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ENC1999-00114CITY 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) Permit expil'es in 12 m~n~ ' APPLICATION. Applicalion is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, S~:fion 11.04. (Appl~on expires in 6 monks if the permk is no~ issued. Application Fee is non-refundable.) Utility ~ Iouagon C. Anach four (4) copies of an engineered plans showing the Iocagon and cx,.en~ of the work. and four (4) copies of the preliminary En~inem-'s Esfim~e of work. The plans shall show the relagon of the proposed work to existin~ surface and underground improvemcn,,. When ~pproved by the C~ Engineer, said plan becomes a p~,x of figs permit. D. All work shall conform to the Cily of Campbell Standard Specificalions and Delalls for Public Works Conslru~on; the C, enorai Pcrmh Condhiom listod on the reverse side; and the Special Provisions for this permit, lisled below. Failure to ~ide by thcs~ conditions and provisions may result in job shut-down and/or forfeiture of Fahhful Performance Sureties and cash deposits. (See General Permit Conditions I and 2.) E. THI/CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT Th'~ SITff AND MUST NOTIFY TI-Il/PUBLIC WORKS DEPAR~ AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVF~/TO PUBLIC WORF,~ AT LF.A~T 2,~ HOURS BEFOR~ RESTARTING ANY WORK. (pria name) Is this work being done by the proper~ owner a~ their own residenc~? Yes Telephone 24 HOUR EMERGENCY TELEPHONE NO. The Applicant/Permiuee hereby agrees by affixing their signature m this permit to hold the City of Campbell, its officers, agents and employees free, sal'e and barrel, ess from any claim or demand for damages resulting from the work covered by this permit. The Applican~ffPermit~e hereby acknowledges that they have read and understand both the from and back of this permit, and they will inform their contraao~s) of the information. (Applicant/P~rmit~e) (sign) SPECIAL PROVISIONS . ;:'. . "'.. ~1. Street shall not b~ open c~t for underground insmllagons. Mi~mum mrs ~ ~ ~o~ f~ m~ or e~lo~on ~i. ~ ~. ~ ~ ~ly ~rov~ by ~e I~tor prior m ~in~ . :...: i :.'~(....:.. ~. Pave~nt ~y be ~t for u~r~nd im~l~om ~ ~t ~ r~ ~ ~r~ wi~ ~e U~i~ T~ ~ S~ ~. M~ 'A' B~, u~s ~he ~prov~ by lmp~r. ..: : Work m be s~ by a li~ ~ S~or or CMl E~r ~ mo ~) ~ of ~ mt s~ ~ ~ ~e ~bF~ Wor~ ~ ~o~ ~ w~ ~r S~n 4215 nf ~ Oovc~ent C~e ~ ~ ~ ~i v~d for ~m ~ U~ ~ Alert ~) ~ ~ ~ ~ ~ ~ ~iif~n n~ h~ b~n ~r~ h~n. U~ ~ 1-~-2~. U~ ~C~ NO. ' ' SEE PUBLIC WORKS IEE SCHEDULE FOR CLrKRENT FEF~ '. :'. ': :. !' TYPE ) AMOUNT . )I.ECEIPT NO. PLAN CHECK DEPOSIT · SECURITY FO~ FAITHFUL PERFORMANCE/LABOR & MATERIA~ '. '. ,--'.ii... ~/.. ~"/~ F .,i...$ ' ~ ~'Z~ "~..~...~ CONSTRUCTION CASH DEPOSIT ~forms\pwperm2/rev.6~9~ GENERAL PERMIT CONDITIONS 1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against this deposit if ther~ is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be biHnd to the Pcrmit~ee. 2. A ONE-YEAR MAINTENAl~CE PERIOD AND SURETY are required. Such period will begin on date of written accep~nco by the City. 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the writ~n acceptance of the work by the City. 4. The Perrnittee MUST REQUEST .~ wRrriNG a f'mal inspection and acceptance of the work upon completion. Acceptance by the City will be made in wri~-~g to the Permit~e. $. MAINTAIN s~fe 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 requital for all lane closures, demurs and street closures. This plan m~st be REVIEWED and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN slmll conform with the Caltrnns Manual of Tra~c Controls for Construction and Maintenance Work Zones, dated 1990, available at Calmms. Traffic control equipment sl~ll include Type II flashing asrow 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 exis~ng improvements. 10. OVERTIME 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 I. 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 times during construction. Contractor or Permittee 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 STORAGE of mat-rials or equipment will be allowed near the edge of pavement, the u'aveled way, or within the shouldeHine which would create a hazardous condition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property ADJACENT to the work. or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 17. This permit does NOT RELEASE the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is NOT 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 regan:ling this permit, shall be at the current overtime rate with a three (:3) hour minimum 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 than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTI.CES established by the Santa Clara Valley Nonpoim 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. j:\forms\pwperm2 6/96 City of Campbell Department of Public Works E,,,..ROACHMENT PERMIT ISSUANCE CHE~..~ LIST ITEMS REQUIRED FOR PERMIT APPLICATION: .g~_. Applicant section complete ~Applicant signature and date (front and back) ~ Permit Application Fee $225.00 paid - Receipt ~Engineer's Estimate Submitted ~ Plan Check Deposit Paid (2 % of Engineer's Estimate, $500 rain) Receipt Number eS~/,dt~29//~'.~'~ /~_ Five Sets of Improvement Plans Submitted ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS an 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 $ ~ t(,tg'zq' Receipt No. (ZY/~k:~' .,/~.~.t,p,,7 (~_ _ff.-~Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount $~ft~'~ Form C ~ I.D. #~ (~'~_~f"" S'~eSecurity for monumentation Amount $ _.,~.~ Receipt No. (~~Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($_500 minimum, $10,000 maximum) Amount $ ._-.~.ff'Z~"~' Receipt No. t~'/,c~/'.,~,~.~//~ ~/ Storm Drainage Area Fee Amount $ .~-/.9~~''''~ Receipt No. ~ Worker's Compensation Insurance Information Sheet Received for Applicant. t~/~~All other Public Works requirements listed in the Condit ions of Approval of the development. l~Tt~P'i-//'~Oflaer Fees, Payments, Deposits Amount$ .-~~~ Receipt No. ~~d~_.~ ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: 'k/~Contractor's signature added to the permit application (front and back) )Norker's Compensation Insurance Information Sheet received from Contractor. . - FOR ~ Permit signed by City Engineer. WHEN ALL OF~..~~.JTEMS ARE COMPLEWE' PERMIT MAY BE ISSLrED' .~tial ;,~ anddate _/'~-_~/~'/ and ffle with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\word\forms\pmtcklst rev. 4/97 CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT public right-of-way) Issued ~ - ~- ,,~ -?/~" Permit expires in 12 months Permit No. X-Ref. file Application Date _~'-~ --_~ '//~ Application expires in 6 months APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if ~ pem~it is not issued. Application Fee is non-refundable.) Ufil~y ~mch location /,e , plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engine~said plan becomes a pn~ of this permit. D. All work shall conform to the City of Campbell Standard Specifications m~l De,ils for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may r~ult 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 RESTARTING ANY WORK. Address d.///~ '. ~'/.~//~//(~., 24 HOUR EMERGENCY TELEPHONE NO. Is tl~ work being done by the property owner at their own residence? Yes Thc Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicam/permittee hereby acknowledges tha~ they have read and understand both the from and back of this permit, and they will inform their contrncmr(s) of the information. (ApplicantLPermit~e) Oign) D~,~ SPECIAL PROVISIONS ~1. Street shall not be open cut for underground installations. Minimum cuts ma~ be allowed for cotmectiom or explomion holes. Such cuts may be specifr, ally approved by the Inspector prior to cutting. Pavement may be cut for underground installations and must be restored in accordance with thc U~lity Trench R~toration Stnodm'd De~ils, Method 'A' mu+fill, unless otherwise ~pproved by Inspector. Work to be staked by a licensed Land Surveyor or Civil Engineer nmi two [2) copi~ of the cut sheets sent m the Public Work~ Department before stnrting work. Per S,~'tion 4215 of the Government Code this permit is not valid for excavations until Under~xmnd Service Alert (USA) ~ been notifml and ~ inquiry identifk~tion number has been emered hereon. USA Phon~ 1-800-22%2600. USA TICKET NO. ~EE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES TY~ · ~o~rr ~c~t~ NO, PERMrr APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONS UCT,o,,, CAS. DEPOsrr / APPROVED FOR ISSUAN(~E ~ :..../~/'~./~'~.~ '~/~;¥"c'~T :\forms',pwperm2/rcv.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: Refundeble Deposit Check Request Loyola Market cio Zankich Construction 10281 Imperial Avenue Cupertino Refund Deposit 101.22O3 101.540.7448 Interest Earned $2,000.00 Refund Monumentation Security State: CA Zip: 95014 Amount: $2,000.00 Amount: Amount: (Finance Dept only) (Exact Amount) Voucher #: Permit #: 99-114 05/04/1999 Receipt #: 1207~8 Requested ~ Title: "" Jeanne D'Ambr_osia Approved by: /~.~A~x~ 7~.~.~J~-~ Title: Lyn~ Penoyer J Finance Dept Only: Verified by: Title: Date: Sr. Office Assistant Date: Land Dev. Manager Date: Accounting Clerk II Date: 09/17/2002 09/17/2002 Approved by: Title: Accountant Date: 5 eciol ]:nstructions For Hondlin Check Mail As Is: Mail in Attached Envelope: Interim Check: Needed By: Return To: Jeanne D'Ambrosia (Name) PW Department/City Hall (Department) Other: f/n: FormsJexcel/chkreq Revised 05/00 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 Loyola Market c/o Zankich Construction, Inc. 10281 Imperial Avenue Cupertino Refund Deposit State: CA Zip: 95014 101.2203 Amount: $3,556.00 Amount: 101.540.7448 Amount: Interest Earned (Finance Dept only) $3,556.00 (Exact Amou.O Refund of Construction Cash Deposit Voucher #: Permit #: 99-114 Receipt #: 1000120769 Requested by: ~ 'C~c~.~.------..~ , Title: AP P roved bY: ~li~(~.!jl.°e~m~./~u i~ Title: Finance Dept Only: Verified by: Title: Date: 05/04/1999 PW Inspector Date: City Engineer Date: Accounting Clerk II Date: 1~/13/2001 1~13/2001 Approved by: Title: Accountant Date: Special ] nstructions For Handling Check Mail As Is: X Mail in Attached Envelope: Interim Check: Needed By: Return To: (Name) (Department) Other: f/n: Forms/excel/chkreq Revised 05/00 ?BI.IC WORKS DEPARTMENT Effeefiw July 1, 1996 4722 A0p[icafion Utili~ Enc~chm~t P~it 2203 Monumenmion 22t,3. Cash De.sit 4722 En~.~c ~ ~0.~1 ~ (12% of · ' 2203 4722 ~ C~nificam of Coition 4721 Sto~ D~inagc .K~a F~ ~r Ac~ { R-I. $2.0(W)) ~92(" ,a~land Uedicatmn FOR RECEIVED BY CITY CLERK 'For P/an ~cg and ~s~ De.si ..... d >cllow copy h:~c frm4(cxc )mp(rcv 1/297') RECEIVED MAY 0 t~ 1999 CITY CLERk'S OFFICE To: City of Campbell- Refundable Deposit Check Reque~_t Interim Check Required: Finance Director Return Check to: Please Issue Check Payable to: Address - Line 1: Line 2: City: Description: Amount Payable: Account Number: Loyola Market 987 Fremont Avenue Los Altos Deposit Refund $1,803.00 (E~act ~o~t) 101.2203 Department: State: CA Zip: Finance Use Only Interest Earned 101.540.7448 94022 Purpose: Refund of Plan Check Deposit Requested by: Approved by: Verified by: Approved by: Voucher #: Helms Permit #: 9 9-114 Date: 1/19/99 Title: Land Dev. EngineerDate: Title: Land Dev. Manager Date: Title: Account Clerk II Date: Title: Date: 10/12/99 10/12/99 Special Instructions For Handling Check Mail As Is: XX Mail in Attached Envelope: Other: f/n: S:/¢xccl/chkreq Revised 1/98 ~iAC WORK~ DEPARTMEN~ R~C~IPT TO: Ci~ CIe~ ~BLIC WO~ ~LE NO. . PROPER~ ADD~S ENC~OA~ENT PE~IT A~cna~Cotl~ 22o3 Plan ~k ~sit - 2% of ~GK ~. 