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ENC2000-00059
CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 Nora First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 3T6-0958 ~t,-I Ci.'~.a:x~::~-- e:)c, c:~--~, Permit No. X-Ref. file ENCROACHMENT PERMIT ' (for working within the public fight-of-way) Issued~:~~-- ~ Application Date Permit lxpires in 12 months Application expires in 6 months APPLICATION - Applicalion is hereby made for a Public Works Per~ in accordance with Campbell Munlc/pal Code, Seclion 11.0~. (Application expires in 6 momhs if the permit is not issued. Application Fee is non-refundable.) Utility trench location C. A~nch four (4) copies of an mgineered plans showing the locaion and extm~ of the work. and four (4) mpies of the prctimina~ EngLecer's Estima~ of work. The plans shall show the relation of thc proposed work to existing surface a ad underground improvements. Wbe~ approved by the City Engineer, said plan becomes a pan of D. All work shall conform to the City of Campbell Standard Sp=incati~ns and Dmiis rot Public Worts Co.~m~o.: the ~ Permit Condltions listed on the revme side: and the Special Provisions for this permit, Ihtod below. Failure t0 abide by these condiuons and provtstons may result m joo shut-down and/or forfeiture of Fai~ful Per'formanee Sureties and cash deposits. (See General Permit Conditions 1 and 2.) · ,-, ,.,,..,.,mt-, r,^y$ BEFORE STARTING WORK NOTICE MU$'I' BE GIVEN TO PUBLIC WORKS AT LEAST 24 ItOUR~ BEFORii l~P~.q'Alt, 1 h'~lz . Is ~his work being done by the property owner az their own residence? The Applicant/Permim:e hereby agrees by gfixing the/r sigmmre to thi~ any claim or demand for damages resulting from the work covered by The Applican~/Permit~e~ hereby acknowledges thaz they ~ve r~ad ant informazion. Accepted I~ (App Ye~ peri.it to hold the City of Campbell, its officers, agents and employe~s free. safe and harmless from ~is permit. understand both the fron~ and back of this permit, and thc~ will inform their co~,raaor~s) of th~ (sign) SPECIAL PROVISIONS X__4. X__S. Su'eet shai not be open cut for underground ins~lagon~. Mi~mum cuts may be allowed for connections or erplomion hol~s such c,~s~ nnnroved by t. he Inspector prior ~o cutting. ' .' ' "' ~a~,ement may be cut for underground installations and Jnust be restored in accordance with the. Utility Trench Restoration St~idard Dermis. Me.od A Backfill. unless o~erwise approved by Inspeewr. Work to be staked by a licensed Land Surveyor or Civil Eni4neer and two (2} copies of the cut sheets sent to the PubBc Works D~aml~nt before stoning work. l~t Section 4215 of fl~ Govermment Code ~ peri. it is no~ valid for excavations 'atuil Underground Ser'vic~ Alert (USA) ~ beea noisier and file inquiry identifsc, auon number has been ~N~O~ ...... '~nnn nnnca $~~'- ........... . PUBLIC WOILKS FEE SCHEDULE FOR CURRE~ FEES PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCEffLABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE APPROVED FOR ISSUANCE ~~ D~ \forms~pwperra2/rev.6/96 SPECIAl ENCROACHME~ The purpose of this permit is to install the east side of Harrison Avenue and th, of on site private improvements only. signage or improvement from within the The permittee shall install and maintain the public right-of-way free of polluta~ vacuum sweeping all public areas surrou drainage facilities. Truck traffic to and from the site or material and/or for the purpos, Hamilton Avenue, Salmar Avert · CONDITION 5 TO ~T PERMIT ENC 2000-00059 portable chain link fence upon the sidewalk areas of south side of Salmar Avenue to facilitate demolition 'he permittee is prohibited from removing any public mblic right-of-way. all fencing, gates, signs, lighted barricades, maintain tts, contaminants, soils, debris, loose materials, by nding the site to and including all downstream storm for the purposes of deliveries of equipment, supplies :s of offhaul of the same shall only use Highway 17, ae and Harrison Avenue between Grant Street and Salmar Avenue. At no time shall construction employees park on Harrison Avenue north of Salmar Avenue (both sides) and between Salmar Avenue and Grant Street (west side). Equipment and material storage ahd employee parking shall be on site only. The Contractor shall submit a traffic control plan to the Engineer for review at least five days prior to beginning of cbnstruction. The traffic control plan shall conform to the "1996 Manual of Traffic Cofltrols for Construction and Maintenance Work Zones (including all revisions)," and Sec~tion 12, "Construction Area Traffic Control Devices" of the Standard Specifications. The Contractor shall install "No will require restricted parking. restrictions, the Contractor shall Stopping" signs at each location City will provide the signs for thc at least forty eight (48) hours pri~ ~topping" signs in areas where the Contractor's work Prior to start of work which requires parking request approval to post and maintain temporary "No where constructions operations will take place. The Contractor's use. The Contractor shall post the signs )r to start of the work at a maximum spacing of sixty (60) feet. The signs shall clearly ,show the date(s) and hours of the parking prohibition. These conditions must be followe~ by the Contractor in order for the no stopping order to be enforceable. The Contractqr shall notify the City of Campbell Police Department immediately after posting the signs at (408) 866-2101. "SIDEWALK CLOSED AHEAD" signs, "CROSS HERE" signs, and "SIDEWALK CLOSED," "CROSS AT CIVIC CENTER DRIVE" signs shall be installed and maintained at the locations showr~ upon the plans, as herein specified and as directed by the Engineer. i H :\permits\2000-00059speciaiconditions(mp) CITY oF CAMPBELL Public Works Department TRANSMITTAL CAMPBELL August5,2003 To: Raymond Barro Summerhill Construction 777 California Ave. Palo Alto, CA 94304 From The Desk Of: Marlene Pomeroy Executive Assistant (408) 866-2776 e-mail: marlenep @ ci.campbell.ca.us Enclosed please find City of Campbel~ Check #102783 which represents a refund, plus interest earned, of Summerhill's Plan (~heck Deposit ($500), Labor and Material Deposit ($2,000), and Cash Deposit ($2,00) wlth respect to Encroachment Permit 2000-00059, installation of a construction fence at 102-190 N. Harrison Avenue. If you have any questions, please contact me at (408) 866-2776. Enclosure 70 North First Street . Campbell, California 95OO8-1436 - TEL 408.866.2150 - FAX 408.376.0958 · TDD 408.866.2790 0000000 04~26~2000 11:02:12 AM Fee Type: APP MENT HISTORY FOR CASE ENC2000-00059 Description: Encroachment Application Fee Total Fee: $236.25 Fee Type: Fee Type: Fee Type: Date Paid Receip~ Check~ !Recorded By 04/25/2000 130044 1046 JD , Total Paid: CASH Description: Construction C~sh Deposit / Date Paid Receipt~ Check~ |Recorded By 04/26/2000 130046 1046 JD Total Paid: LMSD Description: Labor & Materials Security/Dep Date Paid Receipt~ Check# i Recorded By 04/L~:~7'2000 130046 1046 ~JD I Total Paid: PCDP Description: Plan Check Del~osit / Date Paid Receip~ Check# !Recorded By 04/25/2000 130044 1046 JD Totals for ENC2000-00059: $4,736.25 Paid: Fees: Total Paid: Amount Paid $236.25 $236.25 Due: Total Fee: Amount Paid $2,000.00 $2,000,00 Due: Total Fee: Amount Paid $2,OOO.00 $2,000.00 Due: Total Fee: Amount Paid $500.0O $500.00 Due: $4,736.25 Due: $0.00 $0.00 $2,000.00 $0.00 $2,000.00 $0.00 $500.00 $0.00 Page 1 of 1 Refundable Dep°sit Check Request To: Finance Director Check Payable To: Address- Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVENUE PALO ALTO Refundable Deposit 101.2203 101.540.7448 Interest Earned State: CA Zip: 94304 Amount: $4,500.00 Amount: Amount: (Finance Dept only) (Exact Amount) / Maintenance period has e~xpired. Refund deposits as follows: / $500.00 plan check depos~it; $2,000.00 Labor & Material Deposit; $2,000.00 Cash Deposit. I Voucher #: Receipt #: Requested by: Approved by: Finance Dept Only: Verified by: Approved by: 130044 ($500); 130045 ($2000); 130046 ($2000) Alan Horn ~ Michelle Quinney Special [nstruction: Mail As Is: Return To: Other: Mail in Attached Envelop ;: MARLENE POMEROY (Name) Permit #: 2000-00059 Date: 4/25/00 Title: Sr. PW Inspector Date: 7/15/03 Title: City Engineer Date: 7/15/03 Title: Accounting Clerk II Date: Title: Accountant Date: For Handling Check Interim Check: Needed By: PUBLIC WORKS (Department) Please return check to Public Works for transmittal to permit holdm;. h:~ermits~000-00059 102harrison maint accept refund(mp) CiTY OF CAMPBELL CAMPBELL, CA. 101 22(:)3 101. 540 7448 00004389 REMITTANCE ADVICE-PLEASE DETACH BEFORE BANKING SUMMERHILL CR07152(2)(]: 3 CR071520C 3 CONSTRUCTION VOID AFTER 90 DAYS ~.ltv, l[O]gl gl 4., 500.00 349.85 WARRANT NO. 10287:3 REFUND DEPOSIT INTEREST EARNED o~-CB TO PaY CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 FOUR THOUSAND, EIGHT SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVE PALO ALTO CA 94._'.L4 HUh:DRED FORTY ,' ]. 0 ~ 8 ? ~, []' 11-35 1210 AMOUNT BANK OF AMERICA WARRANT NO. CAMPBELL OFFICE CAMPBEL, E. 10287 CAMPBELL, CA. 95008 DATE 08/04/03 10~87._', *****4,849.85** NINE DOLLARS & 85 CENTS SIGN~URE iq,,: PII .C WORKS DEPARTMENT RECEWT Effective August 1, 1999 TO: City Clerk PUBLIC WORKS FILE NO. ;~i~'~i;~i'} ......... ~;0i~i'4;;;~u;(;~;~ii~'~;;i~i ................................. ENCROACHMENT PERMIT 4722 Application Fee Non-Utility Encroachment Permit ($236.25) Minor Encroachment Permit < $5~000 ($50.00) R-I First Permit (No Fee) Subsequent Permit/Yr ($105) utility Encroachment Permit Arterial/Collector Street ($341.25) Residential Street/Other Areas ($236.25) 2203 Plan Check Deposit - 2% of ENGR. EST. ($500 mia} 2203 Faithful Performance Security (FPS) (100% of ENGR.EST.) 2203 Labor and Materials Security 000% of ENGR. EST.} ['"'"~ ~ t ~C.~ 2203 Monu mentation Security 000% of ENGR.EST.) 2203 Cash Deposit [ (4% of ENGR.EST.}($500 mtn/S10,000 max) ,'/ 2203 Labor and Material SecurityI~ 000% of ENGR. EST.} Plan Chnck & Inspection Fee (Non-Utility) 4722 Engr. Est.< $250,000 (12% of ENGR. EST.} ** 2203 Engr. Est.>$250~000 !Deposit 8% of ENGR. iST./$30,000 min.)*' 4722 Utility < $100,000 Minimum Charge Per Location Conduits/Pipelines up to 500 Feet ($1.75/ft) Above 500 Linear Feet ($1.15/ft) Manholes/Vaults/Em. ($1 lO.25/ea) Pole Set/Removal (S 110.25/ca) Street Tree Planting/Removal (S 110.25/tree) ** 22031 Utility > $100,000 Actual Cost + 20% -- * 4722 Street Tree Planting/Removal Permit ($110.25) 476{3 Proiect Plans & Specifications Proiect No. 47643 Standard %pecificatioos & Details ($1/Pg $12.50/Bk} 476d3 Copies of Engineering Maps & Plans Aerial Plot 24' x 36' Aerial Print 8 1/2' x I1' Maps and Plans 24' x 36' 4722 Penalties: Failur~ to restore public improvements (%100/Calendar Day} {Mum Cod~ ~¢.11.34.010~ 4722 Penalties: Failure to correct unsafe conditions (%100/Calendar Day} LAND DEVELOPMENT 4722 Lot Line Adiustment {$577.50) 4722 Parcel Map {4 Lots or Less} ($1,125 + %25/LOt) 4722 Final Tract Map (5 or More Lots} ] ($1,450 + %25/Lot) 4722 Certificate of Compliancel. ($525} 4722 Certificate of Correction ($315) 4722 Notary Fee (per signature} ($10) 4722 Vacation of Public Streets & Easements ($577.50) 4722 Assessment Segregation or Reapportionment First Split ($577.50) Each Additional Lot [ {$178.50} (R-l, $2,000) 4721 Storm Dainage Area Fee Per Acre [ {Mu{ti-Res, $2~250) (AH Other, $2,500) 4920 Parkland Dedication Fee (75%/25% Due U~n Cert. of ~¢ Jpancy} 4965 Postage TRAFFIC 4728 Intersection Turn Counts (Two-Hour Count) ($63} 4728 lntersnction Turn Counts (a.m. or p.m. peaks) ($131.25) 4728 Traffic Flow Map tDaily Traffic Volumes) ($28.35) 4728 Campbell Traffic Model (Full Scope Assessment) {$2,362.50) 4728 Campbell Traffic Model (Reduced Scope Assessment)($T77} 4271 Truck Permits [ ($36.75/trip} 4728 No Parking Signs (SI/each or S25/t00} OTHER . TOTAL $ ,Z~'~ {~:~, 'Z?~' ~AME O~ ^FP=ICAN'r *'Actual Cost Plus ,0% Overhead {Non-[merest ~armg oeposit} ::::::::::::::::::::::::::::::::::::::::::::::::::: ====================================================================================================== Ft.,,,CLERK :w~..,iri/!E !t :~:,:y~¥ .:....:::.. .......................................................................................................................................................................................................................................... v'i' ...... CITY OF CAMPB_P~L: CA $2~000.00 $2'000.00 r,A¥fiD, O/i~iC'DUT~ .~ PfiM{2TDliP TO:DAY'"S DA:-: 04125/00 I ~.rOZo.~rn £:Hir_, v~/;u/vv iO.go,d,,e. TOTdL nii:, CU~, PAID: rw?""~' ~0:1 PLIAii~_r' · $2~.25 """"'"' BY: "":"' """'"""' "" RCbVL~ .JHR~ ~$VVVmvv Duc. b .tiC;_-.r,. ...... ii;. fh li~i i~5 &/iA Ag, $2,000.00 INSURANCE RE1 }UIREMENTS CHECKLIST Pe~it ~ ~ c z~ - O~ CIP Project contractors working in the Ciw of Cmpbell public The followin~ insurance is required of right-of-way. Insurance certificates mu~ These insurance requirements apply to wo work being pertbrmed under contract for Limits Commercial General Liability for )i~ $1,000.000 per occurrence, am ~ $1,000,000 general aggregate ~ $2,000,000 general aggregate ~ Policy expiration date ,~4~i ~ Automotive Liability: 3q "Any Auto" checked on certifi '~ $1,000,000 per accident fo}~ bo~ '~ Policy expiration date 4-' ['2./ Workers' Compensation and Empl, '~ Waiver of Subrogation clause ~7 $1,000,000 per accident for hoc '~ Policy expiration date be accepted by City. staff before work can begin. rk being performed under an Encroachment Permit and ;apital Improvement Projects. ,odilv. personal injury and prope~rty damage: mit applving separatetv to the project, or mit. ate lily injury and property damage Ol )yer's Liability [ly injury or disease OI Course of Construction (if required ~ Completed value of the projectI ,n Policy expiration date txequired Enaorsements ro ueneral Lia~ifirv Additional Insured Endorsement/ The City, the City of Campbel volunteers are named as additio The insurance coverage afforde Cancellation area of certificate such notice shall impose no ob agents or representatives". Workers' Compensation Insurm a For General Contractor ~ For Developer or O~vner~ Acceptability of Insurer(s) )i~ Insurer(s) has current A.M. business in the State of Californ in Special Provisions) and Automobile Liability Policies Redevelopment Agency, its officers, employees and tal insured. to the Additional Insured is primary insurance. dited to delete "endeavor to" and "but failure to mail igation or liability of any kind upon the company, i,~Sr~ iq'~, ,t/() ~ce Sheet Submitted .est Rating of A:VII and ~s authorized to transact ia. Insurance Certificate RevieW~/~~ X Copy of Insurance Certificate placed in tickler file for month of expiration. j:\forms\inscklst (rev 11199) FAX TO: Phone Fax Phone CC: Christopher Olson Maroevich 0 'Shea & Coghlan 425 Market St., 10th Floor San Francisco, CA 94105 (415) 957-0600 (415) 957-0577 REMARKS: [] Urgent [] For y, Re: Insured: SummerhillHomes I Date 5/5/00 I Number of pages including cover sheet 4 FROM: doanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone FaxPhone (40~866-2150 ~0~376-0958 ten day notice is required for cancellati on due to non-payment. Copies of the applicable sections of our ins~trance requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me if you have any questions. Thanks for your help in this matter. ~ If responding by fax please use the above fa: number (408) 376-0958, not the fax number appearing on my transmission. I am working in a different City office for today only. Thanks. We require that the Workers' Compen the insurer aggre~s to waive all fights The City, the City of Campbell Redeve to be covered as additional insureds as Also, the cancellation area of the certif failure to mail such notice shall impose its agents or representatives" and to ch ;ation certificate of insurance include wording that stating f subrogation against the City. lopment Agency, its officers, employees and volunteers are respects automobile liability. ~cate needs to be edited to delete "endeavor to" and "but no obligation of liability of any kind upon the company, ange the 10 days notice of cancellation to 30 days notice. A insurance requirements: Permit No. ENC2000-00059/102-190 N. Harrison Avenue We have reviewed the certificate of insurance :hat has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum mr review [] Reply ASAP [] Please Comment ACORD. fE OF LIABILITY INSUR.