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ENC1999-00181 DE~. OF PUBLIC WO~S (for wor~ng wi~in ~e X-Ref. file ' .,~ 70 No~ F~st St. public right, f-way) Camp~ll, CA 95~8 .. i~ I~_ ~ x[~* (408) 866-2150 Issued11/1 '5~,,~ Application Date ~/--~ ~"~ .~ F~ (408) 3764958 Permit expires in ~ mon~ Applicaaon expire~ in 6 monks . ~. ' . PP' . . ' ' ' C~.S~on 11.~. (~pli~one~ ~ 6 mn~ D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and thc Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faithful Pafforman~ Surctics and cash deposits. (See General Permit Conditions I and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY T'..;' PUBLIC WORKS DEPARTMEN~r AT LEAST TWO DAYS BEFORE STARTING WORK, NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOU~ .~ BEFORE RESTARTING~LY WORK~o ~ ~y ~ or d~ for ~ r~ul~g from ~ work ~vCr~ by ~ ~t. The Applicant/Permiuee hcre~y acknowledge~ that they have read and understand both the front and back of this permit, and they will inform thcir contractor(s) of the information. SPECIAL PROVISIONS So'ect shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be specif~..ally npproved by the Inspector prior to cutting,. Pavement may be cut for underground installations and must be r~stored in accordance with th~ Utility Trench Restoration Smndnnt Details, Me~bod 'A' Backfill, urfless otherwise approved by Inspector. Work to bo staked by a licensed Lm~d Surveyor or Civil Enginecr and two (2) copies of the cut shae~ scm to the Public Works D~partme~ before s~ing work. ~4~ ~'. ~rSec~n42~$oft~o~mm¢nt~x~¢~ais~.mRi'~n~tva~idf~r~x~i~un~U~d~r~mmd.~.~icoA~ert~USA}has~nn~6~ed~mdd~inq~ : . idenfifw~on numt~- h~ ~ cnm-~d h~reon: tJ~ Pho~ 1-800-227-2600. U.~ TICI, r~T NO. PERMIT APPLICATION FEI PLAN CHECK DEPOSIT CONSTRUCTION PLAN CHECK & INSPECTION FEE APPROVED FOR ISSUANCE \forms\pwf~in~2Yrev.6196 GENERAL PERMIT CONDITIONS I. A CONSTRUCTION CASH DEPOSIT is required, Charges will be made against this deposit if there is an emergency call-out, overtim~ inspection or when City ordered barricading is required, Any such ~osts in excess of the deposit will be billed to the Permittee, 2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY ~re required. Such period will begin on date of writ~n acceptance by the City, 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee MUST REQUEST IN WRITING a f'tn~l inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permi~e. 5. MAINTAIN s~fe pedestrian and vehicular crossings and free access to private driveways, bus stops, fi~ hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours end street closures. This plan must be REV1E~D and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Caltrans Manual of Traffic Controls for Construction and Maintennncc Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. $. REPLACE IN KIND any dan~ged or removed existing improvements, including planting. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. I0. 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 1. SATURDAY INSPECTIONS must be arranged in advance. Saturday inspection time is charged at the current overtime rate with a three hour minimum. Advance payment i'or the estimated time is required. 12. Adequate signing and lighted BARRICADING is required on the job site. Failure to provide such signing a~l barricading may result in the City's renting such signing and barricades and charging the cost (including ali labor and materials) against the cash deposit. I'~. Compaction testing of subgrade, base rock, ~ asphalt concrete by Permittee is REQUIRED unless otherwise stated by the City Engineer. I4, The Conmtctor or Permittee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at all times during construction. Contra;tor 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 materials or equipment will be allowed near the edge of pavement, the mtvcled way, or within the shoulderline which would create a l~.ardons con~lition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property ADJACENT to be work or any other work for which a separate permit may be required, nor does it relieve thc 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. Ig. This permit is NOT TRANSFERRABLE. Work must be performed by the Permi~e or his designated agent or contractor as specified thereon, 19. CALL BACK (call ou0 due to emergencies regarding tiffs permit, shall be at the current overtime rate with a three (3) hour minimum charge per 20. Pursuant to Chapter 14,02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the S, anta Clara Valley Nonpoint Source Pollution Control Program. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware of and understsnd all of the above conditions. j:~form~erm2 6/96 To: Finance Director Check Payable To: Address - Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Refundable I)e o.p_9_~t Check Reu~ Dennis Wong 14419 S. Bascom Avenue Los Gatos Refund Deposit 101.2203 101.540.7448 Interest Earned $1,096.00 Refund Construction Cash De_posit State: CA, Zip: _95032 Amount: $1,096.00 Amount: Amount: (Finance Dept only) (Exact Amount) Voucher #: Receipt #: ~ .1214,02 /- Requested by:., Finance Dept Only: Mt'c~lle QuinneY- Verified by: Title: Approved by: Title: Title: Title: Permit #: 99-181 Date: 05/02/1999 Sr. PW Inspector Date: City Engineer Date: Accounting Clerk II Date: Accountant Date: 5_p_ al ]:nstructions For' Handlin Mail As Is: X Mail in Attached Envelope: Interim Check: 05/31/2001 05/31/2001 Return To: Other: (Name) Needed By: (Department) f/n: Forms/excel/chkreq Revised 05/00 PUBUC PROPER~ ADD~S PI~ collar ~ ~i~ f~ ~ foci m~: 435.535.4921 ~ ~j~t Revenue (~i~v ENCROACHME~ pE~ 4722 Applioti0n 2203 PI~ ~k ~sit - 2% of ~G~ ~. ($SIN) mm) 22O3 Fai~ul ~,,~,~ ~ r ~) 2203 ~r and Ma~,b~ ~unW (I~G~ ~.) 2203 ~.:o.,..,en~Uon 2203 C~h ~msit (4% Plan ~k 4722 ~.~ < ~50.~ (12%of~G~ ~.) Condui~ up ~ 5~ F~ (SI.~R) ~ (Muni C~e ~ 11.34.OIO) 4~2~ ~el Map (4 F~ Split (~50) (Mul~-~ ~2~0) ~FFIC 4~g Ia~on Turn C~ ~w~Ho~ Co~t) D~ER ZIP FOR Dam ., Receipt at hAz~c£rm4(cxc~np(rcv City of Campbell - Refundable Deposit Check Requesl To: Finance Director Check Payable To: Address - Line 1: Line 2: City: Description: Total Payable: Account Number: Account Number: Account Number: (Finance Dept only) Purpose: Dennis K. Wong 14419 S. Bascom Avenue Los Gatos Refund Deposit $500.00 101.2203 101.540.7448 Interest Earned Refund Plan Check De_posit State: CA Zip: 95032 (Exact Amount) Amount: $500.00 Amount: Amount: (Finance Dept only) Voucher #: Receipt #: 120607 Requested b y '~c/~,~ CRUZ'. Approved by:_ Bill'~elm~ ' Finance Dept Only: Title: Title: Permit #: 99-181 Date: 0412711999 Assistant Engineer Date: Land Dev. Mgr. Date: Verified by: Title: Accounting Clerk II Date: Approved by: Title: Accountant Date: Special ];nst uctions Handling Chec Mail As Is: XX Mail in Attached Envelope: ~ Interim Check: 07/26/2000 07~26~2000 Return To: Other: (Name) Needed By: (Department) f/n: Fo~msJexcel/chkreq Revised 02/00 to: ci.ty ccrk PROPERTY ADDRESS EHCROACH~£NT pFRMIT U61itv E,,.......4,.,ent Plan Check ~ Inspection Fee INon-Ufillty) Pole Set/Removal 4722 CcrtJl~cal~ o f C6,,~.~m, (12% of ENGR. EET.) IDe~osit g% of ENGIL ESTJ~30.O~X) min.)** ($120) ($1,60/fl) fSI.lO/fi_) (SlOS/ea) ($1/Pg $12/B~k) 4722 ($55o) E,~ch Additional Lot {$170) fall Other. Parkland Dedication Fee 472gl No Parking Signs (SI/each or S25/100) OTHER I TOTAL NAME OF PAYOR /~/ Yd ! .LT.n_~,Yd .7'J A '--.-'- ~CD~DTDTT~ ..... ' ..... -: ~SOA O0 ~SSIGHMENT AND RECEIPT OF INVEF .... ENT CERTIFICATE TO CITY OF CAMPBELL, 70 N. FIRZ_ STREET CAMPBELL, CALIFORNIA 95008 (408) 866-2150 P.w. Per "- No. I TR or Loc. am/We are the owner(s) of a savings account at ~q~ OF at its branch office at ~u~Ug4~, , California, investment certificate No. C:C/~qO0~O in the names of '~0~- ~,. b6~ a%9~ ' ----------- ~ and having a present balance of $ ~, ~_(~ . O~ · I hereby grant, transfer and assign said account, said investment certificate, said balance (including interest which accrues thereon), and all other rights in connection therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration, receipt of which is hereby acknowledged, for the purpose of insuring construction described as follows: _I have physicall~ delivered verification of said inves~_ent certificate and duplicate of this Assi~nment and Receipt to said assignee. I understand that assignee can withdraw from said account any time' on his s~gnat~e alone u~n presentation of a written order to ~e ~ssuer. I also ~derstand ~at I ~y not withdraw from said accost ~less I present a signed release from the assignee. The issuer of the certificate ass~es no res~nsibility for the conduct of the assignee ~d ~y act on the signature of the assignee without further inqui~. Execute~ on ~n~. ~ , ~. at said office of the issuer. sign, ~ ~~ Assignor print ~ ~ ~ sign ~ Assignor print A~O~E~NT BY ISSUER Issuer affi~s that there are no o~er holds on s~ject accost, that s~ject monies are available, and that the a~ve descried assig~ent has ~en noted on ~e Records of said Adthori~6d Signature NOT~Y A~~~ 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. Ci 11 RELEASE BY 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. CAPACITY CLAIMED BY SIGNER(S) County of .