4722 ~.~t < $2~(}.~} (12% of ~O~ E~.) Pole ~oval ~FFIC C~ CLERK ~CEIVED BY 'Date/' Initials h:¥~ fma4(¢xc )m~(tev REGISTER BA'~E~ 01/797 Td [E,i T~" A T~ -D.--'-.¥f,?. i :]¥~i £ k:--'..-r."k'['-T Tfi'i'Ai i'll ii' · Via certified mail 0~ · CITY oF CAMPBELL Public ~'orks Department CAMPBELL July 11, 2003 Steve Zankich Zankich Construction 10281 Imperial Avenue Cupertino, CA 95014 SUBJECT: PERMIT NO. 1999-00114 LOCATION: 1492 Westmont Avenue ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE Dear Mr. Zankich: 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. Your Certificate of Deposit in the amount of $88,900 is enclosed and the Release of Assignee has been executed by the City. Sinc~ Alan Hem Senior Public Works Inspect¢ CC: Permit 1999-00114 Public Works/Maintex H:\permits\ 1999-114maint accept(mp) 70 North First Street . Campbell, Cr SENDER: · Complete items I and/or 2 for additional services. · Complete items 3, 4a, and 4b. · Pdnt your name and address on the reverse of this form so that we can retum this card to you. · Attach this form to the front of the mailpiece, or on the back if space does not permit. · Write'Return Receipt Requested' on the mailpiece below the article number. · T'De Return Receipt will show to whom the article was delivered and the date delivered. A~icleAddressedto: Steve Zankich i~ankich Construction ~0281 Imperial Ave. ~>Cupertino, CA 95014 7002 B. Signature: (Adl~rer'~see d/I,/~t~ent) // - PS Form 3 ll, D,ceaber I also wish to receive the following services (for an extra fee): ~ 1. [] Addressee's Address '[: 2. [] Restricted Delivery (~ Consult postmaster for fee. .~-~' 17. Date of I~vory ! .::' i 0510 0000 3673 2219 4b. Service Type,. [] RegtSt~'-' -. J~iCertifiod a .ExPress ~(;¢~ a R~um B~t f0~ndi~ "" 5: Received By: (Pdnt Name) 8. AddreSsee's'AddreSs (Only if requested and fee is paid) Domestic Return Receipt ASSIGNMENT AND RECEIPT OF IB ;TMENT CERTIFICAT~ %~ CITY OF CAMPB~J?., 70 N. FIRST STREET CAMPB~.r., CALIFORNIA 95008 (408) 866-2150 TR or DEV , certificate ~. ?~Q%(o in ~he names of - ~, Califo~rn~a, /~vesm~nt 0~~.% and ~,~q a present ~l~ce of $ ~9 OO, 00 - I hereby gr~t, tr~sfer and assi~ said acco~, said ~ves~ ce~ft~te, s~d ~l~ce {tncl~g interest which acc~es ~ereon}, ~d ~1 o~er righ~ ~ co~e~ion ~erewi~ to ~e CI~ OF ~B~, assi~ee, for a g~d ~d val~le considerate, recei~ of whi~ is hereby ac~owledged, for ~e ~se of ~=~g cons~ion descried as follows: I have physically delivered verification of said inves~--t cer~ificate and duplicate of this Assignment and Receipt to said assignee. I understand ii, at assignee can withdraw from said account any t/me 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 inquiz~. Executed on ~ ~ . 19~ at said office of the i~er. sign /.C./~ ~.~~ Assignor sign Assignor print ACKNOWLEDGEMENT BY ISSUER Issuer affirms ~at there are ~o o~.er holds o~n]subject account, ~hat subject monies are issuer.aVailable' and ~hat the above descrx~nt, has been noted on the Records of said 1~? Authorized Signature NOTARY INSTRUCTIONS TO ASSIGNEE 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. en Bill Hel~,~gn~ D~vglopment Manager RELEASE B~ASSIGNEE Said assignee hereby releases and relinquishes all his right, title and interest in and to said account, said investment certificate, said balance and all other rights in connection therewith. City 9f 'Campbell L~n Penoyer, ~and Dev~lopmen~ ~an~er CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of SS. Date personally appeared , before me,~, ~ ~ !~j~ ~p~ [~0 ~, - ~ Name and Title of'Officer (e.g., "Jane Doe, Notary Public") Name(s) of Signer(s) [] personally known to me ~ved to me on the basis evidence of satisfactory Santa c~ara County Place Notary Seal Above to be the person(~ whose name(~ is/'~: subscribed to the within instrument and acknowledged to me that he/~he/1;~e~ executed the same in his,O~a~/t~ authorized capacity(i~.), and that by his/l'~.dt~ signature(:s.) on the instrument the person(~ or the entity upon behalf of which the persord~) acted, ex~ instrument. and official seal. Signature of Notary Public OPTIONAL Though 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. Description of Attached~Oocument Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: 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 pf thumb here © 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-§827 CERTIFICATE OF DEPOSIT #0. 2 7 8 [3 ORIGINAL MATURITY DATE *5-3-2000 INTEREST RATE I APY *4.35* %1'4' 35*o/9 DEPOSIT TERM INTEREST OPTIONS PAYMENT OPTIONS 1 year [] Monthly [] Quarterly [-I.Annually 'j~aturity [] Semi-Annually [] Interest Check [] Deposited to X] This Certificate matures on thc maturity date stated above. It will be automatically renewed for successive terms, each equal to the original term. until one of the following things happens: 1 ) this certificate is personally presented for payment nn a maturity date or within ten days after the maturity date; 2) we receive written nntice from you before a maturity date of your intention to cash in this ccrtil'icate: 3) not less than 14 days before ix maturity date we will mail to you a written notice of our intention to cash in this certificate on a maturity date. *5-3-99* ***STEVE ZANKICH FBO CITY OF CAMPBELL** Date. Depositor(s) **STEVE Z_A/qKICH** ssN '565-31-20/+0' "We" means thc financial institution "You" means thc depositor(s) named above. Wc will pay this certifi- cate to you when yon present a,d deliver il to us. properly endorsed (signed by you). on it matmity date. II' nlol¢ than one o[ ylm arc named abnvc, you will own this certificate as joints with right o[ survivership (and Dot ;is lellLilllS in colnlnonl. (Ye, may challgc this ow,crship by wrilten instructions). We will troal any one el yeti ils owner Ior purposes el endorsement, payment oF principal and interest, presentation (demanding plJyl/lelll el tlnlOtllltS dtlcl. [ral/sler and any llolicc to o[ lronl you. Each of yOU appoinls thc other ils yoBr agent. Ior thc purposes el endnrsement, payment of principal and interest, presentalion (demanding pay- nlcnt el amoallLs dae). Iransl'cr and tiny notice to or fi'om you. Each of you appoints thc other as ynLlr agent li)r' d~c purposes described above. Wc will usc thc address nn ()Ltl' records for mailing nnticcs to yott. You Canllol mmsl'er o1' assign this certificate or any rights under il wilhoul our written conscnl. AUTOMATIC RENEWAl.S: Eac renewal~e.~ will be thc same as the original term. beginuing on Lhc maturity dmc. The interest rate wi~me/[vc offer on new certificates on thc maturity date which have the same term. minimum ba~c (ffjzqy))and/other features ils this nriginal certilicatc. You may call us on or shordy before thc m~a~nd./~c ]lfill tells_you what the interest rate will bc lor th .... t ....... I term. We will not pay i~ere.~t ;~cm- tl~oq~y date it' this ccr, ficatc is not automatically renewed CITY OF CAMPBELL 70 NO. FIRST STREET CAMPBELL, CA 95008 (408) 866-2150 FIELD MEMO PERMIT OR PROJECT NO. ADDRESS/LOCATION TO: INSPECTOR/ENGINEER RECEIVED BY CITY OF CAMPBELL FIELD ENGINEER'S DAILY REPORT PROJECT NO. 'PROJECT: REPORT NO. DATE: (-,/J ~ ~'14 //--~ ¢.~-/'~.f WEATHER: CONTRACTOR: ~A¢.¢,.0 /'/~/~'(.]"c'¢A~'~'ct[ INSPECTOR: ITEM DESCRIPTION CO: PAGE OF CITY oF CAMPBELL Public Works Department Date: September 30, 2002 TRANSMITTAL FROM THE PUBLIC WORKS DEPARTMENT TO: Loyola Market c/o Zankich Construction Inc. 10281 Imperial Avenue Cupertino, CA 95014 FROM: Joanne M. D'Ambrosia, Senior Office Assistant SUBJECT: Permit No. 99-114 1492 Westmont Avenue We are forwarding the following: Check in the amount of $2,246.87 representing a refund of your Monumentation Security, plus interest, in connection with the above permit. Senior Office Assistant Enclosure 70 North First Street · Campbell, California 95008-1436 . TEL 408.866.2150 - FaX 408.376.0958 - TDD 408.866.2790 CITY OF CAMPBELL CAMPBELL, CA. WARRANT NO. 97110 ~. 0 1 ,.~, .;v :1. O~L. 540 7448 CR09172002 CR0917~.002 2:,000.00 REFUND DEPOSIT 246.87 INTEREST EArdlED '¥0004623 L..OYOL..A MAI:;.'.KET REMITTANCE ADVICE-PLEASE DETACH BEFORE BANKING CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 VOID AFTER 90 DAYS 1:1-35 BANK OF AMERICA WAR RANT NO. 1210 CAMPBELL OFFICE ,25E. C^MPBELL,VE. '97110 CAMPBELL, CA. 95008 AMOUNT DATE 09/30/02 97110 TO PAY 'T'WO TH[]LISANi'), TWO I-ItJI'.IDRE-D FORTY SIX I...OYOL..A MAF;:.I(lii~"I" C/'O ZAN K I CH [];[]IqS'T'F;~UCT101'1 0281 IMF:'IEFL'IAL. AVE [~X.JF:'IEF;.'.'i" I 1,10 CA 95014 I I,tC 'I')OLL. AF;.:~:~ &. 87 E;IF_'Iq"I"S SIGNATURE ,"Oq?l,l,O," ~:i, 8JOOO:~S~: Oqi, q:~,,,SOSOO,' September 6, 2002 Job No. 98025 MARVIN D. KIRKEBY 2397 FOREST AVENUE SAN JOSE, CA 95128 (408) 984-0331 Harold Housley Departmem of Public Works City of Campbell 70 N. First Street Campbell, CA 95008 Re: 1492 Westmont Avenue Dear Harold; Please be advised that the monumems shown on the Parcel Map have been set. All monumems are as shown on the Map. I have been paid for the work and hereby release any claim for paymem against the developers of the property. If further information is required please contact the undersigned. Registered Civil Enginffer CITY OF CAMPBELL Public Works Department April 16, 2002 Mr. Marvin D. Kirkeby Kirkeby Engineering 3249 Stevens Creek Blvd., Suite 101 San Jos6, CA 95117 Re: 1492 Westmont Ave. EP 99-114 , Parcel Map 716 8/9 Monumentation Cash Security Dear Mr. Kirkeby: On 03-22-2002 we met in my office regarding the monumentation cash security that the City is holding for the above referenced development. An action plan was agreed upon. As of 04-15-2002 there has been no change concerning the stares of the monumentation and related matters. Therefore, I will discuss this matter with the City Engineer and contact the City attorney and Board of Registration for Civil Engineers and Land Surveyors as appropriate. Sincerely, I H~" · arod ousey, P.E Land Development Engineer cc: LD File/1492 Westmont Ave. EP File/99-114 Inspector, Alan Hom City Engineer, Michelle Quinney Loyola Market, Zankich Construction, Inc, 10281 Imperial Ave, Cupertino, CA 95014 70 North First Street . Campbell. California 95008-1423 · TEL 408.866.2150 . F^X 408.376.0958 . TDD 408.866.2790 February 22, 2002 CITY OF CAMPBELL Public Works Department Loyola Market Zankich Construction, Inc. 10281 Imperial Ave. Cupertino, CA 95014 Re: 1492 Westmont Ave. EP 99-114, Parcel Map 716 8/9 Monumentation Cash Security Dear Ms. Market: According to the City records apparently the survey monuments as described in the attached letter to you dated August 21, 2000, have not been set. The City is still retaining the monumentation security in the amount of $2,000.00. It is important that the monuments be set and the security released to the appropriate party. Therefore, if the City does not receive notification by March 22, 2002, that the work has been completed the following actions will be taken: 1. The City will retain the services of a surveyor to perform the work. 2. The surveyor will be compensated from your security. 