO. ~ D~ON 4. [VALLEY G~ !HANDICAP RAMP 6. ~'PE n-I CURB ?. ~ Al-B3 CURB fOBBLF~TONE MEDIAN SURFACE 9. P.C.C. DRWL~VAY CONFORM JO. i.e. DRIVEWAY CONFORM ~PHALT DIGOUT AND R~R.AC~ )AVEMENT WEDGE CUT (6) PAVEMEN"r GRINDING PAV£M£NT FABRIC (PETRO-MAT) ~ASPHALT CONCRETE (TYPE A) ~AGGREGATE BASE (CLASS 2) SLURRY SEAL (TYPE ID ~SLURRY SEAL (TYPE lid D~E~OR L~P (6' x ~OR L~P (6' x ~') 2' RIGID CO~U~ CP SF SY T T SF <~30K Sl.2~O.00 SL~.00 SILO0 S17.00i $1t~0 Slo.Oo $12.00 ~o.~ $1.5 $7'00/ $1.~ SI.S0 $12.nn $1 J0O.00[ 27-J'un-96 Page 2 of 4 8. STRIPING DETAIl. 3[ O"HERMO) 9. S'~tIPING DETAIL 39 lO. STRIPING DETAIL 40 II. LIMIT LINE 12. CROS.~VALK 12,. pAVEmENT MARKINGS (PA~INT) 14. PAVEMENT MARXINGS (THERMO) l~. PAVEMENT MARKER (NON-REFL) 16. PAVEMENT MARKER (REFLECTIVE) 17. ,TYPE K MARKER 18. TYPE N MARKER 19. SALVAGE ROAD SIGN 20. RELOCATE ROAD SIGN 21. INST. RD. SIGN ON EXIST. POLE ROAD SIGN WITH POST Si..~ S!.~ SIO0.OOt ~O. GO SISS.GO 27-Jun-96 Page 3 of 4 ir No. L 2. DF. SCRIP~ON I~IC~o~. ~ worx TREE REMOVAL ROOT BARRI£R (12') $. ROOT ~tARRI~.R (Ir) 6. STREET TREE C24" nOX) '/. ~STREET TREE 06' nOlO & ~"OP SOIL BAC~ILL I. ~£DESTRZAN BARRIER 2. ~CI,IAIN LINK FENCI: 1. ~1S£ MISC. BOX TO ORAD£ RAISE MANHOLE TO GRADE 5. iNSTALL MONUMENT BOX 6, MEDIAN BACKFILL PREPARED BY: REVIEWED BY: APPROVED BY: .'RO/F, Cr AMOUNT J30 X TO SilO K $10.afl $ AMOUNT SUBTOTALI f lOS SECURITY ENFORC~=MENT FEE TOTAL ESTIMATE FOR FAITHFUL PERFORMANC~ SI~CURITY "See SecUon 66499.4 of the M~o Act. H:\C~COS'T'EST,WIC3(MP)REV6/3~96 27-$un-96 Page 4 of 4 nEL En EnGinEE:linG CIVIL ENGINEEF~ING SUI~IVEYING CONSTRUCTION 21801 STEVENS CREEK BLVD. SUITE 7 CUPERTINO, C~, 95014 408) 257-6452 JOB: TO: SUBJECT: We are: Description: L~Enclosing Forwarding Per your request Number o~copies, -.~...f/- /.- ~ Reports Drawings Specifications Other For your: Use ~J Approval Files Other disposition as follows: By: CC: ANFIGLD INSURANCE ~ERViOE~ INC:. 433 CALIFORNIA STREET, 5LIITE 8:20 ~AN FRANCISCO, CA 8~104 TEL' (416) 38~gI08 FAX: (416) 308-848B ~ 4/'-/) . A _...-. U-:-:r~ # o;ee?t_ ._ :, INSURER: NAVZ(U~TOK~ ZNSTAtANCE COMPANY pO'UCYNUMBER: ~9~4562 :BZNDSE EFF]~CTZV~ ].0/39/99 13~01 PRODUOER: MICHELETTI ZNSUiTANC~ AGENCY NAME oF 350 CHPJtRY LJU;~, ST~. 308 INSURED:, ~~, ~ 95337 ~T~: ~A BRZ~E~OFF : ~L LL~:~ , CONSTRUCTION 2,000,000 ~,000,000 ~,000,000 ~OOO,OOO ~O, OOO 5,000 RATE: ~4,025 P'BR $].QQO OF PAYROLl. BA~I~: S.'757 lilt $I.O(X) OF CX~ CO%TS GONDITIQNS:?riH8 ~ CON~IT~;~ FBR OUR QUOT~ OF 09/17/99 ~? :3:G OIWA'JL'X,Y MPimBCXATBD. ADDITIONAL / BY: JAMES, BLODGETT LL