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97-119 CITY 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- f- ay) · Permit No. E( ~.?_//? X-Ref. file P \::::> c:. -04: Issued Permit expires in 1 months Application Date -2 -/y- 99 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 montlu if the pennit is nOI issued. Application Fee is non-refundable.) A. Work address or tract # ??t? E. (!~,e// 4vf1. Ulility trench lOcation B. Nature of worle ~5f/r'~,L 4?;d~~/?J~//;' C. Attach four (4) copies of an engineered plans showing the location and extent of the worle, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed worle to existing surface and underground improvements. When approved by the City Engineer, said plan becomes a pan of this pennil. D. All worle shall confonn 10 the City of Campbell Standard Specifications and Details for Public Works Construction; the General Pennit Conditions listed on the reverse side; and the Special Provisions for this pennit, listed below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTIC M~:r .B.E ~;N "tQ..fUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. I ,. u W~~1'l-- ~ ...t-"\il~Uf ~~L ~~& (.(;dI . ~ . , Telcphone~ ~ .~ ~ ~ 7 2- ~~o~~ ' Address 24 HOUR EMERGENCY TELI!P'HONE No.1'41 ...~ &I . ~ 37 . ~/ Is this worle being done by the property owner at their own residence? Yes v<: The ApplicanrJPermioec hereby agrees by affixing their signature to this pcnnilto hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the worle ered by this permil. ill infonn their contractor(s) of the SPECIAL PROVISIONS _1. \/2. ):Q. V""'4 . Street shall not be open cut for underground inslallations. Minimum cuts ~ be allowed for connections or exploration hoIes. Suchew mav be SllCciticallv approved bv the Inspector prior to cutlinl!. Pavement may be cut for underground inslallations and must be restored in accordance with the Utility TrenchRcstoration Standard Details. Method . A' Baclcfin, unless otherwise approved by Inspcaor. Worle to be stalced by a licensed Land Surveyor or Civil Engineer and !WO (2) copies of the cut sheets Sent to the Public: WorksDcpartDlall before starting work.. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground ServiceAlen(USA) has been notified and the inquiry idenliflCation number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. 'I'h~ ~ont-r<'lrt-or "'~<'Ill ",nhmi t- <'I t-r<'lFFi r ron'!'........l p1:on <'11'11'1 ....:~Ff'i r ron....rol schp-dlllp- For rpV1P-W <'Ind <'Ipprov<'Il by th~ C!t~ R~~inp~r prior t-o <'In~ l<'1np ~lnanr~ ~nrl/nr n~~a;+o ~nr~ . V's. "*' SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES D:fg.. AMOUNT RECEIPT NO. ~~~I~HA:Jil;~~~ FEE ..}~ . ....~ SECURITY FOR FAITHFUL PERFORMANCEILAlIOR& MATERIALS 40 OOO'-S4'!,,-o. ""~ CONSTRUCTION CASH DEPOSIT . S \,"Le>.00 . ~~ I~'t5~~~~~EE~c::m:.."'>t7...\~~ ~ \~.o. O;O~\....U.f..-tClS $~\ t~C:I:.J '\0 l4cv ~~ 1:--\ ~q l .-z......--~ ~0o APPROVEO FOR ISSUANCE ~~ 4 -~~ ~9.;..., Date :- GENERAL PERMIT CONDITIONS 1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date of written acceptance by the City. 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee MUST REQUEST IN WRITING a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. MAINTAIN safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures, detours and street closures. This plan must be REVIEWED and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the Calttans Manual of Traffic Controls for Consnuction and Maintenance Work Zones, dated 1990, available at Calttans. Traffic control equipment shall include Type IT flashing arrow signs if required. 8. REPLACE IN KIND any damaged or removed existing improvements, including planting. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 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. II. SA TURDA Y 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 materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline 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 regarding 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 PRACTIeES established by the Santa Clara Valley Nonpoint Source Pollution Control Program. g services under the applicant are aware of and understand all of the above conditions. j:\forms\pwperm2 6/96 ~- ~ - ROb~t ~hillips Approved by: ftIl.- Mic e e~ulnney FINANCE ONLY: Verified by: To: Accounts Receivable Please Issue Check Payable to: Address - Line 1: Line 2; City: Description: Amount Payable: Account Number: Date and Receipt No: Permit No: Purpose: Requested by: Cit} .)f Camnbell- Chec__ Request Walsh Building Contractors 22 North Almaden Avenue San Jose State: CA Zip: 95110-2425 REFUNDABLE DEPOSIT $1,720.00 101.2203 Finance Onty: INTEREST EARNED 101.540.7448 4/15/97 #101399 97-119 Refund of Cash Deposit Title: Project Inspector Date: lO/16/9t Title: City Engineer Date: 10/16/9 Title: Date: Approved by: Title: Date: Mail As Is: xx Return To: Special Instructions For Handling Check Mail in Attached Envelope: (NAME) (Department) Other: I rev: 3/25/95 tVBLlC WORKS DEPARTMENT RECEIPT Effective July I, 1996 TO: City CIeri< PUBLIC WORKS FILE NO. q_1 ..... \ L~ PROPERTY ADDRESS ~O &. Ch_MP~~ Please collect &: receipt for the followma maaies: ACCT ITEM .. ................... ..:....... , . .... 43S.Sl5.492I Project Revenue (specify project) S ENCROACHMENT PERMIT 4722 Applic.uion Fec Non-Utility Encroachment Permit (S22S) R-I Fint Permit (No Fee), Subsequent PennitIYr (SWill Utility Encroachment Permit AncriallCollcctDr Street (S32S) RcsidcntiaJ Str=tlOther Areas (S22S) 221ll Plan Check Deposit - 2~. of ENGR. EST. ($j()(Jmin) 0 22fll F:)ithful Pcrfonnancc Security (FPS) (100% of ENGR.EST.) 0 221ll L!bor 3nd Materials Security (IlJO'/oofENGR. EST.) 2203 Monumcnmtion Security (I OO~o of ENGR.EST.) 0 22lll Cash Deposit (4% ofENGR.EST.)(S500 minlSlO,()OO mIX) 0 l I'~ .(Jc.> J+'72 Plan Check & Inspection Fee (Non-Utility) ~ L ~.c!o L"\ 4722 Engr.Est. < S2jO.llOO (I2~oofENGR. EST.) .. 2203 Engr.Est.>S2S0,llOO (Deposit 8% of ENGR. EST JS30.000 min. ).. 0 4722 Ulilitv < SlUO.f}()() Minimum Ch'llc Per Location (SI20) Conduits/Pipelines up to 'sOO Fect (S L60/fi) Above SUO Feet (SI.lOlfi.) ManholcsNaultsIErc. (S IllS/..) Pole Set/Rcmoval (SlfJ~l/ca) Street Tree Plantin!VRcmoval (SIOS/_) .. 2203 Utility;> SIOO.OOH Actual Cost'" 20-/. .. 0 4722 Street Tree PlantinglRcmoval Permit (SillS) 4760 Project Plans &. Specifications Project No. 4760 Standard Specifications &: Details (SliPS S12JBook) 4160 Copies of Engineering Maps &: Plans (S.SO/,q.fi. ) 4722 Penalties; Failure to restore public improvements (SIIXI/Calendar Day) (Muni Code Section 11.34.010) 4722 Penahies: Failure to correct unsafe conditions (SIOO/Calendar Day) LAND DEVELOPMENT 4722 Lot Line Adjustment (SSIXI) 4722 Parcel Map (4 Lots or Less) (SI,1l60 + S2SILo.) 4722 Final Tract Map (3 or Mon: Lou) (SI,38ll + S2SILo.) 4722 Certificate of Compliance (SSIKI) 4722 Certificate of Correction ($300) 4122 Vacacion of Public Streeu &. Easemenu (SSSO) 4722 Assessment Segregation or Reapportionment First Split (SSSll) .E.:lch Additional Loc (SI70) 4721 Slonn Drainage Area Fce Per Acre (R-I, S2,OIKI) (Multi.R... S2,2jO) (All Other. S2.SlJO) ~q~ ... c:;. ~92(J P:uidand Dedication Fee 4965 Postage / TRAFFIC 4128 Intersection Tum Counts (Two-Hour Count) (S60) 4728 lntencction Tum Counts (a.m. or p.m. pea1.:s) (SI2S) 4728 Traffic Flow Map (Daily Traffic Volumes) (S27) 41211 Campbell Traffic Model (FuJI Scope Assessment) (S2.2Sll) 4728 Campbell Traffic Model (Reduced Scope Assessment) (S740) 4271 TruCK Permits (S3S/trip) 4728 No Parking Signs (S I/each or $2S/IIKI) OTHER TOTAL S l. c"','S:" . "'2 ~ NAME OF APPLICANT ~"'L3::-,>\+- ~tJ\'~::)i c.-:.~ NAME OF PA YOR ~UTr~;:.. ~l.L.."""""," PHONE ~ L- b-l( C:\~1d '" L l'-t{J-.. D~ ~~ ZIP Cl~ \ l e> ADDRESS ~"'" .~ r"""<,:,,,,_ c::~. .. Actual Cost Plus 20.;;' Ovcrhead fNon.lnteccsl bearing deposit) FOR CITY CLERK ONLY Date "ECEIVED A~R 1 5. CITY CI.ERK'S OffICE -For Pt.m ChecL3nd Cash Deposits, send,,'ctlow cop)'ta b:\rec(rm4(e:'<c)mp(rcv 112197) "'fTV nr" Lrl i i ur r- ...w;....r,r-'. I r." \.'n!,r- :"~;"'J..:' i_on REGilD BY: ANNEE rdlvr.r.. IIA! .'""11 T'IIITt r'....lr '"'l'"'.;"IT r;.; i LH"\' :;inL.-:n !,ilJ 1 !.i.' ~ +..1 ~;,,: i'~ : 7nn^V~C D^T:c ^hj~~iC~ t \.f!,/~! ...: .l.:!"i i~:: ...r''U 4 ,..:l ... : ~~EGISTE~~ DATE; DESCRI PTlON ~HQUNT REF DEPOSITS -101:2203 ;;,rrA; T;:\::~ 1",,',:1.;.. ...__.;,... ('\;'r-~If r,ATT." Li1J:.1.,..r" r :-;l,!)- '!1 :W;'''': "1: .....,; ~ (.. :..' rt i.! ',1' CHES~ t~u~ 09Si':" "!"',.....:......,..... ~.... ~ ~ t.rt:..It~:t.~; i CHANG~ : _._ ...- ."1. .....; .~_.: -. ,__:-t :,) .;. i~! '.}iJ 1. i) l:" '-.' ....' .; .~, .. ..,. r. ..,.....-. "'.. qt. ,. . ......- .,.. -. - ~ ...- ~,l. 'l""""'''' rt:", ~,; _ .- /., i:i. -' . .. ...... ... - '-" ...... .. --.. ..- $! ~ '{i.e' .. '-jC' - : _'\j :i:';'.". CITY OF CAH??:~L: CA RES'JD BY: ANNEr~ PAYOR.; WALSH BUILDING '_U;lii TQDA~'S DAlE: 04/15!97 REGlSTEf.~ I!ATE~ 04/i:/:--~ j''r~c~ , ..."." T',r-f'\t'r"tTI'"tTTI"tU ~I~ ~'...~~ r ~ ~ ~\~~ ~R. t SUtiTllIJ .4. W.nltll'T !": rn..,i\":,~"i ~ ::-Tlr::'i;~ r \ ~:..._\".'... 51Q~~ ~RR}~ FEES .,....,} .. ti~ ~ ---------------- i:~qs:, 125 Tnl',l.,j T!i:i:"K !Ui!"".~ .,i,.,1'...;,-:' [r;:?~~, PHIIi: r: ~..., :.:' ~ :: CHEer\ "iii: t,r:'~ r. ..J .' ___' ,i. "~' ;:7~':1:!:25 l"ENDEREL!J i'll/l;.It"lr. \.rlirH"lI.~~t.. . ~) ~~:~,"~~Gi 014(:':: 1n;3: ;4C ~: ': t6rl ~ \}{~' .T"; '_ "" 2>~7'-,-~~_' IF .,,-.r". i II ....:".~ To: Accounts Receivable Please Issue Check Payable to: Address - Line I: Line 2: City: Description: Amount Payable: Account Number: Date and Receipt No: Permit No: Purpose: Requested by: Approved by: FINANCE ONLY: Verified by: Approved by: Mail As Is: Return To: Other: Citj of Campbell - Chet_ ... Request Richard Fish 3048 Sunny Meadow Lane San Jose State: CA Zip: 9 513 5 REFUNDABLE DEPOSIT $780.00 Finance Only: INTEREST EARNED 101.2203 2/14/97 #99779 97-119 101.540.7448 Refund of Plan Check Deposit /~ 7/ii:t:illlPS QU.LIUH::Y Title: Project Inspector Date: 10/16/971 Title: City Engineer Date: 10/16/97 Title: Date: Title: Date: I Special Instructions For Handling Chec~ xx Mail in Attached Envelope: I (NAME) (Department) I rev: 3/25/95 l'UBLlC WORKS DEPARTMENT RECEIPT Effective July I, 1996 TO: City Clerk PUBUC WOIUCS mE NO. q-, -\tg ~ e-. C~~\F'f'j~L- PROPERTY ADDRESS Pi...... collect & receipt for the followinl monies: ............................... .. ACCT. ITEM ...... I ., ............ 43S.S3S.4921 Project Revenue 'ect) S ENCROACHMENT PERMIT 4722 AppliClltion Fee Non-Utility Encroachment Permit ($22S) '-""2.-."""'.... ~a R-I Fint Permit/No Fee). Suboequent PermitlYr (SIOO) Utility Encroachment Permit AnerioJ/Collector Sired $32S) Residential StreetIOther Areas $22S) 2203 Plan Check Deposit - 2"/. ofENGR. EST. SSOOmin) . t~9. ('''&7> 2203 Faithful Performance SecurilV IFPS) 100% ofENGR.EST.) . 2203 Labor and Materials Security 100% ofENGR. EST.) 2203 Monumentation Security 100'10 ofENGR.EST) . 2203 Cash Deoosit 4% ofENGR.EST.)(SSOO minIS I 0.000 max) . 2203 Labor and Material Security 100'10 ofENGR. EST.) . Plan Check & lnspection Fee (Non-Utility) 4722 EnIU.Est. < $250,000 (12"10 ofENGR. EST) .. 2203 Engr.Est.>S2S0.000 lDeoosit 8~. ofENGR. EST.1S30,000 min.)" . 4722 Utility < S I 00.000 (8"10) Minimum Charge Per Loc:.tion (SI20) ConduitslPipelines up to SOO Feet (SI.60/ft) Above SOO Feet (SUO/ft.) ManholesIV auhslElc. (SIOS/ea) Pole Set/Removal (S 1 OS/ea) Sired Tree PlantingiRemoval (S I OSilree) .. 2203 Utility> SIOO,OOO Actual Co.. + 20% .. . 4760 Project Plans & Specifications Proiect No. 4760 SLvldard SpecifiClltions & Details (SI/Pa SI2IBookl 4760 Cooies ofEngineerina Mans &. Plans (S.SO/sq.ft. ) 4722 Penalties: Failure to restore oublic imorovements (S I OOICaJendar Dav) (Muni Code Section 11.34.010) 4722 PenaJties: Failure to correct unsafe conditions (S I OO/Calendar Day) LAND DEVELOPMENT 4722 Lot Line Adiustment SSOO) 4722 Parcel Map (4 Lots or Less) SI.06O + S2S/Loll 4722 Final Tract Map (S or More Lots) SI,380 + S2S/Loll 4722 Certificate of Compliance SSOO) 4722 Certificate of Correction S3(0) 4722 Vacation of Public Streets & Easements SS50) 4722 Assessment SegreJ!ation or Reapportionmenl First Split (SSSO) Each Additional Lol (SI70) 4721 Stonn Drainage Area Fee Per Acre (R-I,S2.000) (Multi-Res, $2,2S0) (All Oth.... S2.S00 4920 Parkland Dedication Fee 4965 PostaRe TRAFFIC 4728 In_ion Tum Counts (Two-Hour Counl) $60) 4728 Intersection Tum Counts (a.m. or p.m. oeaksl SI2S) 4728 Traffic Flow Map (Daily Traffic Volumes) 517) 4728 Camobell Traffic Model (Full Scooe Assessment) S2.250) 4728 Campbell Traffic Model (Reduced Scope Assessment) S740) 4271 Truck Pennits $3Sltrip) 4728 No Parkina Signs S lleach or S2S/1 (0) OTHER TOTAL S lbCf::.. ~ NAME OF APPUCANT . NAME OF PAYOR rL-lc.. . \.L 1l.Jr;:-::. \.. . .