3. If the security being retained by the City is not sufficient, you will be responsible for the additional amount required.. Please contact me at (408) 866-2158 if you have any questions. I. Harold Housley, P.E Land Development Engineer CC: LD File/1492 Westmont Ave. EP File/99-114 Inspector; Alan Hom Michelle Quinney, City Engineer Marvin D. Kirkeby, Kirkeby Engineering, 2397 Forest Ave., San Jose, CA 95128 70 North First Street · Campbell, California 95008-1436 . rFL 408.866.2150 · F~,X 408376.0958 · TDD 408.866.2790 o~' CITY OF CAMPBELL Public Works Department December 13 , 200]. Zankich Construction, Inc. 10281 Imperial Avenue Cupertino, CA 95014 SUBJECT: PER,MIT NO. 99-114 LOCATION: 1492 Westmont Avenue FINAL INSPECTION AND ACCEPTANCE Dear Mr. Zankich: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins as of the date of this acceptance letter. 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. The Citw' will require you to post a Maintenance Bond in the amount of $22,225.00 for the duration of the maintenance period. Upon receipt of the Maintenance Bond, the City Mil return your Faithful Performance CD #2786 in the amount of $88,900.00. Your Construction Cash Deposit of $3,556.00, plus any interest due. is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2168. Sincerely,/~---.: , Alan H~'~''''~'---~-~ Senior Public Works Inspector cc: Suspense- II months Permit #99-11.4 Inspector File Saratoga National Bank, 15405 Los Gatos Blvd., Los Gatos, CA 95032 H:\wordXpermits\99114timid) 7'0 Ninth [:ir'st %trect - C. ampbcH, Ca',i'~c, rp, i.~ 95005-1 t36 . ri: -~OS ~;t¢6.2i 50 ~:,'x 40"3.370 0959, . Il)l) 405 506.2790 Alan Hom Public Works Inspector City of Campbell 70 North First Street Campbell, CA 95008 Phone: (408) 866-2168 Fax: (408) 376-0958 Fax To: Steve Zankich From: Alan Hom Fax: 395-0549 Pages (including cover sheet): 2 Re: 1492 Westmont - Permit # 99-114 Date: January 11, 2001 [] Urgent [] For Review [] Please Comment [] Please Reply [] Please Recycle · Comments: Enclosed is the punchlist for the abovementioned project. Upon completion of the items, contact me at 866-2168 for a f'mal inspection. Alan Hom Public Works Inspector Janua~ 17,2001 PUBLIC WORKS PUNCH LIST PERMIT 99-114 1492 WESTMONT AVENUE 1. Submit "AS BUILT' drawings with all utility locations. One set of vellums and two blueline copies. 2. Install R-1 "STOP" sign on the southeast corner of AbbottNVestmont. 3. Construct Type VI barricade on the east end of project on Westmont. 4. Install the three Westmont street trees according to plans. Stake and install according to City Standard Detail 12, 13, L-13. 5. Remove all weeds and deleterious plants in Westmont planter strip. Place weed block and cover with bark mulch. 6. Salvage the city "NO STOPPING" signs in the vacant lot. Remove the concrete footing and return sign and post to City Yard. 7. Remove construction fencing off right-of-way. 8. Provide electrical service to street light and energize on Westmont. 9. Clean all catch basins, lines and manholes. · Page 2 August21,2000 CITY OF CAMPBELL Public Works Department Loyola Market c/o Zankich Construction, Inc. 10281 Imperial Avenue Cupertino, CA 95014 Re: Project Address: 1492 Westmont Avenue EP 99-114, Parcel Map No. 716 8/9 Monumentation Cash Security Dear Developer: According to the City's records, a $2,000.00 cash security bond is still being retained for setting the survey monuments for the above-referenced Parcel Map No. 716 8/9. Please provide us with a letter from your civil engineer/land surveyor that all monumentation has been completed in accordance with the Subdivision Map Act Section 66495, and the recorded Parcel Map No. 716 8/9, and that he/she has been paid for his/her services. Upon written request for refund of the security by the party who posted it, the staff will check the site to verify that the monuments have been set. When the monumentation has been completed, the staff will arrange to have your security released by the City Council. According to recorded Parcel Map No. 716 8/9 monuments should have been set on or before May 26, 2000. Please respond within two (2) weeks of receiving this letter. Contact David Corona or me at (408) 866-2158 if you have any questions. Sincerely, / I. Hm:old Housley, P.E Land Development Engineer LD File/1492 Westmont Avenue EP File/99-114 Alan Hom, Public Works Inspector Michelle Quinney, City Engineer Marvin D. Kirkeby, Kirkeby Engineering, 2397 Forest Avenue, San Jose, CA 95128 j :\Id\monuments due 70 North First Street · Campbell, California 95008-1423 · TEL 408.866.2150 · F^X 408.376.0958 - TDD 408.866.2790 Chuck Gomez From: Sent: To: Cc: Subject: Chuck Gomez Thursday, November 11, 1999 2:27 PM Marlene Pomeroy Chuck Gomez; Harold Housley; Joanne D' Ambrosia RE: Eaement at 1520 Westmont Avenue Tract No. 6135 which subdivided the property at the southwest corner of Abbott and Westmont Avenues, also created a 10 feet wide Public Service Easement westerly and contiguous to westerly line of Abbott Avenue. The easement is not just for PG & E. It is for any and all public utilities. A copy of the map is available for viewing at our office. ChuckG ..... Original Message ..... From: Marlene Pomeroy Sent: Thursday, November 11, 1999 1:28 PM To: Harold Housley; Chuck Gomez Cc: Joanne D' Ambrosia Subject: FW: Eaement at 1520 Westmont Avenue This e-mail came in through our Public Works e-mail. You can prepare the response to me and then I'll send it back through the Public Works e-mail. Thanks, Marlene ..... Original Message ..... From: City of Campbell Public Works Sent: Thursday, November 11, 1999 12:16 PM To: Joanne D' Ambrosia; Marlene Pomeroy Subject: FW: Eaement at 1520 Westmont Avenue > > From: SHALHOUB, KAMEL (HP-SanJose,exl) [SMTP:KAMEL SHALHOUB@AGILENT.COM] > Sent: Thursday, November 11, 1999 11:27:42 AM > To: publicworks@ci.campbell.ca.us > Subject: Eaement at 1520 Westmont Avenue > Auto forwarded by a Rule > I live in the house at 1520 Westmont Avenue. I would like to know if there is a PG&E easement between my house and Abbott, the street between my house and the new construction across the street. If there is what is the exact location of the easement. Thanks,. Kamel Shalhoub CITY OF CAMPBELL ENGINEERING DIVISION LAND DEVELOPMENT SECTION DEVELOPMENT CHECKLIST ~APPLICATION NO: ENCROACHMENT PERMIT NO: ADDRESS: APPLICANT NAME AND PHONE: CONSULTANT NAME AND PHONE: o ENCROACHMENT PERMIT ISSUANCE CHECKLIST ENCROACHMENT PERMIT APPLICATION ENCROACHMENT PERMIT INSURANCE CERTIFICATES FEES, SECURITY AND CONSTRUCTION ESTIMAT,ES a. Engineering Plan Check and Inspection Deposil~/?d,~ b./~. Engineering Plan Check and Inspection Fees /,~.~ c./ae~Faithful Performance Security ~.,~..'~..ff...~.~.~.d,~ d./a,~ Labor and Material Security J~..~. .......... ~ Maintenance Sedurity e. f. ~o Emergency Cash Deposit ..... g. Storm Drain Area Fee ,~,O/~'.~)' 4~?.&&~5; ./.. ~¢¢:'. ...... h. Record Map Fee ~./~. i. Traffic Engineering Fee // ..................... j. Monumentation Security ,~.~27".'c.'"'"'" k. Park Impact Fees 1. Miscellaneous Fees ..................... m. Construction Cost Estimate ..................... STANDARD AGREEMENT AND ATTACHMENTS ........ SPECIAL AGREEMENT AND ATTACHMENTS ............ RECORD MAP a. Easements and Dedication b. Taxes and Assessments Letter c. Non-Interference Letters (NILS) ................... d. Signed Check List by Engineer/Surveyors .......... e. Current Preliminary Title Report ................... f. Subdivision Guarantee ................... g. Fictitious Name Certificate ................... h. HOA Management Agreement ................... i. CC&R's j. Mylar Copies After Recording REQUIRED RECEIVED o 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. COMMENTS: RIGHT-OF-WAY BY SEPARATE INSTR ................... SOILS REPORT PLANS a. Street Improvements b. Grading and Drainage c. Landscape d. Traffic Control e. Other CLEARANCE LETTERS OR PERMITS FROM OTHER AGENCIES a. SCVWD PROP. EASEMENT b. WVSD " " " " c. SJWC ........ d. PG&E " " " " e. Pacific Bell ...... f. TCI " ' .... ' g. SCCFPD (Central Fire) h. Cai Trans i. City of San Jose j. Town of Los Gatos k. Private 1. Other LTRS .................. .,///,,5/ .................... SOILS REPORT .................... LETTER FROM DEVELOPER TO PAY ADDITIONAL PLAN CHECK EXPENSES UTILITY COORDINATION PLAN ..... APPLICANT LETTER STATING COMPLIANCE WITH CONDITIONS OF APPROVAL SPECIAL SUBMITTALS PER CONDITIONS OF .......... APPROVAL / PLANNING DIVISION APPROVAL ~.:..~..: ...... BUILDING DIVISION APPROVAL .................... TRAFFIC DIVISION APPROVAL .................... SERVICE CENTER APPROVAL .................... ESCROW LETTER WITH RECORDING INSTRUCTIONS CITY COUNCIL AND PLANNING COMM.RES ........... Prepared by: h:checklist.hh 1/4/96 Date: Approved by: D ate: 2 MEMORANDUM TO: FROM: · MESSAGE: CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA 95008 (408) 866-21§0 DATE: SIGNED Recording Requested by: City of Campbell When recorded mail to: City Clerk City of Campbell 70 North First Street Campbell, CA 95008 ) ) ) ) ) ) ) ) ) ) (Space above this line for Recorder's use only.) STREET IMPROVEMENT AGREEMENT THIS AGREEMENT~e~ntified as Fi.le~N,.o.~P~M 9.8-05/S 98-12 through S 98-15) ZANKICH CONSTRUCTION, INC., A CALIFORNIA CORPORATION, AND LOYOLA MEATS FISH & DELI INC., A CALIFORNIA CORPORATION, hereunder referred to as "Owner," and the CITY OF CAMPBELL, a municipal corporation of the County of Santa Clara, State of California, hereinafter referred tO as "City." WHEREAS, on September 22, 1998, the Planning Commission, by Resolutions 3181 and 3182 granted conditional approval of Application PM 98-05/S 98-12 through S 98-15 for that certain real property described in Exhibit A attached and incorporated as though fully set forth herein, and commonly known as 1492 Westmont Avenue, which property is hereinafter referred to as "said real property"; WHEREAS, compliance with the terms and conditions of this Agreement are conditions to the approval of the above described Parcel Map and architectural approvals; NOW, THEREFORE, IN CONSIDERATION OF THE ABOVE-MENTIONED APPROVAL, arTd satisfaction of the conditions to that approval, (1) Owner shall provide, construct and/or install at his own proper cost and expense, street improvements as described in Section 11.24.040 of the City Code within 12 months from the date first mentioned hereinabove; provided, however, that in the computation of said 12 month period, delays due to, or caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of Owner or his successors shall be excluded. (2) It is expressly understood and agreed to that if Owner shall fail to complete the work required by this Agreement within the said 12 month period, the City, after giving ten (10) days written notice thereof to Owner, or his successors, may construct and/or install said improvements and recover the full cost and expense thereof from owner, or his successors. (3) Owner, or his successors, shall cause to be prepared at his cost and expense improvement plans for the construction and/or installation of said improvements prior to