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ENC2006-00083
CITY OF CAMPBELL F '.OACHMENT PERMIT Perr ~n~t= 2~7(e.' '- (x'C>~ 5 DEPT. OF PUBLIC WORKS +orking within the public X-R le 70 North First St. right-of-way) Campbell, CA 95008 Application Date ~ Z~- d ~' (408) 866-2150 Issued 5l ~'`~"~~ ~ Application Expiration Date (v Fax (408)376-0958 r. Permit Expiration Date ~ `Z3 es7~ APN ~ ~.JS ~ -3 ~' OAS APPLICATION -Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in six (6) months if the permit is not issued. A~p/p_lication Fee is non(r~e-fu~njdable.) A. Work address ortract# ~`~~' Z ` ` ~f r ~i-~~/- ~ ~.-. Utility trench location ~~ B. Nature of work X;i ltn. .~ C. Attach four (4) copies o~ an engineered plan showing the location and extent of the work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show the relation of the proposed work to existing surface and 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 Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this pemrit, listed below. Failure to abide by these conditions and provisions may result in job shutdown and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions I and 2.) E. The Contactor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. ''`` ~~ / Name of Applicant ~6ti1 l~ ~ ~L,(~--~~ ~ Telephon~~C~~ ~~~ "- ~~.~1a~ci (prin ame) ! G, Address .~~ 3 `~ ~ ~~^''~`~ ~~ s~I~~ 24-HOUR EMERGENCY TELEPHONE NO. lob' " ~/ ' L:avrvt ~~ a~~~> ,/ ~ C E-Mail Ad ress ~-~ l[iL~ ~'iT~t=a ~/ ~~~ ~~~-'~ \ e ~~~ is this work being done by the property owners at their own residence? ~ Yes V No The ApplicanUPermittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The ApplicanUPermittee hereby ack edges t they have read and understand both the front and back of this permit, and they will inform their contractor(s) of the information. Applicant is advised t pon ' of this permit, property owner, or property owner's successors, shall be responsible for any and all damages arising out of the conditi any p ~ r eats in the public right-of-way. ~ 2 0~6 Accepted (Applicant Permittee) (sign) Date ~C.-F~/ Contractor (Print Name) Date _l. Street shall not be open cut for underground installations. Minimum cuts>~Y be allowed for connections or exploration holes. Such cuts be saecifically annroved by [he Inspector prior to cutting. ~2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Detai]s Trench Restoration Method "A", unless otherwise approved by Inspector. _3. Work to be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and the inquiry identification number has been entered hereon. USA Phone 1-800-227-2600. USA TICKET NO. _5. Prior to any work, the property owner shall cxccutc an Agreement for Private Improvements in the Public Right-of-Way, which shall be recorded. _6. Public Notification Requirements: 7. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT N0. $ 2~~ 1 /G'1 ~~ PERMIT APPLICATION FEE ~-~--~-r~ - PLAN CHECK DEPOSIT $ SECURITY FOR FAITHFUL PERFORMANCE/LABOR A~JERIALS $ CONSTRUCTION CASH DEPOSIT 1 > $~ F-e--~=~ PLAN CHECK & INSPECTION FEE APPROVED FOR ISSUANCE ~Z t~ ~° For City Engineer Date Permit Expires 12 Months After Date of Issuance ~ ~ ~~~ . b 0 "'A d b x 0 T7 y 'd z o S 0 0 ~ ~, 0 0 ~~ WW ~~ ~~ O o ~. W 0 0 ~~nm d =• ~ ~ ~ trf o Cn ~ c . 0 r. ~ 'ri '» a b n ~ n ... ~' y o ~ o ~ p' w x y 69 J i-- N O ~ ~ O O ~- tr~1y O O ~: F-- N A ~ ~ iy v ~_ O O O G O N N ~ ~ ~ ~ N N "C7 O O A> ~ ~ °' .-. n :- ~ , ~-. ,'0 ~ ~ ~ ~ Cam" ~ ~ ~° a z z d c ~' z ~o 0 0 ~ a ~. d C ~ O O O p p O n m N ~ ~ ~ ~ .. ~ z ° ~ x ~ p~.