\?l ~~\4 PHONE -z... ""l...CJ -~--=:. cl..7 ADDRESS ~~>-.,. ~..:l. ,.. ^... .-~::>C'\uC ~\ ZIP ~ -L ') ~c::r"'~( c:,-.. ~ -::: l ~o;:;. .. Actual Cost Plus 20"/. Over!lead (Non-Interest bearina deoolit) ~ REC FOR 1\ .. .......... ......... CITY CLERK RECEIVED BY I ...... . ........ ONLY j '\ ~. q qllr+ C\X\J/'1 fED Date Receipt # \ .. ... .......... .. \\ , , '/.-00 crrv C 'For Plan Check and Cash Deposits. sene y lIow~pyto Finance. J J'fI<K/~ I f DlIW initials /> f (~J cK 80((\ ~ 2- EIVEiJ 14 tII7 LERK'S OfFICr h:'nc:fnn4. wk3(mp )rev7 /1/96 5/2D if! <8 02-~- hI ~t~. BOND #3SM 891 253 OO-A JLO...!"fOJ:'OR FAXT1.n':lIl.. l'ERFORlYri\l'i(f: OF ,'\rAINTBNAN~ PERIQQ We, the Ur.dCTSi."nCll , ISM! CAM~BELL UNION, A CALIFORNIA__~(r,ereinJf\er "Principan wd AHERICAN MOTORIST S INSURANCE COMPANY . a corpo.~ian ()f):~aizl'{j under tllC luwI ot' th., 5tt1e of ILLINOIS . And 2ulhorJ.le<! co craruac. bu:;incss in Un: S(~te of CJJi(omj~. H Surcty. arc obugat<:-d ,0 the City of Campbell (h:-reinaf1tr "eir/"), ~ rn'Jr~cipc.l cnrparalian under the !a\'.'$ of (he Slate of CaijforrJa, in the sum of ~ TEN THOUSAND AND NO! laOs Dollars (5 10,000.00 ) far the p"}~m of "'hi::1 Stim \lie oblig.Hc OUt>C!YCS ~nd our ~\.lCCc~~ors ~nd ~igru. joinLly anu severally by th~ foliowir.~ pravi~ion.,: 7'r..: ccnci.icior. of tiliS :b;ig:Hior. lS u~.u the Pri1;c\p:tt ~:m.;.J:d, cr is ~Cv:;t to enccr, i~HO u CCrtaUl v.,riutn Conlt:1Ct with the City datd I lSl~ and c(l(itld PFRHT1' JL <t7-11 9, 790 E, CAJ.'1PBELL, CAJ.'1PBELL, CALIFORNIA a cn'~ year mainlCn.1rJcC period of the IVork described in slid Conu-;cl, 1 (rlJe an<1 C0rr.:;l eopy of which is pr':.Sently co. file in t.ic ofIice of the City Ceek o( th~ Cicy of Campbell, which s.tiJ ~sre~m~m I~ ~reby rofemd :0 2nd m::.de a pm htre6(. And, We City require> J. g'JUi\..'1(CC (rem we Prir.c[p;j[ against clerc,nve 1T'.J.(eriili and -;rork1n.'~TJ.5l-jip in connection with lh.1C U1.2.inU;tv.cce. Now I therefore, The Prir.cip.1J ae-recs th~l it shall mm all n:pain or rCflacuncn~ n~!sxU)' during th~ period of onc-ye:u: from the date of acc:ponce of the Contract work, by rc.son of defc~YC m1.:cri.als or \liorkrr,auship in CO"nccuo.n with lh: COnlner. If th()S~ defecuyc mnlcri~ls or workm.a.nshil' oo:ur witl1in UuL pcio<l. t.lje City sluJl giYe- lhe Principal and SUeecy wriRffi nocice of that defect within 60 d.lYs :l.~r discovery, When c.len rep!a~era Is nude 10 Ihe H\lsfJcuon o( the Ciry, ,h.e obllg:Jtion or rhe Principlllaod S\.lrC1)' shJll be dischar,jcd J.S to war rcplacCr:lcr\l, otb.crwisc to ["~ai;) i., full [orc: and e-ffcc:. Any rcpairs or re?lac:mtl1C'S U1.Jd~ \l1]ckr \l1is beed sh.1J[ L'l likc ffin.n.....cr be subject to the xrms anc. con<lidcns of Ir. No pccpaYG:ilt or del.3y in p~Yil'~nt and no ch..a~t1, et~!'.siGr..!, a.ddiGon cr ait.:rJtioo of MY pro'nsion of~::id COI1lt;v::tor in ,~ny p[;tns and specificarioos refc:rcLl to ht:Tcin. and no forb~r~~cc on L~e pan of the City shall op:rat~ 10 release the Surer; Feom liabilicy On (his bond, u..d con.><::r.t (0 mA.'<:e su:h alterations wilholJt furt..'1er fl(J[jc: to or corume by the Su:ety Is ht::n:.by ginn, ar.tl [he SUre!)' hereby waives the jnOYiSlOns of Section 2819 of tl.~ Ci\il CO<.Je of tiJ.C Sr-ale of Ca)i~mil. 1n wimes$. ilie p:Uli~s MV: e:c;:cucu.l ~ a.grc~m~':-.t a~ of ,19._21L. TERN OF BOND IS 10/16/97 to 10/16!98 FACT 1327 SAN MATEO, (!\l~ch AckIlowlc~gcrr:c.r.~) (Both Prir.cipal' sand Sure1"j's Accorney in FJc[) (j :\fQnns\f;llr.bollO) s' ~'~ Bond NUT':1oe:r (. CO:::pl1:,' \!:i.> boed "1:1 ^r-.crn:y-in.hct'; J. t .oriry from SU(~ry \.0 eXeC\J[C lh~ bond c '':-:d to incJuce thc chIc of 1:~C ::'or:d.) -, State of California County of San Mateo On APR 2 9 1998 before me, Sherrie Jones, Notary Public, NAME, TITLE OF OFFICER personally appeared Daniel Jones NAME OF SIGNER . Personally known to me - OR - 0 . 1- SHERlli JOlES Comm,I1068231 lOURY PU8l1C. CAUFORIIA m. Su Mlln Co.u, - I, COAllll, h,ills h,. 27. n" ... proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ESS my hand and official seal. , (SIGNATURE OF NOTARY) OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT o D INDIVIDUAL CORPORATE OFFICER BOND(S) TITLE OR TYPE OF DOCUMENT TITLE(S) --------------------------...---- D PARTNER(S) D o LIMITED GENERAL ..... NUMBER OF PAGES . ATTORNEY-IN-FACT o TRUSTEE(S) D GUARDIAN/CONSERVA TOR o OTHER: DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON{S) OR ENTITY(lES) AMERICAN MOTORISTS INSURANCE COMPANY SIGNER OTHER THAN NAMED ABOVE l~empeR. Home Office: Long Grove, IL 60049 Know All Men By These Presents: That the American Motorists Insurance Company. (hereinafter called the "Company") a corporation organized and existing under the laws of the State of llinois, and having its principal office in Long Grove. Illinois, does hereby appoint POWER OF ATTORNEY Daniel Jones of San Mateo, California ***************************************************** its true and lawful agent(s) and atlorney(s)-in-fact, to make. execute, seal, and deliver during the period beginning with the date of issuance of this power and ending on the date specified below, unless sooner revoked for and on its behalf as surety. and as its act and deed: Any and all bonds and undertakings provided the amount of no one bond or undertaking exceeds TWO MILLION FIVE HUNDRED THOUSAND DOLLARS ($2,500,000.00) *************************************** EXCEPTION: NO AUTHORITY is granted to make, execute, seal and deliver any bond or undertaking which guarantees the payment or colJecticii \:if any promissory note, check, draft or lettei of ciedit. This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond within the dollar limit of authority as set forth herein. This appointment may be revoked at any time by the Company. The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office in Long Grove. Illinois. THIS APPOINTMENT SHALL CEASE AND TERMINATE WITHOUT NOTICE AS OF December 31,2001 This Power of Attorney is executed by authority of a resolution adopted by the Executive Committee of the Board of Directors of the Company on February 23, 1988 at Chicago, Illinois, a true and accurate copy of which are hereinafter set forth and is hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President, or any Vice President, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings. obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the Executive Committee of the Board of Directors of the Company at a meeting duly called and held on the 23rd day of February, 1988: "VOTED, That the signature of the Chairman of the Board, the President, any Vice President, or their appointees designated in writing and filed with the Secretary. and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to resolution adopted by the Executive Committee of the Board of Directors on February 23. 1988 and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company." in Testimony 'vVhereof, tne Company has caused this instrument to be signed ;:.no its c.orporate sea: to be aff:;.ed by ilS authorized officers, this January 1, 1994. American Motorists Insurance Company Attested and Certified: P- ~~-r~m: Robert P. Hames, Secretary by J. S. Kemper, III, Exec.vice President CALIFORNIA ALL.PURPt. ....E ACKNOWLEDGMENT I' [J " [J '-.J 0 [J ,., u 0 I' [, i' State of California Susan A. Gatto, Notary Public Name and Title of Officer (e.g.. "Jane Doe, Notary Public") I' personally appeared Charles K. Stegner Name(s) of Signer(s) Upersonally known to me - OR - [J proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. y hand and official seal. 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. Number of Pages: Signer's Name: [] Individual [J Corporate Officer Title( s): [] Partner - [] Limited [J General [] Attorney-in-Fact [] Trustee [] Guardian or ConseNator [] Other: Top of thumb here RIGHT THUMBPRINT OF SIGNER Signer Is Representing: <tl1995 National Notary Association. 8236 Remmet Ave., P.O. Box 7184. Canoga Park, CA 91309-7184 County of Santa Clara On May 11 , 1998 Date before me, ~ SUSAN A. GATTO - '. CommissiOn#lJ6J131 i ;a. Notary Puoiic - California ~ . Santa Clo'o County My Comm. &Pires Dee 2. 200J Description of Attached Document Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Individual Corporate Officer Title(s): Partner - [J Limited u General Attorney-in-Fact Trustee Guardian or ConseNator Other: Top of thumb here RIGHT THUMBPRINT OF SIGNER Signer Is Representing: Prod. No. 5907 Reorder: Call Toll-Free 1-800-876.6827 I ~ ~ ~ i @ ~ ~ ~ ~@~' . I ~ , I ~ ~ I I I ~] , I ~ I I . I . I '1 , IT , (lY ,(\1' ,[ \(,-6 \Vi ,L,.lJo . V C;lT fj. ) BL.lD FOR FAITHFUL PERFORMA ~E. FtRST TERM PREMIUM FULLY EARNED BOND #3SM 891 253 00 Premium of $800.00 " r '- We, the undersigned ISM/CAMPBELL UNION, a California limited partners,t{h~einafter "Contractor") and (*) , a corporation organized under'the laws of the State of ILLINOIS , and authorized to transact business in the State of California, as Surety, are obligated to the City of Campbell, (hereinafter "City") a municipal corporation under the laws of the State of California, in the sum of FORTY THOUSAND AND NO/ laOs ***iciddc**ic******* Dollars ($ 40,000.00 ) for the payment of which sum we obligate ourselves and our successors and assigns, jointly and severally by the following provisions: The condition of this obligation is: Because the obligated Contractor has, on , 19 , entered into written Contract with the City for the Project entitled PERM IT 9 7 -11 9, 7 9 0 E. C am p be J, Ja copy of which is attached and made a pan of this bond, for construction of Project. Now, therefore, if the Contractor shall faithfully perform the work in accordance with the plans, specifications and contract documents during the original term, and any extensions of the contract which may be granted by the City, with or without notice to the surety, and if it shall satisfy all claims and demands incuITed under the contract, and shall':: fully indemnify and save harmless the City from all costs and damages which it may suffer by reasOn of failure to do so, and shall reimburse and repay the City all outlay and expense which the City may incur in making any default, then this obligation shall be void; otherwise to remain in full force and effect. If any legal action be filed upon this bond, it shall be filed within one year after final payment has been made under the Contract excluding the warranty period, if any, provided for in the Contract, and venue shall lie in the County of Santa Clara, State of California, and that surety, for value received stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract or to the work to be performed under it or the: specifications accompanying it shaH in any way affect its obligation on this bond, and it does by this means waive notice of any change, extension of time, alteration or addition to the tenru of the Contract or to the work or to the specifications, and thereby waives the provisions of Section 2819 of the Civil Code of the State of California. In witness, contractor and surety have executed this agreement as of ISM/CAMPBELL partnership 4/21 h:forms\bonds. frm(mp) By UNr' a I ,19~. limited Title (Attach Acknowledgements) MOTORISTS INSURANCE COMPANY ATTORNEY IN FACT Rnx 1177 's Bond Number 1C;M fig 1 253 00 (Both Principal's and Surety's Attorney in Fact) (Accompany this bond with Attorney-in-fact's authority from Surety to execute the bond, certified to include the date of the bond.) (*) AMERICAN MOTORISTS INSURANCE COMPANY State of California County of San Mateo On APR 2 1 1997 before me, Sherrie Jones, Notary Public, NAME, TITLE OF OFFICER personally appeared Daniel Jones NAME OF SIGNER . Personally known to me - OR - D J.' . . SHERRIE jouES' . ~ -. Comm.' 1068231 II} NOTARY PUllIC .CAlIFORIIIA m . San Maleo COllllty "'" II, COllllll. Esp/res Aug. 27, 1!99 proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ES my ha,nd and official seal. ) ?