- NCE o.,D SUta4E-2 05/0S/02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE Clarendon Ins. Co. Ins. Co. State of PA PRODUCER James Econn & Co. Insurance CA License #0340047 445 S. Figueroa St., 36th Fl. Los Angeles C3~ 90071-1602 Phone: 213-629-3131 Fax: 213-629-4440 INSURED INSURER A INSURER B S oamaerHill Homes et al ~NSURER C 777 California Avenue INSURERD Palo Alto CA 94304 / I N INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I SURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER I~OCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAJD~LAiMS. I POLICY EFFECTIVE POUCY EXPIRATION TYPE OF INSURANCE POLICY NUMBER I DATE (MM/DD/YY) DATE IMM/DD/YY) LIMITS GENERAL UABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE ~ OCCUR .~ENt AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY OCCUR I i CLAIMS MADE DEDUCTIBLE RETENTION ¥ORKERS COMPENSATION AND EMPLOYERS' LIABILiTY OTHER WT0991200 42013026 04/08/01 04/08/01 04/08/03 04/08/03 EACH OCCURRENCE $ 2, 000, 000 FIRE DAMAG:_ (Any one tire) $ l00,000 MED EXP (Anyone person) $ ..~, 000 PERSONAL&ADVINJURY $ 2~ 000 ~, 000 GENERALAGGREGATE $ 2 z 000 ,, 000 PRODUCTS-COMP/OPAGG $ 2 ,, 000 ~ 000 Em~ Ben. COMBINED S NOLE LIMIT (Ed accident) BODILY INJURY (Per person) BODILY INJURY (Per accident~ PROPERTY DAMAGE (Per acciOenb AUTO ONLY - EA ACCIDENT EAACC OTHER THA~ AUTO ONLY AGG 170007000 $ EACH OCCURRENCE $ 10000000 AOOREOATE $ 10000000 $ $ $ WC STATIJ- lOTH- TORY UM TS ER E L EACH AECIDENT EL DISEASE- EA EMPLOYEE E L DISEASE - POUCY UMIT IDESCRIPTI~ OF OPERATIONE/LOCATION~EHIC~XCLUSIONE ADDED BY ENDORSEME~/~E Re: Project/Permit Nua~3er and Location of Harrison Avenue Tract 9244. *10 daxs notice of cancellation for non-pal *Per policx terms, conditions, limitations CERTIFICATEHOLDER [¥ [ADDmORALINEUREO;INSURERLE~ER: City of Campbell Attn: Depart. of Public Works 70 North First Street Cazapbell CA 95008 ~L PROVISIONS 7ork. ENC 2000-000§9 102-190 N. and exclusions. CANCELLATION CITYO-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 3 0 4r DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUDATION OR UABILITY OF ANY KIND UPON THE INSURER, iTS AGENTS OR REPRESENTATIVES, ACORD 25-S (7t97) PROOUI~ER (415)957-0600 FAX (415)957-0577 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~aroevi ch O' Shea & Coghl an HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 425 Harket St reet ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I0th Floor COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 ........................ COMPANY Am~'~'~'~An'"P'~{~'~'{'i'~'"'~'S":""~': Attn: Christopher Olson Ext: 213 A COMPANY SummerHi]] Homes, Thc. B RECEIVED PaiD Alto, CA 94304 COMPANY INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON[~ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RE/J~j~JIJ~j CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION: CO TYPE OF INSURANCE POLICY NUMBER LIMITS LTR DATE (MMIDD/YY) DATE (MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGA] E $ COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/DP AGG $ ii::iiiiiilili?; ...... i CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S PROT ..~'.?~.~;.~.E.I~ ............... ...... i FIRE DAMAGE (Any one fire) $ i MHD EXP (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ i'X" ANY AUTO ............................................................. ]~ !.(~0.0..'..Q(~0 : ..... ALL OWNED AUTOS BODILY INJURY $ B ....... SCHEDULED AUTOS :3ML0703907-08 04/02/2000 04/02/2001 ..!~r..p.~.?! ........................................ ~.!.0(~,!.0.00. HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) i ~ 000 ~ 000 PROPERTY DAMAGE $ 1,000,000 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ EACH ACCIDENT$ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ :i ....... OTHER THAN UMBRELLA FORM $ EMPLOYERS'LIABILITY .... IBR005263-02 03/23/2000 03/23/2001 EL EACH ACCIDENT $ 1,000,000 A THE PROPRIETOR/ 'NCL '~[Di~'E'~'~I'0'~[i~I~' '~ i 6~0', PARTNERS/EXECUTIVE ....... OFFICERS ARE: : EXCL EL DISEASE - EA EMPLOYEE$ 1,000,000 OTHER DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESISPEClAL ITEMS IH: Pro~ec~/Permit Number and Location of Work ENC 2000-00059 102-190 N. Harrison Avenue rract 9244 )ther Insurance Provisions per attached: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL J~X~ MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Campbell Attn: Department of Public Works 70 North First Street J~X0~J~)~Y~X~Xsv~j~Ki~NI~KXXXXXXXX Campbell, CA 95008 AUTHORIZED REPRESENTATIVE Christopher 01son I City of Campbell Certificate issued to City of Campbell 05/05/2000 Maroevich O'Shea & Coghlan 05/05/2000 / Provisions for General Liability and Automobil~ policies are as follows: / The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are to be covered as insureds with respect to liability arising out of automobiles owned, leased, hired or borrowed on or on behalf of the Contractor. Each insurance policy required by this clause cancelled by either party, except after thirty receipt requested, has been given to the City. non-payment of premium. shall be endorsed to state that coverage shall not be (30) days' prior written notice by certified mail, return A ten (10) day notice is required for cancellation due to Provisions for Worker's Compensation and EmplOyers' Liability Coverage are as follows: The insurer shall agree to waive all rights of subrogation against the City, the City of Campbell Redevelopment Agency, its officers, officials, employees and volunteers for losses arising from work performed by the Contractor for the City. , Sent b.y: MAROEVICH O'SHEA / COGHLAN " 05/'85~2000 0~: 22 415 957 4318; 05/05/00 3:39PM;Jet~ #232;Page 1/3 P.,~t4PI~ELL DFW MAINT PA6E IFAX Maroevich 0 'Stuta ~ Coghlan 42~ M~t St., 1~ ~ ~ ~i~o, CA ~4105 Phone (415) 957-06~ F~ ~o~ (4Ii) 957-0577 CC: RgMAI~gS: [] Urgent [] For yo~tr Re: I~ured~ Summerhi]l Homes Permit No. ENC2000-000591102-190 N. Fh We h~ve reviewed the certificate of~mr~mce thai referenced permit and find that tbs followini itom insur,7,,~ requirements: fl, We require that the Work~'s' Compens~ ~. The City, the City of Campbell [ ~e $/5/00 Jo~ume D'~tnbrosta Cuy of C, mpbe t ?0 North First Sar#at Campbell, C,4 ~5008 tgtene (408)866-2150 revlgw [] l~eply,4SAP [] Please Commtnt rosen Avenue has bees ~ublaitted in conne~,-tioa with the above need to bo added er ohaal~-d to mr.~t our minimum n c~'rfificatc ofinsura~ce in;lude wordinll fiat Matins rbrosltion affaio,t the City. ~em ~en~, ks o~ice~, employees and voluntee~ ~e pects automobile liability. ~" "but g needs to be ~ited to d~lete endeavor to and /. be covered u ~ditiomd insur~ls as ms so, the ~cellafion ~ ~the ~1 ute to ~l ouch ~ti~e ~11 ~o~ ~ ob~i~ of~i~ of~y ~ upon the comply, its a~nts or r~r~v~" ~ to ~e ~e 10 ~ n~cc ofc~l~o~ to 30 da~ n~. A t~ day notre is ~u~ ~ ~~on ~ue to ~-pl~t, / Copies of the applicable s~tions of our insu~ce requ~s ~l]ow ~ ~ur ~~ as ~1 u a ~py of ~e ofigin~ ce~ificlte t~t wu lu~. PI~ ~ me ff~u ~ ~ question. T~ for your help in this maker, j If r~sponding by f~ pl~ usa the abo~ ~ na~ (4OS) 376-09~8, not t~ f~ numb~ ~pp~ng my tmns~ssien. 1 ~m workinB in a d~ Ci~ o~ for today o~. / Sent by: MAROEVICH 0'SHEA / C0GHLAN 415 957 4318; 05/05/00 3:40PM;~.:~EX #232;Page 2/3 ~n=v~ch ~'~h=. ~ ~nnhl,n ONLY~DCONFE{NORIGH~UPONTHECNRTIPI~AIk I .................. ~ ...... i I HOLDER. THIS CER~FICATE ~ES NOT AMEND, EXTEND OR l~25 Market Street L ~FO~EO BY THE POLICIES 8EL~, 10Lb F~ 0o~ COMPANIES ~FORDING CO~GE '- San Fra, cisco, ~ 94~05 co~ .... Ameri~n P'~t'ecti0n Ins~"Co~ ....................... A~er~Can.M~.~.fa~.~br~.rs M~t~'ai"'znSU~ance Co, SummerHill Homes, Inc. 777 California Ave. Palo Alto, CA 94304 THIS ~ TO CER~FY THAT ~E POLICIES OF INSU~NCE LISTED BELOW INDICTED, NOT~STANDING ANY REQUIRERS, ~ ~ COND~ION CERTIF~TE ~Y BE ISSUED OR ~Y PERTAIN, THE INSU~NCE AFFORDI EXCLUSIONS AND CONDIT~NS OF SUCH POLICES LIMITS S~OWN ~Y ~0 ~PE OF IN~E ~b~Y LTR, COMPANy COMFAN¥ C COMPANY D :.4;; :.;,; :~;:,',', ~:,2 ~;~ ~., -; ~ ',~.[;~,!~::;;!~;:x:;,~,~g'$:~'fL,.~;~;::.~::~ '~ .~;:;!,;;!;;:; !;,~: !:;t':,~: :Fi ~ ~ ;. ',' ,2 ~:: ~::..i;:i:'~i:~i~'~: ~:~ i: ~E BEEN I~UED TO THE INSURED N~MED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNLS, ~E BEEN REDUCED BY PAID CL.a.~vlS POLICY EFFEC¥IYE POLiCY EXPIRATION OA~ (M~DWYY) DATE INM/DOffY) [ GENERRL LIABILITY COMMERCU~L GENERAL LIABILITY <: ~:: ',:~ x GLAIH~ MADE OCCUR ', ..... OWNERS & CONTRACTOR'S PROT ~TOMO~LE U~lkl~ ~ AuTO OWNED ~O~ GENE~L ~RE~TE PRODUCT~ - COMP/0P AGG PERSONAL &/~3V INJURY EACH OCCURRENCE FIRE DA~GE (~y ~e fi'el , ~H~UL~ AUTOS B MIRED AUT~ NON-O~ED AUTOS , Ga~,AGE L~I~TY ~Y A~O UMBRELLA FORM OTHER THA~I UMBRELLA FORM WO~ ~PE~T~N AND ' EMPLOYEB~ ~LI~ A' : THE PROPRIETOR/ i INCL , PAR~ER~EX~UT~E OFFICERS ARE! , EXCL OTHER 3ML0703907-0~ 04/02/2000 COMBINED SINGLE LIMIt[ 1,000,000 BODILY INJURY ~ (Pc,' p.o.] 1,000,000 04/0;'/200I , ~"'~°'~ , ,1,,,ooo,ooo eROPERTY D~ $ 1 t 000 ~ 000 AUTO ONLY - EA ~CI0~T OTHER THAN AUTO ONLY: EACH ACCIDE. NT AGGRE~TE ; 3BR005263-02 03/23/2000' 0~/23/2001 RE: Project/Permit Number and Location o Work. EN{ Tract 9244 3ther Insurance Prov~Mons per attac~ed: City of Campbell Attn: Department of Public Works 70 North First Street Campbell, ~ 95008 2000-00059 102-190 N. Harrison Avenue ENOULD ~ OF THE ABOVE ~ED POUClF.& BE CANCELLED BEFORE THE E~RA~ DATE THEREOF, THE lS~.JlNG COMPANY ~LL ~ ~L ~0 ~W~N ~O~E TO THE GERTI~O&~ HOLDER N~ED TO THE LEffT. AUTHORIZED REFRESENTATR/E Christopher O1 son Sent by: MAROEVICH O'SHEA / COGHLAN 1 415 957 4318; City Of Campbell O5/O5/OO 3:41PM;,Jet,~-~#232;Page 3/3 Ceetificate issued to City of Campbell ~4aroevich O'Shea& Co~hlan .... os/os/zooo Provisions for General Liability and Automobile p( The City, the City of Campbell Redevelopment Agen( covered as insureds with respect to liability on or on behalf of the ContraCtor. licies are as follows: 05/05/Z000 y, its officers, employees and volunteers are to be lng out of automobiles owned, lease~, hired or Sorrowed Each insurance policy required by thlS clause sha cancelled by either party, except after thirty (3( receipt requested, has been given :o the City. A non-payment of premium. ~ m Provisions for Worker's Compensation and Employer~' Liability Coverage are as follows: m The insurer shall agree to waive all rights of subrogation against the City, the City of Campbell losses arising Redevelopment Agency, its officers, officials, employees and volunteers for from work performed by the Contractor for the City. ] be endorsed :o state :ha: coverage shall not be ~) days' prior written notice by certified mail, return ten (10) day notice is required for cancellation due to PRODUCER (415)957-0600 FAX (415)957-0577 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 4aroevi ch O' Shea & Coghl an ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 42 S Market Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 10th Floor i COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 '"'~ ~ie'~'i"~'"'P'~e~'{i'~'"~n~"~'"'~': ................................. Attn: Christopher Olson Ext: 213 A SummerHill Homes, Inc. B 777 California Ave. COMPANY C Pal: Alto, ~ 94304 ~ .,~;~,~ ............................................................................................................................. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO : TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDD/YY) DATE (MMIDD/YY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ::::::::::::::::::::::::::::::: CLAIMS MADE i OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS i3ML0703907-08 GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY A 3BR005263-02 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL :: OTHER GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person)$ 04/02/2000 COMBINED SINGLE LIMIT $ ............................................................. ~.,.~)0.0..,..~)~)~. BODILY INJURY $ (Per person) 1,000,000 04/02/2001 BODILY INJURY $ . . ?~!. ~i.d.~'.! ........................................ PROPERTY DAMAGE $ 1,000,000 03/23/2000 AUTO ONLY - EA ACCIDENT $ ......................... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: EACH ACCIDENT$ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ $ V : WC STATU- ::::: ::::::::::::::::::::::::::::::::::::!:i:::::::::::::::::::::::::::::::::: .. 2....~9.,?,Y..~!M!~ ......... ::..~fL. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 03/23/2001 . EL ?C~!0[}? ............. ~ ...... 37.000,000 . ~: ~??SE :. ~.~'~ ?Z.. ~ ]: ,. P 0.0..,..0 0 0 EL DISEASE- EA EMPLOYEE $ 1,000,000 DESCRIPTIONOFOPERATIONSlLOCATIONSNEHICLESISPEClALITEMS {E: Project/Permit Number and Location of Work. tract 9244 ENC 2000-00059 102-190 N. Harrison Avenue City of Campbell Attn: Department of Public Works 70 North First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Christopher Olson , CERT. IFICP]'E OF LIABILITY INSUr [ PRODUCER James Econn & Co. Insurance CA License #0340047 445 S. Figueroa St., 36th Fl. Los Angeles CA 90071-1602 Phone=213-629-3131 Fax=213-629-4440 INSURED SummerHill Homes, et al 777 California Avenue Palo Alto CA 94304 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR! LTR I TYPE OF INSURANCE GENERAL LIABILITY ~ ~O,MMERCIAL GENERAL LIABILITY : CLAIMS MADE ~ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POUCY, i JECT LOC AUTOMOBILE LIABILITY j ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS j HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY i ANY AUTO F -- EXCESS LIABILITY OCCUR POLICY NUMBER CGO 0001035-01 CLAIMS MADE DEDUCTIBLE I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER DESCRIPTION OF OPERATION~LOCATIONSNEHICLE~EXCLUSIONS ADDED BY ENDOF Re: Project/Permit Number and Location of Harrison Avenue Tract 9244. Parental Guaraz See addendum for additional insured and pr~ '10 days notice of cancellation in the evez Per policy terms, conditions, limitations CERTIFICATE HOLDER Y i ADDITIONAL INSURED; INSURER LETTER: City of Campbell Attn= Depart. of Public Works 70 North First Street Campbell CA 95008 ACORD 25-S (7~97) THIS CERTIFICATEISISSUED AS A MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTHECOVERAGEAFFORDED BYTHEPOLICIES BELOW. INSURERS AFFORDING COVERAGE ~ INSURERA: Caliber One INSURER B: INSURER C: I INSURER D: i lNSURERE: Replaces cert dated 05/02/00 lAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING [' WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICY EFFECTIVE POLICY EXPIRATION / DATE (MM/DD/YY} DATE (MM/DD/YY} LIMITS EACH OCCURRENCE $ 5, 000, 000 04/08/99 04/08/01 I FIRE DAMAGE (Any onefire) $ 100, 000 i MED EXP (Any one person) $ 5, 000 ! PERSONAL & ADV ItIJURY' $ 5, 000~, 000 ~ECEI .vE~ENERAL AGGREGATE $5, 000, 000 PRODUCTS-COMP/OPAGG $ 5, 000, 000 COMBINED SINGLE LIMIT H4Yl I 2 2000 (Eaaccident) $ 40~I~a '~ iJ BODILY INJURY PU~LI~' OR/(_. (Per person) $ ~ BODILY INJURY i $ i {Per accident) PROPERTY DAMAGE I $ (Per accident) I AUTO ONLY - EA ACCIDENT EA ACC OTHER THAN AUTO ONLY: AGG $ EACH OCCURRENCE I $ AGGREGATE iS $ $ WC STATU- IOTH- I TORY LIMITS I ER ' : E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT ' $ SEMENT~PECIAL PROVISIONS ~or~. ~C 2000-00059 102-190 Lty Endorsement attached. .mary insurance status. ~t of non-payment of premium. ~nd ~xclusions. CIT'[O-1 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI~ DATE THEREOF, THE ISSUING INSURER WILL W~ MAIL 30 * DAYS WRITi'EN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, EN! THIS ENDORSEMENT CHANGES THE POLICY This endorsement, effective 4/8/1999 at 12:01 A.