~ r)"~ On~'L'{.)'~-- ~ ~_P)"D) beforeme, (DAT~) ' personally appeared ~ ~ (NAME(S) OF SIGNER(S)) NOTARY PUBLIC') [] INDIVIDUAL(S) ,~. CORPORATE OFFICER(S) (TITLE(S)) [] PARTNERS [] ATTORNEY IN FACT [] TRUSTEE(S) [] GUARDIAN/CONSERVATOR [] OTHER: . ersonally known to me - OR - [] proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed ----~ __ -. '.. ,,,, tm°et htl~a;'Vl~ehi~ hi;/~r~ m ~ltecau~eddat~ k n o wle d g ed t o " '-- ---- -- '--'- -- ' . Y he same nhis/ ~ ~ _ .A,. CARNEY ~1 her/their authorized capacity(les) and that b ~ ~ N~)omn~t~in #_] ]83,t4! [ his/her/their signature(s) on the instrument they SIGNER IS REPRESENTING: ~' ~ SOhiO CI;?(~°llf ,em,3 ~_ person(s), or the entity upon behalf of which the IN^ME O" PERSO~IS)OR · \~/ oun~y [ person(s) acted executed the instrument ~rrl .......... L v v",~u'~///~d~i,~,al _sea I. ~ (SE. AL) A'i'rENTION NOTARY: The information requested below is OPTIONAL. It could, however, prevent fraudulent attachment of this certificate to any unauthori~ THIS CERTIFICATE MUST BE A'FI'ACHED Title or Type of Docum TO THE DOCUMENT Number of Pages '~ Date of Document ~q DESCRIBED AT RIGHT: Signer(s) Other Than Named Above WOLCOTTS FORM 239---ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACIT'¢-~.~EPRESENTATION.Rev 12-92 1992 WOLC0]q'S FORMS rNC -~SS"'GN. MENT AND RECEIPT OF INV' 'TMENT CERTIFICATE TD C]'i": OF CAMPBELL, 70 N. FI .... f STREET CA2-~PBELL., CALIFORNIA 95008 (408) 866-2150 TR or D~. Loc. I am/We are the owner(s) of a savings account at .mt its branch office at ~ . , California, inves~e----~-~ :ertificate No. C~lZl_ot?v.y in the names of -~_ and having a present balance of $ I hereby grant, transfer and assign said account, said investment certificate, said balance (including interest which accrues thereon), and all other rights An connection therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration, receipt of which is hereby acknowledged, for the purpose of insuring construction described as follows: I have h sicall delivered verification of said investment certificate and du.~licate of this Assignment and Receipt to said assignee. I understand that assignee can withdraw from said account any time on his signature alone upon presentation of a written order to the issuer. I also understand that I may not -withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may act on the signature of the assignee without further inquiry. E ecuted on 27 , 19. ?at said office of th. issuer. prin~ '~--~EzC~' ~ £ ~ Assignor sign ' ~'~ ~ {i~' Assignor print ACKNOWLEDGEMENT BY ISSUER Issuer affirms that there are no other holds on subject account, that subject monies are available, and that the above described assignment has been noted on the Records of said issuer. ' Authorized Sign~ure ?itie: dV ~ INSTRUCTIONS TO ASSIGNRR ATTACH NOTARY CURRENT CALIFORNIA IIOTAIWFOilll 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. · _ . //,,,, . .f _ RELEAS~ BY 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. CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California ~ oo.n ss. On, ~/'~'~ D~¢ /,~'~'~' , before me, ~~~~~~ .~~ ~nd Titl~ O~cer (e.g., "~ane Doe. Nota~ R li~ personallyappeared ~ ~~ ~ ~ % , ~ p~nally known to me roved to me on the basis of satisfactow evidence LORNA K ROACH m N~ARY PUBUC- CAUFORN~A ~: COMMISSION ~ 1129~5 ~ SANTA C~RA COUN~ ~ ~mmi~ion ~ Mamh 16, ~1 to be the person.(.e')' whose name(~¢/, is/am- subscribed to the within instrument and acknowledged to me that he/s~ executed the same in his/~ authorized capacity(i.ee-)T and that by his/~ signature~.C~rn the instrument the person(.e')7-, or the entity upon behalf of which the person.(.8-)-~ acted, executed the instrument. ~si,~y hand and official OPTIONAL Though the information below is not required by/aw, it may prove va/uab/e to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of AttachedJ3ocument ~ Ti/t~ or.,Ty~e of D/pcument:~/~-.,~__.~~_~_.~.~.,./~ [~ocur~nt Date: ~.,///¢.~.._~/ ~umber of Pages: Signer(s) Other Than Named Above: ~______~~ ~~, ~/_ :,,/~ Capacity(ies) Claimed bA~Sfgner ..~ . ./ -- Individual / ~ / ~ ~--~CorporateOfficer--'~itle(s): ~¢_~/~2.~/.~_.~/ '/: //{~/~ ~' -- _- Partner--_- Limited _~ General " ~- Attorney in Fact ~_ Trustee _~ Guardian or Conservator - Other: Signer Is Representing: ~~~/ Top of 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 1-800-876-6827 ASSIGNMENT. AND RECEIPT OF INVE.~MENT CERTIFICATE TO C['~; OF CAMPBELL, 70 N. FI~ STREET C~PB~.T.?., CALIFORNIA 95008 (408) 866-2150 I am/We are the owner(s) of a savings account at at its branch office at ~$~(~ :ertificate No. ~ZZl-o/7~/¥' in the names of P.w. Per~,~ t ~o. ~/~ ~ ! ~o ~ TR or DI Loc. , California, inves~nt -_.__ and having a present balance of I hereby grant, transfer and assign said account, said investment certificate, said balance (including interest which accrues thereon), and all other rights in cormection therewith to the CITY OF CAMPB~3.L, assignee, for a good and valuable consideration, receipt of which is hereby acknowledged, for the purpose of insuring construction described as follows: I have physically delivered verification of said investment certificate and du~licate of this Assignment and Receipt to said assignee. I understand that assignee can withdraw from said account any time on his signature alone upon presentation of a written order to the issuer. I also understand that I may not withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may act on the signature of the assignee without further inquiry. Zxecuted on ~ ~ 7 , i9 ~?at said office of the issuer sign ~,,~,~./ - Assignor print "'--~'~6,~,'u ~ £, ~JC~ sign ' '(~ ~r Assignor ACKNOWLEDGEMENT BY ISSUER Issuer affirms that there are no other holds on subject account, that subject monies are available, and that the above described assignment has been noted on the Records of said issuer. thoriz'e~ Signature INSTRUCTIONS TO ASSIGNEE ATTACH NOTARY NOTARY FOPJ 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· Date: ~/]~.1~7~' City of/~e~ R~LEAS~ BY ASSIGNEE Said assignee hereby releases and relinquishes all his right, title and Interelt in and to said account, said investment certificate, said balance and all other rlghtl in connection therewith. City of Campbell Date: By CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California ooun }ss. O n.~~f~ ~¢/~'~', beforeme, ~~.~~~~ ~X ~ ~ .~ ~ 'n'Titl~O~cer(e.g..'¢aneDoe. Nota~,,~ personally appeared 7~ ~~~. ~--~ % % personally known to me roved to me on the basis of satisfacto~ evidence ~.. ,~"~,~"~ LORNA K ROACH tn ~ ~ NOTARY PUBUC - CAUFORNIA ~ ~ COMMISSION # 1129385 [.. ~'! ~'~z._.;~c~F_J/ SANTA CLARA COUNTY to be the person,/g~ whose name(x,-)-is/are' subscribed to the within instrument and acknowledged to me that he/~ executed the same in his/~ authorized capacity(i.ee-~, and that by his/~ signature~s.)~rn the instrument the person(e-)%or the entity upon behalf of which the person/,,e)-~ acted, executed the instrument. ~SS my hand and official se~.~~ Place Notary Seal Above .~/// Sig~lSublic 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~cument ~ ~c u m e n t '~_~ .?~~¢~~/~/~'~~ ~ocur~nt Date: ~ / I~umber of Pages: Signer(s) Other Than Named Above: .,~____~;~.¢_.¢.~ ~~..~¢'(~ Capacity(les) Claimed b.y~!~fgner .,~ ~..~_ _ Signer's Name: .,~_~,/~..-~5 ~ r__-- Individual / /' / + /,/~ //~( /~. -- ~Corporate Officer--'~,tle(s): ~_-4~~'///.~_~ _'_,~~~ Z Partner--_ Limited ~ General '- ' " -' ~ Attorney in Fact Z Trustee ~- Guardian or Conservator Z Other: Signer Is Representing: ,~_~ ,cf-../ Top of thumb here © 1997 National Notary Association · 9350 De Soto Ave., RO. Box 2402 · Chatsworth, CA 91313-2402 Prod. No. 5907 Reorder: Call Toll-Free 1-800-876-6827 INSURANCE REQ~~NT$ CHECKLIST P rmi # romt ~e g ~urance is ~quired of all co~ctors wor~g ~ ~e Ci~ of C~pbell public right-of-way. Imurance cenifi~tes mint ~ a~epted by Ci~ stuff before work can begin. These i~urance requiremen~ apply to work ~g ~o~ed under ~ Encroac~ent Pe~it and w°~ bei~effo~d under con~c[ for Capitol ~provement pr~ ~/~ ~ . '/~1 t ~ $1 ~ ~"~ Y' ~ ~ju~ ~d pro~ ~ge: ~e ' ~ $1 :~:~ g~e~em~g~e~m lm~it apply~g sep~ately to ~e project, ~d ~ $2,0~,~0 gene~ ag~gate li~it. ~ Policy exp~tion ~te ~ ~ o 0 [{~ ~c~ g~[~. ~motive Liabili~ - "~y auto' . . m"' ~'~ ~ ~~ ~~ '~ ~0~,, / $1,~,~0 per accidem for bodily ~ju~ '~'-~~ ~' } ~~ ~ ~ ~~ Policy exp~tion ~m ~0/~ /~ ~d prgpe~~ge ~ ~.