/}/). /f)h,~ (SIGNATURE OF NOTARY) OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT o o tNDIVIDUAL CORPORATE OFFICER BOND(S) TITLE OR TYPE OF DOCUMENT TITLE(S) o PARTNER(S) 0 o LIMITED GENERAL NUMBER OF PAGES . ATTORNEY-iN-FACT o TRUSTEE(S) o GUARDIAN/CONSERVATOR o OTHER: DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) AMERICAN MOTORISTS INSURANCE COMPANY SIGNER OTHER THAN NAMED ABOVE CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT No. 5907 State of California County of Santa Clara On April 24, 1997 DATE before me, Susan A. Gatto, Notary PlIblic NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC" personally appeared Charles K. Stegner NAME(S) OF SIGNER(S) GJ personally known to me - OR - 0 proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. r..........~....JQI;. ~ Q : . .......~.,.,.. .. ~. ""'1 ...... ; SUSAN A. GATTO o -f!i Comm. No. 1010728 > C/) '", NOTARY PUBLIC. CALIFORNIA (j) ~ SANTA CLARA COUNTY ~ My Commission Expires December 2, 1997 WITNE S my hand and official seal. OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER o INDIVIDUAL o CORPORATE OFFICER DESCRIPTION OF ATTACHED DOCUMENT Bond for Faithful Performance TITLE(S) TITLE OR TYPE OF DOCUMENT KJ PARTNER(S) o LIMITED ILl GENERAL o ATTORNEY-iN-FACT o TRUSTEE(S) D GUARDIAN/CONSERVATOR o OTHER: NUMBER OF PAGES DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(lES) ISM Campbell TTnion SIGNER(S) OTHER THAN NAMED ABOVE @1993 NATIONAL NOTARY ASSOCIATION' 8236 Remmet Ave., P.O. Box 7184' Canoga Park, CA 91309-7184 p - 'ID FOR LAllOR AND MATER!) T. Bond II 3SM 891 253 00 PREMIUM INCLUDED We, the undersigned (*) , (hereinafter "Principal") and (**) -' a corporation organized under the laws of the State of Illinois , and authorized to transact business in the State of California, as Surety, are obligated to the City of Campbell (hereinafter "City"), a municipal corporation under the laws of the State of California, in the sum of FORTY THOUSAND AND NO 11 OOs Dollars ($ 4n, nnn nn- ) for the payment of which sum we obligate ourselves and our successors and assigns, jointly and severally by the following provisions: The condition of this obligation is that the Principal entered, or is about to enter, into a certain written Contract with the City dated , 19 , and entitled PERM I '1' 97 -119 I a true and correct copy of which is presently on file in the office of the City Clerk of the City of Campbell, which said Contract is hereby referred to and made a part hereof. Because Principal is required to furnish a bond in connection with the contract, providing that if Principal, or any of its subcontractors, shall fail to pay for any materials, or other supplies, or for any work or labor on the contracted work of any kind, or for amounts due under the unemployment insurance act with respect to any work or labor on this project, the Surety on this bond will pay for the debt, in an amount not exceeding the sum specified in this bond, and also, in case suit is brought upon the bond, a reasonable anorney's fee to be fixed by the court. Now, therefore, we, (*) , as Principal, AND (**) -' as Surety, are obligated to the City of Campbell, in the sum of $ 40,000.00 lawful money of the United States, for the payment of which sums will and truly to be made, we the said Principal and Surety bind ourselves, successors and assigns, jointly and severaIly, by these provisions. " The condition of this obligation is that if Principal, its successors or assigns, or its subcontractor, or subcontractors, shaIl fail to pay for any labor, materials, or other supplies, used in the performance of the work contracted to be done, or for amounts due under the unemployment insurance act with respect to this work or labor, then the Surety on this bond will pay for them, in an amount not exceeding the sum specified in this bond, and in case suit is brought upon this bond will also pay a reasonable attorney's fee, to be fixed by the court. No prepayment or delay in payment and no changes, extensions, addition or alteration of any provision of said Contract or in any plans and specifications referred to herein, and no forbearance on the part of the City shall operate to release the Surety from liability on this bond, and consent to make such alterations without further notice to or consent by the Surety is hereby given, and the Surety hereby waives the provisions of Section 2819 of the Civil Code of the State of California. In witness, the parties have executed this agreement as of 4/21 ,19~. ISM/CAMPBELL UNIO~, a 1. . d J. lmlte partnersulp f By ~~ (*) ISM/CAMPBELL UNION, A California limited partnership (**) AMERICAN MOTORISTS INSURANCE COMPANY Title f1 ,.r, t'V0\i7<i" l-;'lV'~ (Attach Acknowledgements) MOTORISTS INSURANCE COMPAl; JONES, ATTORNEY IN FACT (Both Principal's and Surety's Attorney in Fact) (h:\forms\bonds. frm) (mp) ur ty's Bond Number 3SM 891 253 00 Accompany this bond with Attorney-in-fact's authority from Surety to execute the bond, certified to include the date of the bond.) ~CALlFORNIA ' ~"''''>>>'':::.,::..-:...:./:::....::;;:"::........::./,:;;~,,,.;.,;,-::~,.........._. State of California County of San Mateo On o P?' ? 1 \991 before me, Sherrie Jones, Notary Public, NAME, TITLE OF OFFICER personally appeared Daniel Jones NAME OF SIGNER . Personally known to me - OR - 0 .r.~- : - . SHERRiE jOIlES' . -( -. Comm.I1068231 UJ. MOYARY PUBLIC .CAlIFORNIA (J) San Mirto Counr, - . M, COIllIll. Erpiru Alg. 27. 1999 .. proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. ~~=0~ ( (SIGNATURE OF NOTARY) OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT o o ~NDIVIDUAL CORPORATE OFFiCER BOND(S) TITLE OR TYPE OF DOCUMENT TITLE(S) o PARTNER(S) 0 o LIMITED GENERAL NUMBER OF PAGES . ATTORNEY-iN-FACT o TRUSTEE(S) o GUARDIAN/CONSERVATOR o OTHER: DATE OF DOCUMENT SIGNER IS REPRESENTING: NAME OF PERSON(S) OR ENTITY(IES) AMERICAN MOTORISTS INSURANCE COMPANY SIGNER OTHER THAN NAMED ABOVE CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT No. 5907 State of California County of Santa Clara On April 24, 1997 DATE before me, Susan A. Gatto, Notary Public NAME, TITLE OF OFFICER. E.G.. "JANE DOE, NOTARY PUBLIC" personally appeared Charles K. Stegner NAME(S) OF SIGNER(S) fil personally known to me - OR - 0 proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and ac- knowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. r. .~~~: h..Q ;~~;~~ ~..~~~~' ~".'l o &1& Comm. No. 1010728 l> CJ) " NOTARY PUBLIC. CALIFORNIA en <( SANTA CLAFlA COUNTY 9 My Commission Expires December 2, 1997 WITN ESS my hand and official seal. ~d~ SIGNATURE OF NOTARY OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER o INDIVIDUAL o CORPORATE OFFICER DESCRIPTION OF ATTACHED DOCUMENT TITLE(S) Bond for Labor & Material TITLE OR TYPE OF DOCUMENT Ii] PARTNER(S) o LIMITED UJ GENERAL o ATTORNEY-IN-FACT o TRUSTEE(S) o GUARDIAN/CONSERVATOR o OTHER: NUMBER OF PAGES DATE OF DOCUMENT SIGNER IS REPRESENTING; NAME OF PERSON(S) OR ENTITY(IES) ISM-Campbell Union SIGNER(S) OTHER THAN NAMED ABOVE @1993 NATIONAL NOTARY ASSOCIATION. 8236 Remmel Ave., P.O. Box 7184. Canoga Park, CA 91309-7184 AMERICAN MOTORISTS INSURANCE COMPANY Hone Office: Long Grove, IL 60049 .~ POWER OF ATIORNEY Know All Men By These Presents: That the AJ.rican ttotorists Insurance CoIlpany, a corporation organized and existinsl U\der the laws of the state of Illinois, and having its principal offieti in Long Grove, Illinois, does hereby appoint Daniel Jones of San Mateo. California AAAAAAAAAAAAAAAA its true and lawful agentCs] and attorneyCs]-in-fact, to Bake, execute, seal, and deliver during the period beginning with the date of issuance of this power and endinsl December 31, 1997, unless sooner revoked for and on its behalf as surety, and as its act and deed: Any and all bonds and undertakings provided the amount of no one bond or undertak:4tg exceeds TWO MILLION FIVE HUNDRED THOUSAND DOLLARS ($2.500.000.00)AAAAAAAAAAAAhA EXCEPTION: NO AUTHORITY is granted to llake, execute, _I and deliver any bond or ~ertaking which guarant_s the payment or collection of any promissory note, check, draft or letter of credit. This authority does not peMlit the saII8 obligation to be split into two or nore bonds in order to bring each such bond within the dollar li.it of authority as set forth herein, This appointment nay be revoked at any tine by the AJ.rican ttotorists Insurance Company. The execution of such bonds and undertakinslS in pursuance of these presents shall be as binding upon the said American Hotorists Insurance Company as fully and amply to all intents and purposes, as if the saII8 had been duly executed and acknowledged by its regularly elected officers at its principal office in Long Grove, Illinois. THIS APPOINTMENT SHALL CEASE AND TERHINATE WITHOUT NOTICE AS OF DECEMBER 31, 1997. This Power of Attorney is executed by authority of a resolution adopted by the Executive COIIIIitt_ of the Board of Directors of said American Hotorists Insurance Company on February 23, 1988 at Long Grove, Illinois, a true and accurate copy of which is hereinafter set forth and is hereby certified to by the underSigned Secretary as being in full force and effect: "VOTED, That the Chainnan of the Board, the President, or any Vice President, or their appoint_s designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys-in-fact, and to authorize then to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indennity and other writings, obligatory in the nature thereof, and any such officers of the Company nay appoint agents for acceptance of process." This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the Executive Connittee of the Board of Directors of the Company at a .eeting duly called and held on the 23rd day of February, 1988: "VOTED, That the signature of the Chairlll8ll of the Board, the President, any Vice President, or their appoint_s designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, nay be affixed by facsimile on any power of attorney or bond executed pursuant to resolution adopted by the Executive Committee of the Board of Directors on February 23, 1988 and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company," In Testimony Whereof, the Anerican Motorists Insurance Company has caused this instrunant to be signed and its corporate seal to be affixed by its authorized officers, this 01 day of January , 1994 , Attested and Certified: AMERICAN MOTORISTS INSURANCE COMPANY tJ by '^- \'rI J. S. Kemper, III, Exec. Vice Presidenl (OVER) t / t,..-" May 10, 1999 ( ;F' ,~i yi' \. /\ T~j pI .' ," !_...~ , J' Vi J ';~(q0 Aon Risk Services AON RECErVED MAV 1 1 1999 City of Campbell Department of Public Works 70 N. First Street Campbell, CA 95008 PUBLIC WORKS ADMINISTRATION RE: PROJECT: Walsh Building ContractorslWalsh Construction Co., Inc. 790 E. Campbell Avenue Retail #EP97-119 Dear Certificate Holder: Please find attached a copy of the Certificate of Insurance which was issued to you for the 10/1/98-10/1/99 policy term for Walsh Building Contractors/Walsh Construction Co., Inc. This letter will serve as formal notification that effective 4-21-99, coverages have been canceled for the following policies: Commercial General Liability. Policy #SC0296519000 Umbrella Policy #OUL0029274 Package Policy #MXX80713860 Excess Auto Policy #XL865702 Effective 5-16-99, coverage has also been canceled for the following Workers' Compensation policy: Workers' Compensation Policy #003391911 Regards, ~~ Tina M. Camacho, CISR Account Administrator Enclosures Aon Risk Services, Inc. of Northern California Insurance Services. License #0363334 99 Almaden Boulevard, Suire 400 . San Jose, Calif(lrnia 951 1.'\-1604 . tel: (40H) 2HH-HOOO . EIX: (iOH) 2H9-9021 ~ *' ONl Y 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 Aon Ri.k Service.. Inc. of Northern C.liforni. 