such construction or installation. Said plans shall be prepared by a civil engineer registered by the State of California and submitted to the City Engineer for examination and approval. All of said improvements shall be constructed and/or installed in accordance with those plans approved by the City Engineer and shall be made under the supervision and inspection and to the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and to all plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes applicable thereto. Upon completion and acceptance of the improvements by City, Owner, or his successors, shall provide reproducible as-built plans to the City Engineer. (4) The construction work of the improvements embraced by this Agreement shall be done in accordance with the specifications of the City of Campbell and West Valley Sanitation District of Santa Clara County, where indicated. (5) Prior to approval of the plans by the City Engineer pursuant to Section (3) of this Agreement, Owner, or his successors, shall pay to the City for examination of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in accordance with Resolution No. 9391, as adopted by the City Council on June 2, 1998, or as may subsequently be adopted by the City Council. (6) Owner, or his successors, shall file with City, prior to beginning construction, surety acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure tull and faithful performance of the construction of all the aforementioned improvement work, excluding sanitary sewers and water distribution system. Said surety shall guarantee that Owner, and his successors, will correct any defects which may appear in said improvement work within one (1) year from the date of acceptance of the work by City and paT-for any damage to other work resulting from the construction thereof, as well as pay the cost of all labor and materials involved. This surety shall remain in effect until one (1) year after date of final acceptance of said improvements by City. Said surety amount may be reduced by the City Engineer after the date of final acceptance to not less than twenty-five (25) percent of its full value. (7) Upon final release of said surety by City, the obligations of Owner, and his successors, contained in this Agreement shall be considered null and void. (8) When called upon by City to do so, Owner, or his successors, will execute a petition for the formation of any special assessment district created pursuant to any special assessment act as provided in the Streets and Highways Code of the State of California created for the purpose of constructing and/or installing any or all of said improvements. (9) Owner, or his successors, shall participate in and become a part of any special assessment district as described in paragraph (8) of this Agreement. It is expressly understood that any obligations of Owner, or his successors, contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district shall be considered null and void. (10) Owner, or his successors, shall make such deposits or file such bonds and enter into such agreement as required by West Valley Sanitation District of Santa Clara County to ensure the installation of a sanitary sewage system to serve said real property, and Owner, or his successors, shall file with City, upon execution of this Agreement, a letter from Said Sanitation District stating that Owner, or his successors, have made such deposits or fried such bonds and entered into such agreements. (11) Owner, or his successors, shall pay to Pacific Gas and Electric Company any and all fees required/;'or installation of underground wiring circuit to all electroliers within said real property when Owner, or his successors, is notified by either the City Engineer or the Pacific Gas and Electric Company that said fees are due and payable. Owner's, and his successors', obligations under this section shall not be relieved by delay or the passage of time, but shall remain binding indefinitely and forever. (12) Owner, or his successors, shall make such deposits or file such bonds and enter into such agreement as required by San Jose Water Company when called upon to do so to ensure the installation of a water distribution system to serve said real property, including fire hydrant. Owner's, and his successors', obligations under this section shall not be relieved by delay or the passage of time, but shall bind Owner and successors indefinitely and forever. (13) Any easement and right of way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans shall be acquired by Owner, or his successors, at his own cost and expense. It is provided, however, that in the event-eminent domain proceedings are required for the purpose of securing said easement and right of way, Owner, or his successors, shall deposit or cause to be deposited with City a sum covering the reasonable market value of the land proposed to be taken and to be included in said sum shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and costs, engineering and other incidental costs shall be deposited with the City. (14) Owner, or his successors, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his own cost and e~pense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation line or lines within the boundary of said real property. (15) To the fullest extent permitted by law, Owner, and his successors, shall indemnify, defend and hold the City of Campbell, and its agents, employees, attorneys, officers, officials and assignees harmless from any and all claims, damages, losses and expenses, including, but not limited to, attorneys' fees, arising out of, or resulting from any negligent or intentional act or omission (including misconduct) of said Owner, or his successors, or any subcontractor, or anyone directly or indirectly employed by him, or anyone for whose acts any of them may be liable in the course of performance of the Agreement. The Owner, and his successors, shall also indemnify, defend and hold the City of Campbell, and its agents, attorneys, employees, officers, officials, and assignees harmless against and fi'om any and all claims, demands, liabilities, losses, lawsuits, judgments, damages, costs and expenses (including, but not limited to, attorneys' fees and court costs, whether incurred at trial, appellate or administrative levels) which the City of Campbell may incur or suffer, or to which the City of Campbell may be subjected resulting from the failure of Owner, or his successors, or his agents, employees, subcontractors, or anyone performing services under him, to fulfill any of the obligations imposed under this Agreement. (16) It is acknowledged that the provisions of this Agreement constitute covenants for the improvement of the subject real property for the mutual benefit of Owner's property, commonly known as 1492 Westmont Avenue, and the City's property, commonly described as Abbott Avenue and Westmont Avenue where it adjoins Owner's property. These covenants shall be considered to affect rights in the above-described real properties, and shall be binding on the heirs, assigns, successors, and grantees of Owner to said real property. (17) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. (18) In the event that Owner, or his successors, should breach any of the terms, conditions, or covenants of this Agreement, the City shall be entitled to recover, in addition to any other relief available in law or equity, all costs incurred in attempting to obtain enforcement of the Agreement, or compensation for such breach. These costs shall include reasonable attorffeys' fees and court costs. (19) This is the entire Agreement between the parties, and there are no representations, agreements, arrangements or understandings that are not fully expressed herein. (20) This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement, binding on all parties. (21) Owner shall provide and construct public street improvements per preliminary plans titled "Street Improvement Plans for 1492 Westmont Avenue, Encroachment Permit No. 99-114,' which are subject to approval by the City Engineer, prepared by Kirkeby Engineering, 2397 Forest Avenue, San Jose, CA 95128. IN WITNESS WHEREOF, said City has caused its name to be affixed by its Public Works Director and City Clerk, who are duly authorized by Ordinance 1951 adopted September 2, 1997, and said Owner has caused his name to be affixed the day and year first above written. ZANKICH CONSTRUCTION, INC., A CALIFORNIA CORPORATION Steve Zan~ LOYOLA MEATS FISH & DELI INC., A CALIFORNIA CORPORATION Thomas F. Andrews Anne Bybee, ~ Clerk CITY OF C.a2),IPBELL /~ obetrt Kass, Public Works Director (Attach Notary Acknowledgment for all parties) h:~agr\ 1492WESTmp) EXHB3IT A The land referred to herein is situated in the City of Campbell, County of Santa clara, State of California, and is described as follows: Beginning at a hub set at the point of intersection of the centerline of Harriett, running in a Northerly and a Southerly direction with the Northerly line of Lot 3 as said Lot 3 is shown upon the recorded Map hereinafter referred to; thence along the said Northerly line of Lot 3 being also the centerline of Westmont Avenue, formerly Lovell Avenue, North 81 °24' East a distance of 126.26 feet to a point in said line; thence leaving said line and mrming South 7o43'30" East 156 feet; thence parallel with the said line of Westmont Avenue North 81 o 24' East 90 feet, more or less, to a point in the Westerly boundary line of Munro Tract, filed in Book 4, Maps, page 22; thence along said line South 7°43 '30" East 150.04 feet to a hub set at the Northeasterly comer of that certain parcel of land conveyed S. Brooks Walton, et ux, by Deed recorded December 15, 1947 in Book 1456 Official Records, page 55; thence along the Northerly line of said parcel so conveyed to Walton, South 83° West 254.12 feet to a hub set therein; thence leaving said Northerly line and running North 7o45, West 300 feet to a pipe set in the said Northerly line of Lot 3, said Northerly line also being the centerline of Westmont Avenue, thence along said line, north 83 o East 38 feet to the point of beginning and being a part of Lot 3. Map of Subdivision of the Lovell Tract, filed September 24, 1896, Book "Fl" Maps, page 5, Santa Clara County Records. STATE OF CALIFORNIA COUNTY OF SANTA CLARA persomlly lo, own to me (or proved m me on the bas~s of mtisf2ctmy evidence) to be the person(s) whose name(s) is/are subscribed to the within ~ and acknowledged m n~ thai heYsheYrt~ execu~ the same in his/her/their autlmrized capacity(ies), and tl~ by h/s/bet/tier signature(s) on the mstrumen~ the person(s), or tt~ e~i~y upon bel~ff of which the person(s) acted, executed the instrmnent. WITNESS my trend and official seal. (This area fornotar~ seal) STATE OF CALIFORNIA COUNTY OF SANTA CLARA On ,~'~/~[ (/ (c~ before me, ('Notary Public) personally known to me (or_p:~.,~_a_ ,-,- m:, ............. ~ to be the person(~) wlmsc namc(-s'-)- is/a~e- subscribed to the within instnnnent and acknowledged to me tlmt he/slm~-y executed the same in his/her4~Wa authorized capacity(4~), and that by ~ signature(s) on the instrument, the person(s}, or the entity upon behalf of which the person(x)-acted, executed the insmunent. (This area fomotarial seal) PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 1492 Westmont Avenue uatc: 4/27/99 ENCROACHMENT PERMIT NO: 99-114 APPLICATION NO. PM 98-05, S 98-12, 15 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 I~ > $1.50 K $ AMOUNT I. SURFACE CONSTRUCTION MOBILIZATION I LS $ 1,500.00 $ 1,500.00 CONSTRUCTION TRAFFIC CONTROL/PHASING I LS $ 2,000.00 $ 2,000.00 EONSTRUCTION STAKING LS $ 750.00 $ 750.00 CONSTRUCTION TESTING I LS $ 1,000.00 $ 1,000.00 II. DEMOLrrION/CLEARING 1. CLEARING & GRUBBING I LS $ 2,000.00 $ 2,000.00 2. SAWCUT P.C.C./A.C.