~. ~ ~ker s Compe~ation md ~ployer's Liabili~ ~ O~~ · . . . s ~ $1,~0,~ per acc~de~ for bMfly mju~ o~~~ ~ Policy exp~fion ~m ~-/_ ~ ~ ~ ~ Course of Com~ction (if ~qu~ ~ Speci~ Provisiom~ ~ ~ Completed value of ~e project Policy exp~fion ~te ,Required Endorsement to General Liability and Automobile Liabili~ Policies tional Insured Endorsement The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured, rimary~ The insurance coverage afforded to the Additional Insured is p [] Workers' Compensation Insurance Sheet Submitted [] For General Contractor ~Subrogation Clause Copy of Insurance Certificate placed in fielder file ',)fie month prior to expiration. j:\forms\inscklst 4~96 (rev 6~96) FAX TO: Phone Fax Phone Nadio de Freitas AM Star Developments 1265 South Bascom, Ste. 209 San Jose, CA 95128 (408)294-4763 (408)297-9968 CC: Date 11/8/99 Number of pages including cover sheet FROM: doanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone Fax Phone (408)866-2150 (408)376-0958 2 REMARKS: [] Urgent [] For your review Re: Insured: AM Star Developments/Michael Achkar Permit No. 99-181/14419 S. Bascom Ave. [] Reply ASAP [] Please Comment We have reviewed the latest certificate of insurance submitted in connection with the above referenced permit. Although the automobile liability does not meet our minimum requirements tbr coverage limits, our Land Development Manager is willing to accept it as currently written. In the case of the workers' compensation coverage, however, the insurer needs to include a clause agreeing to waive all rights of subrogation against the City for losses arising from work performed by the Contractor for the City. A copy of the applicable section of our insurance requirements follows for your reference. When making the above changes it would really help us if you could add the work address (14419 S. Bascom Ave.) and permit number (99-181) somewhere on the face of the general liability certificate. Please call me if you have any other questions. Thanks fbr your help in this matter. Sene By: AM CONSTRUCT[ON; 4082979968; Nov-8-g9 10:41AM; Page 3/6 " CER 81 ITY THIS CF~TIFI'CATE 16 ~8$UE i AS A"MA f ~ P..N OF INFORMATION --- Lorc~ Z~ta~zut~e A~enc~Z Zne, ONLY AND CONFERS NO RI~ HTS UPON THE CERTIFICATE Atlan~'P&¢ificP. o. ~ox 6058 Ills. Brokers HOLDER. THIS CERllFICATi DOES NOT AMEND, EJ(TEND OR San Joes CA 95150 ALTER THE COVERAGEAFF H~DED BY THE POliCIES BELOW. COMPANIES i~l'OIm, DING COVERAGE COMPANy -Ph~"'No.408-559-4140 ~#o. 401~-371-1851 A Lloyds of L~ ~do~ COMPANY B Topa Inaur~ -'e Company 1265 So BalB(=o~ Ave 9209 COMp~' San Jose CA 95128 O COVERAGE8 ' THIS I~ ~ GERTID'~ I HAT 'I~E ~OLI~F,~ O~ INS~IGE M~TF.D ~ELOW 14~VE BEEN I~01'O Tile IN A / X C~UE~GE~L~mU~ LUC99115487 .Jc~ms~ ~ 04/26/99 04/26/00 ~TS.~p~ t [000000 Iu~~M ~-9506-01 04/26/99 04/26/00~ ~ s 1000000 '- WC~_~t~ C~N~TM ~D S Ci~TiRCATE HO~ER ~N~L~T~N AC~ 2~ (1~1 Sent-By:. AU CONSTRUCT[ON; 4082979968; Nov-8-99 10:42AU; Page 4/6 c. You a/Id ltlly othsr involved insured must: (l)Immediately send us cop[es of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist US, upon Our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured &ill, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur ~ny expense, other than for f'u'st aid, without our consent. 3. I.,egal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b, To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an a~'eed settlement or on a trmal judgment against an insured obtained after an actual trial; but we will not be liable for damages that are not payable under thc tcnns of this Coverage Pan of that are in cxcc~ of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant otor the claimant's legal representative. ther lasuran'¢e other valid and collectible insurance is available to the insu?cd for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary., our obligations are not affected unless an5, of the other insurance is also primazy. Then, v,e will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is exce: insurance, whether pti on any other (!) That is Fire, Extent Installation Risk o.r work"; (2) That is Fire insuran o?'temporarily occ[ of the owner; or O) If the loss arises aircraft, "autos" or' subject to Exclusim 1) When this insurance is under Coverages A or against any "suit" if a~ defend the insured aga insurer defends, we wi will be entitled to the those other insurers. When this insurance is we will pay only our s~. if any, that exceeds the (1) The total amount th: would pay for the lc insurance; and (Z)The total of all dedt amounts under all ti We will sha~c the roma other insurance that is Insurance provision an4 to apply in excess of th in the Declarations of ti Method of Sharing if ali of the other insurz equal shares, we will fc Under this approach, e~ amounts until it has pai insurance or none oft[ comes first. If any of the other ins~ contribution by equal limits. Under this metl based on the ratio of it: to the total applicable insurers. CG 00 01 01 96 Copyright, Insurance Services Office_ Inc., 1o94 Fn:CGL96CICMT82098 over any of the other dry, excess, contingenl or ,d Coverage, Builder's Risk. imilar coverage for for premises rented to you led by you w'it~ permission )f thc maintenance or usc of atercraft to the extent not g. of Coverage A (Section x~ess, we will trove no duty to defend the insured other insurer has a duty to st that "suit". If no other undertake to do so, but we :ured's rights against nil r, cess over other insurance, re of the amount o[the loss, Um of: :all such other insurance s in the absence of this tible and self-insured t other insurance. ting loss, if any, with any described in this Excess las not bought specifically .imits of Insurance shown [s Coverage Part. tee permits contribution by low this m~thod also. h insurer contributes equal its applicable limit of loss remains, whichever ncc docs not permit ~res, we ~ill contribute by id, each insurer's share is ~pplicabte limit of insurance ails of insurance of all Page 9 of13 58 Sent By: CONSTRUCTION; 4082979968; Nov-8-gg 10:43AM; Page 5/6 POLICY NUMBER LUC9911-5487 COMMERCIAL LIABILITY THIS ENDORSEMENT CHANGES 'l'ItE POLICY, PLEASE READ rr C~ ADDITIONAL INSURED--OWNERS, LESSEES OR CONTRACTORS (FORM B) THIS ENDORSEMFNT MODIFIT~ ~NSIJRANCP, PROVII)FI) UNDER I'H.,E FOLLOWINg: COMMERCIAL GENERAl. I.IABII,ITY COVERAGE PART: SCHEDULE CITY OF CAMPBELL CITY OF CAMPBELL REDEVELOPMENT AGENCY, 11 $ OI;HCL;RS, VOLUNTEERS DEPT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA 95008 ES AND (.IF NO ENTRY APPEARS ABOVE, INFORMAT ON RFQUIRED TO COMPFTF THIS THE DECI,ARATK}N,~ AS APPI.ICABI.E TO 1 HIS ENFX)R.~EMENT WH(_)~ AN INSIJREI} ~;ECTION 11) IN AMi';NI)~I) I't) INCI .! J[}t.: AN AN IN.~IJRNI'"J THF PFR: SIICJWN ~N'.['-H I-'..~(:l~Fi)[il iEi-Hli:i: [)Ni .y WI ["hi RFNPF.[TT TO I.TAHII try .~R ~INC~j INSURED t4y OR FOR YC')U T WILL BE $I IOWN IN CG 20 I0 11 85 COPYRIGIFF FNSI. rRANCE SERVICES OFFICE, INC t984 Sent By: AM CONSTRUCT[ON; 4082979968; N0v-8-99 10:41AM; Page 2 Automobile Po'"' Declarations PDEASE KEE~Wlrt-/ YOUR POLICY SEE IMPORTANT ~OTICE ON R£VERSE_ H FOR QUESTIONS OR CHANGES CAI~iL: t-sno-g22-8228 ACHKAR MICHAEL A 1265 S BA$COM AVE #209 SAN JOSE CA 95128 AM CNST SAN JO~E Item M~:e ~IVIOC/~I Yr.i~ TV~ 04 GMC : 1999 ~ 3/4 TN 05 eTUDE ~ 2D CPE ~ LI~ICITY LIMITS Bodily ~0,000 Me~Cel 2,0 Payments Uni~ed Meteri~t. Probity _~N1RZ28A2LXO08~30 JTZRA63C4E6205332 1GTGK29U6XE55235Z 61V27124 100,000 II~m 02 50,000 25,000 Amended Dec Policy Tyl:~ Member Policy ,"di. nTtt:~ 3C-41-61-8 YOUR Frc~h POLICY 08- PERIOD 12:O1 A,~A,, Sl AIt~nete ~ 294-4763 C)r evers <Jo Io prlnclI iration$ 1 uf 1 08-13-1999 [ 1983 ' TO -1999 J 10-04-1999 I~ as sfat~ ~ein, TTer~P~ ~ rmc~ari Iv eorrMN3o~d Item Comprehanllva 1 O0 ActUal Cash Value Less Deductible , Colllllon 250 Actual Cash Value Less Deductible All Risks Actual Cash value Less Deductible No Co,versos TOTAL P~EMtuNI P~R VEHICLE ~ EX~T~ OF No CoVerage No Co~erage z No Co~erage !60 ~ , CoVerage Limit A S16 S4 S5 Premium Summary Thi~ is not a bill. Add I tam CA Surcharge ~ !Discounts: Cotl Avoidance Light Item(e), 02, 04. Oood Driver Discount; Item{e}. 02, 04. 05. S~.