88 Alm.den Blvd.. Ste. 400 S.n Jose. CA 85113-1104 408-288-8000 COIf>ANV A Studh COIf>ANV B W.lsh Building Contr.ctors 22 N. Alm.den Avenue S.n Jose. CA 95110 RLI In. CO, COIf>ANV o THISIS TOCERTlFY THA T THE POLICIES OF INSURANCE L1STEDBELOWHAVE BEEN ISSUED TOTHEINSURED NAMEDABOVEFORTHEPOLlCY PERIOD INDICA TED,NOTWITHST ANDINGANYREQUlREMENT. TERMORCONDITIONOF ANYCONTRACTOROTHERDOCLMENT WITHRESPECT TOWHICHTHIS CERTIFICA TE MA Y BE ISSUED ORMA Y PERT AIN. THE INSURANCE AFFORDED BY T HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAlO CLAMS. _ ~.Y~N! ~.Y~.U L'III TWPIlOl' -- POLIDY..- DATI! (WMIDDIYY) DATI! (WWIDDIYY) L...... lII!NDAL U.LITY GUAM LI.LITY ANV AUTO ~tERAL AOOOEOATE . 3000000 10/01/98 10/01/U PRCn.CTS.coIf>/OP AOQ . 1000000 PERSONAl. L AOV 1N.l.RV . 1000000 EAOi cx:aA'lEtCE . 1000000 FIRE OAMACE (Anv _ fire) . 50000 liED EXP (Anv _ perl<<l) . COM!IN:D SINCLE LIMIT . 10/01/98 10/01/U 1000000 ElCDIL V I N.l.RV . (pw perl<<l) ElCDIL V 1N.l.RV . (pw accident) PRa'ERTV OAMACE . A X COMIERCIALCEIERALLIABILITV a.AIIIS MADE [It] 0CCl.R X owtER'S L CONTRACTCR'S PROT SC0291519000 1UT0WOllU LI.LITY X ANV AUTO AlL OWtE[) AUTOS SCI-ED.LED AUTOS HIRED AUTOS t<<)N.OWtE[) AUTOS MXX80713810 B o l!XoasLIULITY UaeREll.A F~M X OTt-ER THAN UI8lEU.A F~M WORICDS OO......ATION MD ~N'LOYI!RS'LI.LITY n.E !'RCPP.!ETrp! PARTtERS/EXECUTIYE a'FICERS ARE: OUL0029274 10/01/98 10/01/91 AUTO ON. V . EA ACCICENT . OTt-ER THAN AUTO ON.V: Y~U~/:YY//::/~ EAOi ACCllENT . AOCflEOATE . EAOi oc:cu:lREtCE . AClROATE . . 6000000 6000000 PUBL.IC ADM'N,sr WR ORf< ArlO C 003818-10 3/05/88 3/05/911 X STATUTCIlV LIMITS ~~nn~~~~YYY~~~~~~~~nH~ EAOi ACCllENT . 1000000 D!SEASE . POUCV LII'" S 1 C CO C C C DISEASE. EAOi EIoFLOVEE . 1000000 It<<..t. EXQ. OTHBI RE: emium. Ci ty of C.mpbell Dep.rtment of Public Works 70 N. First Street C.mpbell. CA 95008 "OUU ANY 01' THI! I8OVI! 1lDOII.. ~... 81! OAfaLLI!D .... THI! I!llP.ATION DATI! THI!III!OI', 1M1! ISIUM OO"ANY WLL tAL DAYS WRITTI!N NOTIOl! TO 1M1! OI!RT..ATI! HOLDa NA-..D TO 1M1 LII'T. '.:..:..:...:..:.:::...:. ..:::::.::...JIPJI'I!IU".,:m . INSURANCE REQUIREMENTS CHECKLIST Permit # 9 '7 - / J 7 CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: fl $1,000,000 per occurrence, and ff $1,000,000 general aggregate limit applying separately to the project, and ~ $2,000,000 general aggregate limit. g Policy expiration date i <"Y'/9 7 Automotive Liability - "any auto". . ,5 $1 ,?OO,oo~ p~r accident for/bodilY injury and property damage rr Pohcy exprratlon date I v I / to) I Worker's Compensation and Employer's Liability cr $1,000,000 per accident for ~y i!\iury or disease 0' ~olicy expiration date .3/5 '7 ~ Course of Construction (if required in Special Provisions) o Completed value of the project o Policy expiration date Required Endorsement to General Liability and Automobile Liability Policies Additional Insured Endorsement Ja' The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. J2l The insurance coverage afforded to the Additional Insured is primary insurance. IT Workers' Compensation Insurance Sheet Submitted o For General Contractor J4'Subrogation Clause ... (-~' ~ Insurance Certffic.re Reviewe~ A-Ji.h <-dL .~ , Initials ''-...".-. d-h g/CJ7 / Date ' }i- Copy of Insurance Certificate placed in tickler file OIie month prior to expiration. j:\forms\inscklst 4/96 (rev 6/96) .eo '0 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Aon Ri s k Se rv i cu, I nc, ot tI!. \" '" HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR No r the r n Cal i to r n i a tI!. G ~ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 100 Puk Center Plna, "5. '" J'l'd COMPANIES AFFORDING COVERAGE San Jose, CA 95113 D.,&~" COIiPANY 408-287-7319 .\1. A Re ublic Indemnit Walsh Building Contractors 22 N. Almaden Avenue San Jose CA 95110 . -.Nv ~ U'>\"\(.. ttp."t\O ~ ....\~\S1 p.O"" COIiPANY B Inve COhPANY C COIiPANY D :::SR::.:.:.:.:.:.:.:::.:::.:.:-:.:.:.:.::::'::::::'):::::::tt:,:,)m'):jjj'ff))j:::j,:::rrt))::m:jj't'jj:j::::j:::::m:::::r:::;'j)tt}'t:t'J:'::::::,:r:::::::::::::i::::(:::':'::i/'/:()':::m::,':::::::::::'/:t:,:,r::':::,:::r::::::::::,:::::.:.::,:,;\\:;:;:;,.::::::,::.:.,:::::::,::\::,,:::::::::::.::.::.:...:.....:..:....;.:..:::::,},{:,:'::::::\:;:::'::':;H::.....:::::::::HH... THISIS TO CERTIFY THA T THE POLICIES OFINSURANCE LISTED BELOWHA VE BEENISSUED TO THEINSURED NAMEDABOVEFORTHE POLICY PERIOD INDICA TED.NOTWITHST ANDINGANYREOUIREMENT. TERM ORCONDITlONOF ANYCONTRACT OROTHERDOCL.MENT WITHRESPECT TOWHICHTHIS CERTlFICA TE MA Y BE ISSUED OR MA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS, 00 TYPI! Of' INSURANCe POLICY NUIoIIEl LTA GENERAL L1ABLITY B X COMlERCIAl GEt-ERAl LIABILITY GLP1002257 ClAIMS MAllE [X] OCClJ< X OWt-ER'S &. CONTRACT~'S PROT AUTOhlOBLI! L1ABLITY ANY AUTO AlL OWt-ED AUTOS SOEllU.ED AUTOS HIRED AUTOS NON.OWt-ED AUTOS GARAGE LIABLrry ANY AUTO EXCEISLlABLrrY UlI3RELLA F~M OTH::R THAN UlI3RELLA F~M WORkERS COMPENSATION AND EMPLOYERS'LIABLrry A 003919-09 TH:: PROPR1ET~1 INCL PARTt-ERS/EXECUTlVE OFFICERS ARE: EXCl OTHER A Workers' Compo 003919-09 POLIC~ I!I'PEOTIVI! POLICY EXPIRAT DATI! (hlWOOI") DATI! (hlWOOIYV) Llhlrrs GEt-ERAl AGGREGATE $ 10/01/96 10/01/97 PROOJCTS.COhP/OP AOO $ PERSONAL II. ADV I~Y $ EACH OCClJ<RENCE $ FIRE DAMAGE (Any one fire) S lED EXP (Any one person) S CO..:lIt-ED SINGLE LIMIT 2000000 1000000 1000000 1000000 50000 BOOIL V I~V (Per person) BOOIL V I N..UlY (Per accident) PROPERTY DAMAGE AUTO Oti.. Y . EA ACCIDENT OTH::R THAN AUTO Oti.. Y: EACH ACCIDENT AGGREGATE EACH OCClJ<RENCE AGGREGATE 3/05/97 3/Q5/S3 X STATUT~Y LIMITS EACH ACCIDENT DISEASE. Pa..ICY LIMIT DISEASE. EACH EhPLOVEE 1000000 1000000 1000000 3/05/97 3/05/98 Waiver of Subrogation RE: Union Avenue/Campbell Avenue Retai I "EP97-119 City of Campbel I Department of Publ ic Works 70 N. First Street Campbel I, CA 95008 I \~$.P:,p::.,a~'~~r:rrrr):'::r:':::'r:::::'r:'r'r:rr:rr:rr:r':::':::':'::,:::::::r:r::rmrmmrr:r::: H H SHOULD ANY Of' THE ABOVE DDORIBI!D POLICES Be: OANCI!LLI!D BUORI! THE EXPRATION DATI! THI!RI!Of'. THE ISSU_ OO....ANY WLL I!NDI!AVOA TO hlAL 30 DAYS WRITTEN NOTICI! TO THE OI!RU'ICATE HOLDER NAhlI!D TO THE LEn. AGENTS OR REPRESENTATIVES. 180640000 7L.J :::O~~g~p:::~p~~p:~~rnp:~:Jt.J) POLICY NUMBER: GLP1002257 Walsh Building Contractors ':;OMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees & volunteers RE: All work in public right-of-way. Union Avenue/Campbell Avenue Retail #EP97 -119 (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 of "your work" for that insured by or for you. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 m:~Y"'AND''''C''O~F~\S..N8UR~~tS UPON TUE CERTIFld!~~ Ao n R i s k Ser vie n, I ne HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR of Northern CII ifornil ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 99 Almlden Boulevud, Ste 400 COMPANIES AFFORDING COVERAGE Sin Jon, CA 95113 . .'-0 COMPANY 408-288-8000~"I.t"":,',r: A Ruubl ic Indllllnitv COIIIDlnV -- ~ 't:;. v '-" COMPANY WIlsh Bui Iding Contrletors , , '999 B of Ameriel n N Almlden Avenue "'~~ COMPANY Sin Jon, CA 95110 C 'fIOs:\~~ C P\Je\..~llS11\1\1\O ~ COMPANY I ~~~, D :\~:::::i:.::=.:.:.:.:.:::::.;;:.:.:.:.:.:.:.:::r::r:::::::::::::=r::::::::::::::::::r:=::r::::rrr::r::::::::rr=::::=::::::::::r::r::::::::::::::::rrr=:::::::::::::rrrr::r::::::rrr::::::::r:::::mrm:::::::r:::::irr::::::r:::::::::::m::r::::::::::::::r::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::t::r::::::::::::::::::::::::::::::r::m::::::mrm:::::::::::::m:::::::::::::::::::::::::::::::::::::::::m:m:: THISIS TOCERTlFY THA T THE POLICIES OF INSURANCE L1STEDBELOWHAVE BEENISSUED TO THEINSURED NAMEDABOVEFORTHE POLICY PERIOD INDICA T ED. NO T WITHST ANDINGANYREOUIREMENT . T ERM ORCONDITlONOF ANYCONTRACT ORO THERDOCWENT WIT HRESPECT T o WHICH THIS CERTlFICA T E MA Y BE ISSUED OR MA Y PERT AIN. T HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. 00 POLICY IPl'I!OTM! POLIOY EXPIRATION L Tll T,,"or INIURAfM POLIOY NIl..... DAm (IIIIolIIlDIYY) DAm (MMIDDIVY) LIMITS CIl!NIRAL L1ABLITY h COMIlERCIAl GEt-ERAL L1ABILlTV PO QAIMS MADE 0 OC~ OWt-ER'S & CONTRACTCFS PROT '-- CEhERAL AClOOEOATE S PROOUCTS.COMP/OP AOO S S S S $ PERSONAl & />DV I~V EACH OCa.mENCE f-- FIRE DAMAC>>: (Any one fire) lieD EXP (Any one person) AUTO_U LIABLITY - ANY AUTO - AlL owt-ED AUTOS - SOEDU.ED AUTOS HIRED AUTOS NON.OWhED AUTOS COIoElI hED SIIO.E LIMIT S BOOILV I~V (per person) S - BOOILV I~V (per accident) $ - - PROPERTV DAMAGE - !XOEIS L1ABLITY I UlBlELLA FORM I OTI-ER THAN UlBlELLA FORM WOAKI!AS CO_AlION _ I!......OYDS. L1ABLITY AUTO ON-V EA ACCIDENT S OTI-ER THAN AUTO ON-V: :>>>>)HU>>H EACH ACCIDENT S AGGREGATE $ EACH OCCI.JlRENCE $ AClOOEGATE $ $ GAR_ LIABLITY ~ ANY AUTO - - A 003391911 3/05/00 x I STATUTORV LIMITS EACH ACCIDENT $ DISEASE PQICY LIMIT $ DISEASE EACH EMPLOYEE S } n 1j1 n~ ~ ~r nn~ ~n1n;;;~;nnn TI-E PROPRIETORI PARThERS/EXECUTlVE OFFICERS ARE: OTHIR R'NCL EXQ 3/05/99 1 000 000 1 000 000 1 000 000 .ITI!:_ RE: 790 E Clmpbel I Avenue Retli I #EP97-119 *ExeeDt 10 dive for non-Dlvment of nremium ::::;::::::::.:::::.::::::::::=:::;::;:;::):::;.:.::!::.':";:::::;:::;::.:::::.:.:.:::tr::t1::t:::!::tt::::f@t::::tt!t:::::t:::tl!t:::!:@@!::::::::::::::::tm!:!tt:::mt:::!:t:tttl{::::::;;:::;:::::::::::::.:.:::.L::::::::;::.::::;::::::.:)t:::f::::::::::::::::::t@:::::t:t:t:mt:tttt:::::tt::::::::::::f:=tt::::::::::@:tt::m:t:::::tt::::t1r:::::::::t::::::::;!: SHOULD ANY or THI! A8OVI! DI!IOR~ POLIOII!S DI! OANCI!LI.BI III!I'OIII! THI! !XPIRATION DAm THlRI!or. THI! IAU... CO"'ANY WLL MAL Ci tv of Clmpbell 30 DAYSWRITTI!NNOTIOI!TOTHI!OI!RT.~~OLDI!RNAMl!DTOTHI!LIPT. Deplrtment of Publ ie Works IiiIt! 70 N. First Street - - ft~ .~ iiiII ::--. Clmpbell. CA 95008 " :A L--"~ 180640000 ml~"::~'l_lll:::::::f:t::::l::::::l:tf::::::::::::ffff::r::f:=:=:t:::f::::::::t:::::llll::t:::::fff::::f:::l:::::ff:::::::::l1:fff::::::::::::::f:~~:t:l::11:;::"::::;':IIQ~:~.IJirt.("dl Aon Risk Services. Inc. of Northern C.I iforni. 88 Alm.den Blvd.. Ste. 400 S.n Jose. CA 85113-1604 408-288-8000 ONL V 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 W.lsh Building Contr.ctors 22 N. Alm.den Avenue S.n Jose. CA 95110 COIf>ANY A Stuelh COloPANY B RLI In. CO. COIf>ANY o ::\:.:::::.:i:.JII::.:.:.:.:.:.:.:IIIi)):III~):Ii)))))):IIi):IIIIIIIi)))::::::):::I:::::::::::):ItII::Ii))):::I:)):::~:~::~~:I:(t~~:::~:::I:)mi):Ii:::imi)):::I:)))))))::)r:I:):IIi)::::::::)::~:)::)):I::I:):::i::t)))::))::::))))))):::Ii):::i THIS IS TOCERTlFY THA T THE POLICIES OF INSURANCE L1STEDBELOWHA VE BEENISSUED TO THE INSURED NAMEDABOVEFORTHE POLICY PERIOD INDICA TED.NOTWITHST ANDING ANY REQUIREMENT ,TERMORCONDITlONOF ANY CONTRACT OROTHERDOCLMENT WITHRESPECT TOWHICHTHIS CERTlFICA TE MA Y BE ISSUED ORMA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. 00 POLIOY !l'l'l!OTIW POLIOY ~XPIlAT L TI TYl'I!Cll' INIURANOI: POLIOY NIl.... DATe (MNIDDIYY) DATe (MNIDDIYY) LIMITS Cll!Nl!AAL L1ABLITY CEt-ERAl AOOREOATE $ 3000000 A X COMlERCIAl OEt-ERAL LIABILITY SC0296519000 10/01/98 10/01/99 PROOUCTS.COIf>/OP AOO . 1000000 Q.AIMS MADE [iJ ~ PERSONAl Il. AnV IN.UlY . 1000000 X OWt-ER'S Il. CONTRACTOR'S PROT EACH OCCU'lRENCE . 1000000 FIRE DAMAOE (Any one fire) $ 50000 lED EXP (Any one person) $ AUTONOBU L1ABLITY COlEl t-ED SI NCl.E LI MIT $ 8 X ANY AUTO M>O<80713860 10/01/98 10/01/99 1000000 AlL OWt-ED AUTOS BODILY IN.UlY SCl-Eoo..ED AUTOS (Per person) X HIRED AUTOS RECEIVE BODIL v I N.UlV X ~N.OWt-ED AUTOS (per accident) DEe 1 " 1998 PROPERTV DAMACE . CIlARAGI! L1ABLITY :. !NORa AUTO ON. Y . EA ACCIDENT . ANY AUTO OTtER THAN AUTO ON.Y: ;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:::::: ............. ..... ... ...........,'. ,- . . ITM,.., .............. .... . ............. ..... ............. ,.... EACH ACCIDENT $ AOOREOATE . IllClDSLlABLITY EACH Cll::CU'lRENCE . 6000000 C UlI3RELLA FORM OUL0029274 10/01/98 10/01/99 AOOREOATE $ 6000000 X OTtER THAN UlI3RELLA FORM . WORICI!RS OOMPENSATION AND X STATUTORY LIMITS :::::::::::::::::::::;::::-:.:::::::: ........... ..... ... ......... ....... . .'. .......................... ~IiFLOVUlS' LIABLITY .... ... . ... ...... ...... D 003919-10 3/05/98 3/05/99 EACH ACCIDENT $ 1000000 Tt-E PROPRIETORI INCL DISEASE. POLICV LIMIT . 1000000 PARTt-ERS/EXECUTlVE OFFICERS ARE: EXQ. DISEASE. EACH EIf>LOVEE . 