-. 0 Q O~ r~ i ~ O O ~ O ~ 00 ~,,,~ W N N W ~ O ~-~ O PUBLIC , . _.KS DEPARTMENT RECEIPT ERective JWy S, 2W5 City Clerk PUBLIC WORKS FILE N0. C~~/v~~~7 r~' '~~L=y •~ ~-`'~/ ~°U e --~ PROPERTY ADDNESS "~T ~7 V~J ~hC~1.• Rease colket & receipt Por the folfovrinp moNese TT1Tdv1' AMOUNT _... .. BMENT PERMIT :2 Applieatbn Fee Non•Utility Encrmchment Permit (SY15.W) Mimr Encroachment Permit < 55,000 (S61.W) R•1 Rrst Permit (No Fee) Srrese cent (5135.W) Utllity Encroachment Permit ArteriaVCdlectar Street (5530.W) ResidedlW Street/Olher Areas (5291.W) i 13 Ran Check Deoosil 2% of Fsalrrrcr's Estimate (5500 min) 220 3 Labor and Materials Securtt (I W % of ENGR. EST.) 220 3 Monumentatbn Security (1W%of ENGR.FST.) 220 3 Cash De t (4 % of Engr. EsU(5500 MWSI0,000 max) 472 2 Ran Check & Irtspection Fee (Nun-Utility) Fngr.Fat.<5250,000 (l3%of ENGR.EST.) 2203 Eo r. Est. >5250,000 (De t 8% of Engr. Est./530,000 ndn)•w d72 2 Utllity<S1W,000 MlNmum ClurEe Per Locatbn CoodWfs/Pipelines up l0 500 Feet (S1g0.W) (52.2.5/R) Above 500 Linear Feet (51.35IR) MadnltsNaWLSIEtc. (5125.OO/ea) Pok Set/RemovW (5125.00%x) Slrxt Trce Rantlog/Removal (5135.W) 2113 Utlllty>SIW,000 Actml Cost+20%•• 47 60 Storage Comainer Permit (5125.W) d7( i0 Pro)ect Karts & iflcatiotts Nro)ect No. 07 60 Stardard S cOtcatlom & Derails (Sl/Pg Sl$.50/Bk) 47 60 Co es of Engineering Maps & Rant Aerial Ro124" xJ6" (S54.W) Aerial Print B I/2" x 11" (S22.W1 d722 Work Without Permits (4 Times Applicable Frc) iEVELOPMEMF d722 Ld LineA uslment (S9W.W) 4722 Parcel Ma (d Lots or Less) (S3AOO.W +575/bt) d722 Rml Tract Ma (5 ar Mom Lots) (54,200.W + SI00/lot) 4722 Certilkate of Co Hance 5650.W) 4722 CertifkaleofCorrcctbn (S4W.W) 4722 Notary Fee ( rsfgmturc) (SIU.W) 4722 Vacalfon of PuWie Streets & Easements (S2,2W.00) 4722 Aareawnent Segrcgatfon or Reapportbnmeot Brat Spilt (5725.W) Each Addllbml Lol (S2W.W) 4721 Storm Draimge Area Fee Per Acrc (R•1 52.120.W) (MWtl•Res 52,385.W) Interseetbn Turn Coma (a.m ur TraRfc Fbsv Map (DWIy TraRk ~ Canmhcli TnfOc Model (FWI Sca Truek No Po TOTAL OF APPLICANT OF PAYOR a PIIONF. FOR ..: ~ . ,~} ~ ~ ,:. CITY CLERK RECEIVE' B J ONLY Date f •ForPWr Check and Caah Dt7wdt.;.:nd ye0ow.oopy.toElma«. - '. -Date/ INihls j:\forms4eoeipt form 05-06 rev.621N5 PUBLIC W iEPARTMLN'1' x>rc:>.lrl E1feUivc July 5, 2005 ~'~I' (~ (~'~i', R)11LIC W ORKS FILE N0. ~~~ ~~" ~° ~ ~ "' "~ " ~ "~ O: Ctty CkMc PROPERTY ADDRESS Pleeec te0eel & reeelpt for We felfewi~ meelec: 7 ENCROACHMENTPBRMIT d722 ApplkutMn Fa Na-Utult EneeeeeMeAt Pamlt (5273.00) MleorExruueYtleet Permit <55,000 (SE1Jq) R•1 Flret Rrulit (No Fee) t fS125.00) UUllt Eneewehamt Perndl ~ArurlWCellcctor &reet RS10.B0) Rddeltiul BtrceUOther Aeeue ff291.00) 2303 PW CYeelc t 2%eT a BRMoets Ifsao mle) ~ ` 2103 IIUYRll l4rfseoute lieeurlt (pp5) (IOD%eTBNGRESC.) ` 2103 LubereadMuterWe6eerrlt (100%ofENCRESTJ ` 2203 MeiroumaWU6eeurit 1100%of 6rICR.FSTJ ` 2303 Ctudl (4% of Esllr. Fi1Nf500 niuIS10,000 mex) PMo CFcek & IeMerlien Fee (Na-UUOty) 4722 Bufr Ha.cS2SA,f00 f13%ey ENGR~1'd 2203 . tiu. >S2S0A00 t 8%eT . Eet.IS30.f00 rlinY" 4722 UWtt <f1f0A00 C]. Miolern CYue{e t4r I.eeeUen ff1f0.M1) CoudWptOpeWm ap to 300 Feel (52.25M) C Absee Slq Lenr Feel (S1351ft) MuulrkeNwlWElc. ff125A0ke) Q Pek &t/Nemsd (5125.0IYea) Street Tree val K135.00) ~1. n 2103 0001 >SI0D.f00 Aeftal Get+20%" J~ ^.! d760 o...i... r Pemil ___ (5125.00) J ~~~ ~..J u7 .: r ~ r~ ~ [ ; ~ r. cr ['•- d J •.rJ CV fr. C17 1 Liz [:J [~ _ i CJ ~-'~,~ r.„i "'1 1 F.- i~ 1 ~ a ~.w L~i"i alk ~~5 i r ~ ~ r~i ~Vi ua W~ La, '~+. z ~,,, .