~e Tutu Mat. Driver, N0~ Addition. I Premium: No CoVerage No Coverage No CoVerage S34 Pr~'nl ~m S34.00 ~010Ci)e? COMMON WEALTH CENTRAL CU 3075 UNION AVE SAN JOSE CA 85124 Sent By: AM CONSTRUCT[ON; 4082979968; Nov-8-99 10:43A~; Page 6/6 Sent By: AM CONSTRUCT[ON; 4082979968; I CONSTI~UCTION Nov-8-99 FACSIMILE MESSAGF TO: Joanne COMPANY: City of Campbell FAX: 376-0958 FROM: Nadia de Freitas DATE: November 8, 1999 PAGES: 6 RE: I~formation required for the Wong Dental project on Bascom Ave, Campbell Dear Joanne Reference is made to our telephone ~onversation of this morning. Should you require any furlher il contact me on 408 294-4763 ext. 25. Kind regards adla de Frmitals 1265 South H%sc. om Ave, Suite 209, San Jose, CA 95128 Telcphonc (408) 294-4763 · Facsimile (408) 297-9968 IO:40AM; Page 1 ~fmation, please do riot hesitale to ACORD. CERTIFICA7 OF LIABILITY INSUR' NC ',D,<O DATE,MM,DDt') ~ ~AMSTA- 1 11/02/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lords Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Atlantic-Pacific Ins. Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 6058 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Jose CA 95150 COMPANIES AFFORDINGCOVERAGE COMPANY A Lloyds of London Pho,e No. 408--559--4140 Pax No. 408--371--1851 iNSURED COMPANY B Topa Insurance Company COMPANY Am Star Developments, Ltd C ~~j~,,. _ · '"-,-,c.t VED 1265 So Bascom Ave #209 COMPANY San Jose CA 95128 D COVERAGES ,, u v 0 $ 1999 THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD PU~.. IND~cATED ~Tw~r^~D~G ANY RE~REME~ ~E~M ~R c~NDmo~ ~F AN¥ c~RA~ ~ ~HE~ D~cUMENT ~TH ~ESPEcT T~ ~H~c~ TH~S `~"..- C ' ' T M "'W~NI CER33FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE ER S, 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 (MMIDD/YY) DATE (MMIDDPfY) ] GGGG~NERAL LIABILITY GENERAL AGGREGATE $ 2000000 A IX l COMMERCIAL GENERAL L AB LITY LUC99115487 04/26/99 04/26/00 PRODUCTS-COMP/OPAGG $ 2000000 i I CLAIMSMADE ~] OCCUR PERSONAL&ADVINJURY $ 1000000 I X ! OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000 $1000 Deductible FIRE DAMAGE (An~ one fire) $ 50000 MED EXP (Any one person) $ 5000 AUTOMOBILE LIABILITY I ANY COMBINED SINGLE LIMIT $ AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY (Per accident) NON~WNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 1000000 B UMBRELLA FORM XL-9508-01 04/26/99 04/26/00 AGGREGATE ~ $ 1000000 X OTHER THAN UMBRELLA FORM ~ $ WC STATU- WORKERS COMPENSATION AND TORY L M TS EMPLOYERS' LIABILITY EL EACH ACCIDENTt~ $ THE PROPRIETOPJ ~-~ INCL EL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL ~ EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCA33ONSA/EHICLESISPEClAL ITEMS · 10 Day Cancellation Notice for Nonpay~_ent of Premium Ail Work in pLtblic. right of way, City of Campbell, City of Campb. ell .Rgd. e.vlopmgn_t Agenqy, its officers,, empl?yees and_v_o~l~u.n~tg.e.e~r.s' are na~. e~ .a.s..~o~i~iona~ ±ns, ure~ as respects lia~i-~ty per u~ zulu~£luD; attacned.witn primary wor~ing per p~ 9of13 CERTIFICATE HOLDER CANCELLATION C ITYCA9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXP~RA~O,N DATE THeReOF. Tt-'.E ',SSUIN~ CC!,tFAkY W~LL City of Ca~pbe!l 3 O* DAYS WR[~EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LE~T, Dept of Publlic Works --::-:: ::c-:n~ -::--.: :::_: ............ :~:: ~. ':--~:: :~., 70 North First Street Campbell CA 95008 -~. ..... - ...............~ --' :"'I~!~,~ ...... AUTHORIZED REP~TA~'E ~t /, ACORD 25-S (1/95) " ACORD CORPORATION 1988 c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection xv~h the cla'.'m or su:t'; (2) Authorize us to obtain records and other info,,-nation; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit"; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's cost, voluntarily make a payment, assume may obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured obtained after an actual trial; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. Other Insuran'ce l f other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B ofthis Coverage Part,. our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in c. below. bo Excess Insurance This insurance is excess over any of the other 'insurance, whether primary, excess, contingent or ...... ,. on any other basis: (1)Tk. zt is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (2) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; or (3)If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Coverage A (Section I). \Vhen this insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" if any other insurer has a duD' to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of~the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this ,~, insurance; and c '- ' ~ (2) The total of all deductible and self-insured ~--" amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. blethod of Sharing If all of the other insurance permits contribution by equal shares, we will follOw this method also. Under this approach, each in~;urer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. CG 00 01 01 96 Fn:CGL%CICMT$209S doc Copyright, Insurance Services Office, Ina., !994 Page 9 of 13 58 POLICY NUMBER LUC9911-5487 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED--OWNERS, LESSEES OR CONTRACTORS (FORM B) THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART: SCHEDULE CITY OF CAMPBELL CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS DEPT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA 95008 (IF NO ENTRY APPEARS ABOVE, INFORMATION REQUIRED TO COMPETE THIS ENDORSEMENT WILL BE SHOWN IN THE DECLARATIONS AS APPLICABLE TO THIS ENDORSEMENT. WHO IS AN INSURED (SECTION I 1) IS AMENDED TO INCLUDE AS AN INSURED THE PERSON OR ORGANIZATION SHOWN IN THE SCHEDULE, BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF "YOUR WORK" FOR THAT INSURED BY OR FOR YOU. CG 20 10 11 85 COPYRIGHT 1NSUPoUNCE SERVICES OFFICE, INC. 1984 11-0~71999 10:40AM FROM !ACO. O. , PRODUCER LOrds InsUrance Agency Atlan~ic-m~cific Ins. Brokers P,o. San JOse C/A 95150 Ph~,,iNo. 408-~ ~a~No 408-371-1851 LORDS TO 29?9968 P. 01 OF LIABILITY IN'SUF 11/02/99 --;/:HIS;CERTIFICATE IS ISSUED AS A ONLy AND CONFERS NO RIGH,TS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. · * COMPANIES AF_FORDING COVERAGE COMPA~/y A i Lloyds of London c OM PA ~ Y Am Star Developments, Ltd 1265 So Bascom Ave %209 San Jose CA 95128 THIS I$ TO CERTIFY 'I'H~T THE POLLO F$ OF INS ...... INC~GATED NOTWITHSTANDING ANY ~ ......~.U_.R~._NG__E ~.STED BELOW HAVE BE*tN ISSUED TO THE INSURED I~ , -==u ~=~vt: POR THE POLICY PERIOD ' ' , ~a~t<cre=Nr, TERM OR CONDITION 0 EXCkuSIONS AND CONDITIO~ OF SUC}~ POLICIE~ L/MI~ ~HOWN MAY -' v ~' ~nc FULI~IE~ DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, · - .... ~ E BEEN REDUCED BY PAID C~IMS. TYPE OF INSURANCE GENERAL COMM*tRCIAL GENERAL LIABILITY ~ CLAIlf4$ MA~E [~ OCCUR OWN*tR'-~] & CONTRACTOR'S PROT __ $1000 Deductibl~ POLICY NUMBER LUC99i15457 AUTOMOBILE LIABILITY ]J ALL OWNED AUTOS ~ 'CHEDULED AUTOS NON~WN*tD AU¥OS A~¥ AUTO' tl '~' { OTH*tR THAN UMBRr-*t ! a FORM XL-9508-01 PROPRIETOR/. leal:{ TN *t R.?.qEX E C U TI V,t INCL /. ~CL | Tops Insurance Company DATE (M MIO~)/~/y) DATE 04/26/00 LIMITS GENERAL AGGREGATE PRQDUCT$ -___COMP/DP AGG PERSONAL & AOV ~NJURY ~C"3C___CURRENC~ FIRE DAMAG*t IA~ Dna timI $2000000 .2000000 sl000000 $1000000 sS0000 COMB~N*tD *tINGLE LIMIT BODILY INJURY (Per pe,raonI fBODIL'i' INJURY (Per accident) PROPERTY DAMAGE AUTO ONLY. EA ACCIO*tN 04/26~99 OTHER THAN AUTO i i EACH ACCIDENT $ " AGGREGATE $ IOCCUR~NCE L000000 :04/26/00 AGG~E~ 1000000 EL EACH ACCIDENT EL DISEASE - POLICY LIMIT EL OISEASE . ~ :ellation No~ice for Non a an City of C ' P Y~- t of Premiu~ ' . . , ~uaF~-ell, Clt o :Ail Work zn · -es and.volunt~.,..Y__~ Campbell RedeWlonment a~.~.ublac P CG 2010(1285~ =~ .... ~ .... ~lona! Znsured ~. City of De~ of Publlic 70 North First Street Campbell CA 95008 C/TYCA2 CANCEL ~LATION SNOUI. DiANY OF THE ABOV~ OE$CR1Er;D POLICIES EE CANCELLED/~EFORE THE EXP~ON DATE THEREOF THE ~$U N~C0~PANy t%, ~ ~ ~ DAYS WR[~EN NO~CE TO THE CERIrFICAYU HOLD~R NAMED T T:~ LEFT, fROM LORDS c. ~/'ou and any o~.her involve~ insured must: fl)Immediately send us copies of any demands, not,cos, summonses or legal papers received in connecric, n with the claim or su.~ ; (2)Authorize us to obtain records and o:her info~ation; i (3) Coop{rate xvi}h us in the ilnvestigation or settler~ent of ~e claim or; defense agsinst the "suit"j and (4) Assl~. us, upon our request, in the enfomemenr Of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or i~cur any expense, other than for first aid, withol.'t :our consent. .3. Legal Actio.