1000000 OTH!R RE: emi um. ::::. ..:::.:.::::::~:::~::::::::::::.:.:.:.::::;::.:.:::::-:::.:::.:::::.:::.:::::.:.;.:.:::::::::::.::::::::::::::::;:;::::'::::.:::::::.:::::::::;':::::::::::::::::::::.:.:.:::.:::.:.:::::::::::::.:::::.:::::::.::::::::~..:::::.:.:.::::;:;..:;.;.::;:;:;.:.;:::::::;::::::::' :::::::.:: :.:: :.:.:.: :.;::.::~::.:;;;::~~:::;:;::i.;.){j}ff~~1~~~~t~~~~ttt~~{~~t~~~tft~;jt~~~~~~~~~~fttmmm~~I1111jmtrtrr}}rtllltttIt City of C.mpbel I Dep.rtment of Publ ic Works 10 N. First Street C.mpbel I. CA 95008 I :::II.I~~::(~.:t_lm::~:r:m:mrrmm:mmm:mr:m::r::::::r::::~:~:~:~:r:m:::m::r:::m:m:m::rrrr::r::::rr::~:::~::m:m:::m::~:~:~m::~:::~:~~~:~:~:)r~:)::~:~:)::~:::)::~:~:~:r::~:::::::::~:~:~:~:::t)r:)::~:r::::f~::::::::::::):m:::::::::::}{ SHOULD ANY Of' TH~ ABOVI! IlUCAIIm POLIOD lie OANOaL!D IIUOM TH~ ~XPIlATION DATe TH!AI!Of'. TH~ IUUINCIl OOhFANY WLL IAL 30 DAYS WRITTeN NOT_ TO TH~ O!RTrlOATIt HOLDER NAMD TO TH~ LI!PT, '. .. ..........................Q...J..."....Jl...Q.....I......'..U.....J....... . . ... . . . . . ...:::...:......::..:..:::......:........::...:......:..:..:;:;......:...:...;:;: Steadfast Insuran\.._ Company POLICY NO.: SC0296519000 NAMED INSURED: Walsh Buildina Contractors EFF. DATE OF POLICY: 10/01/98 EXP. DATE OF POL.: 10/01/99 Additional Insured . Owners, etc./Automatic Status per Contract THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS-COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees & volunteers RE: All work in public right-of-way. Union Avenue/Campbell Avenue Retail #EP97 -119 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. WHO IS AN INSURED (Section II) is amended to include as an insured any person for whom you are performing operations when and such person have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. B. With respect to the insurance afforded these additional insureds, the following additional exclusion applies: The insurance does not apply to: "Bodily injury" "property damage", "personal injury" or "advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: I. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. STF-CGL-1621 A CW (7/98) 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 Aon Risk Services, Inc. of Northern Cel ifornie 99 Almeden Blvd., Ste. 400 Sin Jose, CA 95113-1604 408-288-8000 eEI\! Welsh Building Contrectors 22 N. Almeden Avenue Sin Jose, CA 95110 THISIS TOCERTlFV THA T THE POLICIES OF INSURANCE LISTED BELOWHA VE BEENISSUED TO THEINSURED NAMED ABOVEFORTHE POLlCV PERIOD INDICA TED.NOTWITHST ANDINGANVREQUIREMENT. TERMORCONDITlONOF ANVCONTRACT OROTHERDOCLMENT WITH RESPECT TO WHICH THIS CERTlFICA TE MAV BE ISSUED ORMAV PERT AIN, THE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SlICH POLICIES. LMITS SHOWNMAV HAVE BEEN REDUCED BV PAID CLAMS. 00 POLIOY !PFI!OTIVl! POLIOY EXPRAT LTR T'IPI!OI'INSURANOI! POLIOYNUIi8R DATE (......DDlYY) DATE (M....DDlYY) LIMITS GENERAL LlABLITY GE~RAL AGGREGATE t A X COMIoERCIAL GE~RAL LIABILITY SC0296519000 10/01/98 10/01/99 PROOUCTS.COIP/OP AOO t CLAIMS MADE UU OC~ PERSONAL ll. ADY IIURY $ X OW~R'S ll. CONTRACTOR'S PROT EACH OCC~~ t FIRE DAMAGE (Any one fire) t IoED EXP (Any one person) t AUTOhlOBLI! LIABLITY COIol3I~D SiNGlE LIMIT 8 X ANY AUTO MXX80713860 10/01/98 10/01/99 1000000 AlL OW~D AUTOS BClOIL Y IIURY SCl-EDU.ED AUTOS (Per person) X HIRED AUTOS BClOIL Y IIURY X NON.OW~D AUTOS (Per accident) PROPERTY DAMAGE .MAGI! LlABLITY AUTO ON.. Y . EA ACCI!l:NT ANY AUTO OTt-ER THAN AUTO ON.. Y: EACH ACCI!l:NT t AGGREGATE t EXCESS LlABLITY EACH OCC~~ t 6000000 C UIoI3RELLA FORM OUL0029274 10/01/98 10/01/99 AGGREGATE t 6000000 X OTt-ER THAN UIoI3RELLA FORM $ .... ..,..... WORKERS OO~ATION AND STATUTORV LIMITS ..... ..................... ....... X .............. .... EhFLO'IDIS'LlABLITY :::;:;:;:;:::::;:::::::::::::;:;::::: D 003919-10 3/05/98 3/05/99 EACH ACCI!l:NT t 1000000 Tt-E PROPRIETORI INCl DISEASE. POliCY LIMIT t 1000000 PART~RS/EXECUTlVE OFFICERS ARE: EXCL DISEASE. EACH EIoPLOVEE t 1000000 OTHI!A RE: City of Clmpbell Depertment of Publ ic Works 70 N. First Street Cempbel I, CA 95008 I m,f;"8flfi,nJMI:t:r::rr:ttttmr:tt::::::::::tttt::tt::t:::::::r::r:ttttt:rr:::::::::::::ttt::::::::::::::::tt::::: Steadfast Insurance Company POLICY NO.: SC0296519000 NAMED INSURED: Walsh BuildinQ Contractors EFF. DATE OF POLICY: 10/01/98 EXP. DATE OF POL.: 10/01/99 Additional Insured . Owners, etc./Automatic Status per Contract THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS-COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees & volunteers RE: All work in public right-of-way. Union Avenue/Campbell Avenue Retail #EP97 -119 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. WHO IS AN INSURED (Section II) is amended to include as an insured any person for whom you are performing operations when and such person have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that insured. A person's or organization's status as an insured under this endorsement ends when your operations for that insured are completed. B. With respect to the insurance afforded these additional insureds, the following additional exclusion applies: The insurance does not apply to: "Bodily injury" "property damage", "personal injury" or "advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: I. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. STF-CGL-1621 A CW (7/98) ~~~'''''~l Aon Risk Svcs Inc of No. C.I. 99 Alm.den Blvd. Suite 400 S.n Jose, CA. 95113 ONL Y 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 Wllsh Building Contrlctors 11 N. Alm.den Avenue S.n Jose, CA 95110 COltPANY A Re COll'ANY B ub lie I ndemn i t of Ame i c . COltPANY C COltPANY o ::\',.::9!.:.:.:.:.;'(:.:.:.:.:.:.;::::::fmt:::ff::ff1:tt::ttt:::::::::'t::i1'\f:i:ft:1f'tttttt:':::1::111:'::::::::::ft@:::::::?::i:j::f::t:t::::::?:::@:t:::m:m:::::::::m:t:i::::::t:\::::m::i:j:j@::::::::ttm:@{fm:m::::::::\:\::m:m:m::\t:\::mt:::::\@::::::::::::::::::::::::::@::@::::::::::mm@::::t:\@}::::m:::m:::::::::tm THISIS TOCERTlFY THA T THE POLICIES OF INSURANCE L1STEDBELOWHA VE BEENISSUED TO THEINSURED NAMED ABOVEFORTHE POLICY PERIOD INDICA TED.NOTWITHST ANDINGANYREOUIREMENT. TERMORCONDITlONOF ANYCONTRACT OROTHERDOCLMENT WITH RESPECT TOWHICHTHIS CERTlFICA TE MAY BEISSUEDOqMAY PERT AIN, THE INSURANCE AFFORDED BY THE POliCIES DESCRIBED HEREiN is SUBJECT 10 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. 00 TYPE OI1INSURANOI! POLIOY NIl..... POLIOY II'ROTIVe POLIOY I!XPIRAT LTI DATI! (MMIDOIYV) DATI! (MhlIDDlYV) LiMns Cll!Nl!AAL L1ABLITY GEt-ERAL AClGlEQA TE . COMIERCIAL GEIERAL L1ABILlTV PROOUCTS-COltP/a> Aoo . ClAIMS MAtE D 0Ccu:l PERSONAL 8. AnV IN.UlV . OWIER'S 8. CONTRACTOR'S PROT EACH OCC\.mENCE . NOllVWl FIRE DAMAGE (Any one lire) . S)l\!O M lED EXP (Any one person) . AUTOM08L1! L1ABLITY 866l 9 H~W COlof3lt-ED SinE LIMIT ANY AUTO ALL owt-ED AUTOS a3AI ~3t:1 BOOIL v IN.UlV . SOEDU.ED AUTOS (Per person) HIRED AUTOS BOOIL v I N.,U'lV NON.OWIED AUTOS (per accident) PROPERTV DAMAGE . .MAGI! L1ABLITY AUTO ON.. V . EA ACCIDENT ANY AUTO on~R THAN AUTO O~ V: EACH ACCIClENT AClGlEQA TE I!XOI!SS L1ABLITY EACH OCC\.mENCE Ulof3RELLA FORM AOOREGA TE OTI-ER THAN Ulof3RELLA FORM WORlCI!RS OOt.FI!NSATION AND X STATUTORV LIMITS I!IoR.OY\!llS'L1ABLITY A 0033919-10 3/05/98 3/05/99 EACH ACCIClENT . 1000000 TI-E PROPRIETORI INCl DISEASE - PQICV LIMIT . 1000000 PARTIERS/EXECUTlVE OFFICERS ARE: EXCL DISEASE. EACH ElI'LOVEE . 1000000 OTHER RE: emium. :\::::::.:.:::://::::::::,:::i:::;:::::,::.::\:::.,::.::~:.;::.;::::.:.;.:::::11i:::::::@::::::::::1/::::'t:/::::::::::::::::::::::1:::::::::::::::::::::::::::::::::::::::::::://::::::::::::::::::::::::::::::::::/::::::::;::\:::::,:::::;:::::::::::;::::::.:::.::;;::):.::::,:::::,:::::t::;:;;;:\::::1;::;;:/;;::;r;/:tt:/':::::i:t:;::/f1;:::;;;;1:t:;r:t:::':':::h:::f::i:::::::;::h:::;::::m::;:;;::::::::::::::t::;::::: SHOULD ANY 01 THI! ABOVE DESORIII!D POLIOII!S II! OANOnL!D 8I!I'ORE THE I!XPIRATION DATI! THI!RI!OI1. THI! 1SlIU_ OO"'ANY WLL MAL City 0 f C.mpbell 30 DAYS WRITTI!N NOT_TO THEO!RTPIOAT! HOLDER NAMED TO THEL!PT. Oep.rtment of Publ ic Works 70 N. First Street Clmpbell, CA 95008 ('" ~ ')'~ /~640000 :::J.qg!M:~I]'f:.,:::::::::r:':::;r::'::":::::::::r:'::::;:::::::::::::;,::::::::::::::::r::::r:::::::::;::;:::;:;::::;::::::::::::;:::;:::;:::::',;:::::r::::m:::::r::::::::::::::::::::,:':;:::::,:::::::::r::r::r::::::f.}:::::::::::::r:::t{:::::::~~:'~::;:;:~::,~~~i_llmf:f~.:::: 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 Aon Risk Svcs Inc of No. CII. 99 Almaden Blvd. Suite 400 Sin Jose, CA, 95113 Walsh Building Contractors 22 N. Almaden Avenue San Jose, CA 95110 COII>ANV A. Re COlPANY B ub I i c I ndemn i t of Ame i c a COlPANV C NOt.&. VW'&'IINtwov d COII>ANV o :::::::.:::::::::,:.:::.:.:.:.:.:::::.:M1iIII::::ImmI:mII::::II:}mI::IImmmmI:}}}}}}}:ImmmmImmI:}}}}}:I::I::::::::I::I::::IIIIIIIIII:}mI:~:~~:II::II::I::::::IIm~:::~::::::ImmI:}}}:::III~}:::::::r::::::::: .:t::::::: J: ::r. \: (::.:. ::~.<~(: )~:::.::: .(::::: THISIS TOCERTlFY THA T THE POLICIES OFINSURANCE lISTEDBELOWHA VE BEENISSUED TO THEINSURED NAMED ABOVEFORTHE POLICY I INDICA TED,NOTWITHST ANDINGANYREOUIREMENT, TERMORCONDITlONOF ANY CONTRACT OROTHERDOCL.MENT WITHRESPECT TOWHICHTHIS CERTIFICATE MAY BEISSUEDORMAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. 00 POLIOY !l'l'l!OTM! POLIOY DPIlAT L TR TYPE OF INSUR.... POLIOY MI.... DATI! ("'hIIDDIYV) DATI! ("'''''ODIYV) LI"'ITS Gl!NERAL LlABLITY COMIERCIAl GEIERAl LIABILITY CLAIMS MAIlED OC~ OWIER'S & CONTRACTOR'S PROT A n'E PROPRIETORI PARTIERS/EXECUTlVE OfFICERS ARE: OTHI!Il 0033919-10 GEIERAL AGGREOATE . PROOUCTS.COlP/OP AOO . PERSONAL & AOV I~V . EACH OC~tCE . FIRE DAMAGE (Any one fire) . lED EXP (Any one person) . COIoElIIED SIIO..E LIMIT . BCOIL V I~V . (per person) BCOIL V I~V . (per aooident) PROPERTV DAMAGE AUTO OM. V . EA ACCIDENT OTt-ER THAN AUTO mIx EACH ACCIDENT AGGREOATE EACH OC~tCE AGGREGATE STATUTORV LIMITS 3/05/98 3/05/99 EACH ACCIDENT DISEASE. Pa.ICV LIMIT DISEASE. EACH EloPLOVEE AUTOhlClllU LlABLITY ANY AUTO AlL OWIED AUTOS SCt-EDU..ED AUTOS HIRED AUTOS NON.OWIED AUTOS GARAGI! LlABLITY ANY AUTO EXIlEIS LlABLITY UloI3RELLA FORM OT~R THAN UIIBRELLA FORM WORKI!IlS OOMPI!NSATION AND EhFLO'II!H'LlABLITY INCL EXCL RE: emi um. :~::..:;.::.....:.:.:::::..::::.:;:::..;;.:;::;:.;..::;~::,;,,;:,,:,,:::,:::::,:'::':::::::'::::::'..::::::;.:..:::.;....;.;:..;:;;.;:;.;:;;;;:;.:;::..::.::.:::;:::::.:.:;.;:.:;..:::....:;.::.:::~::;::.;.....::.::::.;.:::.::..:.:...::.:...::....::..::.::::::::::;:;.;:::;:::.:;::'":,,:,:,:,:,:;:,,::,::::::::::,,:,,,:,:::;::,,:;:::::~~~~ffmrrmt1mmm;;;ti;iItti{~t~~~{fmr\~~;~~~;Jt;i;i;j;i;:t;~~~;~;~;~ftrft1ttt~rtm~;:;:;~;t:;;;~;~;:;~t;~;;;; SHOULD ANY OF THE ABOVI! DI!SCR~ POLIOII!S III! OANOl1.U!D III!PORI! THE EllPllATION DATI! THI!IlI!OF, THE IlSUINClI OO"'ANY WLL .IAL C i t Y 0 f C ampb e I I 30 DAYS WRITTI!N NOTIOI! TO THE OERT.IOATI! HOLDI!R NAMED TO THE LeFT, Department of Publ ic Works 70 N. First Street Clmpbe I I, CA 95008 / ~ 180640000 :Aq~~!::f.,:t'l@lmm///:rrr::::r:::::::::::/mm/::::/::/:::::::::rr:/:rr:/:r://::///:://::::::::///::/::::::::/:rr)r:::/::/::i...:::::~:(r:::/:~:(r~)'Bk~//~:::f/:):::\f/]iVil9~~~l"lMO"'r ! A.~.~~~~.~J!:I'I:IIIII!IJil'IIIII!!!I:I!!!!:lil::!I::i!1:1~111'.!lIi!!::!!!!!:::'.' lOR~b .00Al!'tMMiDOiWI........ Aon Risk Services. Inc. of Northern C.liforni. 99 Almaden Blvd.. Ste. San Jose. CA. 95113 408-288-8000 400 Q E C E . " ~ ,/ 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 COloPANY A CI. endon Ame COloPANY B Fi em.n COloPANY C Gene COloPANY o R 99~~Mi~!://f::::::::::::((mmmm111111::::::::::::::::::::::::::::::::::::::::1::::::::):::::::::::::((:::::::::::::::::::::::::::::::::::::/::1::11/:::::::::'::::::::::::::::::::::::::::ff1::1:::::::::'::::mm ........ ... N...... .................................. .... THISIS TOCERTIFY THA T THE POLlCIESOFINSURANCE L1STEDBELOWHAVE BEENISSUED TO THEINSURED NAMED ABOVEFORTHE POLICY PERIOD INDICA TED,NOTWITHST ANDINGANYREOUIREMENT, TERMORCONDITIONOF ANYCONTRACT OROTHERDOCWENT WITHRESPECT TOWHICHTHIS CERTIFICA TE MAY BE ISSUED OR MAY PERT AIN, THE INSURANCE AFFORDED BY THE POL!C!ES OESCfllBED HEREIN IS SUBJECT TO ALL THE 'fERr'AS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. 00 POLICY EffEOTIVE POLICY EXPIRAT L TA TYPEClI'INSURANCE POLICY NUhlIIER DATI! ("'''''DO'YY) DATI! (......'DO.YY) Co. Walsh Building Contr.ctors 22 N. Alm.den Avenue S.n Jose. CA 95110 ;; '....' , ~.