~: ~ _ ~. ~.. a .:J ':L C:J L1 4. LL LL Ci P~•J .. iLn +~ W - -` ri ^. L::i 4~..i u Cs: r f i:C ~ f ? C..7 ' p2f 7'rMk Fisw (Uull Trullic Yalmee) fS3200) 4738 tl Trdlk MuJel (Full Ate) fAelw.q 4718 tl TnIRc Medel (Reduced Atmalent) IAetop d726 T -luttunlulten (fliLFtr) d27/ Tank Permlu 1516 r l ) 4728 Nuh IfUetKh erfl5/I00) IYTFI®t TOTAL S NAME ON APPLICANT ~ M'I n ~H ~ ~.~ ~ ~ NAMF.OF PAYOR ^~ y 2 9 ~ ~ ,.- ,. , / p /~ PHONE ~]` a ~•~ J, A ADDRESS JI J1 ~ VI~''~l ~i ~ >~y~ ~U~` ~~ v ZIP `7 7 UQA lAllM ~, ~ ~AF ... _._._. rY...._,n¢ rw...~...arrM...te~r..m Merlin. droeeltl _ j:VmmwY<xipt loon 05-06 ~ev.6R1A5 PUBLIC ~, i DEPARTMENT RECEIPT En.ctive Jdy 5, 2005 f /~ " ~~ ~ j~ ~~~ ~ ` "' ` ' ~ ~~ ~~ City Ckrk PUBLIC WORKS FILE NO. l ~ (j t- ~ ~~ "~ p J ~/ ~~ Ch ~~~ ~ PROPERTY ADDRESS , ~ ' ' /"9.- /~ Picaec collect & rxcefpt for the fdbxioa monks: RUACHMENT PERMIT 4722 Appllcatbn Fee Non-Udllty Fitcroechmenl Permit (5275.00) Mlmr Emtoxhmeat Permit <$,000 (561.00) R•1 Rnn Perm0 (No Fee) m (5135.00) Uullty Emroachmeot Prrmit I 22031 flan check Deposit 2% of Ettdmer's Erthtute (f500 mm) MENCR.ESr Cadt DepMt (1% o! FnBr. Fet)(5500 midS10,000 max) Plan Cheek & Inapeelbn Fre (Nun•Utility) EnEr.Est. <57311,000 (l3%ol ENGR.ESTJ Eper. Ent. >S250.000 (Deoodl 8% o! Enar. FBt./5.30.000 Mn)++ Conddta/Pipelftacs pp to 500 Feet (52.250Y) Above 500 Lamar Feet (SIJSAt) Manhdex/Vadta/Etc. (5125.4Yea) Pole SeURemoral (5125.00/ea) 2203 Ut11it >S100,000 Aetml Cost+20%'• 4760 Slon},e Cmtalner Permit (5125.00) 1760 Prokct Plain & Speeiflralbos Pnleet No. Aerlpl Rol 24"x36" (S_W.00) AeMI Prim 8 1/2" x I l" IS22.OD) Ma and Plain 24" z 96" (f815) 4723 Penpltkn: Fa0urc to reslorc ublicl roremenLS (SI00/CakMar Ua) IMer r..,t. a«.tt.vcoto) 4722 Pmaltks: Fdlurc to nrrect unsafe conditfore IS100/Calendar Dav) Nltwl TnM Map (5 or Morc Lots) (54,200.41+Sl0onot) Cet9Dnk of Camplbme 5050.41) Certificate of Correetbn (SI00.011) Noury Fee (per aiputurc) (510.00) Vautbn of Poblk 6[reeLS & EaxemenLs 152,200.m) Asses~aned SeBrcPtlon or Reapportloimient Flrxl Spilt (5725.41) Mich Addllbpal Lot (5200.00) Storm Dnim0e Ana Fee Per Acrc (K-1 52,120.00) (Mdtl•Rea 52185.41) (All Other S2,6S0.00) ParkWod Dedfealbn Fee (75%25% Dm Uppn Cert. of Oecup.orv) Model TOTAL OF AR'LICANT PIIONE ZIP Cost Rus 20% ~:v ime4eceipt rprpt os-o6.er.6rzlros INSURANCE REQUIREMENTS CHECKLIST Permit # ~~~~~ ~ " ~~~~-~ CIP Project #, The following insurance is required of all contractors working in the City of Campbell public right-of--way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. ~ /,!`Limits `-'~y;~.~(.. ~~~ek,c~'.a,~..., ~` ~ `'~-1C ~ 't/z"~~~-~"`' Connmercial General Liability for lKodily, personal injury .property damage: $1,000,000 per occurrence, and ~ ~' x~ $1,000,000 general aggregate limit applying separately to the proj~t,~n~d $2,000,000 general aggregate limit. ~ ~'~ ~~'~'~"'` ``` ~~~' ^ Policy expiration date - 5 -~~ ~~ ~Q~~ ~~ L:c,c<J,Iz' B~-~cy Au omotive Liability - "any auto" ,~~.~ y,~ ,/ ~ ~~ $1,000,000 per accident for bodily m~ury and property damage ^ Policy expiration date /~ ~ ~n ~ C(f Worker's Compensation and Employer's Liability '~' $1,000,000 per accident for bodil injury or disease '~ Policy expiration date ~ - / -L' Course of Construction (if required in Special Provisions) ^ Completed value of the project ^ Policy expiration date Required Endorsement to General Liabilit<~ and Automobile. Liability Policies A ditional Insured Endorsement ~tvk~t~--1~ ~ ~ ~ ~' ~~'~ The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. The insurance coverage afforded to the Additional Insured is primary insurance. ~J Workers' Compensation Insurance Sheet Submitted ^ For General Contractor '~ Subrogation Clause ~~, ~~, Insurance Certificate Reviewed i /t~ Wit, - ~- ~.