(UP TO 6') LF 3. P.C.C. REMOVAL SY 4. CURB AND GU'FI'ER REMOVAL LF 5. MEDIAN REMOVAL SF 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA III, STORM DRAhNAGE 1. 12" R.C.P. (CLASS V) 47 LF $ 40.00 $ 1,880.00 2. 15' R.C.P. (CLASS III) LF 3. 18' R.C.P. (CLASS III) LF 4. 24' R.C.P. (CLASS III) LF 5. 30" R.C.P. (CLASS III) LF 6. T.V. INSPECTION (12") 47 LF $ 0.75 ' $ 35.25 7. STD. DRAINAGE INLET I EA $ 1,300.00 $ 1,300.00 (C.C. DETA1L 5) 8. FLAT GRATE INLET EA ~C.C. DETAIL 6) 9. STANDARD MANHOLE EA (C.S.J. DETAIL D-I 1) INCLUDES FRAME & LID) 10. BREAK AND ENTER MH./D.I. I EA $ 550.00 $ 550.00 Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 ~ > $150 K $ AMOUNT IV. CONCRETE IMPROVEMENTS 1. SIDEWALK 630 SF 5; 4.50 5;2.75 $ 2.835.00 (14o)(4.5) 2. DRIVEWAY APPROACH 270 SF $ 5.50 $ 1,485.00 (90)(3) 3. CURB AND GUTTER 51(] LF $ 18.00 $ 9,180.00 4. VALLEY GUTTER SF 5. HANDICAP RAMP 3 EA ,5; 800.00 $ 2,400.00 6. TYPE B-I CURB LF 6a. TYPE B3-6 521~ LF $ 9.00 $ 4,680.00 7. TYPE Al-B3 CURB LF 8, COBBLESTONE MEDIAN SURFACE 690 SF $ 10.00 $ 6,900.00 9. P.C,C. DRIVEWAY CONFORM SF 10. A.C. DRIVEWAY CONFORM SF V. PAVEMENT 1. ASPHALT DIGOUT AND REPLACE CF 2. PAVEMENT WEDGE CUT (6') 240 LF : $ 2.50 $ 600.0{ 3. PAVEMENT GRINDING SF 4. PAVEMENT FABRIC (PETRO-MAT) SY 5. ASPHALT CONCRETE (TYPE A) 396 T $ 50.00 $ 19,800.00 280.5 + 115.5 6. AGGREGATE BASE (CLASS 2) 582 T $ 20.00 $ 11,640.00 384 +198 7. SLURRY SEAL (TYPE II) SF 8. SLURRY SEAL (TYPE III) SF VI, TRAFFIC SIGNALS/LIGHTS 1. DETECTOR LOOP (6' ROUND) EA 2. DETECTOR LOOP (6' x 30') EA 3. DETECTOR LOOP (6' x 50') EA 4. ELECTROLIER EA $ 2,200.00 $ 2,200.00 5. I I/2' RIGID CONDUIT 80 LF $ 7.00 $ 560.00 Page 2 ITEM UNIT PRICES FOR PROJECT AMOUNT NO, DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT 6 2" RIGID TRAFFIC SIGNAL CONDUIT LF 7 CONDUCTOR 24~ LF $ 0.55 $ 132.00 8 PULL BOX (NO. 3 1/2) 2 EA $ 240.00 $ 480,00 9 TRAFFIC SIGNAL PULL BOX (NO, 5) EA VII. STRIPING AND SIGNS 1, REMOVE PVMT. MARKINGS (PAINT) 50 SF S 1.50 $ 75.00 2. REMOVE PVMT. MARKINGS (THERMO) SF 3. REMOVE PVMT STRIPING 225 LF $ 0.80 $ 180.00 4. STRIPING DETAIL 9 LF 4.5 STRIPING DETAIL 22 250 LF $ 1.65 : $ 412.50 5. STRIPING DETAIL 29 70 SF $ 1.65 $ 115.50 6, STRIPING DETAIL 32 SF 7, STRIPING DETAIL 37 (THERMO) LF 8. STRIPING DETAIL 38 (THERMO) SF 8.5 STRIPING DETAIL 38 (PAINT) 250 LF $ 1.65 i $ 412,50 9. STRIPING DETAIL 39 LF 10. STRIPING DETAIL 40 LF 11. LIMIT LINE 1(~ LF $ 1.05 $ 10.50 12. CROSSWALK 205 LF $ 1.05 $ 215.25 13, PAVEMENT MARKINGS (PAINT) 222 SF $ 1.90 ~ $ 421,80 14. PAVEMENT MARKINGS (THERMO) SF 15, PAVEMENT MARKER (NON-REFL.) EA 16. PAVEMENT MARKER (REFLECTIVE) EA 17, TYPE K MARKER EA 18. TYPE N MARKER 3 EA $ 80.00 $ 240,00 19. SALVAGE ROAD SIGN EA 20. RELOCATE ROAD SIGN EA 21. INST. RD, SIGN ON EXIST. POLE EA 22, ROAD SIGN WITH POST 8 EA $ 240.00 $ 1,920.00 Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $[S0 K > $1S0 K $ AMOUNT VIII. LANDSCAPING 1. IRRIGATION, PLANTING WORK LF (28O$ SF)($7.00) 2 PRUNE TREE ROOTS EA 3 I'REE REMOVAL EA 4. ROOT BARRIER ( 12") LF 5. ROOT BARRIER (18') 30 LF $ 15.00 $ 450.00 6. STREET TREE (24' BOX) 3 EA $ 325.00 ~ $ 975.00 7. STREET TREE (36" BOX) EA 8. TOP SOIL BACKFILL CY IX. MISCELLANEOUS 1. PEDESTRIAN BARRIER LF 2. CHAIN LINK FENCE (6') LF 3. RAISE MISC. BOX TO GRADE 2 EA $ 200.00 $ 400.00 4. RAISE MANHOLE TO GRADE EA S. INSTALL MONUMENT BOX 3 EA $ 350.00 $ 1,050.00 6. MEDIAN BACKFILL CY SUBTOTAL $ 80,785.30 PREPARED BY: CRUZ S. OOMEZ 10% SECURITY ENFORCEMENT FEE $ 8,078.53 REVIEWED BY: I. HAROLD HOUSLEY TOTAL ESTIMATE FOR FAITHFUL $88,863.83 APPROVED BY: MICHELLE QUINNEY PERFORMANCE SECURITY $88,900.00 *See Section 66499.4 of the Map Act. h:\excel\landdev\ 1492WEST(rap) Page 4 STATE ..o.: o^ COMPENSATION INSURANCE I=:U N DCERTIFICATE OF WORKERS'iCOMPENSATION. INSURANCE JANUARY 10, 2002 POLICY NUMBER: CERTIFICATE EXPIRES: CITY OF CAMPBELL ATTN DEPT OF PUBLIC klORKS 70 NORTH FIRST ST CAMPBELL CA 93008 JOB: ./AN ~ 4 20172 PUBI,,JlC WORK8 t492 WESTMONT JOB #572 This ~s to certify that we have issued a valid Workers' Com[~ensation insurance policy ~n a form approved by the California Insurance Commissioner [o the employer named below for the po~y period indicated. This Policy ~s not subject [o cancellation by the Fund except upon:~)(q days' advance written notice to the employer. 30 We wdl also g~ve you)~T~N days' advance notice should this policy be cancelled prior to ~ts normal expiration. This certificate of insurance is not an insurance pohcy and does not amend, extend or alter the coverage afforded bythe ooHc~es listed herein. Notwithstanding any requirement, term. or condition of any contract or other document wi,th respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject ~o all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: PRESIDENT $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01/01/02 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER JOHN GLAG'E UNDERGROUND CONSTRUCTION INC P0 B0X 32021'6 LOS GATOS CA 95032 ACORD. CERTIFIC/-E OF LIABILITY INSU' PRODUCER Valley Global Ins. 84 S. First Street, San Jose CA 95113 Phone: 408-947-7111 INSURED Brokers 2nd Floor Fax:408-947-7115 OP,D DATE(MM/DD/YY) ----JOHNG-1 01/04/02 THIS CERTIFICATE IS ISSUED AS A MATTER 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 AFFORDING COVERAGE INSURERA: State Compensation Ins. Fund INSURER 8: John G~age Underground Const. INSURERC: .~ ~ i ..... ~,~ P. O. ~ox 320216 INSURERD: Los Gatos CA 95032-0216 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N(3TW'I3'H~DIII~ O ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH CH TH S CERT F CATE MAY BEd~i~"[ ~:~ 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 {MM/DD/YY) DATE (MM/DD/YYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ I CLAIMS MADE II OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/Dp AGG $ ~ POLICY ~PRO' JECT [~ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) __ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) ~ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ ~ OCCUR [] CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X WC STATU- OTH- TORY L M TS ER A EMPLOYERS'LIABILITY 046-7508-02 01/01/02 01/01/03 E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $ 1000000 i E.L. DISEASE- POLICY LIMIT I $ 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 1492 Westmont; Job No. 572. See attached CG2010 for Additional Insured. -10 days for non-payment of premium. CERTIFICATE HOLDER i Y ! ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION City of Campbell Attn: Dept. of Public Works 70 No. First Street Campbell, CA 95008 CAMPBEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTAT~S. % David -l~E13a='-i-~' ~ ' ' ¢~ -- '~'¥""--CORPORATION(:!~'A~ORD 1988 ACORD 25-S (7~97) ACORD. CERTIFIC,' 'E OF LIABILITY INSU'- ' NC:. io Dc I DATE,M DD , .... '"ZA_NKI- 1 12/20/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FRO Insurance Brokers, Inc. 6130 Stoneridge Mall Rd, #100 Pleasanton CJ% 94588 Phone: 925-460-6222 Fax:925-460-9484 INSURED Zankich Construction Inc. 0281 Imperial Avenue upertino CA 95014-5923 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 INSURERA: Acceptance Indemnity Ins. Co. INSURER B: 'NSURER 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. NOTWITI-~N~ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUB~)&~'t'~- r,.. ! MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION~I~J'~'F~'A? POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' INSR POMCY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any o~e fire) $ I CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ ~ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG , $ ~ PRO- J POL,CY j i JECT ~--~ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (La accident) "J. ° Wu" 2ZoSs I>0L]CY CANCELLED ' HIRED AUTOS ~. (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ IOCCUR ~] CLAIMS MADE AGGREGATE $ $ I DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X I WC STATU- OTH- TORY L MITS ER EMPLOYERS' LIABILITY A FW99984639 04/23/01 12/29/01 E.L EACH ACCIDENT $1000000 E.L D~SEASE - EA EMPLOYEE $ 1000000 E.L DISEASE - POLICY LIMIT S 1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS License #575019 CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION City of Campbell Public Works Joanne 70 N. First Street Campbell CA 95008 CAMPBEL ACORD 25-S (7~97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAiL N/A DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO S0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ©ACORD'~;ORPORATION 1988 INSURANCE REQIJIRE~~S CltF~CKLIST Pe t # c/_ . __ /~,~ ..... CIP Project g, The following ~s required of all conff~ctors w6~-l~ing in ~e City of Campbell Public fight-of-way. Insurance certiHcates mu~t be accepted by Ck~ staff before work can begin.. These insurance requiremen~ apply to work being performed under an Encroachment Permit and work being performed under conu'act for Capital Improvement Projects. Limits .. Commercial General Liability for bodily, personal injury and property damage: ~ $1,000,000 per occurrence, and ~ $!,000,000 general aggregate limit applying separately to the project, and ~ $2,000,000 general aggregate lin~it. ~ Policy e×p~tion date II/~ l~ Automotive Liability -"anv auto".~-- Dca-e_~ V ~/~' d.o 'h,,~ ~ .fo" as ~ $1,000,000 per accident fqr bodily injury and property damage '~ Policy expiration date ,, ]' ] Z¢ ~ ~ q Worker's Compensation and Employer's Liability ~ $1,000,000 per accident for bodily injury or disease [] .Policy expiration date Course of Construction (if required in Special Provisions) [] Completed value of the proj~t [] Policy expiration date Required Endorsement to General Liability and Automobile Liability Policie~ 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 Additio, Nd In.,aired is primary ilksurance. [] Workers' Compensation Insurance Sheet Submitted [] For General Contractor ~Subrogation Clause -. ~ ~=~ Date Copy'of Insurance Certificate placed in tickler file :,fie month prior to expiration. j:\forms\inscklst 4/96 (rev 6~96) STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 ISSUE DATE: CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICy NUMBER: 046-00 UNZT 0007508 01-01-00 CERTIFICATE EXPIRES: 01-01-01 CITY OF CAMPBELL ATTN: DEPT OF PUBLIC WORKS 70 N FIRST STREET CAMPBELL CA 95008 This is to certify that we have issued a valid Workers' Compensation insurance policy in a from 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 30 days' advance written notice to the employer. We will also give you 30 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. ~~~PRESIDEN~ EMPLOYER'S LZABZLZTY LZMZT ZNCLUDZNG DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #2065 ENTZTLED CERTZFZCATE HOLDERS' NOTZCE EFFECTZVE 01/01/00 ZS ATTACHED TO AND FORMS A PART OF THZS POLZCY. EMPLOYER LEGAL NAME JOHN GLAGE UNDERGROUND CONSTRUCTZON, ZNC. P 0 BOX 320216 LOS GATOS CA 95032 dOHN GLAGE UNDERGROUND CONSTRUCTZON ZNC PRINTED: 12-19-99 P0408 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FRO Insurance Brokers, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 6130 Stoneridge Mall Rd, #100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pleasanton CA 94588 COMPANIES AFFORDING COVERAGE COMPANY PiloneNo. 