~ issued to SummerHill Homes by Caliber One Indc This endorsement modifies insurance provided fo )ORSEMENT #1 PLEASE READ IT CAREFULLY. ,1. Standard time forms a part of policy number CGO0001035-01 mnity Company under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PARENTAL GUARANTYENDORSEMENT It is agreed that PMA Reinsurance Corporation gu obligations under this policy. PMA Reinsurance Corporation 1735 Market Street, Suite 2800 Philadelphia, PA 19103 arantees the performance of Caliber One Indemnity Company's IndemniCy Company ,/.COI.E67(01/98) Authorized Representative PAGE 1 OF 1 SummerHill Homes, et al / Caliber One - General Liability Policy #CGO 0001035-01 Addendum to Certificate of Insurance issued to th~ City of Campbell on May 9, 2000 ADDITONAL INSURED It is understood and agreed that coverage afforded!by this policy shall apply to The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers as Additional Insureds if so obligated by written contract to provide same but only with respect to acts or omissions of the Named Insured in connection with the Named Insured's operations on behalf of Additional Insureds. PRIMARY WORDING CLAUSE It is further agreed that such insurance as is afforded by this policy for the benefit of the additional insured(s) shown above shall be primary insurance, but only as respects any claims, loss or liability arising out of the operations of the named insured or from occupancy, maintenance or use of the premises by the named insured and any insurance maintained by the additlonal insured(s) shall be non-contributing. / K:\DATA\COMM\BADA~CERTS\SummerHill GL Al Prinlary.doc FAX TO: Phone Fax Phone James Econn&Co. Insurance 445 S. Figueroa St., 36th Fl. Los Angeles, CA 90071-1602 (213) 629-3131 (213) 629-4440 CC: I Date I Number of pages including cover sheet FROM: doanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone Fax Phone (408)866-2150 (408)376-0958 REMARKS: [] Urgent [] For y°ur review [] Reply ASAP [] Please Comment Re: Insured: SummerHill Homes / Permit No. ENC2000-00059/102-190 N. Harrison Ave. We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance requirements: ! The City, the City of Campbell Redevel to be named as additional insureds eithe SummerHill Homes' insurance coverag, apment Agency, its officers, employees and volunteers are r on the certificate or on an attached endorsement. ~ is to be primary insurance as respects the City and this Dr on an attached endorsement. needs to be stated so on the certificate ~ We require that the insurance provided to the City be issued by an insurer authorized to transact business in the State of California. Cali~er One, the general liability carder, does not appear on the list published by the State of Califo.mia Department of Insurance which includes all insurers admitted to transact liability insurance ipthe state. , ..... The cancellation area of the certificate 0eeds to be edited to delete endeavor to and but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives". / Copies of the applicable sections of our insu copy of the original certificate that was submi your help in this matter. If responding by fax please use the above fax my transmission. I am working in a different C :ance requirements follow for your reference as well as a :ted. Please call me if you have any questions. Thanks for number (408) 379-0958, not the fax number appearing on ity office for today only. Thanks. Search P. esults [ Page 1 of 1 Search Results , on~~9 I nsurance The results of your search are summarized in the following table. For more information on any company, left-click on the company name. To view all companies in the same group, left-click on the group number. / Name 'TypeI Legal Name Company N~me PMA REINSURANCE CORPORATION Last Copyright © C Revised - April 18, 2000 difornia Department of Insurance Disclaimer http://www2.insurance.ca.g~v/iXpress/cdi-pr~fi~es/C~mpPr~fi~es/SearchResu~ts.DML 05/09/2000 FACSIMILE TRANSMISSION FROM JfiMF_S ECONN & CO. INSURANCE 445 South Figueroa Street, 36th ~loor, Los Angeles, CA 90071-1602 CA LICENSE NO. 0340047 FACSIMILE PHONE: (213) 629-4440 TELEPHONE NO.: (213) 629-3131 TO: Joanne D'Ambrosia COMPANY: City of Campbell FAX NUMBER: (408) 3764)958 cc: Raymond Ban'0 FROM: Darlene Bada DATE: May 9, 2000 RE: SummcrHilI Homes General Liability P NUMBER OF PAOES SENT INCLUD Dea~ Joanne: I am sendillg to you thc revised Ccrtific, referenced. The original will be sent If you have any questions, please do not Sincerely, @ SummerHill Homes (650) )licy ~:2GO 0001035-01 lNG COVER PAGE: 4 7° ~te of Liability Insurance for the above h~sitate to contact me. JEC:445 (Rev. 2/98) ["-1 original docum~t to follow by mail if box checked- ~a,l~eS HCOl~ & CO, CA License 60340047 495 S. Figueroa St., 36th Fi. Los Angeles CA 90071-1602 Phone:213-629-$131 Fa~t213-629-4440 Sun~nerHill ~o~es. et al 777 California Avenue Palo Alto CA 9{304 COVERAGES :ME~Ct~L GENERAL.UABL try A t GARAGE UAmUI'Y C'GO 0001035-01 WORK[,R$ COMPEI, IS~TION AalO OESC~%~, ~OPERA~ONS/LOCA~ONS/V:EH~LE~CLUSION&ADOEOBy Re: Proje~/~e~t ~er and Location of ~ See add. d= ~or additional insured and pri~ '10 day~ uotlce of c~cellaticn in the event Per ~o[icy rem, cond[tiO~s, l~ta~i~ns ~ CERTIFICATE HOLDER 05/09/00 ACORD2.~7) City of Ca~be11 Attn: Depart. Of Public Works 70 North First Street Campbell CA95008 ~r. NT~PEOAL ~0~0~ >rk. ENC 2000-00059 102-1~0 N. r Endorsement at~ached. ~ry insurance g~atu~. o~ non-payment o~ premium. ~x¢lu~ions. ABOVE FOR THE ~'OLL-'Y PER~00 ~DICa, TE0. IBJECT TO ALL THE T&~:~M$. EXCLUS[~$ AN0 COND'fl'.~%'S OF SUCH 04/08/99 ]$5,000,000 04/08/01 i~o~,.~(..~,~)}s 100,000 AU"i'OONLY. EAACCIO[NT i $ AUTO ONLY: AC.G; I S ~ AA~C~E i $ j$ TORY EL ~ ACCIO'ENT E.L D~EAS~ · F.A F.~OYEE $ E L DL.~. POUCY UMtT: $ ,, ADDITION,N. I.'I~;RB): It~4Jll~R L~"frER: A c~0~ CANCELLATION UMIT~ INSURERS AFFORDING COVERAGE Replaces cert da=ed 05/02[00 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THL~ CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCI~S BELOW. ~A¥-0~-0~ 11,~ F~O~: PA~£ 3/4 END T. s E"DORSEMEm' C"ANGES TH - POL'CY. This endorsement, effective 4/8/1999 at 12:01 A.M issued to SummerHitl Homes by Caliber One Inclen This endorsement modifies insurance provided f0r~ COMMERCIAL GENEF PARENTAL G~ It is agreed that PMA Reinsurance Corporation guaJ obligations under this policy. PMA Reinsurance Corporation 1735 Market Street, Suite 2800 Philadelphia, PA 19103 DRSEMENT #1 PLEASE READ 1T CAREFULLY. Standard time forms a part of policy number CGO0001035-0I ~nity Company ruder the following: AL UABILIT¥ COVERAGE PART ~,RANTY ENDORSEMENT '"'~ antees the performance of Caliber One indemnity Company's Authorized Representative MAY-O~-00 1I ~2G FRO~ PAGE SummerHill Homes, et al Caliber One - General Liability Polic3 Addendum to Certificate of Insurance issued to the ADDITONAL INSURED_ It is underwood 'and agreed that coverage afforded Redevelopment Agency, its officers, employees am contract to provide same but only with respect to Named Insured's operations on behalf of Additional PRIMARY WORDING CLAUSE #CGO 0001035-01 City. of Campbell on May 9, 2000 ,y this policy shall apply to The City, the City of Campbell volunteers as Additional Insureds if so obligated by written s or omissions of the Named Insured in connectiou with the Insureds. It is further agreed that such insurance as is afford¢d by this policy for the benefit of the additional insured(s) shown above shall be primary insurance, but only Os respects any claims, loss or liability arising out of the operations of the named insured or from occupanc2~, maintenance or use of the premises by thc named insured and any msur .ance maintained by the additional insured(s) shah be non-contributing. MAY. 9.~000 10:54AM SUMMERHILL COMSTRUCTIOM P M0.691 P.i×~ FAX Angela Adams . ~ , James Econn&Co. Insurance 445 $. Pigueroa St, SP~ Fl. Los dngelcs, 0.4 9007]-1602 F~x Phone ('223) 629-3.131 (213) 629-4440 CO: ]~EMARKS: [] Urgent [] Re: Insured: SummerHill Homos Permit No. ENC2000-00059/I02-190 N I-1; [ D~te S15/O0 ] Number of pages including cover sheet FR Phon. ~ (408).866-2150 For youe re~ew rrison Ave. We have reviewed the certificate of insurance tiaa referenced permit and find that the following iten insurance requirements: 1. The City, the City of Campbell Redevelo[ to be named as additional insureds either, 2. SummerHill Homes' insurance coverage needs to be stated so on the certificate o~ 3. We require that the insurance provided to business in the State of California. Calibe the list published by the State of Californi~ admitted to transact liability insurance ha t 4. The cancellation area of the certificate nee to mail such notice shall impose no obllga or representatives". Copies of the appLicable sections of our insura~ copy of the original certificate that was submitte your help in this matter. ff responding by fax please use the above fax nl my transmission. I am working in a different City [] Reply ASAP [] Please Comment :has been submitted in connection with the above ~s need to be added or changed to meet our minimum ment Agency, its officers, employees and volumeers are m the certificate or on an attached endorsement. ~ to be primary insurance as respects the City .and this on an attached endorsement. the City be issued by an insurer authorized to transact r One, the general fiability carder, does not appear on t Department of Insurance which includes all insurers he state. ~ds to be edited to delete "endeavor to" and "but ~ailure ~on of liability of any kind upon the company, its agents :ce requirements follow for your reference as well as a fl. Please call me if you have any questions. Thanks for tmber (408) 379-0958, not the fax number appearing on office for today only. Thanks. }DULl ,5 -~ UREO CERTI! AGORr MAY. 9.2000 10:54AM SUMMERHILL COHSTRUCTIOM P A M0.691 CERTIFICA OF LIABILITY INSURA ' ' ' THiS CE~IFI~TE IS IS~u=D ~ A MAWR OF I~Fd~MATION ~CO~ a Co, Zneu;~ce ONLY ~P ~NFERS NO RIGHT5 UPON ~E CER~FICA~ ,e~e ~03~00~? I ALTER THE C~GE ~FORDEO.BYTHE POUCIES BECk. 777 Calt~a~ta Avenue ~su~o: RUR~ ,~ . ~M OR CON.ON OF A~ ~ a ~m ~M~ W ~ ~SP~ ~ ~l~ ~16 O~Ft~T~ MaY E ISSUED OR ~i I~U~ ABR~ IY T~ ~LIGI~ O~ H~IN IS IUi lf~ TO ALL ~E ~ ~610N6 AND CONDITION6 OF ~ ~CH OCCU~NC~ S, 000,000 em~A~ s 5,000, OOP ~ GOMB~N~ SINGLE LIM~ ANY ~ A~ OWN~ ~ ~DILY I~URY ~HEDULED A~ ~Per Hl~ ~ 8001LY INJURY $ (PeP ~0 ONLY: ~ ~H OCCU~ENCE C~IMS ~ AGGRE~ COMP~N~O ~ WC~TAT~ [ notice of cancellation in the even~ o~ ~n-~a~ent o~ 70 No~th P~rl~ Gtreeb FAX TO: Phone Fax Phone CC: Angela Adams James Econn&Co. Insurance 445 S. Figueroa St., 36th Fl. Los Angeles, CA 90071-1602 (213) 629-3131 (213) 629-4440 For y~ ur review Harrison Ave. REMARKS: [] Urgent [] Re: Insured: SummerHill Homes Permit No. ENC2000-00059/102-190 N. I Date 5/5/00 I Number of pages including cover sheet FROM: Joanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone Fax Phone (408)866-2150 (408)376-0958 [] ReRly ASAP [] Please Comment We have reviewed the certificate of insurance ~hat has been submitted in connection with the above referenced permit and find that the following il~ems need to be added or changed to meet our minimum insurance requirements: 1. 2. 3. The City, the City of Campbell Redeve to be named as additional insureds eith. SummerHill Homes' insurance coverag needs to be stated so on the certificate We require that the insurance provided business in the State of California. Cai: the list published by the State of Califo admitted to transact liability insurance opment Agency, its officers, employees and volunteers are ,~r on the certificate or on an attached endorsement. e is to be primary insurance as respects the City and this >r on an attached endorsement. to the City be issued by an insurer authorized to transact ber One, the general liability cartier, does not appear on -nia Department of Insurance which includes all insurers n the state. 4. The cancellation area of the certificate )eeds to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives". Copies of the applicable sections of our ins4rance requirements follow for your reference as well as a copy of the original certificate that was subn~tted. Please call me if you have any questions. Thanks for your help in this matter. If responding by fax please use the above fa,~ number (408) 379-0958, not the fax number appearing on my transmission. I am working in a different ~ity office for today only. Thanks. ACORD.CERTIFIC., T E OF LIABILITY INSUI DATE,M.DD ) 05/02/00 PRODUCER James Econn & Co. Insurance CA License #0340047 445 S. Figueroa St., 36th Fl. Los Angeles CA 90071-1602 Phone:213-629-3131 Fax:213-629-4440 INSURED SummerHill Homes, et al 777 California Avenue THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AF F O RDI NF~e~ Q.V_E RAG E I 'NSURERA: Caliber One INSURER B: INSURER C: ~4Y 0 4 2000 INSURER D: Palo Alto CA 94304 '-?