~ Again'si: Us No person o~ organization has a iright uader this Coverage PC: ; a. To join us, as a p .irt'y or otherWise bring us into a "suit" asEing for damages fr~m an insured; or b. To sue us on thisCoverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an a'.~'eed settlement or on a finaljudgrnent against an insured obtained after an actual trial; but we will not be liable for damages that are not payable under the terms of this Coverage Part Or that are in excess of the :applicable li~it of ins.urarice. An agreed settlement means a settlement and release of liability signed by u~, the insured mad the claimant ,,~ or the :claimant's legal representative. ~Oth:er Insuran'ce i :'~__jlf Other valid:, and co!lectible insurance is available ii to the'insured for a loss we corel- under Coverages A Or B ofthii Cover.hdC Part, ou? obligations are ! limited as roi!lows: a. PrfmaD' !nsura6ce This insurance is lprimary except when b. be[ow applies. If this insurance is primary., our 0bl'igations are not affected unless any cf the other insurance is also primal,. Then, ~,'e w~ll $:hare with all that other insurance by thc method described in c. below. CG 00 01 01 ~6 Fn:CGL~6CICMT82098.doc TO 2979968 P.02 Iasurance Service': b. ~xcess Insurance ~his insurance is excess over any of the other 'in. surance, whether primlary, excess; contingent or oh any other basis: (!) TE*[I is Fire, Extended Coverage, Builder's Risk, Inst~llation Risk or similar coverage for "vt ur (2~) That ii Fire insurance for premises rented.t< you or temporarily occupied by you with perm'i, s:ion ofth,~ owner; or ' (~ ~I f tM loss arises out of the maintenance or Use of : aircraft, "autos" or watercraft tolthe extent not subject to Exclusion g. of Coverage A (Section g~en this insurance is excess, we will have no duty u~der Covera_*es A or B to defend the insured against any "suit" if any other insurer has a dubs' to d~fend the insured against that "suit". If no otl~.'r Insurer c~efends, we will undertake to do so, b~: we mill be ~ntitled to the insured's rights agains~.a .t ose ot er i.surers. 'When this insurance is ex,xess over other insur~ w~ will ~ay only our shoe of tl~e remount i~any, tfiat exceeds the sum of: ' '(1~) The total amount that ail such other insurance I would pay for the loss in the absence of this [ insurance; and (i) The ~otal of all deductible and self-insured: I amounts under all that other insurance. We will !share the remaining loss, litany, with an5, ot]ner insurance that is not described in this Excess Ir~surance provision and Was not bo.~ght specifically · to apply :in excess of the :'Limits of Insurance inl the Declarations of this Coverage Part. Method of Sharing* · l~all of {he other in"surance permits contributib,!iby equal sh~tres, we will follow this method also.. U~hder tfl. i, approach, each inibrer contribute$ie, iaal amount~I until it has paid its applicable limit cfi m~ rancle or none of the loss remains, whiche.:ve? cc~mes fi{,rst. . ' l~,ny of the other insurance does not permit c6ntribution by equal sh,ares, xve will contribute by liznits. Under this meth6d, each insfirer's share is b~ sed on, the ratio of its applicable limit of insurance tcIthe total applicabl.e limits of insurance of all insurersJ P~ 0~ POLICY NUMBER LUC9911-5487 COMMERCIAL GENERAL LIABILITY' THIS ENDORSEMENT CHANGES. TIiE POLIC~, PLEASE READ IT CAREFULLY. ADDITIONAL SURED--OWNE,RS, LESSEES OR CONTRACTORS (FOR~ B) THIS ENDORSE MENT MODIFIES INSURANCE PROVIDED UNDER T{I-/ ~ ' ' ' E FOLLOWING: COMMERCIAL GENERAL LIABILITY COVER4~ GE P~RT: SCHEDULE CITY OF CAMPBELL CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS DEPT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA 95008 . (IF NO ENTRy APP~AR.q AiSOVE, INFORMATION RE U] . WHO IS AN INSURED (SECTION I l.) IS A.MENDEO TO INCLUDE AS J/NSURED THE PERSON OR ORGANiZATIoN 'SHOWN IN THE $CHEDUL£, BUT ONLY WITH RESPECT 'to LI . .. ,. INSURED BY OR H)R YOU, ABILITA~ ARISING OUT OF YOUR WORK FOR THAT CG20101185 COPYRIGHT FNSURANCE SER VICES OFFICE, INC. ENDORSEMENT '~LL BE SI-IOWN IN 984 TOTAL P. O3 ACORD. CERTIFICA-E OF LIABILITY INSUF NC. ,D DATE,MM,DDt) ~' ' ~' ~AMSTA-1 10/05/99 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lords Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Atlantic-Pacific Ins. Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O, Box 6058 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Jose CA 95150 COMPANIES AFFORDINGCOVERAGE Pete Edwards COMPANY PhoneNo. 408-559-4140 FaxNo. 408-371-1851 A L1oyds of London INSURED COMPANY B Topa Insurance Company COMPANY Am Star Developments, Ltd C 1265 So Bascom Ave #209 COMPANY San Jose CA 95128 D COVERAGES 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. CTOR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MMIDD/YY) LIMITS GENERAL LIABILITY --- GENERAL AGGREGATE $ 2000000 A X COMMERClAL GENERAL LIABILITY LUC99115487 04/26/99 04/26/00 PRODUCTS-COMP/OPAGG $2000000 IcLAIMSMADE [] OCCUR PERSONAL&ADViNJURY $ 1000000 X OWNER'S & CONTRACTOR'S PROT -- EACH OCCURRENCE $ 1000000 $1000 Deductible FIRE DAMAGE (Any one fire) $ 50000 MHD EXP (Any one person) $ 5000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ 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 $ 1000000 B UMBRELLA FORM XL-9508-01 04/26/99 04/26/00 AGGREGATE $1000000 X OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND I WC STATU* L!OETRH' EMPLOYERS' LIABILITY ~TORY LIMITS EL EACH ACCIDENT I $ THE PROPRIETOR/ ~ INCL PARTNERS/EXECUTIVE~ EL DISEASE - POLICY LIMIT$ OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS *10 Day Cancellation Notice for Nonpay~_ent of Premium All Work in public _ri~_.ht__o__f way,.City of C. amp~bel.1, City of Campb. ell _Re.d. evlopm_ent agen%y, its u~cers, employees and vo-un~eeers are namer as Aa~itional Insured as respects liability per AC 212 (8-98) attached) CERTIFICATE HOLDER CANCELLATION C ITYCA2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL City of Campbell 30' DAYS WRI]-FEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dept of Publlic Works 7 0 North First Street BUT FA!LU~~ T(% UAII ~-'-'C:: ;;CT:C~- t.u..a ~~_ ,,aO9~ ~ ~RL!~-~T!C~, C.~. L:AD;L;TY Campbell CA 95008 o ~F43k~- K:~-- NY, ~TS AGENTS OR REPRESENTATIVES. "^CORD 1988 ENDORSEMENT # 1 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: AM STAR DEVELOPMENT LUC9911-5487 COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: BLANKET ADDITIONAL INSURED UP TO TEN ONLY (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. THIS INSURANCE DOES NOT APPLY TO: "Bodily Injury" or "Property Damage" arising out of any act or omission of the ADDITIONAL INSURED(S) or any of their "employees", other than the general supervision by the additional insured(s) of your ongoing operation performed for the ADDITIONAL INSURED(S). AC 212 (08/98) STATE ~.0. BOX 420807, SAN F.ANCISCO, CA g4142-0807 COMPENSATION INSURANCE I::U N D CERTIFICATE OF WORKERS, COMPENSATION INSURANCE NOVEMBER 17, 1999 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ATTN: JOANN 70 N FIRST STREET CAMPBELL, CA 95008 POLICY NUMBER: 1427359-99 CERTIFICATE EXPIRES: 04'01'2000 RECEIVED NOV 181 1 ) t PUBLIC WORK8 L_ ADMINISTRATIOIi_ This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms; exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE PRESIDENT COST: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 11/12/99 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT THIS CERTIFICATE CORRECTS AND SUPERSEDES THE CERTIFICATE ISSUED ON: NOVEMBER 12, 1999 EMPLOYER MICHAEL ACHKAR CONSTRUCTION 1265 S BASCOM AVE #209 SAN JOSE, CA 95128 SI'ATE COMPENSATION INSURANCE FUND NOVElV[BER 12, 1999 / P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS, COMPENSATION INSURANCE CITY OF CAMPBELL PUBLIC WORKERS DEPARTMENT ATTN: JOANN 70 N FIRST STREET CAMPBELL, CA 95008 POLICY NUMBER: 1427359- 99 CERTIFICATE EXPIRES: 04-01'2000 i RECEIVED PUBLIc WORK8 ADMINJSTRATiO~ This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER' S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000~00 PER OCCURRENCE. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 11/12/99 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF CAMPBELL PUBLIC WORKERS DEPARTMENT EMPLOYER MICHAEL ACHKAR CONSTRUCTION 1265 S BASCOM AvE #209 SAN JOSE, CA 95128 FUND P. 1/~ SAN JO'--' DISTRICT OFFICE FACSII~,,L.E COVER SHEET TELEFAX NUMBER IS: &08-36:~!--7640 , DELIVER TO: NAME: COMPANY: FROM: NAME' DEPARTMENT/SECTION: CERTXIrX ,CA~ DEPAR~mmT 4~,363-77~, 8 PHONE: ....... · ~MOV 1~ '99 03:55PM SCIF POLIC]~" p.