925-460-6222 FaxNo. 925-460-9484 A Clarendon National Ins. Co. INSURED COMPANY B COMPANY b'b-IVED Zankich Construction Inc. C mperia Avenue COMPANY OCT 0 5 Cupertino CA 95014-5923 D THIS IS TO CERT,FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P~'~[~?.ATION INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W~TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP/DP AGG $ I CLAIMS MADE~ i I I OCCUR PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: ' '.'.'...'.'.'.'.'.'.'.'.'.. '. EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ i UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X I WC STAIU- i OTH- TORY LIMITS I EMPLOYERS' LIABILITY EL EACH ACCIDENT $ l, 000, 000 a THEPROPRIETOPJ [] INCL 02AC0001812 03/01/99 03/01/00 EL DISEASE - POLICY LIMIT $ i 000, 000 PARTNERS/EXECUTiVE · OFFICERS ARE:I ,Xt EXCL EL DISEASE- EA EMPLOYEE $ '1 · 000 · 000 OTHER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/SPECIAL ITEMS Ail California oper,atio,ns and locations. License #575019. Cancellation for non-payment of premlu~ is ten (10)days. Waiver of Subrogation is Included. CERTIFtC/~TE ::::::::::::::::::::::::: ::::::::::::::::::::::::::::: ::: :::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::: :::::::::: :::::: :::::: :::::::::::::: :::::::::::::::::: :: ::::::::::::::::::: ::: :::::::::::::::::::::::::: :: ::: Ci~ET, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Campbel 1 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Public Works 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Joanne BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 70 N. First Street Campbell CA 95008 OF ANY KIND UPON THE COMPANY, ITS AGENTS%OR REPRESENTATIVES. 10-- 4--99; 2:44PM;+¢0 ;925 460 9494 # 1/ PRODUCER ~lS CE~IFI~TE IS ISSUED AS A MA~ER OF INFOR~TION ONLY ~D CONFERS NO RIGHTS UPON THE CERTIFICATE ~O I~e~ce ~o~e~, ~c. HOLDER. THIS CERTIFI~ ~ES NOT ~END, ~END OR 6[30 ~o~e~ge ~11 ~, ~100 ~TERTHE COVE~GE~F~DED BYTHE POLICIES BELOW. ~leaeaa~Oa ~ ~588 ~OMPANIESAFFORDING COVE~GE ~MPA~ ~e~, 925-460-6222 Fa.~. 925-460-9484 A Clarendon National Ins. Co. COMPLY 10281 I~erial Aveuue COMPANY PUBLIC WORKO ~pertino ~ 95014-5923 D-.--,.,,v ~IS IS TO CER~ ~T THE ~LlClES OF INSU~NCE LIS~D B~OW ~ BEEN ~SSUED TO THE INSU~D ~MED ABOVE FOR THE POLICY PERIOD INDICTED, NO~I~ST~DING ~Y REQUIRERS, T~ O~ CON.ION OF ANY CO~CT OR OTHER D~UMENT ~ ~SPECT TO ~H T~S CE~FI~ ~Y BE iSSUED OR ~Y P~TAIN, THE ~E AFFORDED BY THE POLICIES DESCKBED HEREIN IS SU~ECT ~ A~ THE ~S, ~CLUSIONS AND ~NDfflONS OF SUCH ~LIClES. LIM~S ~O~ ~Y ~VE BE~ REDUC~ BY PAID CO ~LICY EFFEC~ ~LICY ~I~T~N LTR i ~E OK INSU~CE POLICY NUMBER DA~ (MM/D~ ~TE ~M~] LIMITS GENE~L L~BIL~ GENE~L AGG~TE .:, :. C~ ~DE ~R ~RS0~L & ~ ;~U~ O~E~S & C~CTO~S PROT ~H O~U~ FI~ ~AGE ~ny ~e fire) MED ~ (~y ~ P~) AUTOMOBI~ L~IL~ ..... ~M~N~ SINGLE LIMIT ~Y AUTO ~ ~L O~ED A~OS ~DiLY i~URy $ SCH~ULED AUTOS (~ ~) ~ HIRED A~ BODILY I~URY NON-O~ AUTOS (~ a~t) ~ ~OPER~ ~AGE GA~ LI~IE~ A~O ONLY - ~ ~CID~T ~CN ~ClD~T UMBRELLA FORM AGGRE~ WORKE~ COMPEN~T~N AND ~PLOY~' LI~IL~ EL ~H ACClDE~ $ ~ ~ 000 / 0 ~ THEPROP~O~ ~ ~NCL 02~C000~8~2 03/0Z/99 03~0~00 ELDI~E-P~ICYLIMIT OFFtCE~ ~E: ~ ~ ] ~CL EL DI~E - ~ ~PLO~E O~ DESCRI~ION OF O~ON~ATDN~IG~GIAL C~BEL S~ULD ~ ~ ~E A~ DE~RI~ ~LlClES BE ~CE~ED BEFO~ THE City of C~bel 1 ~I~T[ON DATE ~E~F, THE ~UING ~MP~Y ~ END~VOR TO ~L ~ ~O~ 30 ~YS ~EN NOTICE TO THE CER~F~ HO~ ~M~ TO THE L~T, ~O~e BUT FNLURE TO ~IL S~ NO~E S~LL ~E NO O~I~N OR L~lL~ 70 N. First Street OF ~Y ~ND U~N THE COMPLY, ~S AGE~ R ~TATIVES. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LOS GATOS-CAMPBELL INS. CNTR. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P . O . BOX ]3 3 0 5 3 COMPANIES AFFORDING COVERAGE LOS GATOS, CA. 95031 COMP^.¥ 408-354-1660 FAX 408-354-8469 A USF INSURANCE COMPANY INSURED COMPANY ZANKICH CONSTRUCTION, INC. COMPANY 10281 IMPERIAL AVE. C CUPERTINO, CA 95014 COMPANY ~? 3 O ;999 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POMCY EFFECTIVE POLICY EXPIRATION CO TYPE OF INSURANCE POMCY NUMBER LIMITS LTR DATE (MM/DD/~ DATE (MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 2 , 0 0 0 , 0 0 0 X COMMERCIAL SENE~L L~AB,L,TY PRODUCTS- COMP/OP AGG ~ 1, 0 0 0, 0 0 0 ::::::::::::::::::::::: CLAIMS MADE OCCUR PERSONAL & AD¥ ~NJUR¥ $1, 000, 000 A OWNER'S&CONTRACTOR'SPROT SHO 10590 11-24-98 11-24-99 EAC. OCCURRENCE $1, 000, 000 X 2500 DED ~REDAMAG~{Anvo~i~e) $ 50,000 MED EXP (Any one person) $ 5 , 000 AUTOMOBILE LIABILITY -- COMBINED SINGLE LIMIT $1 __ ANYAUTO , 000, 000 ALL OWNED AUTOS -- BODILY INJURY SCHEDULED AUTOS (Per person) $ A ~x~ HIREDAUTOS SHO 10590 11-24-98 11-24-99 BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM wc STATU- OTH- " EMPLOYERS' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ II INCL EL DISEASE POLICY L~MIT $ PARTNERS/EXECUTIVE OFFICERS ARE: I I EXCL EL DISEASE - EA EMPLOYEE $ OTHER RE:?ERMIT#99-114 @ 1492 WESTMONT AVE CMPBI.,CA.AI.I. WORK IN PUBI,IC RI CITY OF ChMPBRI,I,,CIT¥ OF C32UlPBELI, REDEVELOPMENT AGENCY, ITS OFFICERS,EMPLOYEES & VOI,UNTEERS NAMED AS ADDITIONAl, INSUR~DS AS R~S?gCTS LIABII,IT¥ PER CG2009 SNOULD ANY OF THE ABO¥£ DESCRIBED POLICIES BE CANCELLED ~EFOR£ THE CITY OF CAMPBELL EXPIRATION DATE THEREOF, THE ISSUING COMPANY W1LL~TO MAIL ATTN: DEPT. OF PUBLIC WORKS 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 70 NORTH FIRST STREET ........... .,,,, CAMPBELL, CA. 95008 ......................... ~ nrnnr ........... PE[:~I T # 9 9 - 114 AUTHORIZED REPRESENTATIVE i:~)I. JCY NU]~BER: S~O 1 0 5 9 0 THIS ENDORSEMENT CI. iAN~ THE POLICY. PLEASE READ ri' CAREFTJt.i¥. ADDITIONAL INSURED. OWNERS, LESSEES or CONTRACTORS [Form A] This endorsement rnod~s ~nsur~ce p-rovl~md under t~e followin~ COMMEF:[CIAL C-~EN~L [JABILrTY COVEP~GE PART Nameof'=~'rs°~or~rc3mnu~n(A~t~itk~lnsure~9: Lm--.atlctt~ City of Campbell C~C~mra~ attn. Dept. of Public Works ~All work in public right-of-way. City 70 North First Street City of Campbell Redevelopment Agency, Campbell,Ca.95008 employees and volunteers are named as insureds as respects.liability per CG of Campbell its officers, additional 2009. Property I::)a.n~ge ~ 31,000,000 each occurrence ~2,000,000 aggregate T~aJ~Prel~ulTt $ SEE DECLARATION PAGE ~ .~-~p~icz3~e to m~s CG 20 (~J ~ 1 85 C~pydgnt, Insurance Service Office, ]nc., 1984 $EP-30-~999 14:32 LOS GATOS CAMPBELL INS LO5 GATOS-f,~M~ELL INSURANCE CENTER 3760958 P.O1 FAX TR,4N$~~ · COMMENTS; LICENSE NUMBER: 0509451 ***IF YOU DO NOT RECEIVE ALL PAGE, S, PLEA.E.E CALL A~AP*** PHONE: 40&,354-1660 FAX: 40f1-$54-1859 SEP-50-1999 14:32 FROM LOS GATOS CAMPBELL INS 5?60958 P.02 Zankich Construction, Inc. USF Insurance Company Policy # SHO 10590 Primary Wording: SUBJECT TO ALL OTHER TERMS AND PROVISIONS OF TH~ POLICY, SUCH INSURANCE ]~S PROVIDED BY THE ENDO~$E~4ENT $~ALI, FE DEEF~D PRIMARY, BUT ONLY WITH RESPECT TO WORK PERFORMED BY OR FOK THE NAMED INSURED IN CONNECTION WITH THE ABOVE D~SUKIBSD CONTBJiCT. TOTAL P. 02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR LOS GATOS-CAMPBELL INS. CNTR. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P . O . BOX 33053 COMPANIES AFFORDING COVERAGE LOS GATOS, CA. 95031 COMPANY 408-354-1660 FAX 408-354-8469 A USF INSURANCE COMPANY INSURED COMPANY B ZANKICH CONSTRUCTION, INC. COMPANY 10281 IMPERIAL AVE. C CUPERTINO, CA 95014 COMPANY D I .................. '"""' ``~`~`~`~.~....~.~;~;~;~;~;~;~;~;~;~;~;.;~.~;.;.;.;.;.;.;.;:;:;:;:::::::::::::::::::::::::::::::::::::::: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDD/YY) DATE (MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP/DP AGG $ i, 0 0 0, 0 i?,i?,i',i', I CLA, MS MADE [--~ OCCUR PERSONAL & ADV,NJURY $1, 0 0 0, 0 A OWNER'S&CONTRACTOR'SPROT SHO 10590 11-24-98 11-24-99 EACH OCCURRENCE $1,000,000 X 2500 DED FIRE DAMAGE (Any one fire) $ 501000 MED EXP (Any one person) $ 5 i 0 · AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1 ANYAUTO , 000 1000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A XIHIREDAUTOS SHO 10590 11-24-98 11-24-99 BODiLY iNJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND i WC STA] U- TORY LIMITS i OTH- EMPLOYERS' LIABILITY EL EACH ACCIDENT $ THE PROPRIETOR/ ~ INCL EL DISEASE - POliCY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE$ OTHER DESCRIPTION OF OPERAllONS/LOCATIONSA/EHICLES~SPECLAL rrEMS RE:PERMIT#99-114 @ 1492 WESTMONT AVE CMPBL,CA.ALL WORK IN PUBLIC RIGHT OF WAY. CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS,EMPLOYEES & VOLUNTEERS NAMED AS ADDITIONAL INSUREDS AS RESPECTS LIABILITY PER CG2009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF CAMPBELL EXPIRAT,ON DATE THEREOF, THE ISSUING COMPANY WlLL ATTN: DEPT. OF PUBLIC WORKS ~ HOLDER NAMED TO THE LEFT,'W~V) 70 NORTH FIRST STREET --/ r CAMPBELL, CA. 95008 PERMIT # 99-114 I ITY OF I AMPBE£L Public Works Department 70 North First Street Campbell, CA 95008 Date: FACSIMILE COVER SHEET TO: FROM: MESSAGE: Fax Telephone No. Number of Pages Transmitted (including this page) --7 z - ~ Transmitted from Fax Phone ~ (408) ~76-0958 If there are any problems with this transmission, please ca~. De'pt. Phone No. J:\FORMS\FAXFORM(WORD) INSURANCE REQUIREMENTS CFrI*~C~IST Pemlit # ? ~' / /%t/Sc ~ CIP Project The following insu 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 $1,000,000 general aggregate limit applying separately to the project, and $2,000,000general aggregate limit. '~ Policy expiration date ~ ~2'/! t,, · Automotive Liability - "any auto" I~t $1,000,000 per accident_~o}- b~dily injury and property damage ~ Policy expiration date ~-~7'~ ct/t Worker's Compensation and Employer's Liability $1,000,000 per accident for bodily injury or disease .Policy expiration da~ //1/2~o~)o~'A~j ~~ia[ {.th --~t. ~Z Course of [] [] Construction (if required in Special Provisions) Completed value of the proj<t Policy expiration date Required Endorsement to General Liability and Automobile Liability Policies Additional Insured Endorsement ~ Campbell Redevelopment Agency, its officers, The City, the City of employees and volunteers are named as additional insured. The imurance coverage afforded to the Additio3~l Insured is primary insur~ce. [] Workers' Compensation Inmrance Sheet Submitted [] For General Contractor [] Subrogation Clause ,. ~ [nit/~Ls Dam Copy'of Insurance Certificate placed in tickler file ',)~e month prior to expiration. j:\forms~scklst 4/96 (rev 6/96) ACORD. CERTIFICA', : OF LIABI PRODUCER Valley Global Ins. Brokers 84 S. First Street, 2nd Floor San Jose CA 95113 Phone: 408-947-7111 Fax.