~LIC · ' I INSURER E: ~.DMIN,o.._WORK~ COVERAGES / THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED ~AMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS~ / POLICY NUMBER / I DATE (MM/DD/YY) i DATE {MM/DD/YY) ' LIMITS INSRi LTRI GENERAL LIABILITY A ! Z i COMMERCALGENERALLABLITY CiaO 0001035-01 TYPE OF INSURANCE EACH OCCURRENCE 04/08/99 04/08/01 FIRE DAMAGE (Any one fire) CLAIMS MADE l~ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: AUTOMOBILE LtABILITY ANY AUTO ~ ALL OWNED AUTOS i HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY I ANY AUTO EXCESS LIABILITY i OCCUR [ '-! CLAIMS MADE '-] DEDUCTIBLE ! RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY i I OTHER MHD EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Fa accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT EA ACC OTH ER THAN AUTO ONLY: AGG EACH OCCURRENCE AGGREGATE $ $ ,$ :$ is is $5,000,000 $100,000 $5,000 $5,000,000 $5,000,000 s5,000,000 $ $ I ~ WCSTATU- ; OTH-: ~ TORY LIMITS i ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE! $ E.L. DISEASE - POLICY LIMIT i $ DESCRIPTIONOFOPERATIONSILOCATIONS~EHICLES/~CLUSIONSADDEDBYENDO~ Re: Project/Permit Number and Location of Harrison Avenue Tract 9244. -10 days notice of cancellation in the eve~ Per policy terms, conditions, limitations CERTIFICATEHOLDER !NIADDITIONALINSURED;INSURERLE~ER: CIT~ City of Campbell Attn: Depart. of Public Works 70 North First Street Campbell CA 95008 ACORD 25-S (7/97) SEMENT/SPEClAL PROVISIONS Work. ENC 2000-00059 102-190 N. .t of non-payment of premium. .nd exclusions. CANCELLATION .'O - 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESE~'ATIVES. ,~ ~ ©ACORD CORPORATION 1988 To: Finance Director Check Payable To: Address ~ Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Voucher #: Receipt #: Refundoble bep¢ sit? Check Request? SUMMERHILL CONSTRU(:TION 777 CALIFORNIA AVENU[ PALO ALTO Refundable Deposit 101.2203 State: CA Zip: 94304 Amount: $4,500.00 Amount: Amount: (Finance Dept only) 101.540.7448 Interest Earned (Exact Amount) / Maintenance period has e~(pired. Refund deposits as follows: $500.00 plan check deposlt; $2,000.00 Labor & Material Deposit; $2,000.00 Cash Deposit. ($2000); Permit #: 2000-00059 130044 ($500); 130045 Date: 4/25/00 130046 ($2000) Requested by: Approved by: Finance Dept Only: Verified by: Approved by: Alan Hom Title: Sr. PW Inspector Date: Michelle Title: City Engineer Date: Special ]:nstr'uctiom Mail As Is: Mail in Attached Envelo Title: Accounting Clerk II Date: Title: Accountant Date: 7/15/03 7/15/03 For Handling Check Interim Check: Needed By: Return To: Other: MARLENE POMEROY PUBLIC WORKS (Name) (Department) Please return check to Public Works for transmittal to permit holder. ! h:~permits~2000-00059 102harrison maint accept refund(mp) CITY Public April 27, 2000 Mr. Jim Barriteau New Service Department San Jose Water Company 1221 S. Bascom Avenue San Jose, CA 95128 Re; 102-190 N. Harrison Avenue, TraCt Dear Mr. Barriteau: We are enclosing two copies of the plans development, the City of Campbell is fun the west side of Harrison Avenue north of 12 inch storm drain pipe across Harrison your 12 inch water main. We have not concluded the review of construction plans, but hope to conclude Please let us know if you have any questio~ Very truly yours, Cruz S..'Gomez Assistant Engineer OF CAMPBELL Y~orks Department No. 9244, Summerhill Homes for your review and comments. As a part of this fling the construction of the street improvements on Grant Street. Please note that the installation of the Avenue east to west will require that you relocate offsite construction plans, nor of the onsite very shortly. or comments. Please call me at (408) 866-2163. Cc: Bill Helms, Land Development Manager Kirk Heinrichs, Redevelopment Manager Michelle Quirmey, City Engineer H:\landdev\ 102harrison4 271tr 70 North First Street . Campbell, California 95008-1423 · T~L 408.866.2150 - ~^x 408.376.0958 · TDD 408.866.2790 Chuck Gomez From: Sent: To: C¢: Subject: Chuck Gomez Tuesday, May 09, 2000 1: Bill Helms; Bill Bruckart; A Chuck Gomez; Randy We RE: 102-190 N. Harrison, 47 PM lan Hom; Matthew Jue stfall; Harold Housley; Vince Jimenez ;ummerhill Homes, EP ENC2000-00059 / We have issued the EP to install and maintain the construction fence within the public right of way and for traffic control and public property cleanup and maintenance including parking restrictions. We therefor have no objection for the Building Department to issue the demolition permit. Raymond ~arro of Summerhill Homes has been informed. ..... Original Hessage ..... J From: Chuck Gomez Sent: Friday, April 28, 2000 11:03 AM To: David Corona Cc: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes Please see me first thing this afternoon about an aerial photo that we need for a plan to show fencing, barricades, and signing for a trafic control plan for this project. Tha ~ks! ..... Original Message ..... From: Chuck Gomez Sent: Thursday, April 27, 2000 1:34 PM To: Randy Westfall; Harold Housley; Alan Hom Cc.' Bill Helms; Chuck Gomez; Hatthew .]ue Subject: RE: 102-190 N. Harrison, Summerhill Homes Please do not sign off for Summerhill Homes c,r Summerhill Construction Company to get their demolition permit until Public Works issues them the encroachment permit to install the construction fence on the public right-of-way. The fence permit requires them to install and ~aintain all signage and to clean and maintain the public property clean at all times and it limits the truck route nd parking. Thanks, Chuckg ..... Original Message ..... From: Chuck Gomez Sent: Wednesday, April 26, 2000 4:2:' PM To: Bill Helms Cc: Chuck Gomez; Harold Housley Subject: RE: 102-190 N. Harrison, Sumrr erhill Homes Bill, Reyad Katwan of Summerhill Homes s being evasive and nonresponsive with respect to submitting information that they are required to furnis~ the City. The conditions of approval state that on Harrison Avenue they are required to remove and to reconstruct to street center line. That is not being shown shown upon the plans. The soils report, the street structurE.I section design, the report on the coring, the analysis of the core samples for asphalt concrete thichness ar d aggregate base thichness, none of this information has been furnished to the City eventhough they are part of the conditions. Paul Kruger says that the soils report will come from the soils engineer and that existing asphalt will not be removed and reconstructed as required. Katwan has known from the beginning what the requirements are and his civil has been informed by me to design the structural section based upon the TI and R-value and to show it on the plans. Katwan is stonewalling and delaying in hopes that I may forget to continue to insist that they comply with the requirements. I placed a call to him this mC)rning to remind him to submit the soils and coring lab investigation reports. I wii call Kruger to ask him whatever gave him the idea about not showing reconstruction to centerline. I can only proceed with plan check of the plans to a certain point and then I will have to stop due to their nonresponse. Chuckg ~ ..... Original Message ..... From: Chuck Gomez Sent: Tuesday, April 25, 2000 3:)5 PM To: Randy West'fall; Matthew .1Je Cc: Bill Helms; Chuck Gomez Subject: RE: 102-190 N. Harrison, ;ummerhill Homes I am having Marlene type up a Special Condition 5 to an encroachment permit to allow Summerhill Homes to install a fence to close off the publiC; sidewalk areas of the east side of Harrison Avenue and the south side of Salmar Avenue that includes r~o parking on the east side of Harrison Avenue which I need for both of you to review and comment upon as soon as possible. Thanks, Chuckg / ..... Original Messacj,. --- From: Chuck Gomez Sent: Thursday, April 20, 2( To: Randy Westfall Cc: Bill Helms; Matthew Subject: RE: 102-190 N. Hard., Randy, comments please, thanks, ..... Original Message ..... From: Matthew 3ue Sent: Thursday, April 20, 2000 9:06 AM TO: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes / How's this (see text in red)? i 00 9:56 AM ~e; Chuck Gomez on, Summerhill Homes Chuck§ ..... Original Message ..... From: Chuck Gom Sent: Thursday, l To: Matthew .lu Cc: Chuck Gore Subject: RE: 102-19 Matthew, we do not want Is there a clear and simpl, ..... Original Message ..... From: MatthE Sent: Wedn~ To: Chuck Subject: RE: 1( Here are some suggE the gravel parking lot 1. Generally, trL Municipal Code Secti~ their point of origin (e Salmar to Harrison. 2. At no time sh Avenue (both sides) 3. At no time si Avenue (both sides) 4. Equipment a 5. The i least five days prior t( the "1996 Manual of' (including all revisiom 6. The ~ Contractor's work will parking restrictions, ti "No Stopping" signs ~ City will provide the s least forty eight (48) feet. The signs shall conditions must be f( enforceable. The Cor immediately after pos .pdl 20, 2000 8:00 AM ~Z ) N. Harrison, Summerhill Homes for them to park on the west side of Harrison north of Grant Street. ; way to make that clear? w ]ue ~sday, April 19, 2000 2:56 PM Gomez 2-190 N, Harrison, Summerhill Homes sted Oonditions of Approval which may change depending on how at GrantJHarrison is allowed to be used: cks may use the Unrestricted Streets mentioned in the Campbell )n 10.40.020, "Unrestricted streets or truck routes". Depending on g., from Highway 17), I would assume Highway 17 to Hamilton to 311 construction trucks drive on Harrison Avenue north of Salmar ~nd between Salmar Avenue and Grant Street (west side). 311 construction employees park on Harrison Avenue north of Salmar ~nd between Salmar Avenue and Grant Street (west side). ~d material storage and employee parking shall be on site only. ;ontractor shall submit a traffic control to the Engineer for review at beginning of construction. The traffic control plan shall conform to 'raffic Controls for Construction and Maintenance Work Zones ontractor shall install "No Stopping" signs in areas where the require restricted parking. Prior to start of work which requires ~e Contractor shall request approval to post and maintain temporary t each location where construction operations will take place. The gns for the Contractor's use. The Contractor shall post the signs at ~ours prior to start of the work at a maximum spacing of sixty (60) :learly show the date(s) and hours of the parking prohibition. These Ilowed by the Contractor in order for the no stopping order to be tractor shall notify the City of Campbell Police Department ting the signs at (408) 866-2101. 7. Safe pedestrian and handicapped access shall be provided at all times throughout the project site. ..... Original Message ..... From: Chuck Gomez To: Cc: Subject: Mike Walters of Wednesday, Apdl 19, 2000 1:5't PM Bill Helms; Matthew .lue; Randy Westfall C luck Gomez; Vince .limenez; Bill 8ruckart )2-190 N. Harrison, Summerhill Homes ummerhill Homes, 1-415-517-2402, needs an encroachment permit to fence off the si~tewalk on Harrison Avenue and fence off the whole site for Haz Mat removal. As soon as they do that, they will want a demo permit. We need to let them know now what it is that we expect from them. We need to let them know what the truck route will be no parking in the residential streets, equipment and material storage, employe parking, signs, barricades, cleanup, sweeping, plan, schedule, fees for assuranc of compliance, etc. We do not know if RDA will allow them to park at the SVV corner Grant and Harrison. Matthew, can you stipulate the conditions, the minimum con~]itions of approval that we will require. There are other issues like other City closure that should be noted. Thanks, Chuckg CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT .:,,- Permit No.~ (for working within thc X-Ref. file public right-of-way) Issued' Permit APPLICATION - Application is heroby made for a Public Works Per if the permit is not issued. Application Fee is non-r~undable.) A. Work address or tract # Tr/.~ ~..~T q7.~ :xpires in 12 months Application Date Application expires in 6 months nit in Iccordanc~ w~ Campbell Municipal Code, Section 11.0~. (Application e. xpi~es in 6 mom~.s Utility u'ench localion C. A~ f~r (4) ~ of ~ ~in~ p~ $~owi~ ~ I~o~ p~ $~1 ~how ~ ml~on of ~ pm~$~ wo~ ~ ~ D. NI wo~ s~l ~o~ to ~e Ci~ of C~il S~d S~ifi~ s~e; ~ ~e Sp~ ~ovisiom for ~h ~it, I~ ~low. F~lu~ P~o~ Sur~i~ ~ ~h d~osi~. (S~ G~ P~t E. ~ CO~CTOR MUST ~VE T~S PE~ ~ APPR ~ ~O DAYS BEFO~ STATING WO~. NO~CE MUS' Is ~ work ~ing done by ~e prope~ owner a ~eir own ~id~ ~ Appli~i~ her~y ~r~ by ~fa~g ~ek sil~ ~ ti ~y ~ or de~ for ~g~ r~ulfing from ~e work ~v~ b) ~o~ion. Accepted (Ap!: and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The md underground improvement. When approved by the City Engineer, said plan becomm a pan of iota and ~ for Public Works Consmiction; the General Permit Conditions lismd on the reverse ~ abide by these conditions and provisions may result in job shut-down and/or forfeiture of Pai~ful ~ns I and 2.) 3V~D PLANS AT TIIE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT · BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RF. STARTING ANY WORK. Yes ~/ .No t~'rmit to hold th,' City of Can~bell, it~ officer~, a~,n~ and employ-''~ fr~, ~'¢ and harmless this permit. t undemand both the front and h~k of this I~-rmit, and they will inform d~ir (sign) SPECIAL PROVISIONS ~Xl. Street shall not be open cut for underground hxstallatior, approved by the Inspector prior to cutting. __2. Pavement may be cut for underground installations and unless o~erwise -,pproved by Inspecior. 3. Work to bc staked by a lic~.~sed Land Surveyor or C'wl ~"--4. Per Section 4215 of the Government C-~-e ~ permit i ~ id~ntificahon number has been enttred hereon. USA P XI_5. Sgg A??At:HK. ~Pl~.C~TRI, CONT~Iq~ SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES Minimum cuts !!~ be allowed for cormectinns or exploration holes. Such cms ~ mst be rmtored in accordance with the Utility T~ Rtstoration Standard De~'ls. M~od 'A' Backfill, Enxineer a~l two C2) copies of the cut shee. s sent m the Pubr~ Works 1~ before staninl work. I not valid for excavations ~ Underground Service Alert (USA) hns ~ m:~if~l ~d ibc inqui~ ~one 1.800-227-2600. USA TICKET NO. PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE \forms~pwperra?./rcv.6190 SPECIA ENCROACHME The purpose of this permit is to install the east side of Harrison Avenue and tl~ of on site private improvements only. signage or improvement from within the The permittee shall install and maintain the public right-of-way free of polluta vacuum sweeping all public areas surro drainage facilities. Truck traffic to and from the sit~ or material and/or for the purpo: Hamilton Avenue, Salmar Avm Salmar Avenue. o At no time shall construction e Avenue (both sides) and between Equipment and material storage The Contractor shall submit a t~ five days prior to beginning of c the "1996 Manual of Traffic Co (including all revisions)," and Se of the Standard Specifications. The Contractor shall install "No will require restricted parking. restrictions, the Contractor shall Stopping" signs at each location City will provide the signs for th at least forty eight (48) hours pr: (60) feet. The signs shall clearly These conditions must be follow{ to be enforceable. The Contract, immediately after posting the sig L CONDITION 5 TO NT PERMIT ENC 2000-00059 ~ portable chain link fence upon the sidewalk areas of e south side of Salmar Avenue to facilitate demolition l'he permittee is prohibited from removing any public )ublic right-of-way. all fencing, gates, signs, lighted barricades, maintain nts, contaminants, soils, debris, loose materials, by anding the site to and including all downstream storm ~' for the purposes of deliveries of equipment, supplies ',es of offhaul of the same shall only use Highway 17, rue and Harrison Avenue between Grant Street and mployees park on Harrison Avenue north of Salmar Salmar Avenue and Grant Street (west side). nd employee parking shall be on site only. 