~×~ ' FRANCISCO. CA 94142-08O7 CONIP,ENSATIO N IN~,~ U F~A N O E F L ATTN: JOANN ':' 'L ', CAN~BI~L, CA 95'008 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California insurance CommiSSioner to the employer named below for the policy period indicated, This policy in not subject to cancellation by the Fund except upon ten days' aavance written notice to me' employer. We will also give y~u TEN days' aclvance,notice should this policy be cancelte~l prior to its normal expiration, This certificate of'insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by .the policies listed herein. Notwithstanding any requirement ,term, or condition of any contract or other document with respect to which th s eoriifica~ of ill~rance may be ~s~d' o[ m~t pertaith, ~e insuran~~ ~,fford~:t by the ~licies descr bed heroin i{ subj,'ct to all the tgrrns; exclusions ar~l'conditto~s of such..l~tioie$. · ',. "." ".' . ' · . ,EI~OI~EH~lqT #2570 ENTITLED ,I~IAIVI~R OF SUBROGATION EKEECTIYE 11/12/99 ]ES ATTACHED TO ~ FORRS A PART' OF ~ftlS POLICY. TRIRD PARTY NAtiE: CITY OF CAHPBELL PUBLIC NOEKERS DEPA~THE~T mCHAEL ACHKAK':CONSTRUCTION 1265 S BASC0~I AV, E SAI~ JOSlg, C~ 95128 P. 1/.::' SAN, ,~E DISTRICT OFFICE FACSIMILE COVER SHEET TELEFAX NUMBER IS: DELIVER TO: NAME: COMPA.y: DATE: //-/~- -~'~ TELEFAX NO: ~ FROM: ~.~E: DEPARTMENT/~ECTION: C]~TLa,ZCLT~ PHONE: e,u 408-363-.772~ . MESSAGE: l'EXs ~Ox,~rct, /S ]~ ~ ~ ~-~Z~ ~ ~E TOTAL NUMBER ~ PAGES, ~ ~lS ~R ~E~, ARE .~OV 1~ '99 04~4PM SCIF POLIC]-- p l-- This is to certify that we have issueO a valid Workers' Compensation ~nsurance policy in a form approved.by the California Insurance Commissioner to the employer named below for the policy period indicated. ' This policy iS not subject to cancellation by the Fund except upon te.n days' advance written notice'to the empl°Yer. We will ills0 give you TEN days' advance notice should this Dolicy 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 looJicJes listed herein. Notwithstanding any requlceme~nt;,term, or condition of any contract or' other document With respect to which this,certificate of insurance may .be issUed or may per~a,n,'the nsurandi~';~fo~rded. ~ the ~olicles described herein'is'Su'bject to all the ti)~ms .exctusio~,~ and °°nditionS of such'.pol ci~_ '. ' '/'. ~ "'. '". ' ;. · ]gl~[,0YgR' S LXA]~XL~TY LXI~XXT XNCI,~9YNG ;D.E~ENSE "' COST'.. $1, ooO,'0ocr.. 0e..ps~, .'0c~c~.. EI~ORSEI~'NT #2570 ENTITLED NAIVER OF'SUBROGATION EFFECTIVE 11/12/99 IS ATTACHED TO AND FOR_SiS A PART OF THIS POLICY. THIRD PARTY N,~: CITY OF CAI~BELL PUBLIC WORKERS DEPARTHENT EMPLOYER :' ' '~ , MIlL ACIIK.~ C,O] ,:~, TRUCTZON s SASC0M z00. JOSE, ~ 95128 RECEIVED STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE PL~JL~c WORKS I=:U N ~ CERTIFICATE OF WORKERS!COMPENSATION INSURANCE OCTOBER 8, 1999 POLICY NUMBER! CERTIFICATE EXPiREs:; CITY OF CAMPBELL DEPT OF PUBLIC WORKS 70 !"4 FIRS]" ST CAMPBELL CA 95008 / This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be iSsued or may pertain, the insuranCe afforded by the policies described herein is sub!eot to all the termsl exclus °~s and conditiOns of such POliCies. AUTHORIZED REPRESENTATIVE EMPLOYER' S LIABILITY LIMIT TNt"! Iin'r~,iR ~F?F&°~ ........................ COSTS: ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMI:::'LBYER EFFECTIVE 10/07/99 IS ATTACHED TO AND FORMS R [:'ART OF THIS POLICY, NAME OF ADDITIONAL INSURED= CITY OF CAMPBELL ACHKAR, MICHAEL ALLnN MICHAEL ACHKAR CONSTRUCTION 1265 S BASCOM AVE ff209 SAN JOSE CA 95128 "rATE COMPENSATION INSURANCE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE 19,gq This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer. We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which els Certificate of: inS8rance may be issued or may pertain; the nsuran6e afforded by the policies described herein i~ s~bject to a the ~;rms; exclusi°:~s and ~°~d t ~s of suchP0 ce~ i D POLDYHOLDER'$ COPY CSAA Inter-Insurance Bureau 150 Van Ness Avenue PO. Box 429186 San Francisco, CA 94142-9186 Automobile Policy Declarations PLEASE FEP WITH YOUR POLICY. SEE IMPOR?/~,VT NOT/CE ON REVERSE. 1. Name and Address of Insured ACHKAR MICHAEL A 1265 S BASCOM AVE #209 SAN JOSE CA 95128 Alternate Address AM CNST SAN JOSE I tern Make 02 t N I SSN 03 i TOYOT 04 ! GMC 05 i STUDE Model Yr. 1999 1961 Body Type 2D HBK' 2D CPE 3/4 TN 2D CPE COVERAGE Each Person IOccupat i on Vehicle Identification Number JN1RZ26A2LX008530 JT2RA63C4E6205332 1GTGK29U6XE552352 61V27124 .ITY IITS Item 02 Each Occurrence Deduct. i Premium 100,000 FOR QUESTIONS OR CHANGES CALL: Policy Type Member I ! YOUR I ~ PERIOD Bodily Injury 50,000 Medical 2,000 Payments Uninsured Motorists 30,000 Property $123 $44 1-800-922-8228 Declarations Type IPa: Renewal Certificate of 1 Process Date 08-27-1999 Policy Number Ensured Since 3C-41-61-8 1993 From To POLICY 10-04-1999 10-04-2000 12:01 A.M., Standard Time at the address of the Named Insured as stated herein. Alternate Number I Telephone Number 294-4763 I Name Driver License No. MICHAEL C4131551 NADIA A0000000 Drivers do not necessarily correspond to principally operated vehicles. Item 03 Deduct. Prerniurn $418 $129 60,000 $36 $74 25,000 $102 $439 Item 04 Deduct. Premium Comprehensive Actual Cash Value Less Deductible Collision Actual Cash Value Less Deductible All Risks Actual Cash Value Less Deductible TOTAL PREMIUM PER VEHICLE 100 i $165 250 ~ $394 No Co'ye r age $864 ; EXPLANATION OF LIMIT CODES Automobile Death Benefits i A=$15,000 first named insured. i B=$15~000 each first named insured and spouse, Premium Summary CA Surcharge: This is not a bi//. Savings Dividend: Schedule of Changes No Coverage No CoVerage No CoVerage $1060 C=$15,000 each additional named in- sured shown on eedo;&~,,t F329. 100 j $88 250! $273 No CoVerage $617 Limit Cods A $0.00 $168.00 Annual Premium: I tern 05 Deduct. i Premium $25 No Co~verage No Cok/erage No CoVerage $194 Premium $4 $2,739.00 Discounts: Coll. Avoidance Light Item(s), 02, 04. Mat. Driver, None. Good Driver Discount: Item(s), 02, 04, 05. Item COMMON WEALTH CENTRAL CU o4 3075 UNION AVE SAN JOSE CA 95124 I tern 10 I0CP97 I tern I t em RECEIVED NOV I 0 1999 PUBLIC WORKS ADMINIBTRATION Declarations Continued on Reverse reasons to "Stick" with OLD REPUBLIC TITLE CQMPANY! Ask about our ne},, Homeowner's Policy . . . Mik; kar Const~ ~.,on Engineer AM Star Developments, Ltd. Northern California Division 1265 South Bascom, Suite 209 San Jose, CA 95128 Fax: 408.29719968 mike@amconstruction.com STEEL BUILDINGS Ucense ~ 698195 · Complete items 1,2, ~' Als0 complete item 4 if Restricted De~, / is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Dr. Dennis Wong 14419 S. Bascom Ave. Los Gatos CA 95032 A. Sigrr4,tu~ X ~ ~/' [] Agent [] Addressee B, Received by ( Printed Name) C. Date of Deliver,/ D. Is delivery address different from item 1 ? [] If YES, enter delivery address below: [] No 3..~rvice Type 1.3'Certified Mail [] Express Mail [] Registere~ [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number ('l'ransfer from service label) 7 0 0 1 1940 0007 9737 8133 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1035 Postage C~rtified Fe~i Return Receipt Fee (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees Postmark Here VIA CERTIFIED MAIL August 2, 2002 0~ · C/id/mm CITY oF CAMPBELL Public V,/orks Department CAMPBELL Dr. Dennis Wong 14419 S. Bascom Ave. Los Gatos, CA 95032 SUBJECT: PERMIT NO. 99-181 LOCATION: 14419 S. Bascom Avenue ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE Dear Mr. Wong: The City of Campbell has made the final one year maintenance inspection of subject Public Works improvements and find that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Please find attached your original Maintenance Certificate of Deposit of $6850.00 which we are returning to you. Sincere~ Senior Public Works Inspector Enclosure cc: Permit 99-181 Public Works/Maintenance Division Bank of America, 1310 S. Mary Avenue, Sunnyvale, CA 94087 H:~Permits~99-18 I\ MTCEACC(WORD) 70 North First Street · Campbell, California 95008-1436 · TEL 408.866.2150 . F^X 408.376.0958 . TDD 408.866.2790 CITY OF CAMPBELL Public Works Department May 31,2001 Dr. Dennis Wong 14419 S. Bascom Avenue Los Gatos, CA 95032 SUBJECT: Dear Dr. Wong: PERMIT NO. 99-181 LOCATION: 14419 S. Bascom Avenue FINAL INSPECTION AND ACCEPTANCE 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. Your Maintenance Deposit of $6,850.00 has been received, therefore, we are returning the attached Certificate of Deposit No. 06221-01744. Your Construction Cash Deposit of $1,096.00, plus any interest due, is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2168. Sincerely,/'3 /' Alan om~'~~ Public Works Inspector MQ Suspense- 11 months Permit #99-181 Inspector File Surety Company Name and Address J:\FORMS\FINALFRM(WORD) 70 North ~First Str¢c? Campb¢ Q~l;f(,rnia 95OO$-1 '"~, TF!. 405 q66.2 t 50 F~X 408 376.0958 TOO 408.8662790 City of Campbell Depaxmient of Public Works ,{OACHMENT PERMIT ISSUANCE CH ; LIST Encroachment Permit No. /_--~F ~_/~o/ Tract No. ~ ITEMS REQUIRED FOR PERMIT APPLICATION: t~ Applicant section complete _~ Applicant signature and date (front and back) ~./~/ Permit Application Fee $225.00 paid- Receipt Number .