- 408-947-7115 INSURED LITY INSUF NC. ,D ,P I DATE,MM,DDt, "' ~' '~OHNO- 1 09/24/01 THIS CERTIFICATE IS ISSUED AS A MATTER 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 AFFORDING COVERAGE INSURERA: Lexington Insurance Company ~NSURERB: Hartford Insurance Company John Glage Underground Const. ~NSURERC: State Compensation Ins. Fund P. O. Box 320216 INSURERD: ---~Pt% ~eili~ I Los Gatos CA 95032-0216 I 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 suci-p U aLI POLICIES· AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS· INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE {MM/DD/YY} LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A _X COMMERCIAL GENERAL LIABILITY] ~ 1140609 09/16/01 09/16/02 flRE DAUAGE (Any one fire) $ 50000 i CLAIMS MADE iX] OCCUR MED EXP (Any one person) $ X Owner/Cont PERSONAL&ADVINJURY $1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG $ 1000000 I POLICY [~ PRO- JECT [~ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 B X I ANYAUTO 57OITRIT~9129 09/16/01 09/16/02 (Fa accident) I ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ RGE LIABILITY AUTO ONLY - EA ACCIDENT $ NYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ ~ OCCUR ~ CLAIMS MADE AGGREGATE $ $ ---~ DEDUCTIBLE $ RETENTION $ $ I I WC STATU- I OTH- WORKERS COMPENSATION AND ,5.~ I TORY LIMITS I ~E_R C I EMPLOYZRS'LIABILITY 046-7508-01 01/01/01 01/01/02 E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE $1000000 E.L. DISEASE - POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 1492 Westmont; Job No. 572. See attached CG2010 for Additional Insured. *10 days for non-payment of premium. CERTIFICATE HOLDER I Y I ADDITIONAL INSURED; INSURER LETTER: __ CANCELLATION City of Campbell Attn: Dept. of Public Works 70 No. First Street Campbell, CA 95008 ACORD 25-S (7/97) CAMPBEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER)~i~¢~~ * 30 DAYS WRI'I-FEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Bg~J~Lv~J~,,~l~g)t~lN~l¥. David McGarry ©ACORD CORPORATION 1988 POLICY NUMBER: 1140609 COMME~IAL~3ENERAL LIABILITY INSURED: John Glage Underground Construction, Inc. 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: The City of Campbell Redevelopment Agency, The City of Campbell (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. Project: 1492 Westmont; Job No. 572 CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 H:\MODEL\0291A ACORD. CERTIFICAT OI [ INSURANCE ~RODUCER (650)934-0300 FAX (650)934-0495 Tho'ts Insurance CA L,cense · 0243213 444 Castro Street. Suite 200 Mounta'n View, CA 94041-2017 ~ 3ohn Glage Underground Construction 3ohn Glage Underground Construction, [nc. P.O. Box 320216 Los Gatos, CA 95032-0216 I 09/25/2000 THIS CEI~I II-ICATE 151, ~D A5 A MATTbR O1'* iNPORMAHON ONLY AND CONFERS N~ ~tlGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Steadfast Tnsurance INSURERB: Pennsylvan'a Den Ins Co. INSURER C: National Un,on INSURERD: State Comp. Ins. Fund INSURER E: COMMERCIAL GENERAL LIABILITY PRODUCT GEN'L AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY ' B O ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS 3ARAGE LIABILITY ANY AUTO 09/16/20OO RE( ADM~ -'~-/16/2001 ;E - $ 2000 -~-/16/2001 C,ty of Cambell Attn: Dept. of Public Norks 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY W1LLgI~O~-~ MAIL ~ O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORIZED REPRESENTATIVE 3__oan Borella/T/S623 ~NDICATED. NOTWITHSTANDING IlS CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH LIMITS EACH OCCURRENCE ~ I, 000,000 FIRE DAMAGE (Any one fire) $ ~0,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1, O00,000.. GENERAL AGGREGATE $ 2, O00, O00 PRODUCTS- COMP/DP AGG ' $ 2 , O00 ~ 000 COMBINED SINGLE LIMIT $ (Ea accident) I, 000,00~ BODILY INJURY $ (Per person) B~DILY INJURY r accident) $ =ROPERTY DAMAGE $ (Per accident) ~ AUTO ONLY - EA ACCIDENT $ ~ OTHERTHAN EAACC $ AUTO ONLY: AGG $ -- EACH OCCURRENCE $ I, 000,000 AGGREGATE S I, 000,000 $ $ $ E.L. EACH ACCIDENT $ 1,000,000 E.~-~. DISEASE- EA EMPLOYEE $ I, OO0,000 E.L. DISEASE - POLICY LIMIT $ I, O00,00__.._.__~0 i LIABIUTY BE 740-35-51 09/16/2000 -- OCCUR [~ CLAIMS MADE DEDUCTIBLE RETENTION $ . COMPENSATION AND 146-7508-00 ~01/2000 01/01/2001 DESCRIPTION OF OPERATIONS/LOCATION,SA/ 70 24 10 93 ~ Primary wording applies per form CGBT .s.red .amed per form c 2olo ClO/9. arran',ed. [~:)~'-C:[R Attached/ 10 Day Not,ce of cancel/at'on fOr non-payment Of premium CE ADDITIONAL INSURED; INSURER LETTER CANCELLATI 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. City of Cambell 09/25/2000 Certificate issued to City of Cambell 07/21/1999 POLICY NUMBER: PX8618514 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: The City, the City of Campbell Redevelopment Agency, it's officers, employees and volunteers. Re: ]ob #572 1492 Westmont (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 ongoing operations performed for that insured. CG 2010 10/93 633 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 444 CastroStreet, Suite 200 Mt. View, CA 94041 Telephone: (650) 934-0300 Facsimile: (650) 934-0495 CA License # 0243213 By: Jan Galbraith Direct Line (650) 210-1633 Form C[R PRODUCER (650)934-0300 FAX (650)934-0495 Thoits Insurance CA License · 0243213 444 Castro Street. Suite 200 Mountain View, CA 94041-2017 ACORD CERTIF. . E OF LIABILITY I1 ' U NCE ~[ 09/20/2000DATE(MM/DDffY) THIS CERTIFICATe- IS I~SUI-D AS A MA I I l::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. INSURER A: INSURER B: INSURER C: INSURER D: INSURER E: RAGES INSURED 3ohn Glage Underground Construction 3ohn Glage Underground Construction. Znc. P.O. Box 320216 Los Gatos, CA 95032-0216 I INSURERS AFFORDING COVERAGE Steadfast ]:nsurance Pennsylvania Gen Ins National Union · I~._~_._~~ State Comp. TnB. Fund ~'*::~r'mr~:~¢= ~,122 ,ld~H~&ldt~_l:: ,IRTI::r) RI:::/('~W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IN~' V'~-.~-~T--~.~NDING ; .n,.~. ~,~,:~,,~,=, ~=o, ~ ~'a'~ ~d%,--T,-r~-C~ ANY C:.C~ RACT OR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS CERTIFICATE MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDI~H POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POUCY NUMBER DATE (MMIDD/YY) DATE (MM/DD/YY) GENERAL LIABIUTY 5CO3780753-00 O9/16/2000 09/16/2001 EACH OCCURRENCE $ 1,OO0,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 50,000 I C~MSU~OE ~ OCCUR ~ED ~xP(~ny~o~) $ excluded I PERSONAL &ADV INJURY $ I ~ 000 ~ 000 A GENERAL AGGREGATE $ 2,000, OO0 GEN'LAGGREGATE."' P"ESPER: ,ODUCTS-COMP,O, AGG ' 2.000.000 JECT r~ loc AUTOMOBILE LIABIUTY :AX62775 09/16/2000 09/16/2001 COMBINED SINGLE LIMIT Ea accide~) 1,000,000 X ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS B X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OV~4ED AUTOS PROPERTY DAMAGE $ (P~ accident) AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY EA ACC $ t ANY AUTO OTHER THAN ... AUTO ONLY: AGG $ EXCESS UABIUTY ~E 740-35-51 O9/16/2000 09/16/2001 EACH OCCURRENCE $ 1,000,000 '1 OCCUR [----I C~IMS M~DE AGGREGATE $ 1,000,000 X I I I $ C I DEDUCTIBLE $ RETENTION $ vv~ ~ ~ ~ ~ u- WO.ERSCO~PE.SA~O"ANO 14~-ZSO~-O0 01/01/200~ 01/01/2002 ×I~ORYUM'TSl EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 1,0 0 0,0 0 0 O E.L DISEASE- EA EMPLOYEE $ I, OOO, 0OO E.L DISEASE- POLICY LIMIT$ I, 000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS~VEHICLESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS :e: 3ob ·572 1492 ~/estmont Primary wording applies per form CGB! 70 24 10 93 [dditional Tnsured named per form CG2010 (10/93) attached. :orm CTR Attached/ 10 Day Notice of cancellation for non-payment of premium /~AKIf~e'I I ATII'tM CERTIFICATE HOLDER J J ADDITIONAL INSURED; INSURER LETTER City of Cambell Attn: Dept. of Publlc ~orks 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~[J~=~ ~RJ(I~ MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~rx,~N X'pl~:~::W~ ~ ~',~ .~X~qX~X ~ W~ R"~"~ X~Rd~ · X x x X X X x AUTHORIZED REPRESENTATIVE 3Dan Borella/TTS623 c~AC;ORD (;ORlaOFLR11UN 19~11 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. CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 444 CastroStreet, Suite 200 Mt. View, CA 94041 Telephone: (650) 934-0300 Facsimile: (650) 934-0495 CA License # 0243213 By: Joan Borella Direct Line (650) 210-1623 Form CIR ACORD= CERTIr PRODUCER (650)934-0300 FAX (650)934-0495 Thoits Insurance CA L~¢ense ~ 0243213 444 Castro Street. Suite 200 Nountain View, CA 94041-2017 'E OF LIABILITY It' Lr' NCE DATE,MM,DDt, 09/20/20OO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tnc. INSURED 3ohn Glage Underground Construction 3ohn Glage Underground Construction, P.O. Box 320216 Los Gatos, CA 9S032-0216 I COVERAGES INSURERS AFFORDING COVERAGE INSURER,~ Steadfast Insurance INSURERB: Pennsylvania Gen Tns Cc INSURER C: National Union INSURERD: State Comp. Ins. Fund INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITH~ 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. LTR TYPE OF INSURANCE POUCY NUMBER DATE (MM/DD/YY) DATE (MMIDD/YY} LIMITS GENERAL UABIUTY 5C03780753-00 09/16/2000 09/16/2001 EACH OCCURRENCE $ 1,000,000! X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 50 I CLAIMS MADE X~ OCCUR MED EXP (Any one person) $ e x ¢ 1 u d e d A PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG ~ $ 2,000,000 ] POLICY ~"~PRO- JECT [~ LOC AUTOMOBILE UABIUTY CAX62775 09/16/2000 09/16/2001 COMBINED SINGLE LIMIT S X ANY AUTO (Em accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ IANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABIUTY BE 740-35-51 09/16/2000 09/16/2001 EACH OCCURRENCE $ 1,000,000 { OCCUR I I CLAIMS MADE AGGREGATE S X 1, 000, 000 C $ I DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 046-7508-00 01/01/2001 01/01/2002 X }TORY LIMrrs EMPLOYERS' MABIMTY E.L. EACH ACCIDENT $ I ~ 000,000 D E.L. DISEASE - EA EMPLOYEE I $ 1,000,000 E.L DISEASE* POLICY LIMrT S I, 000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Ze: 3ob #572 1492 Westmont Primary wording applies per form CGBT 70 24 10 93 tddit~onal Insured named per form CG2010 (10/93) attached. :orm CIR Attached/ lO Day Not~ce of cancellatlon for non-payment of premium CERTIFICATE HOLDER { { ADDITIONAL INSURED; INSURER LETrER CANCELLATION City of Cambell Attn: Dept. of Public Works 70 N. F~rst Street Campbell, CA 95008 ACOF{D 25-5 (7197) SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY INtLL ~J['l'~..~*'~-'~ ~ MAIL ~ O DAYS WRIT'rEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, R R ~R'~ N X't:kex<x)~ ~ R~ aiq[e~ f ~X Re, e~ R'4L~ ~ ~, x x x x x x X AUTHORIZED REPRESENTATIVE 3oan Borel la/TIS623 C~)AC;OI~U C;URPURATIUN 198~ 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. Aco~u zs-s CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 444 CastroStreet, Suite 200 Mt. View, CA 94041 Telephone: (650) 934-0300 Facsimile: (650) 934-0495 CA License # 0243213 By: Joan Borella Direct Line (650) 210-1623 Form CIR PRODUCER (650)324-0606 FAX (650)853-3882 rhoits Insurance CA License # 0243213 250 Cambridge Ave. Suite 300 Palo Alto, CA 94306-0190 Attn: Laurie Phi ri ppi di s Ext: 623 INSURED 3chh Glage Underground Construction P.O. Box 320216 Los Gatos, CA 95032-0216 THIS CERTIFICATE IS ISSUEU AS A MATTER OF INI;ORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY Reliance Insurance compa~'~';~ ............... A COMPANY CGU (General Acci dent) B .................................. RECEIVED COMPANY C COMPANY D SEP 2 4 I999 INDICATED, NOTV~THSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WlTH RESPECT TO VVHICH TRI~ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION i LIMITS LTR DATE {MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY iiiiiiiiiiiiii!' CLAIMS MADE i X i OCCUR A ::::::::::::::: ........ : ....... ' P X 8618514 OWNER'S & CONTRACTOR'S PROT X Broad form prop damage; XCU AUTOMOBILE LIABILITY "~'" ANY AUTO ALL OVVNED AUTOS SCHEDULED AUTOS A ~r0 BE DETERMINED X HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ : ....... INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL OTHER 09/16/1999 09/16/2000 GENERAL AGGREGATE $ 2,0 0 0 0 0 0 · PRODUCTS- COMp/Op AGG . ~ ........ ~.!.0.00 000 PERSONAL & ADV INJURY $ 1, 000 000 EACH OCCURREN~E ..$. ........~'..'.?~0 000 FIRE DAMAGE (Any one fire) $ 50 000 MED EXP (Any one person) $ 5 000 09/16/1999 09/16/2000 COMBINED SINGLE LIMIT $ 1,00o,ooo BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ AUTO ONLY- EAACCIDENT : $ ~6¥~E~{~.i:~`~:~6~[~:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: EACH ACCIDENT $ .......................... · ~.~...~ .................................... EACH OCCURRENCE AGGREGATE TORY LIMITS i i ER EL EACH ACCIDEhlT EL DISEASE - POLICY LIMIT EL DISEASE - EA EMPLOYEE DESCRIPTION OF OPERATION~LOCATIONS/VEHICLE~SPECIAL ITEMS ~e: 3ob #572 1492 Westmont Primary wording applies per form CGBI 70 24 10 93 kdditional Insured named per form CC2010 (10/93) attached. :cfm CIR Attached/ 10 Day Notice of cancellation for non-payment of premium City of Cambell Attn: Dept. of Public Works 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~I~I~L=~ MAIL ,~ 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORIZED REPRESENTATIVE Jan Gal braith/TIS633 Certificate ~ssued to C~ty of Cambell Tho~ts Znsurance C~ty of Cambel] 09/20/1999 07/21/1999 POLICY NUMBER: PX8618514 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: The City, the City of Campbell Redevelopment Agency, it's officers, employees and volunteers. Re: lob #572 1492 Westmont (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 ongoing operations performed for that insured. CG 2010 10/93 Copyright, Insurance Services Office, Inc., 1984 Page I of 1 633 r~.0.6~Ji~i~i~--.~-~.~-~-~..~.~.~.]-~-~.~ ................... I~AX (6~'~'!)"~'~;":i']'~'~'~ ................... THIS CERTIFICATE 15 / I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~hoi ts Ins u rance I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ICA License # 0243213 I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 250 Cambridge Ave. Suite 300 COMPANIES AFFORDING COVERAGE Pale Alto, CA 94306-0190 COMPANY Reliance Insurance Company* A Attn: Laurie Phi ri ppi di s Ext: 623 I"sURBD COMPANY ccU' (~;~'"e'~a~ A¢~i ~en~) ....................... ]ohn Glage Underground Construction B P.O. Box 320216 RECEIVED Los Gates, CA 95032-0216 C CO ANY $ EP 2 4 1999 ....... f~i~i~i~.~¥6~.[~i~¥i~.~¥~iX~.~`[~`~6(~i~i~.§~6~.i~.~i§~..~£6W~i~`~i~i§~b~6~i~ii4~i~.~i~.D ~AMi~D ABovi~'iP~ll%~l~l~i~i~ ........ INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TH RESPECT TO WHI~I~ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE LTR POLICY NUMBER GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY iiii::ii?:ilili! CLAIMS MADE ::X i OCCUR A ::::::::::::;::' ' ....... ' P X 8618 S 14 OWNER'S & CONTRACTOR'S FRet X Broad form prop damage; XCU AUTOMOBILE LIABILITY A X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS ~-0 X HIRED AUTOS X NON-OWNED AUTOS ~ BE DETERMINED GARAGELIABlUTY ANY AUTO EXCESS MABlUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ ....... INCL PARTNERS/EXECUTIVE i : OFFICERS ARE: : EXCL OTHER POLICY EFFECTIVE POLICY EXPIRATION DATE [MM/DD/YY) ;~ATE (MM/DD/Y~') LIMIT~ 09/16/1999 09/16/2000 i GENERAL AGGREGATE $ 2 000 000 : PRODUCTS-COMP/OPAGG $ 2,000,000 : PERSONAL & ADV INJURY $ 1, 0 0 0, 0 0 0 FIRE DAMAGE (Any one fire) $ 50 , 000 · MED EXP (Any one person) $ 5 , 000 09/16/1999 COMBINED SINGLE LIMIT $ ......... ~ ,.000,000 BODILY INJURY (Per person) $ 09/16/2000 BODILY INJURY (Per accident) PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT $ .............................................. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: OTHER THAN AUTO ONLY: ::::::::::::::::::::::::::::::::::::::::~:~:~:i:!::i:~:: :!::::::: .......... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: EACH ACCIDENT $ ............... '~'h~X:F~'"i ................................. EACH OCCURRENCE AGGREGATE EL EACH ACCIDENT EL DISEASE - POLICY LIMIT EL DISEASE - EA EMPLOYEE DESCRIP~ON OF OPERATION~LOCATIONSNEHICLE~SPECIAL ITEMS ~e: 3ob #572 1492 Westmont Primary wording applies per form CGBI 70 24 10 93 ~dditional Insured named per form C~-Ol0 (10/93) attached. Form CIR ~ttached/ 10 Day Notice of cancellation for non-payment of premium City of Cambell Attn: Dept. of Public Works 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POUClES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY W~LL ~1~1[1:)~.~ MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, R ~ ~kYx"~ ~ X~t~ ~ ~X~ f ~ ~'W ~'~ ~e~v~ ~ x x x x x x x AUTHORIZED REPRESENTATIVE ~ 3an Galbraith/TIS633 (~ i Certificate issued to City of Cambell Thoits Insurance City of Cambell 09/20/1999 07/21/1999 POLICY NUMBER: PX8615514 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: The City, the City of Campbell Redevelopment Agency, it's officers, employees and volunteers. Re: 3ob #572 1492 Westmont (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 ongoing operations performed for that insured. CG 2010 10/93 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 633 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::: : ::::::::::::::::::::::::::::::::::::::::::::::::::: ............................... ....... .......................... PRODUCER ( 650 ) 324 - 0606 FAX ( 650 ) 853 - 3882 IHl$ UERTIFIGAIE lB ISSUED AB A MAITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ¥ h o i t s I n s u r a n c e HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA L i c e n s e # 0243213 ALTER THE COVERAGE AFFORDED BY THE POLIOIE~ BELOW. 250 Cambridge Ave. Suite 300 COMPANIES AFFORDING COVE~GE Palo Alto, CA 94306-0190 ' coMPAN~ Reliance Insurance A.n' ]oanna Oilbride Ext' ~ A msu,~. ]o~. c~... u.~.,~,o.., co.,~,u~o. CO%A.V JUL ~ .- ~U I P.O. Box 320216 COMPANY PUE~Li Los Catos, CA 95032-0216 C ~DI~iNiC~...~ORKs . D - THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 1881JED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION CO TYPE OF INSURANCE POLICY NUMBER LIMITS LTR DATE (MM/DD/YY) DATE (MM/DD/YY) GENERAL LIABILITY · '~"i COMMERCIAL GENERAL LIABILITY ::::::::::::::::::::::::::::: CLAIMS MADE :: X OCCUR A :::::::::::::::' ' ....... ~ X 8618514 OWNER'S & CONTRACTOR'S PROT X Broad form prop damage,; XCU AUTOMOBILE LIABILITY "~'" ANY AUTO ALL OWNED AUTOS ....... SCHEDULED AUTOS A ' PX8618514 X HIRED AUTOS X NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ i ....... INCL PARTNERS/EXECUTIVE : OFFICERS ARE: : EXCL OTHER 09/16/1998 09/16/1999 GENERAL AGGREGATE $ 2, 000 000 PRODUCTS - COMP/OP AGG $ 2 , 000 000 ...~:~?~:~:.~:.~:~.'?~ ........ ~ ........... ~..,..~.~ ~....~?.~. EACH OCCURRENCE $ I, 000 000 FIRE DAMAGE (Any one fire) $ 50 000 MED EXP (Any one person)$ ~ 000 09/16/1998 09/16/1999 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT EAOH ACCIDENT AGGREGATE EACH OCCURRENCE $ AGGREGATE $ $ : VVL. ~) I ,~, I u- : : U I H- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: EL EACH ACCIDENT $ EL DISEASE - POLICY LIMIT $ E~ DisEASE:E~'EMpLOYEE $ DESCRIPTIONOFOPERATION~LOCATIONS~EHICLESlSPEClALITEMS {e: 3ob #572 1492 Westmont Primary wording applies per form CGB[ 70 24 10 93 ~dditiona~ Insured named per form CG2010 (10/93) attached. Form C~R Attached/ 10 Day Notice of cancellation for non-payment of premium City of Cambell Attn: Dept. of Public Works 70 N. First Street Campbell, CA 9S008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WlLL~I)II~)~A~J~)0)0 MAIL ] 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORIZED REPRESENTATIVE Ioanna Gilbride/TTS622 City of Cambe11 Certificate issued to City of Cambell 07/21/i999 Thoits Insurance 07/21/1999 POLICY NUMBER: PX8618514 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: The City, the City of Campbell Redevelopment Agency, it's officers, employees and volunteers. Re: ]ob #572 1492 Westmont (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 ongoing operations performed for that insured. CG 2010 10/93 Copyright, Insurance Services Office, Inc., 1984 Page I of 1 633 RELIANCE POLICY NUMBER: PX8618514 COMMERCIAL GENERAL LIABILITY JOHN GLA GE UNDER GR 0 UND CONSTRUCTION, INC. PRIMARY INSURANCE - DESIGNATED ADDITIONAL INSURED This endorsement provides supplementary provisions to be used with the Additional Insured Endorsement(s) listed below. SCHEDULE This endorsement applies to the following additional insured endorsement(s)*: CG 2010 10/93, Additional Insured - Owners, Lessees or Contractors (Form B) *See commercial General Liability Coverage Part Forms List for the titles of the endorsement(s). The Additional Insured Endorsement(s) listed in the above Schedule amend the Who Is An Insured (Section II) of the Commercial General Liability Coverage Part. For these designated additional insured endorsement(s) the following applies: To the extent that coverage is provided by this coverage part, this insurance shall apply as primary insurance as respects liability of the designated additional insured, arising solely out of the insured's performance of operations as described in the additional insured endorsement. Any other insurance available to the designated additional insured shall apply on an excess basis. CGBI 70 24 10 93 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 633 CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 250 Cambridge Avenue, Third Floor Palo Alto, CA 94306-0190 Telephone: (650) 324-0606 Facsimile: (650) 853-3882 By: Joanna Gilbride Direct Line (650) 617-0622 Form CIR STATE COMFIENSATION IN SUIRANCE I UND P.O. BOX 8U7, SAN FRANCISCO,CA 94101-0807 CERTIFICATE OF WORKERS, COMPENSATION INSURANCE ISSUE DATE: 01-01-99 POLICY NUMBER: 046-99 UNZT 000'/508 CERTIFICATE EXPIRES: 01-01-00 CITY OF CAMPBELL ATTN: DEPT OF PUBLIC WORKS 70 N FIRST STREET CAMPBELL CA 95008 This is to certify that we have issued a valid Workers' Compensation insurance policy in a from 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 ul3on 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this ~olicy 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 reduirement, 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 hereto is subject to all the terms, exclusions and conditions of such policies. ~IDEN~ EMPLOYER/S LZABZLZTY LZMZT ZNCLUDZNG DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #2065 ENTZTLED CERTIFZCATE HOLDERSf NOTICE EFFECTZVE 01/01/99 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER RECEIVED .~a~.~c WOrK LEGAL NAME dOHN GLAGE UNDERGROUND CONSTRUCTZON P 0 BOX 111208 CAJ4PBELL CA 95011 UOHN GLAGE UNDERGROUND CONSTRUCTZON ZNC PRINTED: 12-18-98 P0408 Phone (408)873-1737 Lic. #575019 Page # (408) 553-9125 Zankich Construction, l~n~' 10281 Imperial Ave. Cupertino, CA 95014 Steve Zankich President Loyola Inc. BUILDING AND DEVELOPMENT ! (408) 406-7455 Tom Andrews Fax: (408) 366-2011