~:~ ~ Initials Date ^ Copy of Insurance Certificate placed in tickler file one month prior to expiration. , (? ~~ I~ j:\forms\inscklst 4/96 (rev 6/96) J ~~~~~ ~ ~g ~ ~~~~ J p~ ~.~..~~, ~,~, ..~ C..y // ~~ ~~~~ O ~ Lin.. ~'c E:.L~ 0610712006 18:45 8981142 APPLIEDUW2625 PAGE 01/01 ACC)RD~, ~ERTIFICATB ~F' LIABILITY INSURANCE DATE(MM(DDM(YY} D6~o7~2oD6 PRODUCER A'C Ialxuxexxaa services PO Elox 3646 N>: 88103-0646 CaDak~a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONtY AND CONFERS NO RIQHT9 UPON THE CERTIFICATE HOLpER. THI$ CERTIFICATE DDES NOT AMEND, EXTEND OR ALTER THE COVERAQE AFFORDEp BY THE POLIgES BELOW. , { 577 } 234_aaao INSURERS AFFORDING COVERAQE NAIC ! INSURED INSURER /l' Cali£Orls18 Taauraa0e Ga~pany Cax, AathoaX L mei t db C t & D l INSURER 6: a a A Trac or BVa oD 1112 bi >>daia St M 3 D1 INSURER C: D[aritacet, GA 55336-3208 InISURERD~ CT7:, 1x73 3297$0 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD INDICATED. TERM OR CONDITION OF ANY CONTRACt OR 07HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NOTWITMSTANbINGAHY REQUIREMENT , MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CDNDITIONS OF SUCH POLICIES. AQQREQATE LIMITS SHpwN MAY HAVE 6Et`N REDUCED BY PAID CLAIMS. L7p gp TYPE OF INSURANCE POLICY NUMBER DATE JD LIMIT S GENERAL LIABILITY EAGN ~GURANCE S COMMERCIAL GENERAL uABlurY PREMISES Ee occurence ~ CLAIMS MADE OCCUR MED ExP ane n $ PERSONAL d ADV INJURY S _.. ~ _~ QENERALAGGREGAT $ GeN2 AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMaroP AGG S POLICY JECT L~ $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO s~ ~ u '~UFIKS (Ee ecdaenc) ALL OWNED AUTOS , .'~,`...itE?IIfVIS ATION BODILY INJURY $ (PeY p9rBOn) SCHEDULED AUTOS HIRED AU7O5 BODILY INJURY 5 (Pgr acCldant) NON-OW NED AUT03 PROPERTY DAMAGE d (Pmr Itecltlerlt) GARAGELIAHILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER ThIAN ~ ACC S AUTO ONLY: AGG $ EXCESSIUM6RELLALIABILITY EACH~CURENCE $ OCCUR ~ CLAIMS MADE AGGREGATE :i S DEDUCTIBLE $ RETENTION S $ WOR KERS COMI~NSATION AND ,~, • t7JIP ANY L0YSA3' LIABILITY PROPRIETORIPARTNER/EXECUTIVE E,L,EAGN"'GCtD~Nr S 1.000,000 46-006342-01-02 06/01/06 06/01/07 OFFICERJMEMBEREXCLUDED7 E,L,DIgEASE-F116MPLOY6E $ 1 000 000 tt yes, tleecrlba antler SPECIAL PROVISIONS below E.L. DISEASE • POLICY UM(T $ 1, 0 D0, 000 oTNeR DESCRIPTION OF OPERATIONS J LOCATICNti J vEINCLES I EXCLL1810N9 ADDED 9Y t°NDOR9EMENTJ SPL-CIAL PROV1910N3 RE: Riacaa Ave., Cambeli, CA -- Waiver of BubroQativa is favor of Ciby oa* Cas~beil, Sad Cau~bell Redeveiot~t 7lveaoX, its oflicers, oliiciais, est~ioyaes s and volvaeeera relative to work performed under eoatraot. f`FCIT7FIf'ATC MAI 1'fCR ['_AKICELLA.TIAtJ - --------------- SNCULD ANY 6F THE ABDVE DESCRIBED POUCIE3 BE CANCELLED BEFORE THE EXPIRATION C'~~y ~~ 4'a>7'~b811 DATf? THEREOF, THE 189UINQ INSURER WILLMAIL 30 DgYS wptiTEN NOTICE 70 N. >I~irlst Street Cas~bali, CA 95008 TO THE CERTIRCATE HOLDER NAMED T8 THE LF,1-r•,>smbBntfts Attn: nepertmeat of ~ublio Works AUTNDRI2ED REPRESENTATIVE ~' ~~~" 0>D78336 ACORD 25 (2001/08) ®ACORD CORPORATION 1968 OF ~ n ~~ ~~F u ~ s ARCH ARC CITY of CAMPBELL Public Works Department FAX TRANSMITTAL June 6, 2006 Carolyn Webberson McGee & Thielen Insurance 916-561-4660 Re: Certificate of Liability Insurance A C Tractor & Development From The Desk Of.