'affic control plan to the Engineer for review at least onstruction. The traffic control plan shall conform to ntrols for Construction and Maintenance Work Zones :tion 12, "Construction Area Traffic Control Devices" Stopping" signs in areas where the Contractor's work Prior to start of work which requires parking request approval to post and maintain temporary "No where constructions operations will take place. The e Contractor's use. The Contractor shall post the signs or to start of the work at a maximum spacing of sixty show the date(s) and hours of the parking prohibition. '.d by the Contractor in order for the no stopping order ~r shall notify the City of Campbell Police Department Is at (408) 866-2101. "SIDEWALK CLOSED AHEA])" signs, "CROSS HERE" signs, and "SIDEWALK CLOSED," "CROSS AT CIVIC CENTER DRIVE" signs shall be installed and maintained at the locations showg upon the plans, as herein specified and as directed by the Engineer. H:\permits\2000-00059specialconditions(mp) CITY Publi( OF CAMPBELL Works Department CAMPBELL TRANSMITTAL August 5, 2003 To: Raymond Barro Summerhill Construction 777 California Ave. Palo Alto, CA 94304 Enclosed please find City of Campbe] interest earned, of Summerhill's Plan ($2,000), and Cash Deposit ($2,00) From The Desk Of: Marlene Pomeroy Executive Assistant (408) 866-2776 e-mail: marlenep @ ci.campbell.ca.us Check #102783 which represents a refund, plus heck Deposit ($500), Labor and Material Deposit ,ith respect to Encroachment Permit 2000-00059, installation of a construction fence at 1.)2-190 N. Harrison Avenue. If you have any questions, please contazt me at (408) 866-2776. Executive Assistant Enclosure 70 North First Street . Campbell, California 95008-1436 . TEL 408.866.2150 · FAX 408.376.0958 . TDD 408.866.2790 04/26/2000 11:02:12 AM P/ MENT HISTORY FOR CASE ENC2000-00059 Fee Type: APP Description: Encroachment Date Paid Receip~ Check~ 04/25/2000 130044 1046 Fee Type: CASH Description: Construction Fee Type: Fee Type: Date Paid Receip~ Check"# 2.5 04/26/2000 130046 1046 Application Fee Total Fee: $236.25 Recorded By Amount Paid JD $236.25 Total Paid: $236.25 Due: $0.00 ash Deposit Total Fee: $2,000.00 Recorded By Amount Paid 2..~' 04/26/2000 130046 1046 JD Total Paid: PCDP Description: Plan Check De, posit / Date Paid Receip~ Check# ! Recorded By 04/25/2000 130044 1046 JD Total Paid: $4,736.25 Paid: $4,736.25 Due: JD $2,000.00 $2,000.00 Due: Total Paid: LMSD Description: Labor & Materi~als Security/Dep Total Fee: / Date Paid Receipt~ Check~ !Recorded By Amount Paid $2,000.00 Totals for ENC2000-00059: Fees: $2,000.00 Due: Total Fee: Amount Paid $500.00 $500.00 Due: $0.00 $2,000.00 $0.00 $500.00 $0.00 $0.00 Page 1 of 1 To: Finance Director Check Payable To: Address- Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Voucher #: Receipt #: Requested by: Approved by: Finance Dept Only: Verified by: Approved by: Refundable bep~ SUMMERHILL CONSTRU 777 CALIFORNIA AVENU )sit Check Request PALO ALTO Refundable Deposit 101.2203 ~,TION 101.540.7448 Interest Earned Maintenance period has. State: CA Zip: 94304 $500.00 plan check depo Cash Deposit. 130044 ($500); 130045 ($2000 130046 ($2000) Alan Hom ~ Amount: $4,500.00 Amount: Amount: (Finance Dept only) (Exact Amount) ,~xpired. Refund deposits as follows: sit; $2,000.00 Labor & Material Deposit; $2,000.00 Michelle Quinney ~/~L(J Permit #: 2000-00059 Date: 4/25/00 Special ]:nstruction Other: Title: Sr. PW Inspector Date: Title: City Engineer Date: Mail As Is: Return To: Title: Accounting Clerk II Date: Title: Accountant Date: s For Handling Check Interim Check: Needed By: PUBLIC WORKS 7/15/03 7/15/03 __ Mail in Attached EnveloPe: ~ / MARLENE POMEROY ! (Name) i (Department) Please return check to Publiq Works for transmittal to permit holdm;. h:~permits~2000-00059 102harrison maint accept refund(rap) CITY OF CAMPBELL CAMPBELL, CA. 1 ('.) 1 22(:)5 CR07152()~ 101. 540 7448 CR071520~ 00004389 SUMMERHILL CONSTRUCTION REMITTANCE ADVICE-PLEASE DETACH BEFORE BANKING REFUND DEPOSIT INTEREST EARNED TO CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 4,500. (])0 WARRANT NO, 102873 PAY FOUR THOUSAND, AMOUNT *****4,849.85** EIGHT HUI~DRED FORTY NINE DOLLARS & 85 CENTS SIGNATURE SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVE F'ALO ALTO CA 94504 ~-' ~ 2 ~000 5,o,,: Oq ~q ~,,,80 2OD,' VOID AFTER 90 DAYS 11-35 1210 )3 349.85 BANK OF AMERICA WARRANT NO. CAMPBELL OFFICE ,2 E. CAMPBE,,^VE. 102873 CAMPBELL, CA. 95008 DATE ('.)8/04/03 t (-)of=lT~ CrTY OF CA&iPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT .... Permit (for working within the X-Ref. file public right-of-way) lssued<:~-- ~ Permit !expires in 12 months Application Date zL.-Z Application expires in 6 months APPLICATION - Application is hereby made for a Public Works Petit in accordan~ with Campbell Municipal Code, Section 11.O4. (Application expires in 6 months if the permit is not issued. Application Fee is non-refundable.) Utility trench location of ork C. A~ach four (4) copies of an engineered plans showing the Iocatiop and ext_--nt of the work, and four (4) copies of the prdiminary Engineer's Estima~ of work. The pinns sludl show the relation of the proposed work to existing surface ~nd underground improvements. When approved by the City Engineer, said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specific:~ions and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Spec~ Provisions for this permit, listed below. Failure Ito abide by these conditions and provisions may result in job shut-down and/or forfeiture of Fai~ful Performance Sureties and cash deposits. (See General Permit ConditiOns ! and 2.) E. THE CONTRACTOR MUST HAVE TI-IlS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST T~O DAYS BEFOILE STARTING WORK. NOTICE MuST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Is this work being done by the property owner at their own residence? Yes 24 HOUR EMERGENCY TELEPHONE ~// ,No The Applicant/Permit~t hereby agrees by affixing theh' signature to thh permit to hold the City of Campbell, its officers, agents and employee~ free, s~t'e a~d boo. ess from any claim or demand for damages re~ulting from the work covered by this permit. The ApplicantffPermiuee hereby acknowledges that they have read and undersumd both the front and back of this permit, and they will inform their conu'acwr(s) of the information. , SPECIAL PROVISIONS Street shall not be open cut for underground ins~latinns. Minimum cuts mm/be allowed for cora-,~:io~ or exploration holes. Such cuts ~ approved by the Impector prior to anting. Pavement may be cut for underground installations and must be restored in accordance with L~ Utility Trench Restoration Standard Detai]s, Me~hod 'A' I~addiIl, unless o~erwise approved by Inspector. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to thc PubFm Works D~arln~nt befor~ shqrting work. Per Section 4215 of the Government C~e ~ permit i~ not valid for excavauons ~ Underground Service Alert (USA) has been notif~l and the inquiP/ identific~ion number has beea entered he.on. USA Phon~ 1-8(}0-227-2600. USA TICKET NO. ~'[~ ,i~Jt~,~t~HKI} ~p:~CYz~f~J CONI'iT"PTn~¢ R 'l'n w~nar,~:n~n~n, PRI~MTq~ 1L'la'f' 9nnn-nnnK_o_ SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES PERMIT APPLICATION FEE H. AN CHECK DEPOSIT SECURITY FOR FAITHFUL pEP~ORMANCE/LABOR & MA'I'ERIAI~ CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE A?,'ROVED,:0RX.=U C -. ;\f0rms~pwperm2/rev. 6/96 SPECIAL CONDITION 5 TO ENCROACHMENT PERMIT ENC 2000-00059 The purpose of this permit is to install a portable chain link fence upon the sidewalk areas of the east side of Harrison Avenue and the south side of Salmar Avenue to facilitate demolition of on site private improvements only. The permittee is prohibited from removing any public signage or improvement from within the public right-of-way. The permittee shall install and maintain all fencing, gates, signs, lighted barricades, maintain the public right-of-way free of pollutants, contaminants, soils, debris, loose materials, by vacuum sweeping all public areas surrounding the site to and including all downstream storm drainage facilities. Truck traffic to and from the site for the purposes of deliveries of equipment, supplies or material and/or for the purposes of offhaul of the same shall only use Highway 17, Hamilton Avenue, Salmar Avenue and Harrison Avenue between Grant Street and Salmar Avenue. At no time shall construction employees park on Harrison Avenue north of Salmar Avenue (both sides) and between Salmar Avenue and Grant Street (west side). 3. Equipment and material storage and employee parking shall be on site only. The Contractor shall submit a traffic control plan to the Engineer for review at least five days prior to beginning of construction. The traffic control plan shall conform to the "1996 Manual of Traffic Controls for Construction and Maintenance Work Zones (including all revisions)," and Section 12, "Construction Area Traffic Control Devices" of the Standard Specifications. The Contractor shall install "No Stopping" signs in areas where the Contractor's work will require restricted parking. Prior to start of work which requires parking restrictions, the Contractor shall request approval to post and maintain temporary "No Stopping" signs at each location where constructions operations will take place. The City will provide the signs for the Contractor's use. The Contractor shall post the signs at least forty eight (48) hours prior to start of the work at a maximum spacing of sixty (60) feet. The signs shall clearly show the date(s) and hours of the parking prohibition. These conditions must be followed by the Contractor in order for the no stopping order to be enforceable. The Contractor shall notify the City of Campbell Police Department immediately after posting the signs at (408) 866-2101. "SIDEWALK CLOSED AHEAD" signs, "CROSS HERE" signs, and "SIDEWALK CLOSED," "CROSS AT CIVIC CENTER DRIVE" signs shall be installed and maintained at the locations shown upon the plans, as herein specified and as directed by the Engineer. H:\permits\2000-00059specialconditions(mp) CITY~ OF CAMPBELL Public ~(/orks Department CAMPBELL TRANSMITTAL August 5, 2003 To: Raymond Barro Summerhill Construction 777 California Ave. Palo Alto, CA 94304 From The Desk Of: Marlene Pomeroy Executive Assistant (408) 866-2776 e-mail: marlenep @ ci.campbell.ca.us Enclosed please find City of Campbell Check #102783 which represents a refund, plus interest earned, of Summerhill's Plan Check Deposit ($500), Labor and Material Deposit ($2,000), and Cash Deposit ($2,00) with respect to Encroachment Permit 2000-00059, installation of a construction fence at 102-190 N. Harrison Avenue. If you have any questions, please contact me at (408) 866-2776. Executive Assistant Enclosure 70 North First Street · Campbell, California 95008-1436 · TEL 408.866.2150 · [^x 408.376.0958 - TDD 408.866.2790 04~26~2000 11:02:12 AM P/"MENT HISTORY FOR CASE ENC2000-00059 Fee Type: APP Description: Encroachment Application Fee Date Paid Receip~ Check# Recorded By 04/25/2000 130044 1046 JD Total Paid: Fee Type: CASH Description: Construction Oash Deposit Date Paid Receipt~ Check~ Recorded By 04/26/2000 130046 1046 JD Total Paid: Total Fee: Amount Paid $236.25 $236.25 Due: Total Fee: Amount Paid $2,000.00 $2,000.00 Due: $236.25 $0.00 $2,000.00 $0.00 Fee Type: Fee Type: LMSD Description: Labor & Materials Security/Dep Date Paid Receipt~ Check# Recorded By 04/~;~2000 130046 1046 JD Total Paid: PCDP Description: Plan Check Deposit Date Paid Receipt-# Check~ Recorded By 04/25/2000 130044 1046 JD Total Paid: Totals for ENC2000-00059: Total Fee: Amount Paid $2,000.00 $2,000.00 Due: Total Fee: Amount Paid $500.00 $500.00 Due: Fees: $4,736.25 Paid: $4,736.25 Due: $2,000.00 $0.00 $500.00 $0.00 $0.00 Page 1 of 1 To: Finance Director Check Payable To: Address- Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Voucher #: Receipt #: Requested by: Approved by: Finance Dept Only: Verified by: Approved by: Refundable DepOsit Check Request SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVENUE PALO ALTO Refundable Deposit State: CA Zip: 94304 101.2203 101.540.7448 Interest Earned Amount: $4,500.00 Amount: Amount: (Finance Dept only) (Exact Amount) Maintenance period has expired. Refund deposits as follows: $500.00 plan check depo~sit; $2,000.00 Labor & Material Deposit; $2,000.00 Cash Deposit. 130044 ($500); 130045 ($2000); 130046 ($2000) Alan Ham ~.~ Michelle Quinney ~'~(J~i Permit #: 2000-00059 Date: 4/25/00 Title: Sr. PW Inspector Date: 7/15/03 Title: City Engineer Date: 7/15/03 Title: Accounting Clerk II Date: Title: Accountant Date: Special ]:nstructionS For Handling Check Mail As Is: Return To: Other: Mail in Attached Envelope: MARLENE POMEROY Interim Check: Needed By: PUBLIC WORKS (Name) (Department) Please return check to Public Works for transmittal to permit holdm;. h:~permits~2000-00059 102harrison maint accept refund(mp) CITY OF CAMPBELL CAMPBELL, CA. '"'-'<')?' CRC)7152C)03 1(:_)1 .~* .... · 1 5.-(. 1(:)1 54(:) 7448 CR07 "" ') ' ~ :!~I~11]11~1 4,500.00 549.85 WARRANT NO. 102873 REFUND DEF'OSIT INTEREST EARNED C)00C)4389 SUMMERHILL CONSTRUCT I ON REMITTANCE ADVICE-PLEASE DETACH BEFORE BANKING o CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 VOID AFTER 90 DAYS 11-35 1210 AMOUNT BANK OF AMERICA WARRANT NO. CAMPBELL OFFICE ,25E. CA.PBELLAVE. 102873 CAMPBELL, CA. 95008 DATE 08/04/03 ~ (-)om-7 .-r. *****4,849.85** TO PAY FOUR THOUSAND, EIGHT HUNDRED FORTY NINE DOLLARS & 85 CENTS SIGNATURE SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVE PALO ALTO CA 94304 PI. C WORKS DEPARTMENT RECEH'T Effectiw August 1, 1999 TO: City Clerk PUBLIC WORKS PILE NO. Please collect & receipt for the following monies: ;~i~;;'&'i'] ......... ~;i~;; '~;;;;;;,;; '{;~i~;/~;;i';;;i ................................ ...................................................................................................................................... ENCROACHMENT PERMIT 4722 Application Fee Non-Utility E .... h .... Permit ($236.25) Minor Eacroachmetu Permit < $5,000 ($50.00) R-I First Permit (No Fee} Subsequent Permit/Yi ($105) utility Encroachment Permit Arterial/Collector Street , {$341.25) Residential Street/Other Areas , ($236.25) 2203: Plan Check Deposit - 2% of ENGR. EST. , {$500 rain) 22031 Faithful Performance Security (FPS} (100% of ENGR.EST.) 2203 Labor and Materials Security 000% of ENGR. EST.) 2203 Monumetuation Security (100% of ENGR.EST.) 2203 Cash Deposit (4% of ENGR.EST.)($500 rain/S10,000 max) 2203 Labor and Material Security (i00% of ENGR. EST.) Plan Check & luspection Fee (Non-Utility) 4722 Engr. Est.< $250,000 (12% of ENGR. EST.) ** 2203 Engr. Est. > $250,000 {Deposit 8% of ENGR. iEST./$30,000 min.)*= 4722 Utility < $I00~000 Minimum Charge Per Location ($126) Conduits/Pipelines up to 500 Fe~t i ($1.75/ft) Above 500 Linear Feet ($1.15/fl) Manbo[es/Vaults/Ete. fSI lO.25/ea) Pole Set/Removal ~ ($1 lO.25/ea} Street Tree Planting/Removal , ($110.25/tree} ** 2203 Utility > $100.000 Actual Cost + 20% ** 4.722 Street Tree Planting/Removal Permit ($110.25) 4760 Pruiect Plans & Specificatious i Proiect No. 4.760 Standard Specifications & Details {$1/Pg $12.50/Bk} 4.760 Copies of Engineering Maps & Plans Aerial Plot 24.' x 36' Aerial Print 8 I/2" x 11' Maps and Plans 24' x 36' ($5) a722 Penalties: Failura to restore public improvements {$100/Caiendar Day} a~4um Coa~ 4.722 Penalties: Failure to correct unsafe conditions ($I00/Calendar Day) LAND DEVELOPMENT 4.722 Lot Line Adinstment ($577.50) 4.722i Parcel Map {4 Lots or Less) , ($I,125 + $25/Lot) 4722 Final Tract Map {5 or More Lots) i ($1,4.50 + $25/Lot} 4722 Certificate of Compliance ($525) 4722 Certificate of Correction ($315) 4.7'22 Notary Fee (per signature} , 4722 Vacation of Public Streets & Easements i {$577.50) 4722 Assessment Segregation or Reapportionment , First Split ($5T'/.50} Each Additional Lot {$178.50) 4721 Storm Drainage Aras Fcc Per Acre (R-l, $2,000) {Multi-Res, $2,250) (All Other, $2,500) 4.920 Parkland Dedication Fee (75%/25% Due Upon Cert. of Oepupancy) 4.965 Postage TRAFFIC 4.728 Intersection Turn Counts (Two-Hour Count) ($63) 4728 Intersection Turn Counts (a.m. or p.m. peaks} ($131.25) 472_8 Traffic Flow Map (Daily Traffic Volumes) 4.728 Campbell Traffic Model (Full Scope Assessment) ! {$2,362.50) 472.8 Campbell Traffic Model {R~ducnd Scope Ass~sment) 4.271 Truck Permits , ($36.75/trip) 4728 No Parking Signs {SI/each or $25/100) OTHER NAME OF APPLICANT =*Actual Cost Plus 20% Overhead (Non-Interest bearing deposit} , h:\forrns\ecfrm4.xls rev. 7/13/99 (rap) Il ~E~DTDTT~ ^~Ii~T L.