~ Engineer's Estimate Submitted ./~ Plan Check Deposit Paid (2% of Engineer's Estimate, $$00 rain) Receipt Number ~ive Sets of Improvement Plans Submitted ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, the~f 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 $ ,~aff..ff~/~'zae Receipt No. Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Security for Monumentation Amount $ Receipt No. ~ Construction Eme;gency Cash Deposit: 4% of Engineer's Estimate. ($500 minimxtm, $10,000 maximum) Amount $ /./~'.~ Receipt No. ~~ __.~_~- Storm Drainage Area Fee AmountS d~;' _~ Receipt No. ~~_~ ~%-.c~Worker's Compensation Insurance Information Sheet Received for Applicant. Ajl:.oothe.r Public Works r,equirements listed in the Cond~ions~f Approval of the development. Other Fees, Pa~y~ts, Deposits Ameffnt $ ~ ./~/~ P)J~ipt RE0UmSD PRIOR TO SSUANCE OV ENCROaC S'r PERMrr: Contractor's signature added to the permit application (front and back) Worker's Compensation Insurance Information Sheet received from Contractor. Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped APPROVED FOR CONSTRUCTION. Permit signed by City Engineer. WI:tEaN ALL OF THE ABOVE ITEMS ARE COMPLE'IE, PERMIT MAY BE ISSUED. Issuer: Initial and date and f'fie with permit. -~I~: ~ ,UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\wor~ f~o'rms\pmtcklst rev. 4/97 WORKER'S COMPENSATION INSURANCE INFORMATION The following worker's compensation insurance information is required for all Applicants and Co. ntractors. One of the following items for each Applicant and Contractor must be submitted prior to working under a Public Work permit or contract. WORKERS' COMPENSATION INFQRMATION: Name of Contractor/Applicant A Certificate of Consent to Self-Insure issued by the Director of Industrial Relations; OR A Certifi~i~-of~W0rkers' Compensation Insurance Insurance Co. Policy No. Expiration Date ; OR A signed Certificate of Exemption from the Workers' Compensation laws as printed below. CERTIFICATE OF EXEM]YTION Title I 'certify that in the performance of the work for this contract, I shall not employ.any person in a manner so as to become subject to the Workers' Compensation Laws of California. Signed /~~ ~"/~'-b'z7 Date 10 NOTICE TO APPLICANT/CONTRACTOR: If after signing this Certificate of. Exemption, you should become subject to the Workers' Compensation provision 'of the I~bor Code, you must forthwith comply with such provisions or the Permit or Contract will be cancelled or revoked. j:\forms\workcomp(rev6/96) WORKER'S COMPENSATION INSURANCE INFORMATIO~ The following worker's compensation insurance information is required fog,all,].Applicants and Contractors. One of the following items for each Applicant and prior to working under a Public Work permit or contract. PUBLIC WOR WORKERS' COMPENSATION INFORMATION: Roaav, ..... Ks Name of Contractor/Applicant Certificate of Consent to Self-Insure issued by the Director of Industrial Relations; ,OR Certificate of Workers' Compensation Insurance Insurance Co. Policy No. Iz4q--7' . Expiration Date ;OR A signed Certificate of Exemption from the Workers' Compensation laws as printed below. CERTLP1CA1E OF EXEMI~r'ION I Certify that in the performance of the work for this contract, I shall not employ.any person in a manner so as to become subject to the Workers' Compensation Laws of California. Signed Title Date NOTICE TO APPLICANT/CONTRACTOR: If after signing this Certificate of Exemption, you should become subject to the Workers' Compensation provision of the I2bor Code, you must forthwith comply with such provisions or the Permit or Contract will be cancelled or revoked. j:\forms\workcomp(rev6/96) 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 (identified as File No. S 98-24 made and entered into this ~.3 r_.4. day of ~[c~L! , 19 ~, by and between DENNIS K. WONG AND DORA S. NG, HUSBANDMAND WIFE AS JOINT TENANTS, 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 January 26, 1999 the Planning Commission per Resolution No. 3217 granted conditional approval of S 98-24 for that certain real property described in Exhibit A attached and incorporated as though fully set forth herein, and commonly known as 14419 South Bascom 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 Site and Architectural Permit; NOW, THEREFORE, IN CONSIDERATION OF THE ABOVE-MENTIONED APPROVAL, and 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 full 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 detects which may appear in said improvement work within one (1) year from the date of acceptance of the work by City and pay for any damage to other work resulting from the construction thereof, as well as pay the cost of all labor and materials involved. This 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 ahy 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 satisthction 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 filed 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 for 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 tbr the purpose of securing said easement and right of way, Owner, or his successors, shall deposit or cause t° 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 tbr 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 expense 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 o? 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 from 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 14419 South Bascom Avenue, and the City's property, commonly described as South Bascom 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 attorneys' 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 14419 South Bascom Avenue, Lands 6f Dennis Wong, Encroachment Permit 99-181," which are subject to approval by the City Engineer, prepared by Westfall Engineers, Inc., 14583 Big Basin Way, Saratoga, CA 95070. IN WITNESS WHEREOF, said City has caused its name to be affbted 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. Dennis K. Wong and Dora S. Ng, husband and wife as joint tenants Dennis Dora S. Ng (Notary Acknowledgment for above signator(ies) MUST be attached.) CITY OF CAMPBELL Robert Kass, Public Works Director ATTEST: Anne Bybee, City Clerk h:\agr\ !4419bas (mp) EXHIBIT A Ali' that certain real property situate in the City of Campbell, County of Santa Clara, State oi' California, described as follows: BEGINNING at an iron axle set at the point of intersection of the Northwesterly line of the San Jose-Los Gatos road, with the Northerly line of that certain 3.00 acre tract of land described f'u'stly in the Deed from James Long, et ux, to Cornelius O'Donnell dated August 11, 1873, recorded September 5, 1873 in Book 30 of Deeds, page 273, Santa Clara County Records; thence from said point of be~innlng South 89° 1.3' 40" West along the said Northerly line of the 3.00 acre tract, 114.69 feet to an iron pipe; thence North 0° 47' 20" West and parallel with the Easterly line of White Oaks Road for a distance of 86.04 feet to an iron pipe set on the Southerly line of that certain tract of land described in the Deed from Raymond Angelo, et ux, to Clyde J. Stemel, et ux, dated September 1.9, 1952, recorded September 22, 1952 in Book 2491 Official Records, page 300, Santa Clara County Records; thence North 89° 13' '40" East along said last named line, 177.41 feet to an iron pipe set at the Southeasterly corner thereof on the said Northwesterly line of the San Jose-Los Gatos Road; thence Southwesterly along the said Northwesterly line of the San Jose-Los Gatos Road on the are of a curve to the left, with a radius of 6,028.