• Marlene Pomeroy Executive Assistant (408) 866-2776 fax (408) 376-0958 We are in receipt of a Certificate of Liability Insurance for A C Tractor & Development. Thank you for sending it so promptly. It meets all of our requirements except the following: 1. At the bottom of the page under Cancellation, we require that the wording after "...certificate holder named to the left...." be deleted (strike through). We will not accept the language "but failure to mail such notice shall impose no obligation or liability of any kind upon the insurer, its agents or representatives." Please fax back a certificate indicating this change at your earliest convenience. 70 North 1 first Strcc[ Camphcll, California 950(18- 1436 TPI 408-866.2150 PAX 408.376.0958 l'UU 408.86(1.2790 _ ACORD,M ~;~~ i IFIC~TE 4 PRODUCER AU Insurance Services PO Box 3646 Omaha, NE 68103-0646 (877)234-4420 INSURED Cox, Anthony L dba AC Tractor & Development 1112 N Main St # 301 Manteca, CA 95336-3208 LIABILITY IN~UR~NCE_~DAO6`M07/2006 THIS CERTIFICATE IS ISSUE .i 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 _ _ _ NAIC # INSURER A: Cali':Ornia IriSUranCe Company _ INSURER B' _._. - - -- INSURER C: ---- - .-__-_-- -_-- -i. -- INSURER D: INSURER E: ___ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO I Ht INSUHtU IVHIVICU NbVVC rvn i n~ r vuv ~ ~ ~~ ~~~+~ ~~•~~~• ~ • ~-~- ONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS NOTWITHSTANDING ANY REQUIREMENT, TERM OR C THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, RTAIN , CERTIFICATE MAY BE ISSUED OR MAY PE AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NDITIONS OF SUCH POLICIES . . EXCLUSIONS AND CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS ILTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DDIYY EACH OCCURRENCE $ GENERAL LIABILITY - -- - ~--- DAMAGETU RENTED COMMERCIAL GENERAL LIABILITY PREMISE~a occurrence $ i ~ CLAIMS MADE f OCCUR MED EXP (Any one person) $ __ _ PER-SONAL 8 ADV INJURY $ _ I 'GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: 'PRODUCTS - COMPIOP AGG $ _ _ ~~-- -- - PRO- POLICY JECT LOC AUTOMOBILE LIABILITY $'~ p+~ M~~~' . ~"'•t ~ ~j ;,{ +~m COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO , \ ___-_ -_ _ ALL OWNED AUTOS s 1 ~ t`~~ ~ h ~"I ~ ~ I ~ ~ BODILY INJURY (Per person) $ _~ __ SCHEDULED AUTOS ~- ~ r - ---- - HiREG AiiTOS ~L~ ~Liv V~V ~..~ ~I {~.~~` BODILY INJURY (Per sccldent) ~ $ NON-OWNED AUTOS MINiSTi=.N ICy~,~ -~- - ~ PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ _ _._ _ - - - .- _._ GAR AGE LIABILITY I-_.. ___- N EA ACC $ __ ANY AUTO OTHER THA _ _ AUTO ONLY: AGG $ - ±--- ~ EACH OCCURRENCE $ - _ __ EXCESS/UMBRELLA LIABILITY ~ ~ AGGREGATE $ - - CLAIMS MADE i ]OCCUR $ I _ $ - DEDUCTIBLE $ RETENTION $ ~-- ][ WC STATU- OTH - WORKERS COMPENSATION AND TORY LIMITS ER _ _ EMPLOYERS' LIABILITY 46-006342-01-02 06/01/06 06/01/07 _ ACCIDENT E.L.EACH 1, 0 0 0, 0 0 0 $ NY PROPRIETOR/PARTNER/EXECUTIVE _ 0 0 0 0 0 0 1 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE • • $ If yes, describe under E.L. DISEASE POLICY LIMIT $ 1 , 0 0 0 , 0 0 0 SPECIAL PROVISIONS below I OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ation in favor of City of bro f S g u RE: Riacoa Ave., Cambell, CA -- Waiver o bell Redevelopment Ageacy, its officers, officials, employees d Cam p Campbell, an s and volunteers relative to work performed under contract. CERTIFICATE HOLDER City of Campbell 70 a,. First Street Campbell, CP_ 95008 Attn~ Department of Puh7.ic works ACORD 25 (2001/08) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EgD1P~MAIL _30 DAYS WRITTEN NOTICE TO THE CERTIFICATE_ HOLDER NAMED TO THE LEFT, ~ ~~~~- OD78336 © ACORD CORPORATION 1988 u of Cqy~~~` r ARCH ARC CITY of CAMPBELL Public Works Department FAX TRANSMITTAL June 5, 2006 From The Desk Of.