~t_b F: -~9.AfiA g6 $oVv,vv BY: JA~H 010001.30047 ~l;itit~"-",ij? ; PtI~I~TI::,ItP TO'.:i;~Y'"S DA~ 04/.25/00 TfiTfii iiii~'.. cur,,,~ PAID: 6n:.6h ~g, TcN,.,:~.cD. r!Tv nF C-~mn , -iAi qOn~ ~3VVVsvv $2,000.00 CHECK PA!D: ,~n=,~ NO: !046 CHANGE: INSURANCE REQUIREMENTS CHECKLIST f J'NJ' ~ ' --' ' '--"' '~-~' FN ' "' '7~ Permit #,P t='-~_ c ZOoO - O~':J' CIP Project # The followin= insurance is required of all contrzictors 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 pertbrmed under contract tbr Capital Improvement Projects. Limits Commercial General Liability tbr bodil,¥, personal in{~.q and prope, rtv damage: ~ $1,000.000 per occurrence, and ,'ZIC -n $I,000.000 ,oeneral aggregate limit applying separately to the project, or ~ $2,000,000 general aggregate limit. ~ Policy expiration date ,z~a] ~]tJq ~ Automotive Liability,: ~ "Any Auto" checked on certificate 'j~ $1,000,000 per accident fo[ bo~tily injury, and property damage '~ Policy expiration date 4-- l'2.]0 1 Workers' Compensation and Employer's Liability ~ Waiver of Subrogation clause ~ $1,000,000 per accident for bodily injury or disease '~ Policy expiration date ~/2z3,10I Course of Construction (if required in Special Provisions) ~ Completed value of the project -n Policy expiration date R~equired Endorsements to General £iabilitv and Automobile Liabiliw Policies Additional Insured ~ndorsemem ~ The Cky, the Cky o~ C~pbell Redevelopmem Agency, ks officers~ employees and volunteers ~e ~amed as additional ~nsured. ~ The insur~ce coverage afforded ~o the Additional Insured is primaw ins~ce. ~ Cancellation area o~ certificate edited m delete "endeavor to' and "but ~ailure to mail such notice shall impose no obligation or liability of ~y kind upon the comp~ ' a ents or representatives". a ~orkers' Compensation Insur~ce Sheet Submi~ed ~ For General Contractor ~' ~ For Developer or Owner~. i }~~- Acceptability of Insurer(s) [&~3 ~ Insurer(s) has cu=ent A.M. Best Rating of A:VII and Ts authorized to fransact ~ business in the State of California. Insurance Ce~ificate Revie~~ ' ~D~t~~ of Insurance Cemificate in tickler file for month Copy placed of expiration. j:XfomsXinscklst (rev 11/99) FAX I Date 5/5/00 I Number of pages including cover sheet TO: Phone Fax Phone CC: Christopher Olson Maroevich 0 'Shea & Coghlan 425 Market St., JOth Floor San Francisco, CA 94105 (415) 957-0600 (415) 957-0577 FROM: Phone Fax Phone Joanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 (408)866-2150 (408)376-0958 REMARKS: [] Urgent [] For your review [] Re: Insured: SummerhillHomes Permit No. ENC2000-00059/102-190 N. Harrison Avenue Reply ASAP [] Please Comment We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance requirements: We require that the Workers' Compensation certificate of insurance include wording that stating the insurer aggre~ to waive all rights of subrogation against the City. The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are to be covered as additional insureds as respects automobile liability. Also, the cancellation area of the certificate needs to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives" and to change the 10 days notice of cancellation to 30 days notice. A ten day notice is required for cancellation due to non-payment. Copies of the applicable sections of our insurance requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me if you have any questions. Thanks for your help in this matter. If responding by fax please use the above fax number (408) 376-0958, not the fax number appearing on my transmission. I am working in a different City office for today only. Thanks. ACORD. CERTIFIC fE OF LIABILITY INSURANCE o.,0 SUtv~4~-2 05/01/02 PRODUCER James Econn & Co. Insurance CA License #0340047 445 S. Figueroa St., 36th Fl. Los Angeles CA 90071-1602 Phone: 213-629-3131 Fax:213-629-4440 INSURED SmmaerHill Homes et al 777 California Avenue Palo Alto CA 94304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Clarendon Ins. Co. INSURERB Ins. Co. State of PA INSURER C INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANy CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE IMM/DD/YY) UMITS GENERAL LIABIUTY EACH OCCURRENCE $ 2 , 000t 000 A X COMMERC~L GENERAL LD%BIUTY WT0991200 04/08/01 04/08/03 FtRE DAMAG:- (Any one tire) $ 100,000 I C~MS~E ~occuR MEDEXP(An'/oneperson) $ 5, 000 PERSONAL S,a~7'/INJURY $ 2 , 000 , 000 GENERALAGGREGATE $ 2 , 000, 000 GENt AGGREGATE LIMIT APPUES PER: PRODUCTS - COMP/DP AGG $ 2 ~, 0 0 0 ,, 0 0 0 tPOLiCY I~lPRO'JECT ~"~ LOC E~i~ Ben. 1,000t000 AUTOMOBILE LIABILITY ' COMBINED SNGLE LIMIT ANY AUTO J (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per per, on) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accidenb PROPERTY DAMAGE (Per accidentJ GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO OTHER THA~ EA ACC $ AUTO ONLY AGO EXCESS LIABIMTY EACH OCCURRENCE $ 10000000 Z~1occUR [~ C~MS~E 42013026 04/08/01 04/08/03 AGGREGATE $ 10000000 B DEDUCTIBLE $ RETENTtON $ $ WC STATU- WORKERS COMPENSATION AND J TORYDMITS I- EMPLOYERS' LIABILITY EL EACH ACCIDENT '$ E.L DISEASE- EA EMPLOYEE E.L DISEASE- POUCY UMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES~EXDLUSIONS ADDED BY ENDORSEMENT/SPEDIAL PROVISIONS Re: Project/Permit Number and Location of Work. ENC 2000-00059 102-190 N. Harrison Avenue Tract 9244. *10 days notice of cancellation for non-pay. *Per policy terms, conditions, lin%itations and exclusions. CERTIFICATE HOLDER J y J ADDITIONALINSURED;INSURER LEI'rER: CANCELLATION CITYO-1 City of Campbell Attn: Depart. of Public Works 70 North First Street Campbell CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRII'rEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITE AGENTS OR REPRESENTATIVES, ~b-~RECO-RPOR~"rlON 1988 ACORD 25-S (7197) PRODU~;ER (415)957-0600 FAX (415)957-0577 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ~aroevi ch O' Shea & Coghl an HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 425 Market St reet ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. lOth Floor COMPANIES AFFORDING COVERAGE ~an Francisco, CA 94105 ..................... COMPANY )~r~e~'i"~A~'"[~'~(~i~'~'{i'6~'"'~6~":""~J': .~ttn: Christopher Olson Ext: 213 A SummerH~qq Homes, Znc. B 777 California Ave. COMPANY RECEIVED Pa~o A~to, CA 94304 ...... COMPANY iNDICATED, NO~ITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTACT OR OTHER DOCUMENT WITH RE~~~ CERTIFICATE ~Y BE ISSUED OR ~Y PERTAIN, THE INSU~NCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE EXCLUS ONS AND COND TONS OF SUCH POL C ES UMITS SHOWN ~Y HAVE BEEN ~EDUCED BY PAID C~IMS. POLICY EFFECTIVE POLICY EXPIATION: CO ~PE OF INSU~NCE POLICY NUMBER LIMITS LTR DATE (MMIDD~) DATE (MMIDD~) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ::::::::::::::::::::::::::::: CLAIMS MADE i ........ OCCUR i OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY ALL OWNED AUTOS SCHEDULED AUTOS : HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE ........ OFFICERS ARE: OTHER GENERAL AGGREGA1E $ PRODUCTS - COMP/DP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person)$ 3ML0703907-08 O4/02/2OO0 04/02/2001 COMBINED SINGLE LIMIT $ ............................................................ L909,097 BODILY INJURY $ (Per person) 1,000,000 BODILY INJURY $ .. ?~. ~i.~.~,.! ..................................... ~. ,. ~) ~ O..% .~) ~ P PROPERTY DAMAGE $ 1,000,000 3BR005263-02 INCL i EXCL i 03/23/2000 AUTO ONLY - EA ACCIDENT $ EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ $ X: wc STATU- :OTH- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ....... EL EACH ACCIDENT $ 1,000,000 03/23/2001 :. ~.~??~.~.:, ff~?~.~.??......~ .......... EL DISEASE- EA EMPLOYEE $ 1,000,000 City of Campbell Attn: Department of Public Works 70 North First Street Campbell, CA 95008 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ~E: Project/Permit Number and Location of Work. ENC 2000-00059 102-190 N. Harrison Avenue Tract 9244 )ther Insurance Provisions per attached: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~g~l(~ MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, AUTHORIZED REPRESENTATIVE Christopher O]son Certificate ~ssued to C~ty of Campbell Maroev~ch O'Shea & Coghlan C~¥ of Campbell o5/o5/zooo os/os/2ooo Provisions for General Liability and Automobile policies are as follows: The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are to be covered as insureds with respect to liability arising out of automobiles owned, leased, hired or borrowed on or on behalf of the Contractor. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City. A ten (10) day notice is required for cancellation due to non-payment of premium. Provisions for Worker's Compensation and Employers' Liability Coverage are as follows: The insurer shall agree to waive all rights of subrogation against the City, the City of Campbell Redevelopment Agency, its officers, officials, employees and volunteers for losses arising from work performed by the Contractor for the City. Sent b.y: MAROEV[CH O'SHEA / COGHLAN "05~05~2000 09:22 48837~[ 415 957 4318; 05/05/00 3:39PM;Je~rax #232;Page 1/3 ~ DIaN MAINT PA~iE 01 ]FAX,, Phone F~x Phone iztopher OIson vic3 0 'Slma & CogMan .f Market ,St.. I 0a Floor San Francisco, CA 94105 (415} 9§ 7-0(~00 HI.s) 9,s~-oszz CC: $/5/00 Joaro~ D',4tnbrosta Cay of Campbell ?0 North I~rst Street Campbell, C,4 95008 laltone (408)866-2150 F~ Phane (4..~.)$ 7~-09§8 lt~M~I~a~S: [] Urgent [] For yottr revtew [] Re: Insured: Summer~l Homes Permit No. ENC2000.00059/102-190 N. Hah'itOh Avenue P, eply ASAP [] Ptea#e Comment We have reviewed the certificate ofinmrance that has been mbrnitted in conneotion with the above referenced permit and find that the followinB items need to be added or changed to mr. et our minimum insur~ge requirements: ~. We require that the Workers' Compensation ccttificatc of~n~rasme include wordinl~ that ~atin8 thc insmer aggre~s to waive aU ri~ts of aubroBation asaia~t thc City. ~. The City, tl~¢ City of Campbell Rcdavdopmeat Asenoy, ks officers, employees and volunteers are / 9~be covered as additional insured$ as mspecls automobile liability, , aa, the cancellation area et'the c. etedlicate nmda to b~ e(lited to delete "endeavor to' and "but ute to mail au~h notioe ~lall Lmpoae no obltgjtioa of liabilky of any kind upon the company, its ascnts or r~pr~tativ~a" and :o chan~e the 10 claya notice ofcancdlation to 30 days notice. A ten day notice is required for canc, ell~on due to non-payment, Copies o¢ the applicable sections of our insurance requirements follow tm' your reference as well a~ a copy of the original certi§~ate that wan submitted. Please call me it'you have any questions. Thanks for your help in this matter. If responding by fax please use the above fax numb~ (408) 376-0958, not the fax number appearing my transmission I am workin8 in a different City otlice for today only. Thanks. Sent by: MAROEVZCH 0'SHEA / C0GHLAN 415 957 4318; 05/05/00 3:40PU;J~IX #232;Page 2/3 qaroewcn u bnea a ~ogn~ ~ HOLDER. THIS CERTIFICATE ~ES NOT AMEND, ~TEND OR 425 ~arket Street I AL~R THE COVE~GE ~FORDED BY THE POLICIES BEL~. 10Lb FI ocr COMPANIES ~FORDING CO~GE San Fra.c~sco, ~ 94105 co~ .... American P*~tecti0n ins~'*Co~ ~: Chr~stophe~ O~son E~: 2L3 A ........................ A~er~can ' ~h'~fas~re'rs 'M~t'~'a]" 'InSUrance COMP~ ~NSU~° SummerH~ll Homes, Inc. COMPLY 7~7 California Ave. C Palo Alto, ~ 94304 COMPLY D THIS · TO CER~FY THAT ~E POLICIES OF INSU~NCE LISTED BELOW ~VE BEEN I~UED TO THE INSURED ~ED ABO~ F~ THE POLICY PERIOD INDICTED, NOT~BTAN DING ANY REOU~E~, ~ ~ COND~ION OF ANY CO~CT OR OTHER ~CUMENT W~H RESPE:T TO WHICH CERTIF~TE ~Y BE I~SUED OR ~Y PERTAIN, THE ~NSU~NCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TER~, EXCLUSIONS AND CONDIT~N8 OF SUCH POLtC~S LIMtT8 SHOWN ~Y HAVE BEEN REDUCED ~ PA~D ~0 .TR. ~PE OF INEaJff~l~;E FOLIDY NUMBER A COMMERCU~L GENERAL LIABILITY i CLAIMS MADE ! OCCUR '. OWNER'S · CONTRACTOR'S PROT AUTOMDBI~.E LIA&II.ITY ALL OWNED ~O~ HIRED ~O~ NON-O~ED A~O5 3ML0703907-08 , C~J~AGE LIABILITY &NY AUTO EXCESS LL&BtLITY : UMBRELL~ FORM OTrtER THAN UMBRELLA FORM WORKER~ COUPEN~ATION ANn F.,MPLOYER~' UA~LITY 3BR005263-02 THE PROPRIETOR/ INCL PARTNERS~XECUTIVE OFFICERS ARE' EXCL OTHER POLICY EFFECTIVE POLICY EXPIRATION OA'rf. (MM/DD/YY) DATE (NM/OOfV"fl 04/02/2000 03/23/2000 : GENERAL AGGREGATE PRODUCTS * COMPIOP AGG $ 'PERSONAL · ADV INJURY $ ~I~ACH OCCURRENCE ~FIRE DANCE (~y C~BINED 5INGLE LIM~ [, 000,000 BODILY INJURY (~e~ p~on: 1,000,000 04/~/ZO0[ BODILY iNJURY (Per PROPERTY DAJ~OE AUTO OnLY - EA ACCIDENT OTHER THAN AUTO DNLY: EACH ACCIDF. NT AGGREGATE 03/23/2001 EACH OCCURRENCE AGGRE~TE $ X w~ STATU, :OTH-~ :'; ;~:;i: i g g ~:,,:i,:i,i.::';i,ii :t ~: :, ~,: EL E~H ACCIDEN't ~ 1,000,000 ~ ms~: ~ouc, u.~r ~ ~, 000,000 EL DISE~E · EA EMPLOYEE [E: Project/Permit Number and Location or Work. ENIC 2000-00059 102-190 N. Harrison Avenue Frae: 92¢4 )ther Insurance Provisions per attached: Ci:y of Campbell At:n: Department of Public Works 70 North F~rSt Street Campbelq. CA 95008 ' i~i~:1 ';'/;¥-"~ ~ ~ ~ ~ ~ ?; ~:~: ,: ~'~ ~ ~: ::: ~ ~ ~i ~!:~: ~ ;,~ ;:; ~: :~ ~NOULD ~ ~ THE A~ ~ED P~ BE CANCELLED BEFORE THE E~ ~T[ TH~EO~, THE I~ING ~MP~Y ~LL ~ ~L ~O ~ W~ ~E TO THE OERTI~TE HOLDER N~ED TO THE LEFT. AUTHORIZED Rt~EBENTATIVE Sent by: MAROEVICH O'SHEA / COGHLAN 415 957 4318; 05/05/00 3:41PU;~e~Jr-dX #232;Page 3/3 city cam. Certificate issued to City of Campbell Naroevich O'Shea & Coghlan os/os/zooo Provisions for General Liability and Automobile policies are as follows: 0s/0s/z000 The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are to be covered as insureds with respect to liability arising out of automobiles owned, leased, hireO Or ~orrowed on or on behalf of the Contractor. Each insurance policy required by thlS clause shall be endorsed to state that coverage shall not be cancelled by either party, except after thirty {30) days' prior written notice by certified mail, return receipt requested, has been given to the City. A ten (LO) day not~ce is required for cancellation due to non-payment of premium. Provisions for Worker's Compensation and Employers' Liability Coverage are as follows: The insurer shall agree to waive all rights of subrogation against the City, the City of Campbell Redevelopment Agency, its officers, officials, employees and volunteers for losses arising from wOrk performed by the Contractor for the City. PRODUCER (415)957-0600 FAX (415)957-0577 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Vlaroevi ch 0' Shea & Coghl an I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 425 Market Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 10th Floor COMPANIES AFFORDING COVERAGE San Francisco, CA 94105 COMPANY Attn: Christopher Olson Ext: 213 A INSURED SummerHill Homes Inc. COMPANY American Manufacturers Mutual Insurance Co ' B 777 California Ave. COMPANY C Palo Alto, CA 94304 COMPANY ~ D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE LTR GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY iiiiiiiiiiiiiii CLAIMS MADE i i OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS POLICY NUMBER i3ML0703907-08 GARAGE LIABILITY ....... ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ~3BR005263-02 THE PROPRIETOR/ INCL :: PARTNERS/EXECUTIVE ...... OFFICERS ARE: EXCL :: OTHER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ PERSONAL & ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MHD EXP (Any one person)$ 04/02/2000 COMBINED SINGLE LIMIT $ ...................................................... !~, P~0.,..0~)P BODILY INJURY (Per person) $ 04/02/2001 ...................................................... ~.~g.0~).,.0.0.0. BODILY INJURY (Per accident) $ i 000,000 PROPERTY DAMAGE $ 1,000,000 AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ::::::::?:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::?:::::?:?::::::::::::::?:::: :::: ............................................... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: EACH ACCIDENT$ AGGREGATE $ 03/23/2000 EACH OCCURRENCE $ i AGGREGATE $ $ V : WC STATU- ! :OTH- · .. 2_ i.!9~.MM. LTA.: ....... ::...EH. 03/23/2001 ...E.[.?~U ~!DE? ~ !, 000., 000 EL DISEASE- EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS~EHICLES/SPEClAL ITEMS ~E: Project/Permit Number and Location of Work. Fract 9244 ENC 2000-00059 102-190 N. Harrison Avenue City of Campbell Attn: Department of Public Works 70 North First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Christopher Olson ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: : :: :: ........................ CER'i'.IFIC. ' 'E OF LIABILITY INSUr' DB I DATE,MM,DD ) .... 'b"b'MME - 2 05/09/00 PRODUCER James Econn & Co. Insurance CA License #0340047 445 S. Figueroa St., 36th Fl. Los Angeles CA 90071-1602 Phone:213-629-3131 Fax:213-629-4440 THIS CERTIFICATEISISSUED AS A MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED SummerHill Homes, et al 777 Californla Avenue Palo Alto CA 94304 COVERAGES , INSURERA: Caliber One INSURER B: INSURERC: I INSURER D: i INSURER E: Replaces cert dated 05/02/00 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR! LTR I TYPE OF INSURANCE _ENERAL L=AB=UTY COMMERCIAL GENERAL LIABILITY CLAIMS MADE .X__! OCCUR I POLICY NUMBER CGO 0001035-01 POLICY EFFECTIVE I POLICY EXPIRATION DATE (MM/DD/YY} I DATE (MM/DD/YY} 0~/08/99 I 0~/08/0l LIMITS EACH OCCURRENCE $ 5 ~. 000, 000 FIRE DAMAGE (Any one fire) I $ 100, 000 MED EXP (Any one person) ] $ 5 · 000 PERSONAL &ADV ItlJURY $ 5, 000,, 000 $ 5,000,000 .OL,CY: ,EcTPRO' I LOC AUTOMOBILE LIABILITY ~4 y i ~ ~ ~ ~ICCOMBINED SINGLE LIMIT -ANYAUTO _ I'Z 2000 (Ea accident) ALL OWNED AUTOS , ~ . BODILY INJURY~ ~ SCHEDULED AUTOS ~ HIRED AUTOS ~ BODILY INJURY ~ NON-OWNED AUTOS (Per accident) GARAGE LIABILITY j ANY AUTO EXCESS LIABILITY OCCUR : ICLAIMS MADE DEDUCTIBLE ~ ~ RETENTION $ i WORKERS COMPENSATION AND iEMPLOYERS' LIABILITY OTHER i $ 5,000,000 ~$ PROPERTY DAMAGE (Per accident) . AUTO ONLY- EA ACCIDENT i $ EAACC i$ ' OTHER THAN , AUTO ONLY: AGG I $ ' EACH OCCURRENCE i AGGREGATE $ i I WC STATU- I IOth- i TORYLIMITSl I ER E.L. EACH ACCIDENT i $ E.L. DISEASE - EA EMPLOYEE! $ E.L DISEASE - POLICY LIMIT ! $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re.- Project/Permit Number and Location of Work. ENC 2000-00059 102-190 N. Harrison Avenue Tract 9244. Parental Guaranty Endorsement attached. See addendum for additional insured and primary insurance status. -10 days notice of cancellation in the event of non-payment of premium. Per policy terms, conditions, limitations and ~xclusions. CERTIFICATE HOLDER I Y i ADDITIONAL INSURED; INSURER LETTER: .~_ CANCELLATION CITGO - 1 City of Campbell Attn: Depart. of Public Works 70 North First Street Campbell CA 95008 ACORD 25-S (7~97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI~ DATE THEREOF, THE ISSUING INSURER WILL W~4[~O MAIL 30 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ENDORSEMENT #1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement, effective 4/8/1999 at 12:01 A.M. Standard time forms a part of policy number CGO0001035-01 issued to SummerHill Homes by Caliber One Indemnity Company This endorsement modifies insurance provided for under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PARENTAL GUARANTY ENDORSEMENT It is agreed that PMA Reinsurance Corporation guarantees the performance of Caliber One Indemnity Company's obligations under this policy. PMA Reinsurance Corporation 1735 Market Street, Suite 2800 Philadelphia, PA 19103 Indemni'r..y Company /-,C01.E67(01/98) PAGE 1 OF 1 Authorized Representative SummerHill Homes, et al Caliber One - General Liability Policy #CGO 0001035-01 Addendum to Certificate of Insurance issued to the City of Campbell on May 9, 2000 ADDITONAL INSURED It is understood and agreed that coverage afforded by this policy shall apply to The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers as Additional Insureds if so obligated by written contract to provide same but only with respect to acts or omissions of the Named Insured in connection with the Named Insured's operations on behalf of Additional Insureds. PRIMARY WORDING CLAUSE It is further agreed that such insurance as is afforded by this policy for the benefit of the additional insured(s) shown above shall be primary insurance, but only as respects any claims, loss or liability arising out of the operations of the named insured or from occupancy, maintenance or use of the premises by the named insured and any insurance maintained by the additional insured(s) shall be non-contributing. K:\DATA\COMM\BADA\CERTSXSunmlerHill GL Al Plinlary.dl)c FAX TO: Phone Fax Phone James Econn&Co. Insurance 445 S. Figueroa St., 36t* Fl. Los Angeles, CA 90071-1602 (213) 629-3131 (2]3) 629-4440 CC: [ Date Number of pages including cover sheet 5 FROM: doanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone Fax Phone (408)866-2150 (408)376-0958 REMARKS: [] Urgent [-~ For your review Re: Insured: SummerHill Homes Permit No. ENC2000-00059/102-190 N. Harrison Ave. [54] Reply ASAP [-~ Please Comment We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance requirements: The City, the City of Campbell RedeveLopment Agency, its officers, employees and volunteers are to be named as additional insureds either on the certificate or on an attached endorsement. SummerHill Homes' insurance coverage is to be primary insurance as respects the City and this needs to be stated so on the certificate or on an attached endorsement. We require that the insurance provided to the City be issued by an insurer authorized to transact business in the State of California. Caliber One, the general liability carrier, does not appear on the list published by the State of California Department of Insurance which includes all insurers admitted to transact liability insurance in the state. The cancellation area of the certificate needs to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives". Copies of the applicable sections of our insurance requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me if you have any questions. Thanks for your help in this matter. If responding by fax please use the above fax number (408) 379-0958, not the fax number appearing on my transmission. I am working in a different City office for today only. Thanks. Search R.esults Page 1 of 1 Search Results Insurance The results of your search are summarized in the following table. For more information on any company, left-click on the company name. To view all companies in the same group, left-click on the group number. Name 'yin?il ~: Legal IIPMA REINSURANCE I Name llCOp. Po~rION I PA I 39675 [ Q7~6.7 Last,Revised - April 18, 2000 Copyright © California Department of Insurance Disclaimer http://www2.insurance.ca.g~v/iXpress/cdi-pr~fi~es/C~mpPr~fi~es/SearchResu~ts.DML 05/09/2000 FACSLMILE TRANSMISSION FROM JAMES ECONN & CO. INSURANCE 445 South Figueroa Street, 36th :Floor, Los Angeles, CA 90071-1602 CA LICENSE NO. 0340047 FACSIMILE PHONE: (213) 6294440 TELEPHONE NO.: (213) 629-3131 TO: Joanae D'Ambrosia COMPANY: City of Campbell FAX NUMBER: (408) 376-0958 cc: Raymond Barro @ SummerHill Homes (650) FROM: Darlene Bada ,. ~a ~ DATE: May 9, 2000 RE: SummerHfll Homes General Liability Policy #CGO 0001035-01 NUMBER OF PAGES SENT INCLUDING COVER PAGE: 4 Dear Joanne: I am sendiag to you the revised Certificate of Liability Insurance for the above referenced. The original will be sent via mail. If you have any questions, please do not hesitate to contact me. Sincerely, JEc:445 (Rev_ 2/~) [~] original document to follow by mail ff box checked- MA¥-0~-00 1 ! :~ FROM~ CkRTIFIC -*E OF LIAB J~es ECO~ & CO. ~ L~cense 4{5 S. Fi~eroa St., 36th Fl. Los ~gele~ ~ 90071-1602 ~houe = 213-629-~131 P~: 213-629-4440 I D = PAGE 2/~ 0S/09/00 THiS CE~IF~ATE IS ~UEO AS A ~ ~R OF INFO~ON ONLY AND C~ERS NO ~GHTS UPON THE C~TIF~ATE H0~E[ ~ CE~Fi~ DOES NOT AMEND, ~ND OR ALTER THE COVE~GE ~RDED BY ~E ~MC~S BELOW. INSURERS AFFORDING COVERAGE Caliber One ! EXC~ UAmMT~ POI.ICY NUMAR u 0001035-01 ;~-~: Replaces eert da~ed 05/02/00 i COM~.NED S~C..LE LL~rr WORKER'S COMPENSATION EMPt. OYER~' LIABILJTY 04/08/99 UMIT~ $5,000,000 s lO0,000 $5,000 $ I)O01LY INJUR'Y r (Per p~'~o-) r P~OP~RTY [~AGE sS,000,000 sS,000,000 sS,000,000 i AUTOONLY. F. AACC~ENT i S OT~R THAN ~, ACC AUTO ONLY: AGG EACH OCC. UI:U:~=.,'~ e $ AGGREGATE $ 5, $ '$ ~, w(;; $7A i U- TORY' . E.L ~ ACCIDENT E.L. 0t~EA~E · F~A F. MPLOYEE~ E L. OL~ - POLICY LIMIT D~I~F%~a~u~01~a/I.0CA~I.F.3/~CLUSION~ADOEOBy~~T~PECUtL~0Vie~0~ ~e: Projeat/Permit Number and Location of WOrk. ENC 2000-00059 102-1~0 N. Harrison Avenue Tract 924%. Parental ~ua~anty E~do=sement attached. See adde~ld~ £or a~ditional insured and prima~ in=urance statu~. '10 ~ay~ =otlce o~ c~cella:$on in ~he event o~ non-paten: of pr~i~. Per ~llcy ~e~, conditions, I~ta=io~s ~ ~Clu~ions. CE~I~H~ER ~YT~~~RL~V~=~ A CANCELATION City of Campbell Attn: Depart. Of Public Works 70 North First Street Campbell CA9S008 CITYO - 1 ACORD25,~7) SHOULD aNY O1:: ?H~ A~:rV'E DE:~CR~IF_D POUCIES BE C.,Id~CELLF_.D ~.F. FO~E THE EXIqRAYION Da'TE ~0F, THE ISSUING IN~A./R~R WILL ][1~ MAIL :~0*' DAYS WPJTrEN No'nc~ 'fo THE C. ER'nRCATE t'tO~Oe~ N4MED TO ~ ~', ~'l'~]~[zi~ ENDORSEMENT #1 THIS ENDORSEMENT CHANGES THE POLICY.: PLEASE READ IT CAREFULLY. This endorsement, effective 4/8/I999 at 12:01 A.M. Standard time forms a p~ of policy number CGO0001035-0I issued to SummerH[ll Homes by Caliber One indemnity Company This endorsement modifies insurance provided for under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PARENTAL GUARANTY ENDORSEMENT .-'"'~ It is agreed that PMA Reinsurance Corporation guarantees the performance of Catiber One indemnity Company's obJigations under this policy. PMA Reinsurance Corporation 1735 Market Street, Suite 2800 Philadelphia, PA 19103 Authorized Representative PAGE 1 OF 1 :: SummerHill Homes, et al Caliber One - General Liability Policy #CGO 0001035-01 Addendum to Certificate of Insurance issued to the City_ of Camobell on May 9, 2000 ADDITQNAL INS.IJRED It is understood 'and agreed that coverage afforded by this policy shall apply to The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers as Additional Insureds if so obligated by written contract to provide same but only with respect to act~ or omissions of the Named Insured in connection with the Named Imm'ed's operations on behalf of Additional Insureds. PRIMARY WORD/NG CLAUSE It is further agreed that such insurance as is afforded by this policy for the benefit of the additional insured(s) shown above shall be primary insurance, but only as respects any claims, loss or liability arising out of the operations of the named insured or from occupancy, maintenance or use of the premises by the named insured and any insurance maintained by the additiOnal insured(s) shall be non-contributing. MAY. ~.2000 10:5~AM FAX SUMMERHILL TO: Fa.~c Phone C~ Angels Adams . , . dames Econn&Co. Insurance 445,5. Figueroa St,, $6~ Fl, Los Angeles, CA 90071-1602 ('2]$j 629-$J3J (215j 629-4440 CONSTRUCTION P A MO. 691 P. i/2 i Date 515100 Number of pages including cover sheet FROM.~ Phone ~ (408)866-2150 REMARKS: [] Urgent [] For your revww [] Reply ASAP [] Please Comment Re: Insured: SummerI4.~ Homcs Permit No. ENC2000-00059/I02-190 N Iffarrison Ave. 'We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance requirements: 1. The City, the City of CampbeU Redevelopment Agency, its officers, employees and volunteers are to be named as additional insureds either on the certificate or on an attached endorsement. 2. SummerHill Homes' insurance coverage is to be primary insurance as respects the City.and tiffs needs to be stated so on the certificate or on an attached endorsement. 3. We require that the insurance provided to the City be issued by aa insurer authorized to transact business in the State of Califorrda. Caliber One, the general liability carrier, does not appear on the list published by the State of California Department of Insurance which includes all insurers admitted to transact liability insurance in the state. 4. The cancellation area of the certificate needs to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives". Copies of the applicable sections of our insuraace requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me ff you have any questions. Thanks for ~,our help in this matter. If responding by fax please use the above fax number (408) 379-0958, not the fax number appearing on my transmission. I am working in a different City office for today only. Thanks. '145 IN~URED AGORi~ MRY. 9.2000 10:54RM SUMMERHILL COMSTRUCTIOM P R M0.691 CERTIFICA"'-. OF LIABILITY INSURe"C [ Sco~ & Co, Ineura~co .cunco #0340047 ~. Fig~ero& St., 36th =goles ~A 90071-1602 =2~3-629-313L Yeuc=213-629-4440 su~erHil! Komem, et al 777 C&ll~az~ia Avenue Palo Alto CA S4304 THiS CERTIFICATE I$ ISSU.-I:) A~ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS C£RTIFK;ATE DOES NOT AMEND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. caliber ~ . .... -' ! -. -~ rtON I THE II~URED NAM~ ABOV~ FOR THE POUCY ~RIOD ~NDIGATEO. NOTWITHSTANDrNG TERM OR CONDITION OF ANY GONTRaCT OR OTHER OOGLIMENT wrrH RE~pi~r TO WHICH THJ8 CI~FIGATE MaY B~ I~UEO OR *ISuRANGE AI~ORDE~ BY THE POLICIES D~CRISEO HER~IN I~ EuILIEGT TO ALL THE T~RM8~ EXCLUSIONS AND ¢ONDITION8 OF &UGH TYPE QF IN.SUItE COMIMERCI&C G~NERAL UAB~LITY __ ~IMG~E ~ OCCU~ ANY ~ A~ ~N~ ~MEDULEO ~u~ IMS COMPlaN COO 0001035-01 04/08/99 , PROPERT~ DAMAGE (F~r KC~a,,nL) AUTO ONL,¥ - ~A ACCIDENT OTHER ~ AUTO ONLY: AGO EACH OCCURRENCE S AGGREGATE S t WG~TATU- I · TORY LIMITS_I_ g.L EAGH ACCIDENT E L. OL,~,I~le - Faa EMPLOYE~ F~L. OLqEASE - POUGY LIMIT SS,000 S5,000,00~0.~ s5,000,0~ $S,q00,0o0 ~ 2000-00059 102-190 notice o~ cancellation in the event foe non.payment o~ ,olAc~ terms, conditions, l!