$0 feet, through a central angle of 1° 00 43" for an arc distance of 106.46 feet to the point of beginning, and being shown upon that certain Map entitled, "Record of Survey of the Lands of Raymond Angelo", which Map was filed for record on December 15, 1953 in Book 65 of Maps, at Page 26. EXCEPTING THEREFROM all that portion of said land as granted to County of Sa,ia Clara by instrument recorded January 14, 1951 in Book 9185, page 8, Official Records, and as more particularly described as follows: Beginning at the point of intersection of Easterly prolongation of the Northerly line of that certain parcel of land conveyed in the Deed to Saivatore Cannata and Carmelina J. Cannata recorded April 6, 1959 in Book 4375 of Official Records, Office c,f the Recorder, County of Santa Clara, State of California at Page 201 with that certain monument line established for record on that pa,-ti~; -alar map entitled "Record of Survey of a Monument Line of South Bascon; Avenue from Union Avenue to Lark Avenue" Fried for record in Book 264 of Maps, Office of the Recor~ler, County of Santa Clara, State of California at Pages 49 to 54; thence from said point of beginning Southerly along said monument line to the point of intersection with the Easterly prolongation of the Southerly line of the above mentioned parcel of land: thence Westerly along said Easterly prolongation and Southerly line to the point of intersection thereof with a line parallel with and 43.00 feet distant Northwesterly measured at right angles from said monument line; thence Northeasterly along said parallel line to the point of intersection thereof with the Northerly line of the above described parcel of land; thence Easterly along said Northerly line and Easterly prolongation to the 'point of beginning of this description. STATE OF CALIFORNIA COUNTY OF ~ ^ ~' ~ '"' .... (Notary Public) . personally appeared ~ personally known to me (or proved to me on the basis of satisfactory evidence) to be th~eperson(s) whose name(s) is/~ subscribed to the within instrument and acknowledged to me that he/sh the~executed the same in his/her/~r authorized capacity(les), and that by his/herB signature(s) on the instrument, the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. (Signature o~Notary Pu7 Comm.//1125025 NOTARY PUBLIC-CALIFORNIA ~ City & County of San '"" My Comm. Expires Jan. 3~, 2001 T (This area for notarial seal) CITY OF CAMPBELL Public Works Department June 30, 1999 Mr. Kevin D. Kelly Assistant Vice President Bank of America, Pruneyard Branch 200 The Pruneyard Campbell, CA 95008 Re' CD Investment Certificate No. 06221-01744 Purchased by Dennis K. Wong, DDS Permit No. 99-181 14419 S. Bascom Avenue Dear Mr. Kelly: Enclosed is a copy of the fully executed Assignment and Receipt of Investment Certificate for your records in connection with the above CD. Sincerely, Joanne M. D'Ambrosia Principal Clerk H:\WORD\LANDDEV\ 14419BAS(JD) 70 North First Street · Campbell, California 95OO8.1423 · TEL 408.866.2150 · F^X 408.376.0958 · TDD 408.866.2790 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 14419 S. BASCOM AVENUE Date: 5120199 Encroachment Permit No. 99-181 Application No. "S' 98-24 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT I. SURFACE CONSTRUCTION MOBILIZATION 1: LS $ 1,000.00 $ 1,000.00 CONSTRUCTION TRAFFIC CONTROLCONTROIdPHASING LS $ 1,000.00 $ 1.000 (X) CONSTRUCTION STAKING LS $ 500.00 $ 500.00 CONSTRUCTION TESTING I LS $ 500.00 $ 500.00 Il. DEMOLITION/CLEARING 1. CLEARING & GRUBBING LS $2,000.00 $2,000.00 2. SAWCUT P.C.C/A.C.(UP TO 6") LF $4.50 $3.~0 $2.00 3. P.C.C. REMOVAL 6 SY $30.00 $23.00 $10.00 $ 18000 4. CURB AND GUTTER REMOVAL 61 LF $6.00 $3.00 $2.00 $ 366.lx) 5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA $300.00 Ill. STORM DRAINAGE I. 12" R.C.P. (CLASS V) LF $60.00 $40.00 $20.00 2. 15" R.C.P. (CLASS lid LF $65.00 $48.00 $38.00 3. 18" R.C.P. (CLASS III) LF $70.00 $60.00 $52.00 4. 24' R.C.P. (CLASS IH) LF $80.00 $68.00 $59.00 5. 30" R.C.P. (CLASS lid LF $90.00 $7500 $65.00 6. T.V. INSPECTION (12") LF $1.20 $0.75 $0.60 7. STD. DRAINAGE INLET EA $1,600.00 $1,300.00 $1,00000 C.C. DETAIL 9) 8. FLAT GRATE INLET EA $1.400.00 $I,100.00 $900.00 C.C. DETAIL 6) 9. STANDARD MANHOLE EA $2,000.00 $1.600.00 $1,300.00 10. BREAK AND ENTER M.H./D.I. EA $700.00 $550.00 $450.00 11 3" DRAIN PIPES 48 LF $10.00 $ 480.~0 , Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO, DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT IV. CONCRETE IMPROVEMENTS 1. SIDEWALK 722 SF $6.50 $4.50 $2.75 $ 4,693 00 (76)(9.5) 2. DRIVEWAY APPROACH 342 SF $7.50 $5.50 $3.75 $ 2,565.130 (36)(9.5) 3. CURB AND GUTFER 6t LF $22.00 $18.t30 $15.00 $ 1,34200 4. VALLEY GU3~FER sr S12.50 $10.00 $825 5. HANDICAP RAMP EA $1,200.00 $800 00 $700.00 6. TYPE B-I CURB LF 512.(Y0 $9.50 57.50 7. TYPE Al-B3 CURB LF $15.00 $12.00 $10.00 8. COBBLESTONE MEDIAN SURFACE SF $12.00 $8.00 $5.00 9. P.C.C. DRIVEWAY CONFORM SF $7.00 $5.50 $4.50 I0. A.C. DRIVEWAY CONFORM SF $4.50 $3.75 $3.00 V. PAVEMENT 1. ASPHALT DIGOUT AND REPLACE CF $2.00 $350 $2.50 2. PAVEMENT WEDGE CUT (6') 490 LF $5.00 $2.50 $1.50 $ 2,450 tX) 3. PAVEMENT GRINDING SF $0.80 $0.50 $0.35 4. PAVEMENT FABRIC (PETRO-MAT) 353 SY $2.00 $1.85 $1.50 $ 706.(X1 (1061(301/9=353 5. ASPHALT CONCRETE (TYPE A) 50 T $80.00 $50.00 $35.00 $ 4,00000 (1261(301(0. 171(0.07751 6. AGGREGATE BASE (CLASS 2) T $4000 $20 (X) S12 (X} ~73.41(18)(0.92)(0.070) 7 SLURRY SEAL (TYPE Il) SF $0.07 $0.06 $0.05 8. SLURRY SEAL (TYPE Ill) SF $0. I l $0.09 $0.07 VI. TRAFFIC SIGNALS/LIGHTS I. DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $250.00 2. DETECTOR LOOP (6' x 30') EA $650.00 $540.00 5a~40 O0 3. DETECTOR LOOP (6' x 50') EA 5900.00 S750.00 4. ELECTROLIER EA $2,6(X) 00 $2,2(X) tX) $1.80{IO0 5 I/2" RIGID CONDUIT 15 LF $900 5700 $5.00 S 135(X) 6. 2" RIGID CONDUIT LF $17.00 $13.00 $10.00 7 CONDUCTOR 45 LF $0.70 $0.55 $0.45 5 31 50 Page 2 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT 8 PULL BOX (NO. 3 I/2) 2 EA $300.00 $240.00 $185.00 $ 600.00 9 PULL BOX (NO. 5) EA $400.00 $350.00 $300.00 VII. STRIPING AND SIGNS 1. REMOVE PVMT. MARKINGS (PAINT) SF $2.50 $1.50 $1 2. REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40 3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40 4. STRIPING DETAIL 9 292 LF $1.35 $0.85 $0.35 $ 394.20 4.5 STRIPING DETAIL 22 LF $2.25 $1.65 5. STRIPING DETAIL 29 LF 5225 $1 65 $1.20 6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25 7 STRIPING DETAIL 37 (THERMO) LF $1.85 SI .50 $1.00 8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 S I. 15 9. STRIPING DETAIL 39 LF $1.50 $0.85 $0.45 10. STRIPING DETAIL 40 LF $2.20 $1.70 $I 00 I 1. LIMIT LINE LF $1.35 $1.05 $0.90 12. CROSSWALK LF $1.35 $1.05 $0.90 13. PAVEMENT MARKINGS (PAINT) SF $2.50 $1 90 $1.60 14. PAVEMENT MARKINGS (THERMO) SF $5.50 $3.80 $2.60 15. PAVEMENT MARKER (NON-REFL.) EA 54.50 $3.00 $2.20 16. PAVEMENT MARKER (REFLECTIVE) EA $6.00 $4. I5 $3.15 17. TYPE K MARKER EA $95.00 $80.00 $70.00 18. TYPE N MARKER EA $95.00 58000 $70.00 19. SALVAGE ROAD SIGN EA $85.00 $7500 $6500 20. RELOCATE ROAD SIGN EA $100.00 $85.00 $75.00 21. INST. RD. SIGN ON EXIST. POLE EA $200.00 $145.00 $110.00 22. ROAD SIGN WITH POST EA $300.00 $240.00 $195.00 23 ISTANDARD BARRICADE LF $15.00 Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT V II I. LANDSCAPING 1. IRRIGATION, PLANTING WORK SF $8.00 $8.00 2 PRUNE TREE ROOTS EA $125.00 5;100.00 $85.00 3. TREE REMOVAL EA $650.00 $500.00 $400.00 4. ROOT BARRIER (12') LF $20.00 $10.00 $6.00 5. ROOT BARRIER (18') 40 LF $25.00 $I5.00 S10.00 $ 1.000.00 6. STREET TREE (15 GAL) EA $45000 $32500 $250.00 7 STREET TREE (24" BOX) 2 EA $450.00 S 7. STREET TREE (36" BOX) EA $700.00 5550.00 $400.(X) 8. TOP SOIL BACKFILL CY $20.00 520.00 IX. MISCELLANEOUS I. PEDESTRIAN BARRIER LF S75.00 $60.00 $50.00 2. CHAIN LINK FENCE (6') LF $15.00 $11.50 59.25 3. RAISE MISC. BOX *O GRADE EA $300.00 $200.00 S175.00 4. RAISE MANHOLE TO GRADE EA S400.00 $275.00 $200.00 5. INSTALL MONUMENT BOX EA $450.00 $35000 $300.00 6. MEDIAN BACKFILL CY $19.00 SI7.00 $15.50 PREPARED aY: ~-'"'~I~ SUBTOTAL $24,942.70 10% SECURITY ENFORCEMENT FEE S 2,49427 REVIEWED BY: TOTAL ESTIMATE FOR FAITHFUL $27,436 97 APPROVED BY: PERFORMANCE SECURITY $27,4(X).00 *See Section 66499.4 of the Map Act. h: \landdev\ 14119bas. xls (rap) Page 4 WESTFALL ENGINEERS, INC. Victorian Village 14583 Big Basin Way SARATOGA, CA 95070 (408) 867-0244 LET' .R OF TRANSMITTAL IWE ARE SENDING YOU J~Attached [] Under separate cover via the following: [] Shop Drawings [] Specifications [] Copy of letter [] Change order [] Prints [] Plans [] Samples [] vCOPIES DATE NUMBER DESCRIPTION THESE TRANSMISSIONS ARE: [] For your approval [] Approved as submitted [] For your use [] Approved as noted [] .~A~.per your request [] Corrections noted ~ For your review and comment(s) [] [] FOR BIDS DUE 19 LREMARKS: [] Resubmit with copies for approval [] Submit copies for distribution [] Return corrected prints [] PRINTS RETURNED AFTER LOAN TO US ~p~ 0 9 1999 fI-IITE - ORIGINAL IF ENCLOSURES ARE NOT AS DESCRIBED, PLEASE NOTIFY US II~ME/~ELY ///'YELLOW - DUPLICATE