• Marlene Pomeroy AU Insurance Services Executive Assistant 877-234-4421 (408) 866-2776 fax (408) 376-0958 ATTN: Team 35 Re: Workers Compensation and Employers' Liability Certificate of Insurance Anthony Cox dba AC Tractor and Development We are in receipt of a Certificate of Insurance for the above referenced contractor. The City requires a waiver of subrogation before the Certificate is acceptable to the City. The language should read: "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." Please call or fax if you have any questions. 7(i Nurth First Street Campbell, California 9~OOR-Id36 TII X08-8(ifi.2150 I,1X aU8.376.0958 ~fUl~ 408.R6G.2790 1 C • '70 TI It`I f]C '7fafaL ~~~c,~ Plar.~: pia ACORQ~, CERTIFIC~ 'E OF LIABILITY INSURA~ E 06/06/2006) PRODUCER (glb)646-1919 FAX (916)64b-0995 McGee & Thielen Insurance °r~kcrs, Inc. 3780 Rosin Court Suite 200 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION eLY AND CO NFERS NO RIGpeS~PONTHE CERTIFICATE-^ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lic # 0633187 Sacramento, CA 95834 INSURERS AFFORDING COVERAGE - NAIC # - ___ - INSURED INSURERA North American Capacity A C Tractor & Development INSURER B. PMB 301 INSURER C: 1112 N. Main Street INSURER D. Manteca, CA 95336-3208 INSURERE rnvcoAn_rc THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT , 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 DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY PNG0002 74500 04/25/2006 04/25/2007 EACH OCCURRENCE $ 1 ~ OQO ~ 00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 5O , OO CLAIMS MADE a OCCUR MED EXP (Any one person) $ 5 , OO A PERSONAL & ADV INJURY $ 1 , 000 , OO GENERAL AGGREGATE $ 2 , OOO , OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 1 , OOO, OO X POLICY PRO LOC JECT AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (EaacddenQ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ^ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ If yes, describe antler SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS !VEHICLE I EXCLUSIONS ADDED 8Y ENDORSEMENT 1 SPECIAL PROVISIONS E: All work in public right-o~-way. City of Campbell, City of Campbell Redevelopment Agency, •ts officers, employees and volunteers are named additional insured per attached G2010 1185. ~ ESC ~. V U (~ '! ~C~)~> .~ °10 Day Notice of Cancellation applies for non payment of premium. !`FRTIFI!`ATG 1.1!11 f1GR If:AN(:FI I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL iQr~XaHW(~6 MAL c, ty of Campbel 1 3O'•` DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, f 14Xi(d6XdE)kIQXIXEi(xd(Mi67f~JfiWOWEY~(IVKdNCXX Public Works Attn: Dept. o 70 North First Street ~(l6XAH(dC#X~Hf~UIEiO~(~7(X~tJfXlfi(i49E~Xi~4XA6X0EXXXXXXXXXX Campbel 1, CA 95008 AUTHORIZED REPRESENTATIVE -~ Daniel Caudill/CSW ~''' ACORD 25 (2001108) ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certfficate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) 11 ~ 41~ JUN 1~6, 2006 POLICY NUMBER: PNG000274500 A C Tractor & Development #2263 PA6E~ 5i5 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ lT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRADTORS - FORM Bj This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Person or Organization: SCHEt]Ul_E Any person or organization to which you are obligated by virtue of a written contract to provide insurance such as is afforded by this policy, but only with respect to (1 }occurrences taking place after such written contract has been executed and (2) occurrences resulting from work performed by you during the policy period. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.} WHO IS AN INSURED (Section Ii} is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Coverage provided by this policy to the Additional Insured{s) shown in the Schedule shall be primary insurance and any other insurance maintained by the Additional Insureds) shalt be excess and non-contributory, but only as respects any claim ar liability determined to be the result of the sale negligence or responsibility of the Named Insured and only if required of the Named Insured by written contract. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ^ 16 28 JUN 06, 2006 #2302 PAGE 1i4 r ~~~r~~~ .~ J ~! ~~ ~~ ?UC) rtse;~i~; L~'CJR}~S ~ :~:VM::A:;~T~'u~T1~~V 1~~~~~ Thiclen Yns~ran~c Braker~, 7n~ To: Marlene with the City of Campbell Fax Number : 1(408) 3760958 Phone Number From : CAROLYN WEBBERSON Fax Number : 561-4660 Phone Number 561-4619 Time Sent : Tuesday, Jun 6, 2006 04:27PM Pages : 4 Description : Revised Certificate for A C Tractor 16~cS JU~V 06, c006 T1aar Ma~^~ ~~~ Enclosed please find the revised certificate for A C Tractor as requested. Feel free to give me a call with any questions. Thanks, Carolyn S. Webberson McGee & Thielen Insurance Brokers, Inc. 3780 Rosin Court, #200, Sacramento, CA 95834 Phone: {916) 561-4619 Fax: (916) 561-4660 E-MAIL CONFIDENTIALITY NOTICE: The contents of this e-mail message and any attachments are intended solely for the addressees} and may contain confidential and/or legally privileged information. If you are not the intended recipient of this message or if this message has been addressed to you in error, please immediately alert the sender by reply e-mail and then delete this message and any attachments. If you are not the intended recipient, you are notified that any use, dissemination, distribution, copying, or storage of this message or any attachment is strictly prohibited. iF~30c SAGE ~ c7 "~ A CERTIFICATE OF INSURANCE ' ~ ~`,~; .,......,. This certifies that ^STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois ~~~~~' /,~ ®STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ~ ~{, IN.R.N~~ ^ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario ~~ ^STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ^ STATE FARM LLOYDS, Dallas, Texas insures the following policyholder for the coverages indicated below: ~ ~ ; ~ ~? i.... •«s Policyholder AC TRACTOR AND DEVELOPMENT AKA ANTHONY COX ~ ~"~' %"'" °"~~~~`"""- Address of policyholder 802 SWEET PEA LN, MANTECA CA 95336-8555 Location of operations ~f,~ii~!'thiISTRATInRt Description of operations UNDERGROUND PIPELINE The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is suhiect to all the terms. exclusions. and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Date (at beginning of policy period) 074 0783-D20-05B Comprehensive 04/20/2006 10/20/2006 BODILY INJURY AND Business Liability PROPERTY DAMAGE This insurance includes: ^ Products -Completed Operations ^ Contractual Liability Each Occurrence $ 1, 000, 000 ^ Personal Injury ^ Advertising Injury General Aggregate $ 1, ooo, 000 ® Hired Autos ® Employer's Non-Ownership Coverage Products -Completed $ 1, 000, 000 ^ Operations Aggre