~tatAone and exclusions. ICATE HOLDER AoDmowu. J~C'~O; IN~URER I~ City o~ Cmqzbell ACCn~ Depart. oE ~blAc Works ?0 North Firet Streo~ Ca~pbeXX ~A 95008 J CANCELLATION s~ ANY OF THE ABC)V~ FAX TO: Phone Fax Phone Angela Adams James Econn&Co. Insurance 445 S. Figueroa St., 36th Fl. Los Angeles, CA 90071-1602 (213) 629-3131 (2139 629-4440 CC: Date 5/5/00 Number of pages including cover sheet FROM: Joanne D'Ambrosia City of Campbell 70 North First Street Campbell, CA 95008 Phone FaxPhone (408)866-2150 (408)376-0958 REMARKS: [] Urgent [] For your review [] Re: Insured: SummerHillHomes Permit No. ENC2000-00059/102-190 N. Harrison Ave. Reply ASAP [] Please Comment We have reviewed the certificate of insurance that has been submitted in connection with the above referenced permit and find that the following items need to be added or changed to meet our minimum insurance requirements: 1. The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are to be named as additional insureds either on the certificate or on an attached endorsement. 2. SummerHill Homes' insurance coverage is to be primary insurance as respects the City and this needs to be stated so on the certificate or on an attached endorsement. 3. We require that the insurance provided to the City be issued by an insurer authorized to transact business in the State of California. Caliber One, the general liability carrier, does not appear on the list published by the State of California Department of Insurance which includes all insurers admitted to transact liability insurance in the state. 4. The cancellation area of the certificate needs to be edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation of liability of any kind upon the company, its agents or representatives". Copies of the applicable sections of our insurance requirements follow for your reference as well as a copy of the original certificate that was submitted. Please call me if you have any questions. Thanks for your help in this matter. If responding by fax please use the above fax number (408) 379-0958, not the fax number appearing on my transmission. I am working in a different City office for today only. Thanks. ACORD. CERTIFICA E OF LIABILITY INSU[ NC .2'D = I. DATE05/02/00,.M,DD , PRODUCER James Econn & Co. Insurance CA License #0340047~., 445 S. Figueroa St., 36th Fl. Los Angeles CA 90071-1602 Phone=213-629-3131 Fax=213-629-4440 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AF F O R DI N~ ~..E RAa~%G E~.~.' J INSURED INSURER A: Caliber One INSURER B: SummerHill Homes· et al INSURERC: 777 California Avenue INSURER D: Palo Alto CA 94304 iINSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY X i COMMERCIAL GENERAL LIABILITY ~ ! CLAIMS MADE i ~ } PRO- I POLICYi i JECT : I LOC AUTOMOBILE LIABILITY ii ANY AUTO ! ALL OWNED AUTOS ' SCHEDULED AUTOS I i HIREDAUTOS I NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO CGO 0001035-01 I EXCESS LIABILITY !DEDUCTIBLE i RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OTHER i POLICY EFFECTIVE DATE (MM/DD/YY) 04/08/99 POLICY EXPIRATIONI DATE (MM/DD/YY) i o4/o8/ol LIMITS EACH OCCURRENCE $ 5, 000, 000 FIRE DAMAGE (Any one fire) I $ 100, 000 MHD EXP (Any one person) i $ 5 · 000 PERSONAL & ADV INJURY $ 5, 000, 000 GENERAL AGGREGATE $ 5, 000 · 000 PRODUCTS-COMP/OPAGG $ 5, 000, 000 COMBINED SINGLE LIMIT (Ha accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC L $ AUTO ONLY: AGGI $ EACH OCCURRENCE : $ AGGREGATE i $ ,$ $ $ I WC STATU- ] IOTH- ~ TORY LIMITSi ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE! $ E.L. DISEASE - POLICY LIMIT: $ DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re= Project/Permit Number and Location of Work. ENC 2000-00059 102-190 N. Harrison Avenue Tract 9244. '10 days notice of cancellation in the event of non-payment of premium. Per policy terms, conditions, limitations and exclusions. CERTIFICATE HOLDER ! N i ADDITIONAL INSURED; INSURER LETTER: A City of Campbell Attn: Depart. of Public Works 70 North First Street Campbell CA 95008 CITYO-1 ACORD 25-S (7~97) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESE~I~ATIVES. ~ ~ ©ACORD CORPORATION 1988 To: Finance Director Check Payable To: Address- Line 1: Line 2: City: Description: Account Number: Account Number: Account Number: (Finance Dept only) Total Payable: Purpose: Voucher #: Receipt #: Requested by: Approved by: Finance Dept Only: Verified by: Approved by: Refundeble Deposit Check Request SUMMERHILL CONSTRUCTION 777 CALIFORNIA AVENUE PALO ALTO Refundable Deposit 101.2203 101.540.7448 Interest Earned Maintenance period has expired. State: CA Zip: 94304 Amount: $4,500.00 Amount: Amount: (Finance Dept only) (Exact Amount) Refund deposits as follows: $500.00 plan check deposit; $2,000.00 Labor & Material Deposit; $2,000.00 Cash Deposit. 130044 ($500); 130045 ($2000); 130046 ($2000) Alan Ham (~ ~, Permit #: 2000-00059 Date: 4/25/00 Title: Sr. PW Inspector Date: Title: City En~lineer Date: 7/15/O3 7/15/O3 Michelle Quinney Title: Accounting Clerk II Date: Title: Accountant Date: Special ]:nstructions For Handling Check Mail As Is: Mail in Attached Envelope: Interim Check: Needed By: Return To: MARLENE POMEROY PUBLIC WORKS (Name) (Department) Other: Please return check to Public Works for transmittal to permit holder. h:',permits~2000-00059 102harrison maint accept refund(mp) CITY OF CAMPBELL Public Works Department April 27, 2000 Mr. Jim Barriteau New Service Department San Jose Water Company 1221 S. Bascom Avenue San Jose, CA 95128 Re; 102-190 N. Harrison Avenue, Tract No. 9244, Summerhill Homes Dear Mr. Barriteau: We are enclosing two copies of the plans for your review and comments. As a part of this development, the City of Campbell is funding the construction of the street improvements on the west side of Harrison Avenue north of Grant Street. Please note that the installation of the 12 inch storm drain pipe across Harrison Avenue east to west will require that you relocate your 12 inch water main. We have not concluded the review of these offsite construction plans, nor of the onsite construction plans, but hope to conclude that very shortly. Please let us know if you have any questions or comments. Please call me at (408) 866-2163. Very truly yours, Cruz S. Gomez ..,~ Assistant Engineer Cc: Bill Helms, Land Development Manager Kirk Heinrichs, Redevelopment Manager Michelle Quinney, City Engineer H:\landdev\ 102harrison4 271tr 70 North First Street . Campbell, California 95008-1423 · TEL 408.866.2150 · Fax 408.376.0958 · TDD 408.866.2790 Chuck Gomez From: Sent: To: Cc: Subject: Chuck Gomez Tuesday, May 09, 2000 1:47 PM Bill Helms; Bill Bruckart; Alan Hom; Matthew Jue Chuck Gomez; Randy Westfall; Harold Housley; Vince Jimenez RE: 102-190 N. Harrison, Summerhill Homes, EP ENC2000-00059 We have issued the EP to install and maintain the construction fence within the public right of way and for traffic control and public property cleanup and maintenance includin,g parking restrictions. We therefor have no objection for the Building Department to issue the demolition permit. Raymond Barro of Summerhill Homes has been informed. ..... Original Message ..... From: Chuck Gomez Sent= Friday, April 28, 2000 11:03 AM To-' David Corona Cc: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes Please see me first thing this afternoon about an aerial photo that we need for a plan to show fencing, barricades, and signing for a trafic control plan for this project. Thanks! ..... Original Message ..... From: Chuck Gomez ~ent: Thursday, April 27, 2000 1:34 PM To: Randy Westfall; Harold Housley; Alan Hom Cc: Bill Helms; Chuck Gomez; Matthew .]ue Subject: RE: 102-190 N. Harrison, Summerhill Homes Please do not sign off for Summerhill Homes or Summerhill Construction Company to get their demolition permit until Public Works issues them the encroachment permit to install the construction fence on the public right-of-way. The fence permit requires them to install and maintain all signage and to clean and maintain the public property clean at all times and it limits the truck route and parking. Thanks, Chuckg ..... Original Message ..... From: Chuck Gomez Sent: Wednesday, April 26, 2000 4:23 PM To: Bill Helms Cc: Chuck Gomez; Harold Housley Subject: RE: 102-190 N. Harrison, Summerhill Homes Bill, Reyad Katwan of Summerhill Homes is being evasive and nonresponsive with respect to submitting information that they are required to furnish the City. The conditions of approval state that on Harrison Avenue they are required to remove and to reconstruct to street center line. That is not being shown shown upon the plans. The soils report, the street structural section design, the report on the coring, the analysis of the core samples for asphalt concrete thichness and aggregate base thichness, none of this information has been furnished to the City eventhough they are part of the conditions. Paul Kruger says that the soils report will come from the soils engineer and that existing asphalt will not be removed and reconstructed as required. Katwan has known from the beginning what the requirements are and his civil has been informed by me to design the structural section based upon the TI and R-value and to show it on the plans. Katwan is stonewalling and delaying in hopes that Imay. forget to continue to insist that they comply with the requirements. I placed a call to him this morning to remind him to submit the soils and coring lab investigation reports. I wii call Kruger to ask him whatever gave him the idea about not showing reconstruction to centerline. I can only proceed with plan check of the plans to a certain point and then I will have to stop due to their nonresponse. Chuckg ..... Original Message ..... From: Chuck Gomez Sent: Tuesday, April 25, 2000 3:05 PM To: Randy WestCall; Matthew .]ue Cc: Bill Helms; Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes I am having Marlene type up a Special Condition 5 to an encroachment permit to allow Summerhill Homes to install a fence to close off the public sidewalk areas of the east side of Harrison Avenue and the south side of Salmar Avenue that includes no parking on the east side of Harrison Avenue which I need for both of you to review and comment upon as soon as possible. Thanks, Chuckg ..... Original Messa9,. -- From: Chuck Gomez Sent: Thursday, April 20, 2000 9:56 AM To: Randy Westfall Cc: Bill Helms; Matthew .lue; Chuck Gomez Subject:: RE: 102-190 N. HarriSon, Summerhill Homes Randy, comments please, thanks, Chuckg ..... Original Message ..... From: Matthew 3ue Sent: Thursday, April 20, 2000 9:06 AM To: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes How's this (see text in red)? ..... Original Message ..... From: Chuck Gomez Sent: Thursday, Apdl 20, 2000 8:00 AM To: Matthew .]ue Cc: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes Matthew, we do not want for them to park on the west side of Harrison north of Grant Street. Is there a clear and simple way to make that clear? ..... Odginal Message ..... From-' Matthew .]ue Sent: Wednesday, April 19, 2000 2:56 PM To: Chuck Gomez Subject: RE: 102-190 N. Harrison, Summerhill Homes Here are some suggested Conditions of Approval which may change depending on how the gravel parking lot at Grant/Harrison is allowed to be used: 1. Generally, trucks may use the Unrestricted Streets mentioned in the Campbell Municipal Code Section 10.40.020, "Unrestricted streets or truck routes". Depending on their point of origin (e.g., from Highway 17), I would assume Highway 17 to Hamilton to Salmar to Harrison. 2. At no time shall construction trucks drive on Harrison Avenue north of Salmar Avenue (both sides) and between Salmar Avenue and Grant Street (west side). 3. At no time shall construction employees park on Harrison Avenue north of Salmar Avenue (both sides) and between Salmar Avenue and Grant Street (west side). 4. Equipment and material storage and employee parking shall be on site only. 5. The Contractor shall submit a traffic control to the Engineer for review at least five days prior to beginning of construction. The traffic control plan shall conform to the "1996 Manual of Traffic Controls for Construction and Maintenance Work Zones (including all revisions)". 6. The Contractor shall install "No Stopping" signs in areas where the Contractor's work will require restricted parking. Prior to start of work which requires parking restrictions, the Contractor shall request approval to post and maintain temporary "No Stopping" signs at each location where construction operations will take place. The City will provide the signs for the Contractor's use. The Contractor shall post the signs at least forty eight (48) hours prior to start of the work at a maximum spacing of sixty (60) feet. The signs shall clearly show the date(s) and hours of the parking prohibition. These conditions must be followed by the Contractor in order for the no stopping order to be enforceable. The Contractor shall notify the City of Campbell Police Department immediately after posting the signs at (408) 866-2101. 7. Safe pedestrian and handicapped access shall be provided at all times throughout the project site. ..... Original Message ..... From: Chuck Gomez ~._.,t: Wednesday, April 19, 2000 1:54- PM Te: Bill Helms; Matthew .lue; Randy Westfall Cc: Chuck Gomez; Vince .~imenez; Bill 8ruckart Subject: 102-190 N. Harrison, Summerhill Homes Mike Walters of Summerhill Homes, 1-415-517-2402, needs an encroachment permit to fence off the sidewalk on Harrison Avenue and fence off the whole site for Haz Mat removal. As soon as they do that, they will want a demo permit. We need to let them know now what it is that we expect from them. We need to let them know what the truck route will be, no parking in the residential streets, equipment and material storage, employee parking, signs, barricades, cleanup, sweeping, plan, schedule, fees for assurance of compliance, etc. We do not know if RDA will allow them to park at the SW corner of Grant and Harrison. Matthew, can you stipulate the conditions, the minimum cor~ditions of approval that we will require. There are other issues like other City closures that should be noted. Thanks, Chuckg '~.~CROACHMENT PERMIT ISSUANCE CB~,2K LIST City of Campbell Department of Public Works Encroachment Permit No. Tract No. Address: ITEMS REQUIRED FOR PERMIT APPLICATION: Applicant section complete Applicant signature and date [f_.Kqnt and back) Permit Application Fee Saa$.00 paid - Receipt Number Plan Check Deposit Paid (2 % of Engineer's Estimate~Receipt Number __ Five Sets of Improvement Plans Submitted ITEMS REQUIRED PRIOR TO PUBLIC WORK CI,EARANCE FOR BUILDING PERMITS Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then 12% of Engineer's Estimate. If Engineer'S Estimate > $250,000, then Actual Cost + 20%. (Deposit of 8% of Engineer's Estimate required; $30,000 minimum deposit). Amount $ Receipt No. Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount $ "~/..D~L>,~'? Form I.D. # / Security for Monumentation Amount $. Receipt No. x// Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount $ q--.tdg~O/?, ~f Receipt No. Storm Drainage Area Fee Amount $. Receipt No. Worker's Compensation Insurance Information Sheet Received for Applicant. All other Public Works requirements listed .in the Conditions of Approval of the development. ~ Other Fees, Payments, Deposits Amount $ Receipt No. ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: Contractor's signature added to the permit application (front and back) Worker's Compensation Insurance Information Sheet received from Contractor. /~Cenificate 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 COMPLEIE, PERMIT MAY BE ISSUED. Issuer: Initial and date and t'de with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\word\forms\pmtcklst rev. 4/97