-.; '. :~~\'~iSlRATlO\" Co. Co. LI...ITS GENERAL UABLITY A X COMMERCIAlClEfERAlLlABILlTV TNC0698-97-0226 QAIMS MADE!2U ~ X OWfER'S So CONTRACTOR'S PROT ClEfERAL AGGREGATE $ 10/01/97 10/01/98 PROOUCTS-COIF/QP AOO $ PERSONAl So ADV I N-WY $ EACH OCC~RENCE $ FIRE DAMAClE (Any one lire) $ MED EXP (Any one person) $ C0t.f31 fED 51 NGlE LI MIT 2000000 1000000 1000000 1000000 50000 AUTOhlOBlLE LIABLITV B X ANY AUTO MXX80684902 AlL OWfED AUTOS SC~DU.ED AUTOS X HIRED AUTOS X NON.OWfED AUTOS 10/01/97 10/01/98 1000000 BODIL Y IN-WY (Per person) BODILY IN-WY (Per accident) PROPERTY DAMAClE D 003919-09 3/05/97 3/05/98 STATUTORY LIMITS EACH ACCIDENT DISEASE. POliCY LIMIT DISEASE. EACH EMPLOYEE 6000000 6000000 C EXCESS UABLITY UIlI3RELLA FORM X OT~R THAN UlM3RELLA rorll. WORKERS OOhlPENSATION AND EhlPLOVERS'UABLITY OUL026188 10/01/97 10/01/98 AUTO O~ Y . EA ACCIDENT OT~R THAN AUTO O~Y. EACH ACCIDENT AGGREGA TE EACH OCCURRENCE AGGREGA TE GARAGE UABLITY ANY AUTO TI-E PROPRIETORI PARTfERS/EXECUTlVE OFFICERS ARE. OTHER INCL EXCL DESO RE: City of C.mpbel I Department of Publ ic Works 70 N. First Street C.mpbel I. CA 95008 I ::~~~Rlt:IFJ]~~~~t:::::::::::::::::::::mmm11::::::(?m} . .............. ........................................... ............................................ ............ ............................. ...................................... . ................................. . ............................... ........................ .................. POLICY NUMBER: TNC0698-97-Q2: Walsh Building (" ..,actors COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, its officers, employees & volunteers RE: All work in public right-of-way. Union Avenue/Campbell Avenue Retail #EP97-119 (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 of "your work" for that insured by or for you. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. CG20101185 Copyright, Insurance Services Office, Inc., 1984 .i. A4~4~.~.~.~.~~....lillll.ill.lljlllljllllli.i'I.I:II:1.111:1'111:1:!IIIII.IIIIIII.III'li:'.:.' .. iS~6iMiER. .... ... .. ................. . . . . . . . . . . . . . . . . . ..'OAlf(MMiDO;YYj.......... 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 COVE Aon Risk Services, Inc. of Northern Cal ifornia 100 Park Center Plaza, #506 San Jose, CA 95113 406-267-7319 I S RE COMPANY A Re ubi ic Indemnit COMPANY B I nve COMPANY C Gene COMPANY o Walsh Building Contractors 22 N. Almaden Avenue San Jose CA 95110 . Co. ance Co. 9R~~MP~!::...,.,::..,\::::::L.. .. ....... ....... ......... ......<< .,:.:.::.:.......:(,//'???:,.....:>::::.:::...:.. ...........:...:....:::::::::,;.::;;;:::;;;:.... THISIS TOCERTIFY THA T THE POLICIES OFINSURANCE L1STEDBELOWHA VE BEENISSUED TO THEINSURED NAMEDABOVEFORTHE POLICY PERIOD INDICA TED.NOTWITHST ANDINGANYREOUIREMENT, TERMORCONDITIONOF ANYCONTRACT OROTHERDOCWENT WITHRESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED ORMA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMlTS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. CO LTR POLICY NUMBER POL IC Y EffECT IVE POL IC Y EXP IR A TlON LIMITS DATE (MM'DD'YY) DATE (MM'DD'YY) GENERAL AGGREGATE 10/01/96 10/01/97 PROOUCTS.COMP/OP AGG PERSONAL I!. ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Anyone fire) MED EXP (Any one person) COMBINED SiNGlE LIMIT 10/01/96 10/01/97 BODIL V INJURY (Per person) BODILY INJURY (Per accident) PROPERTV DAMAGE AUTO ON.. Y . EA ACCIDE NT OH-IER THAN AUTO ONLY. EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE 10/01/96 10/01/97 X STATUTORY LIMITS 3/05/97 3/05/98 EACH ACCIDENT DISEASE. POliCY LIMIT DISEASE. EACH EMPLOYEE TYPE Of INSURANCE GENERAL LIABILITY B X COMMERCIAL GENERAL LIABILITY GLP1002257 CLAIMS MADE [X] OCCUR X OWNER'S I!. CONTRACTOR'S PROT AUTOMOBILE LIABILITY o X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON.OWNED AUTOS MXX80657453 GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM C X OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY UB61492 A 003919-09 THE PROPRIETORI PARTNERS/EXECUTIVE OFFICERS ARE. OTHER INCL EXCL 1000000 6000000 6000000 1000000 1000000 1000000 A Waiver of Subrogat on 003919-09 3/05/97 3/05/98 Workers' Compensation D SC IPTlON Of OPERA I S LOCATIONS VEH ICL S S ECIAL ITEMS City of Campbell Department of Publ ic 70 N. First Street Campbel I, CA 95008 A$PR!)f~~~la~'~~)))))) .... SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE EXPIRATION DATE THEREOf, THE ISSUING COMPANY- WIU .....iICa1IdbJ(jb MAIL 30 DAYS WRITTEN NOTICE TO THE CERTifiCATE HOLDER NAMED TO THE LEfT, ~.. Xt](JiKtlJlIJX.JrdtIlllIl(~.xXltifo""'lIb"X*~~ ~XiKI...x I1....X tut XolhlWl.... x Ii' ~ ~ll(II:JWU&I~W A:T~:::1t~1:'LE[Z~I~d ;'lZ t{ ~. /1 V 180640000 ;:;:;:::::;:::::;:::;:;:::;:;:::::::;:::::;::;::::;:;:.:.:........ ~~~~~~~~~jjj~:j1j1::j1::::::::::::::::~1A~9RP:::~P1~~P]~~r!P1~:::1:'~'::::: Works ....................... ........................ ....................... ........................ ....................... ........................ ....................... ...............,...,.,.....,.,..'.............. . . . . . . . . . . . . . . . . . . . . . . .. ..... .................................. .................................. .................................. .................................. .................................. .................................. ,................................. .................................. .................................. POLICY NUMBER: GLP1002257 Walsh Building Contractors COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, it's officers, employees & volunteers RE: All work in public right-of-way 790 E. Campbell Avenue Retail #EP97 -119 (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 of "your work" for that insured by or for you. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance ofthe additional insured will be called upon to contribute to a loss. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 WORKER~S COTvlPENSA TION lNSURA1",JCE INFOR.l\fATION The following worker's compensation insurance information is required for all Applicants and Conrractors. One of the following items for each Applicant and Contractor must be submitted prior to working under a Public Works permit or contraCt. WORKERS' COMPENSATION INFORMATION: Name of ContrnCtorl Applian! Imwalle, Stegner & Cropper o A Certificate of Consent to Self-Insure issued by t.~e DirectOr of Industrial Relations; QE o A Certificate of Workers' Compensation Insurance lnsurance Co. Policy No. ExniratiOD Date " ; .QR ~ A signed Certificate of Exemption from {he Workers' Compensation laws as primed belov;o CERTIFICATE OF EXEMPTION I certify that in the performanr-e of the work for t.1is contraCt, I shall not elY'.ploy any person in a manner so as to become subject to the Workers' Compensation La.wsof California. ~ I r? ' /J~ W~J;~ Signed onald F. lmwal e Date April 30, 1997 Title President NOTICE TO APPUCANT fCONTR..\CTOR: If after signing this Certificate of Ex.emp[icn, you should become subject to L~e Workers' Compensation pwvision of the Labor Code, you must forthwith comply with such provisions or the Permit or ContraCt will be cancelled or revoked. j:\forms\wo!kcc::n:p(rev6/96> 0\ . CAItt . /.)& ~ (<' - .... U r 1- <' >. ... ,-' o . R C H.' Ill) CITY OF CAMPBELL Public Works Department August 24, 2001 Dominic Giacalone Imwall Stegner 102 Park Center Plaza San Jose, CA 95113 SUBJECT: PERMIT NO. 97-119 LOCATION: 790 E. Campbell Avenue MAINTENANCE INSPECTION - ACCEPTANCE Dear Mr. Giacalone: The City of Campbell has made the final 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. Attached is your original Bond for Faithful Performance Maintenance Period which we are returning to you. since~~___ Alan Horn Senior Public Works Inspector MQ ~\,~ cc: Permit 97-119 Public Works/Maintenance Division American Motorists Insurance, P.O. Box 1327, San Mateo 94401 J :\FORMS\MTCEACC(WORD) 70 North First Street Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790 o".c,"4t f...,.~ j}~~ ... t'" U t"'" . . .... .. 1- " ~ -' . /').q C H A \l. {) "-' CITY OF CAMPBELL Public Works Department May 20, 1998 Ms, Katherine Zerounian Alburger Basso De Grosz 301 Island Parkway Belmont, CA 94002-4110 Subject: Permit #97-119 Location: 790 E. Campbell Ave. Release of Faithful Performance Bond Dear Ms. Zerounian: Enclosed please find the original Faithful Performance Bond for the above referenced permit. We have received the Maintenance Bond in the amount of$10,000.00 Additionally, Dominic Giacalone has requested that I also forward to you a copy of the letter granting final acceptance by the City of Campbell, which is enclosed. For your information, the one year maintenance period will end on October 16, 1998. If you have any questions, please call me at (408) 866-2165. Sincerely, / (~CL~ Q)QtfLl\~~ frt.-=l. Randy Westfall Public Works Inspector Enclosures cc: Dominic Giacalone, ImwaIIe Stegner, 102 Park Center Plaza, San Jose, CA 95113 H:\WORD\PERMITS\97119BON(JD) 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TDD 408.866.2790 o \'. CAA.( r~~'. A-Jl~ .... r" . . ... ... 10 " ... , -ot)ItCH" v. " '" CITY OF CAMPBELL Public Works Department October 16, 1997 Mr. Richard Fish 3048 Sunny Meadow Lane San Jose, CA 95135 SUBJECT: PERMIT NO. 97-119 LO CATION: 790 E, Campbell Avenue FINAL INSPECTION AND ACCEPTANCE Dear Mr, Fish: 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 City will continue to hold your Faithful Performance Bond as your Maintenance Surety unless you choose to submit a Maintenance Bond in the amount of $10,750 in its place. Additionally, your Plan Check Deposit of $780.00, plus any interest due, is now being processed and will be sent to you under separate cover. The cash deposit in the amount of $1,720.00, plus any interest due, will be refunded directly to Walsh Building Contractors. If you have any questions, please call me at (408) 866-2168. Sincerely, :::::9--- - _/ -- Robert Phillips Project Inspector MQr-' cc: Suspense - 11 months Pennit #97-119 Inspector File Walsh Building Contractors, 22 North Almaden Avenue, San Jose, CA 95110-2425 H:\WORD\PERMITS\97119FIN(JD) 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790 7/~// ? I ----- May 11, 1998 A. REAL ESTATE DE\'ELOPl\tENT CORPORATION RECt=IVED MAY t , 1998 PUUL.IC AOMIN'ST wR ORKS AT/ON Mr. Randy Westfall Public Works Department City of Campbell 70 North First Street Campbell, CA 95008 RE: Permit # 97-119, 790 E. Campbell Avenue Dear Mr. Westfall, Enclosed is a Maintenance Bond in the amount of $1 0,000.00 to replace the existing $40,000.00 Improvement and Performance Bond, at the above referenced location. Also enclosed is a letter from our insurer with additional items that need to be addressed before the Surtey will replace the existing bond. If possible, please send those items directly to Katherine Zerounian at ABD, with a copy tome. Please do not hesitate to call me with any questions. Sincerely, ~~ r . ~I~,I!J~~ Dominic )l. Giacalone 102 PARK CENTER PLAZA . SAN JOSE, CA 95113 TELEPHONE: 408-287-3838 . FAX: 408-287-0541 ABDALBURGER BASSO .. DE GROSZ Insurance Brokers Benefit Consulting Risk Management May 6, 1998 Mr. Dominic Giacalone Imwalle Stegner 102 Park Center Plaza San Jose, CA 95113 RE: City of Campbell Maintenance Bond #3SM 891253 OO-A Dear Dominic: Enclosed please find the one year Maintenance bond as requested by you as well as the City of Campbell regarding Permit 97-119, 790 E, Campbell Avenue. Please have bond signed appropriately and send to the City for filing. Please also note the following: The Surety does not consider this bond to be reduced to a one year warranty term until such tine as they have been released from the existing Improvement bond (3SM 891 253 00). The Improvement bond is considered to be in full force and effect until such time the surety has received the original improvement bond m1d an acceptance resolution from the City of Campbell. Please be sure to obtain both of the above items and send to me as quickly as you can for processing. Thanks Dominic, and if you have any questions please do not hesitate to contact me. Very truly yours, kgz.. enc1 Member of liBNI International Broker Network 30llsland Parkway. Belmont, California 94002-4110 . ph: 650/598-0900 . fax: 650/598-0370 . www.abdi.com License # 0460S90 Campbell & Union Traffic Signal/Street Lighting Punch List Sept. 5, 1997 West side of Union. south of Campbell: #3 1f2 (N9) "Fire Alarm" pull box, #5 (N30) "Service" pull box and #3 1f2 (N9) "Telephone" pull box: _ UNACCEPTABLE grout job. Grout is uneven, has dips and gouges. Grout does not cover up the sides of the box, dirt is exposed. Dirt exposed around conduits. If contractor is unwilling to have G.A.B. perform the work, then at least the person should walk across the street, open a box, and see how an "ACCEPT ABLE" rock and grout job looks first hand. SEE ATfACHMENT "PULL BOX ROCK AND GROUT DETAll..S" #3 1f2 (N9) "Telephone" pull box: -Lid broken and chipped, concrete in lift eyes; replace lid with "CAMPBELL TELEPHONE" . #5 (N30) traffic signal pull box at base of the Type 17-3-70: -Has wrong lid, reads "CAMPBELL STREET LIGHTING", should read "CAMPBELL TRAFFIC SIGNAL". _ UNACCEPTABLE grout job. Grout is uneven, has dips and gouges. Grout does not cover up the sides of the box, dirt is exposed. Dirt exposed around conduits. If contractor is unwilling to have G.A.B. perform the work, then at least the person should walk across the street, open a box, and see how an "ACCEPTABLE" rock and grout job looks first hand. SEE ATTACHMENT "PULL BOX ROCK AND GROUT DETAll..S" South side of CampbelL west of Union: #5 (N30) "Traffic Signal" pull box, #5 (N30) "Service" pull box and #3 1f2 (N9) "Telephone" pull box: _ UNACCEPTABLE grout job. Grout is uneven, has dips and gouges. Grout does not cover up the sides of the box, dirt is exposed. Dirt exposed around conduits. If contractor is unwilling to have G.A.B. perform the work, then at least the person should walk across the street, open a box, and see how an "ACCEPTABLE" rock and grout job looks first hand. SEE ATTACHMENT "PULL BOX ROCK AND GROUT DETAILS" 1 #3 112 (N9) street lighting "Service" pull box at base of wood PG & E pole: -Clean excess cement from legend. -Drain hole plugged. 2 "PULL BOX ROCK AND GROUT DETAILS" Refer to City of San Jose Detail E-02 on next page. . The crushed rock should be CLEAN with aggregate size MIN 1" to 2" MAX. . The depth of the rock sump shall be 6" MINIMUM. . Tarpaper shall be placed over the rock before I" MIN. to 2" MAX of sand-mix grout is applied to the bottom and sides of box and around conduit openings. . Conduit ends shall be 1" MIN. to 2" MAX from bottom and/or sides of box AFTER grout is in place. . A drain hole shall be placed at the lowest point in the pull box and shall be 1" MIN to 2" MAX in diameter. . While grout is damp and before it sets, lightly "paint" the grout with a 2" brushed dipped in water to smooth the finish. 1 ~-- SEE NOTE 2 - DWC E-oS 1< l 3 /8' BRASS HOLD DOWN BOLTS, NUTS, AND WASHERS, RECESSED IN COVER; 2 PER BOX lffiERS TO BE l' MIN. TO 3' MAX. HIGH (SEE NOTE 4 - OWG ~) TOP VIEW PRECAST CONCRETE BOX WtJD SUITABLY MARKED #3 1/2 MIN. (SEE NOTE 2\ ~~) \ r I~ '.. ~ .. , - . .. :. . ... .. .. .. Do . .:;" ,:; .:. . .. .. . ..... .... II> . 3 /8" BRASS HOLD DOWN BOLT, NUT, AND WASHERS RECESSED IN COVER; 2 PER BOX z ~ L FIN. GRADE r (SEE NOTE 3 DWC E-oSJ -. , . 1lo. l>:. . ~ SEAl AROUND CONDUIT WITH GROUT (TYP.) ROOFING PAPER ~~ 6' MIN. (TYP.) CROUT BOTTOM OF BOX l' MIN. AND 2" MAX. DRAIN HOLE l' MIN. - 2" MAX. DRAIN ROCK, l' MIN. - 2" MAX. AGGREGATE SECTION A - A DIMENSION A: l' MIN., 2" MAX. (TYP. - ALl CONDUITS) . B: l' MIN, 2' MAX. ABOVE GROUT (TYP. - ALL CONDUITS) NOTES: APPLICATION: PlACED IN CONDUIT RUNS IN AREAS WHERE BOX IS NOT SUBJECT TO VEHICULAR TRAFFIC lOAD. SEE DRAWINGS E-04, E-oS, AND E~ FOR PUll BOX DETAILS AND NOTES. APPROVED BY DATE CONCRETE PULLBOX NON-TRAFFIC DRAWING NO. DEPARTMENT OF PUBUC WORKS E-02 -'" 7:) ,.-n /___.... ,'. i" . I) :.' "-'.' / /0 'f/>. ' " " V\' .Of'C"'Af.o f..~~dl~ ... r' U !'" . . .. "- os. .. ~. ~' O-,C H A Ill>. ---~ ...,,--' t:t1 . ! 17 CITY OF CAMPBELL Public Works Department. Maintenance Division August 29, 1997 Pacific Gas & Electric Co. 10900 Blaney Ave. Cupertino, Ca. 95014 Attention: Phyllis Goble SUBJECT: Request for service connection for 1 new street light in Campbell Phyllis, G.A.B. Construction has installed 1 new street light in front of a new commercial development. The City's Signal & Lighting Shop has inspected and approved the installation and would like to have the service connection to the street light performed and the light added to the Campbell Municipal Lighting District billing under the LS-2A rate. The light fixture is a 240 volt, 200 watt High Pressure Sodium unit. Fees should already have been paid by either Fish Development Co. or Walsh Building Contractors. Please let me know what the number will be for the new pole. The City of Campbell will number the pole. The following is the location of the new street light and the it's connection point: Pole Location (Address) Service Point (Secondarv Box) Pole Number (of orevious) 790 Campbell Ave., south side, west of Union Ave. At base of joint wood pole #7559, approx. 150' west of Union NEW You may recall this is the same pole where I asked you on February 10th of this year to disconnect and abandon the old steel riser so we could pull out the old system, which was done. We now have a new PVC riser, conduit, boxes and conductors for the new lighting standard. 70 North First Street. Campbell. California 95008,1423 ' TEL 408.866.2145 ' FAX 408,370.3304 ' TOD 408.866,2790 If there are any questions, I can be reached at 408-364-2827 or you can page me at 408- 631-1815. The fax here at Signals & Lighting is 408-374-9738. Sincerely, ~~ TOny~ Lighting & Traffic Signal Supervisor cc: Bob Phillips PG& E file 2 MRY. 16. 1997 9: 15RM KIER & l.JRIGHT . KfER & WRIGHT CIVIL ENGINEERS & SURVEYORS, INC. 3350 Scott Boulevard, Building 22 Santa Clara. Callfomia 95054 . (408) 727.6665 STAKING FOR: So BENCH MARK: B.D. ~/G. ~ /1!iJ~u, OFFSET: B' COLOR OF NOS.: ~ ELEVATIONS -- STATION CUT STAKE GRADE S I"~'~ OZ /B'J.tt,() //1,7.91)1. .('.1'..3 fAt,.,.7!uq 1C..Z82 7 A'e Cdmr I B~,~t. /81, / ~~ C,..{) (.! let.,. ~ '.n. ~.2.~ L~ I ~.o Ptrt I e,,; , 1'1 - P-> SD AD 18C:; ,t1~ ~~ ~ 8 ~D AD / f3'i . 10 188, (" r2 ~ 'bsg ~lC. ,P,7 l'vrJ C. -Z~ J ~ Sf) tJIJ I '0':; , J~ /~91 (p,z C -('J 'S~ 0,,- /9,7,Z, fUrl t..-/~ ~ S $ D AD I eq ,z." I/PJP.. ~ t. C.O~ AsJ, 187. ~ J~t/ e./~ oa 5D AD 18'].14- J 65/1/ e C ~'Z.1 le7, !?J I~>/ ~. !,1~ - Q?, .'~' S D ~e, / 8B .'7 I Bfi . fo+1r. C ~Q ~1. ('J u PIt. tlLlE IBln ,~~ I,. IJC.Z"~ 'i) I rc.. 'tL) e,' C:;" 1'.11, , 8e - q 3 188.t,4-1'C c-()~ au ~ /1". 11m: , Bl".l<" f" II C .Z~ Z9 ZCi -AI .04 -.,.z~ 30 - 4- &?. ~" - d..,... 29 - .,...O~ '3 .. 1j..1(/ .4.3r (luJ (z 3~ -4,:, \ . i' NO. 094 ( / SHEET P.2/2 BY: *113M DATE:..:3 - 2,7-9? JOB NO.:CJ(,It;-r PAGE NO,: I O~ I 1."&. STATION ELEVATIONS CUT STAKE GRADE Ik,C04Tl?D NA!>c:. C 11c:.~ 111'..1 r,! n~ 6:J wfJ~Et[ " /oj 'T1:' '0) !!, Jr. ",::,11.. nl. I'M"'''''. U ~ I.itS s~ ~Q!':. :;: 188, "'fA H 44{,7 .d~ 1. e. "'ftf4-8 . 4~ I SE'7 A/J'R,A~_ S€i =+ .. JAJ YI.cJ . MDAJ ftJ /I. ,bell / U~ I!)'" ~ ~DOO ,00 e.. ~O(.;{. .00 NOIJ tf Z. I lA..i~Jt ,l.(.lA....l"'I .\\1 r'f ~ .d. . t.J ~........~ ,qt. 8 ~ ~10 .4;0 Ua~ ..~ r ~~ ... ~.!\ I / g Q.i'" \: o~o ~ .87Z. ~ C::;~ , ~ .~~ ..... .... ~ \~~ - ........ ~t1\a.uT'\~ rc.. t..J. IIltk ll-r- ........ ~ Ca...u...tJ)be \ \ Jru,.. r~ I ~lbrfT-~' ; el"' ~. .... C;;~ ., f'J D tb fo,.!, lI.J , ~lt\.o /"'if- 'Of iV'C..- 4~ , I ,JCL&,..\ ~ ' ~ '?ru. ~'-4Q.fd ., r;:-,- - 8<:1, oC;- T ~ E'I.J.- I .,,- , I'" ---.J ..... ll. .-. ..-. - - .:3"'0 '5 .:/.1; G, ENCROACHMENT PERMIT ISSUANCE CHE.CK LIST . " City of Campbell Department of Public Works Encroachment Permit No. =c,- \..l<::::t -:L- l4 - q.., ITEMS REQUIRED FOR PERMIT APPLICATION: .~- l4-~1 '-:z.. - l q... -q.:-, l--ll-C1, '<.. - \4--9' ""!-.- IA -=t., Applicant section complete Applicant signature and date (front and back) Pennit Application Fee $225.00 paid - Receipt Number <=t=Yl' ~.:- Engineer's Estimate submitted Plan Check Deposit paid (2 % of Engineer's Estimate, $500 min) Receipt Number c-,\Ct-n9 Five sets of improvement plans submitted ITEMS REOUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS ,,- ~'S: -.q., 4-"2A-~'1 4-.\~-e>tl &- let-en. Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then 12 % of Engineer's Estimate. If Engineer's Estimate> $250,000, then Actual Cost + 20%. (Deposit of 8% of Engineer's Estimate required; $30,000 minimum deposit). <\\. ""= l G:ocj. ~~ r-~....c. . ~ \ C>\ 4-- ~ C> Security for Faithful Perfonnance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. k:.~,~/..-t.C..f.'"'-..J . t'--<<:.:>-:r-o\"v=:'~"~ \~~.:.. c.c:'> , o .:.3'.. .( '--'- \ \o--..tC~\~~ Amount $ 4e.j ~. e-.o Fonn LD. r..;,C"sfo--1. <t'..~, -L...<"'-:'::"~v.e:) Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum; $10,000 maximum) Amount $ \l--z.O. (>,0 Receipt No. \ C>~~~ot~ -STDt:aV"1 f:::>~~ k.J ~~ ~~ :(b.'~\. ~,.\ A... c:) (<q~c,o )::l.1 ~9~..'Z:S Worker's Compensation Insurance Infonnation Sheet received for Applicant.~.:\t: \ C> \ +0.0 All other Public Works requirements listed in the Conditions of Approval of the development. ITEMS REQUIRED PRIOR TQ ISSUAt'l'CE OF ENCROACHMENT PERMIT: 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. WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PE&vIIT MAY BE ISSUED. Issuer: Initial and date and file with pennit. 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C> Q) m t:: a.. :J L- a.. E e - l/) t:: L- :J +-' ~ ~ "'C t:: :J 0 ..c ~ +-' :J 0 l/) Q) "'C :J <3 .5 l/) +-' t:: :J 0 () iJj +-' 0 Z .. OO:~(: 00:0(: 00:6~ OO:g~ OO:L~ 00:9~ OO:g~ OOW~ '6 c: odtt~ ::l o O~~ 00: ~ ~ PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 790 E. CAMPBELL ENCROACHMENT PERMIT NO. 97-119 Date: Application No. 4/ I 4/97 PD 96-04 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT I. SURFACE CONSTRUCfION MOBILIZATION I LS $ 1,500.00 $ 1,500.00 CONSTRUCTION TRAFFIC CONTROL/PHASING I LS $ 1,000.00 $ 2,000.00 $ 2,000.00 CONSTRUCTION STAKING I LS $ 750.00 $ 750.00 $ 750.00 CONSTRUCTION TESTING 1 LS $ 750.00 $ 750.00 II. DEMOLITION/CLEARING I. CLEARING & GRUBBING LS 2. SAWCUT P.C.C.lA.C.(UP TO 6") 278 LF $4.50 $3.00 $2.00 $ 834.00 3. P.C.C. REMOVAL 196 SY $30.00 $23.00 $10.00 $ 4,508.00 4. CURB AND GUITER REMOVAL 216 LF $6.00 $3.00 $2.00 $ 648.00 5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25 6. DEMOLISH EXISTING INLET/PLUG RCP'S EA $300.00 7 REMOVE INLET, CONDUITS I LS $750.00 $ 750.00 III. STORM DRAINAGE 1. 12" R.C.P. (CLASS V) 27 LF $60.00 $40.00 $20.00 $ 1,080.00 la. 8"PVC II LF $15.00 $ 165.00 2. 15" R.C.P. (CLASS III) LF $65.00 $48.00 $38.00 3. 18" R.C.P. (CLASS III) LF $70.00 $60.00 $52.00 4. 24" R.C.P. (CLASS III) LF $80.00 $68.00 $59.00 5. 30" R.C.P. (CLASS III) LF $90.00 $75.00 $65.00 6. T.V. INSPECTION (12") 38 LF $1.20 $0.75 $0.60 $ 28.50 7. STD. DRAINAGE INLET I EA $1,600.00 $1,300.00 $1,000.00 $ 1,300.00 (C.C. DETAIL 5) 8. FLAT GRATE INLET EA $1,400.00 $1,100.00 $900.00 (C.C. DETAIL 6) 9. STANDARD MANHOLE EA $2,000.00 $1,600.00 $1,300.00 (C.S.J. DETAIL D-II) (INCLUDES FRAME & LID) 10. BREAK AND ENTER M.H.lD.I. EA $700.00 $550.00 $450.00 Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT IV. CONCRETE IMPROVEMENTS I. SIDEWALK 1121 SF $6.50 $4.50 $2.75 $5,044.50 2. DRIVEWAY APPROACH 627 SF $7.50 $5.50 $3.75 $ 3,448.50 3. CURB AND GUITER 216 LF $22.00 $18.00 $15.00 $ 3,888.00 4. VALLEY GUITER SF $12.50 $10.00 $8.25 5. HANDICAP RAMPS I EA $1,200.00 $800.00 $700.00 $800.00 6. TYPE B-1 CURB LF $12.00 $9.50 $7.50 7. TYPE AI-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 10. A.C. DRIVEWAY CONFORM SF $4.50 $3.75 $3.00 V. PAVEMENT I. ASPHALT DIGOUT AND REPLACE 99 CF $2.00 $3.50 $2.50 $ 346.50 2. PAVEMENT WEDGE CUT (6') 119 LF $5.00 $2.50 $1.50 $ 297.50 3. PAVEMENT GRINDING 97 SF $0.80 $0.50 $0.35 $ 48.50 4. PAVEMENT FABRIC (PETRO-MAT) II SY $2.00 $1.85 $1.50 $ 20.35 5. ASPHALT CONCRETE (TYPE A) 38 T $80.00 $50.00 $35.00 $ 1,900.00 6. AGGREGATE BASE (CLASS 2) T $40.00 $20.00 $12.00 7. SLURRY SEAL (TYPE II) SF $0.07 $0.06 $0.05 8. SLURRY SEAL (TYPE III) SF $0.11 $0.09 $0.07 VI. TRAFFIC SIGNALSILIGHTS 1. DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $2.50.00 2. DETECTOR LOOP (6' x 30') EA $650.00 $540.00 $440.00 3. DETECTOR LOOP (6' x 50') EA $900.00 $750.00 $640.00 4. ELECTROLIER 1 EA $2,600.00 $2,200.00 $1.800.00 $ 2,200.00 5. 1 1/2" RIGID CONDUIT 78 LF $9.00 $7.00 $5.00 $ 546.00 6. 2" RIGID TRAFFIC SIGNAL CONDUIT LF $17.00 $13.00 $10.00 7 CONDUCTOR 234 LF $0.70 $0.55 $0.45 $128.70 Page 2 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30K $30 K to $150 K > $150 K $ AMOUNT 8 PULL BOX (NO.3 1/2) 3 EA $300.00 $240.00 $185.00 $720.00 9 TRAFFIC SIGNAL PULL BOX (NO.5) EA $400.00 $350.00 $300.00 10 PULL ROPE LF $0.55 VII. STRIPING AND SIGNS 1. REMOVE PVMT. MARKINGS (PAINT) SF $2.50 $1.50 $1.00 2. REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40 3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40 4. STRIPING DETAIL 9 LF $1.35 $0.85 $0.35 5. STRIPING DETAIL 29 LF $2.25 $1.65 $1.20 6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25 7. STRIPING DETAIL 37 (THERMO) LF $1.85 $1.50 $1.00 8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 $1.15 9. STRIPING DETAIL 39 100 LF $1.50 $0.85 $0.45 $85.00 10. STRIPING DETAIL 40 LF $2.20 $1.70 $1.00 II. LIMIT LINE LF $1.35 $1.05 $0.90 12. CROSSWALK, 12" WHITE 10 LF $1.35 $ 1. OS $0.90 $1O.S0 13. PAVEMENT MARKINGS (PAINT) SF $2.S0 $3.80 $1.60 14. PAVEMENT MARKINGS (THERMO) 30 SF $S.SO $3.80 $2.60 $114.00 TYPE IV ARROWS IS. PAVEMENT MARKER (NON-REFL.) EA $4.50 $3.00 $2.20 16. PAVEMENT MARKER (REFLECTIVE) EA $6.00 $4. IS $3.IS 17. TYPE K MARKER EA $9S.00 $80.00 $70.00 18. TYPE N MARKER EA $9S.00 $80.00 $70.00 19. SALVAGE ROAD SIGN EA $8S.00 $7S.00 $6S.00 20. RELOCATE ROAD SIGN (W81 ON NEW POST) 1 EA $100.00 $8S.00 $8S.00 21. INST. RD. SIGN ON EXIST. POLE EA $200.00 $14S.00 $110.00 22. ROAD SIGN WITH POST EA $300.00 $240.00 $195.00 23 INSTALL 1226S SIGN WITH POST EA $240.00 24 STANDARD BARRICADE LF $IS.OO Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K $ AMOUNT VIII. LANDSCAPING I. IRRIGATION, PLANTING WORK LS 2 PRUNE TREE ROOTS EA $125.00 $100.00 $85.00 TREE REMOVAL EA $650.00 $500.00 $400.00 4. ROOT BARRIER (12") LF $20.00 $10.00 $6.00 5. ROOT BARRIER (18") 38 LF $25.00 $15.00 $10.00 $570.00 6. STREET TREE (IS GAL) EA $450.00 $325.00 $250.00 7. STREET TREE (36" BOX) 2 EA $700.00 $550.00 $400.00 $1,100.00 8. TOP SOIL BACKFILL CY $15.00 9 IRRIGATION LS $675.00 IX. MISCELLANEOUS I. PEDESTRIAN BARRIER LF $75.00 $60.00 $50.00 2. CHAIN LINK FENCE (6') LF $15.00 $11.50 $9.25 3. RAISE MISC. BOX TO GRADE 3 EA $300.00 $200.00 $175.00 $600.00 4. RAISE MANHOLE TO GRADE EA $400.00 $275.00 $200.00 5. INSTALL MONUMENT BOX EA $450.00 $350.00 $300.00 6. MEDIAN BACKFILL CY $19.00 $17.00 $15.50 7 RESET BENCH MARK LS $150.00 $150.00 SUBTOTAL $ 36,416.55 PREPARED BY: CRUZ S. GOMEZ 10% SECURITY ENFORCEMENT FEE $ 3,641.66 REVIEWED BY: I. HAROLD HOUSLEY TOTAL ESTIMATE FOR FAITHFUL $40,058.21 APPROVED BY: MICHELLE QUINNEY )Ai( PERFORMANCE SECURITY $40,000.00 .See Section 66499.4 of the Map Act. h: \excel\landdev\ 790ecamp(mp) Page 4 . ./4" . ..,/' CITY OF CAMPBELL ftlBUC WOItJCS DEPARntENT ENGINEER'S ESTIMATE 0, Addreu ~ Permit No. rTEM ' ! NO. I DESCRIPTION IL (::~~ rNTROLCONTROUI'KASING tONnRUCTlON STAKING r-~=n~ pEMOLmONICLEAlUNG I, rRING '" GRUBBING 2. rWClITP.C.C.lA.C.<UPT06.) 3. ~.C.C. REMOVAL I I 4. fmB AND GUTTER REMOVAL , IL I I I I !. rotEDIAN REMOVAL bell e UANllTJES - LS - LS LS1 _ LSI - LSI I '37 LF; I /70 "I '1./ , lFi i - SFI I 6. DEMOLISH EXISTING INLET/PLUG RCP"S I I W. fORM DRAINAGE I. ~2" R.C.P. (CLASS V) , 2. ~. R.C.P. (CLASS III) I I I 3. ..0 R.C.P. (CLASS III) : I I ! i IV. ! 4. 240 R.C.P. (CLASS III) i ! ,. ~o R,C.P.JCLASS III) I I 6. (-V. INSPECTION (12") 7. sm. DRAINAGE INLET 1 ~C.C. DETAIL 9) I .. ~T(jRATEINLET 1 r.c. DETAIL 6) 9. StANDARD MANHOLE ,c.SJ. DETAIL 0-11) (INCLUDES FRAME '" UD) I 10. ~REAK AND ENTER M.H.ID.1. I fONCRElE IMPROVEMENTS I. !,DEWALK 2. PRIVEWAY APPROACH , 27-Jun-96 I , EAi i lFI I - LFI B .- IF' I 1 - LF' I LFi LFI I I EAJ -EA1 -EA -EAI I I I Mo SF! I hfJO SF! Appllcllioa No. UNrr PRICES FOR PROJECT AMOUN1' < SJOK SJOKI051!OK > 51!OK 54.!O ::1 I 54.!O S60.00 i I S6S.001 I S'lll.00 ! I I $80.001 I 590.001 51.20 SI,6OO.00 SI.4OO.001 S2.CXXl.OO S7lXl.00 S6.5O j I 57.!O i I m.oo SI,300.00 SI.IOO.OO 51,600.00 WO.OO , 54,S01 SS.!OI I , Page 1 of 4 S AMOUNT' ale ,,,e fE 111991 WOR~5 puS ~~STRA liON AO 53.00 52.001 1 ! 510.001 S2.001 I I 51.2!! m.oo 53.001 SU! 540.00/ $41.001 S60.00 S20.00 :::1 , SS9.00: I 565.001 so.60 I I 51.CXXl.OO, S61.00 SO.7' S9lXl.00 . 51,300.00 S4!0.00 S2." I 53.", I I~ 7 5) /6tJ /278 480 I ~ oC) q 3~O 6/00 J-?/~8' rmMl DESCRIPTION UANTrTIES : > SI50 K S AMOUNT NO. . 3. iRB AND GtnTER ~/8 LF mcol S15.CO 4 ~8 G:J 4. Iv ALLEY GlTTTER - SF SI2.50 I SIO.CO SI.2S ~~rM ~. I s. / EA SI.2lIl.CO I SIlXI.CO smco / ?.O 0 I I 6- in'PE B.I CURB - LF S12'COI 8.50 $1.50 1 I 7. PE AI'B3 CURB LF S15.COI SI2.CO SIO.CO I .. OBBLESTONE MEDIAN SURFACE SFI SI2.COI Sl.COI SS.CO I , , 9. .C.C. DRIVEWAY CONFORM - SFI S7.CO/ 15.50 SoI.501 I reo DRIVEWAYCONFOR. I 10. SF SoI.50 $3,75 $3.COI I I Iv, PAVEMENT I I. rHAL T DIGOl!I' AND REPlACE 450 CF ss.col $3.50 S2.501 1..1.50 I I 2. rA VEMENT WEDGE Cl!I' (6') -LF ss.CO! SUO I $1.50 ! ! I I 3. PAVEMENT GRINDING 240 SF SO.IOI SO.5O SO~I ,qZ- I I I i I 4. PAVEMENT FABRIC <PETRO-MAT) SYI S2.COI $I.IS $1.50 LPHALT CONCRETE (TYPE A) S. - Tl SID.coi SSO.CO S3S.CO lGCiREGA TE BASE (CLASS 2) I s.o.co! 6- I S20.CO $12.COI TI I SFI I I I ; 7. SLURRY SEAL (TYPE II) - 50.07 i 5O.~1 50.05 : i I I I I I .. ~LURRY SEAL (TYPE nn -SFI SO.lI: $0.09 $0.07: I I I lmc SICNALSILJCIn"S I i VI. I I bETECTOR LOOP (6' ROUND) 1 I. _EAI ~.CO: S3OO.CO S2.50.COI I - I I I I I i 2. bETECTOR LOOP (6' x 30.) -EA S650.CO i SS40.CO ~.COI I I I 3. pETECTOR LOOP (6' x 50') -EA S!IlXI.CO S750.CO S640.CO I I '2- (poD 4. ELECTROUER EA S2.6CO.CO $2.2CO.CO SI,IOlI.CO I 73 I fe'j 7 s. t 112" RIGID CONDUIT LF 8.col S7'COI ss'COI I 6. . RIGID CONDUIT LF S17.COI SI3.CO SIO.COI /I, 58, , rrEM I NO. I DESCRIPTION UANTIT1ES <SJOIC S AMOUH1' 7. fONDUCTOR . LF 1L101 SWI 1L61 153 .... i L Puu. BOX (NO.3 112) .9 EA S3lXl.OOI S2A0.00 SllSml qtJO - --- I smoo/ I I 9. PULL BOX (NO. 5l EA S4CII.oo I wo.oo I i I IVIL i I !mUJ'INc AND SIGNS I. REMOVE PVMT. MARKINGS (PAlm) SF S2.5O I SI.50 SJ.oo I i Z. ~EMOVE PVMT. MARKINGS rrHERMO) SF 13.00 ~I SJ.40 3. REMOVE PVMT STRIPING LF SJ.40 SO'~I SO'401 i c. IITRIPING OET AIL 9 LFI SI.3S alSj SO.3S I , " IITRIPING OET AIL 29 ./ LFI S2.2S ' SI.65 : SI.20~ I SI.251 I $2.40 I 6. STJtIPING OET AIL 32 :1 SI.7S I I I I I 7. STRIPING OET AIL 37 (THERMO) SI.IS I SI.50 Sl.oo : S2.5O I I I .. STRIPING OET AIL 3& (THERMO) LF SI.asl SI.15: I , 9. STRIPING DETAIL 39 LF SI.501 SO.IS! SO.61 I SI.101 I SUO I 10. STRIPING OET AIL 40 LF SI.ool I , ) i i : I 11. lIMIT UNE SI.3S: SI.l151 Sll.llOi lFI , 12. CROSSW AU SI.35' SI.05I Sll.110 ! SFI I 1 I i i 13. 'A VEMENT MARKINGS (PAlm) S2.5O : SI.llO! SUO' I SFI i sr.ml I 14, T'A VEMENT MARKINGS (THERMO) 55.50 1 $2.60 I I I I ! I I ~. l>AVEMENT MARKER (NON-REFL) EAi 54.SO: $3.00: SUO I I 54.J I I I 16. PAVEMENT MARKER (REFLECTIVE) EAI $6.00 I $3.151 ! I I i I I 17. n'PE K MARKER EA' 595.001 sm.oo/ $70.00 ! TYPE N MARKER I $70.001 II. EA 595.00 ; sm.ool I , 545.001 19. kVAGEROADSIGN EA $&5.001 m.oo I Sloo.ooI ! 20. RELOCATE ROAD SIGN EA $&5,00 m.oo , ~.ool I 21. INST. RD. SIGN ON EXIST. POLE EA S16.oo S1I0.00 I , , 22. ROAD SIGN WITH POST EAI S3lXl.00 1 $240.00 SI95.oo I , /c53 27-Jun-96 Page 3 of 4 rrEM NO. I VID. 1, I I .. "'OOT BARRIER (l2") I S. ROOT BARRIER (lS") I I I 6. rEETTREE (2." BOX) 7. rEET TREE (36" BOX) .. jP SOIL BACKFIU IX. ~JSCElJ..A.NEOUS 1, PEDESTRIAN BARRIER i 2. CHAIN UNK FENCE (6') I ! 3. tlSE MISC. BOX TO ORADE 4. ISE MANHOLE TO ORADE I I 5. INSTAU MONUMEIn' BOX 6. MEDIAN BACKFIU .; . UNIT PRICES fOR PR01ECf AMOUHr < S30K S30K TO SI!O K SI!OK S AMOUHT LS EAj SI25.00 SIOO.OO SIS.OO; I EA S650.00/ S!OO.OO S4OO.00 : I LF S20.00 1 SI0.00 $6.00 i I LF $25,00 SLS.OO Slo.OO , EA $&50.00 ms.OO wo.OOI EA S7lXI.OO 1 S!!O.OO S4OO.oo I I CY -LF, S7!.00 / SSl.oo S!O.OO, - LF1 I t , SLS.oo! SIl.!O $9.25: I S3OO.oo! I i -EAI SDl.oo SI7S.oo I I I I EAI S4OO.ool $275.00 S2OO.oo: I smool I EAi $&50.00 , S3OO.oo' I S17.00I I -CY/ $19.001 SLS.!Oi 35/7 ,. SUBTOTAL! I ~, ~7Z. IDS SECURITY ENFORCEMENT FEE I , TOTAL ESTIMATE FOR FAIllIFUL PERFORMANCE SECURITY ;''1, ').95 PREPARED BY: I(ler ~ Wr/9h f- REVIEWED BY: APPROVED BY: "See Section 66499.. of lhe Map Act. H:\CECOSTEST. WK3(MP)REV6I3196 :!'!I~~,!.~.~!,~.JII:~:I'.lllllllil~~::::'::'::'II:'1::::..:'.).I,II.....i::::......::::::...::'...i:.....:.:.:j"'!!!!i'!!i!i":i!!!i!i::jij::ijj:i: '';':'i)Alli!''tl;i);;jjDi)jyyf'') Aon Risk Services, Inc. of Northern CII ifornil 100 Plrk Center PIIZI, #506 Sin Jose, CA 95113 408-287-7319 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 Inve COIof'ANY C Gene COliPANY o A~9!MI!iI:~::::/mm::::t/::::::::t::::::::::::::::::::::t::t:t::::::::t:::::ttm:::t:::::::m::t::::::tt:::::m::/:mi{mi?t::m:mi:::::tt::::t:m::t:::mi:::::!::mimi:!:::::f::::t:::::m:::::t:::!::::t:::::::::mm:m::m:::f:m:m::::::!:::::::t:m:mm?:::::f::!::::::::::::::m:::::tm:m::/!m::::::::!:::::::::ittii:}::::::i:,:i::::::::::}:/i?:t: THISIS TOCERTIFY THA T THE POLlCIESOFINSURANCE L1STEDBELOWHAVEBEENISSUED TO THEINSURED NAMEDABOVEFORTHE POLICY PERIOD INDICA TED. NOTWITHST ANDINGANYREQUIREMENT. TERM ORCONDITlONOF ANY CONTRACT OROTHERDOCLMENT WITHRESPECT T OWHICHTHIS CERTIFICA TE MAY BEISSUEDORMAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS co POlIOY EffECTIVE POLIOY EXPIAATIO L TR TYPEOf' _ANOe POlIOY NU/leER DATE (NWDD'YY) DATE (NWDD'YY) Wllsh Building Contrlctors 22 N. Almlden Avenue Sin Jose COIof'ANY A Re COliPANY B ub lie I ndemn i t CA 95110 Co. L1NITS GeN9AL L1ASLITY GENERAL AGGREGATE $ B X COMMERCiAl GENERAl LIABILITY GLP1002257 10/01/96 10/01/97 PROCllX:TS.COliP/OP AGO $ CLAIMS MADE Ii] OC~ PERSONAl Il. AOV I~V $ . . X OWNER'S Il. CONTRACTOR'S PROT EACH OCClIlRENCE $ FIRE DAMAGE (Any one lire) $ MED EXP (Anyone person) $ AUTOIolOllU L1ASLITY COMBINED SINGLE LIMIT D X ANY AUTO MXX80657453 10/01/96 10/01/97 ALL OW~D AUTOS BOOILY I~Y SOEDU..ED AUTOS (Per person) X HIRED AUTOS BOOIL Y IN~Y X NON.OWNED AUTOS (Per accidenl) PROPERTY DAMAGE QAA~ L1ASLITY AUTO O~ Y . EA ACCIDENT ANY AUTO OTt-ER THAN AUTO O~ V, EACH ACCIDENT AGGREGATE EXcns L1ASLITY EACH OCClJ'lRENCE UM3RELLA fORM AGGREGATE C X OTt-ER THAN UM3RELLA fORM UB61492 10/01/96 10/01/97 WORkERS CONPENSATlON ANO X STATUTORY LIMITS EhlPLOYERS'L1A:::lLITY IOACH ACCIDEW A 003919-09 3/05/97 3/05/90 Tt-E PROPRIETORI INCL DISEASE. POLICY LIMIT PART~RS/EXECUTlVE OFfiCERS ARE, EXCL DISEASE. EACH EMPLOYEE OTHER 1000000 6000000 6000000 1000000 1000000 1000000 SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLm BEfORE THE EXPIRATION DATE THEREOf. THE ISSUING COhlPANY WILl~AL C i t Y 0 f C ampb e I I 30 DAYS WRITTEN NOTICE TO TH!CERTIfICATE HOLDER NAhlED TO THE LEfT. Deplrtment of Publ ic Works Wlr .- - 'III .._~_, _ A _ _. I 1 _.. 70N. First Street .IF.__. -'..In.................."... I'.n._.___ .. Campbe I I, CA 95008 U HOR EP N IV . ~ ' ell#- 180640000 :::4.~P:l~li:f.la.t:")::(':((::(:m::((mm((mm:m::~:(((:m:::::m:m:'::~:'m::(((:::m:m:m:m:m::':((mmmm:m:m:m:mmm::mm::::(/,m::(((m::::(:m:tti((((((:':':tti(~it:::::{:(ti~~q~I.:.i.::PA~~p~irl\:ntt'~,::: POLICY NUMBER: GLP1002257 Walsh Building Contractors COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: City of Campbell, City of Campbell Redevelopment Agency, it's officers, employees & volunteers RE: All work in public right-of-way. Union Avenue/Campbell Avenue Retail #EP9? -119 (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 of "your work" for that insured by or for you. Such insurance as is afforded by the General Liability policy is primary insurance and no other insurance of the additional insured will be called upon to contribute to a loss. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 UNION/CAMPBELL RETAIL 790 E. CAMPBELL AVENUE TRAFFIC CONTROL PROGRAM 1, Close turning lanes & sidewalks approximately 2 weeks. 2, Enable adjacent apartment complex to use (E) driveway. 3. Use 700 mm delineator cones with "CAUTION" tape for pedestrian & bicycle paths. 4. Monitor cones every 24 hrs. ! ~i i ~.~ \S !~ I Q '" ~ , .~~ \\..\ ~ ~ -(, s .~~ -..;. ~ ~ ~ '~~ lit ~ ~'" Q.. ! r ~ \l' --1 U' ~ _.-----,~- I ----t~- ' ! L ( ir r ~. ~ c ~. . . I '. · ~ ~' r .r .. a- t '. ~ ~ " . .. o L ~ ~ ~ b ~ ~ t ~ - "'-a"1-- i"q'!'If) I ~_~~)~~:t ! ,a ~~ ~~ ,~\ ~ - ~ ~\ "3 '901 /() z/. LI J,~ I I Ii /' I ~st\~ ' .' C"; I 1 ~- \\ ., ~ li'" & ~ , ~\ I~_... 1~ ~ ~