ate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE EXCESS LIABILITY Effective Date ;Expiration Date (Combined Single Limit) ^ Umbrella Each Occurrence $ ^ Other Aggregate $ POLICY PERIOD Part I -Workers Compensation -Statutory Effective Date ~ Expiration Date Workers' Compensation Part II -Employers Liability and Employers Liability Each Accident $ Disease -Each Employee $ Disease -Policy Limit $ POLIGY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date ;Expiration Date (at beginning of policy period) 074 0783-D20-05B AUTO 04/20/2006 ~ 10/20/2006 1,000,000 SINGLE LIMIT 081 2430-D07-OSC AUTO 04/07/2006 10/07/2006 1,000,000 SINGLE LIMIT ruF cFC~TtGirteTF nF ituct iReNCF is NnT o CONTRACT OF INSURANCE AND NEIT HER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certificate Holder CITY OF CAMPBELL ATTN: PUBLIC WORKS DEPARTMENT 70 N. FIRST STREET CAMPBELL, CA 95008 ENCROACHMENT PERMIT # 2006-0083 ADDITIONAL INSURED: ALL WORK IN PUBLIC RIGHT OF WAY. Title CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS THELMA L. FEDRICK OFFICERS, EMPLOYEES & VOLUNTEERS ARE NAMED AS ADDITIONAL Agent Name INSUREDS AS RESPECTS LIABILITY Telephone Number 408.723.2268 tf any of the described policies are canceled before their expiration date, State Farm will try to mail a written notice to the certificate holder 30 days before cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State Farm of -its nts or represents ~ es. Signature of Authorized Represent tive AGENT 06.05.2006 rh ~ ~~~) ~y' ~ ~~~~ Agent's Code Stamp `~ C_, A OnC~. FEDRICK 558-994 a.5 Rev. 11-08-2004 Printed in U.S.A. {/AMPBEl1. II Date 05-2837 F155 ~~/06I2006 09:20 408266750 STATE FARM PAGE 02 CERTIFICATE aF INSURANCE .,.T~ This Certifies that ^ STATE FARM FIRE ANp CA5UALTY COMPANY, Bloomington, Illinois ® STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ~"'•'""` ©STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario [] STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida ^ STATE FARM LLOYDS, ballas, Texas insures the following policyholder for the coverages indicated below: PoUcyhoider COx, ANTHONY L DBA AC TRACTOR AND D1;VE,raOpMENT Address of policyholder 8D2 SW1;ET FEA I,N MANTECA CA 95336-9555 Location of operations SAME Description of operetions TRACTOR AND DEVELOPMENT ~~~~ ~~ ~.~`~'`~ The policies listed below have been issued to the policyholder for the policy periods shown, The insurance described in these policies is subject to a(I the terms, exclusions, and conditions of those policies, The limits of liability shown may have been reduced by any paid claims. POLICY NUMEER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY Effective Date ~ Expiration Date (at beginning of policy pAriod) xxxxxxxxxXXXxxxx Comprehensive xxxxxxxxxx xxxxxxxxxx BODILY INJURY ANO xxxxxxxxxxxxxxxx - Business Liability xxxxxxxxxx xxxxxxxxxx PROPERTY DAMAGE This insurance includes: ^ products -Completed Qperations ^ Contractual Liability Each Occurrence $ xxxxxxxxxxxxx ^ Personal Injury ^ Advertising Injury GenerHl Aggregate $ xxxxxxxxxxxxx D XXXxxxXXXxxxxXXXxxxxXXXXXxXXxxXXxxXxxxXXxxx ^ xxxxxxxXxxxxxxXxxxxxxxXXxxxxxxxxxxxxxxxxxxx Products -Completed $xxxxxxxxxxxxx ^ xxXxxxxxxxXxxxxxxxxxxxxxxxxxxxxxxXxxxxxxxxx O eralions Aggregate EXCESS LIABILITY POLICY PERIOD BODILY INJURY AND PROPERTY ^AMAGE Effective Date ; Expiration Palle (Combined Single Limit) xxxXxxXxxxxXXxxx ^ Umbrella xxxxxxxxxx ~ xxxxxxxxxx l=ath Occurrence $xxxxxxxxxxxxx xxXxXXXxxxxxXxxx ^ Other XXXXxxxxxxX xxxxxxxxxx xxxxxxxxxx Aggregate $xxxxxxxxxxxxx POLICY Pt=R10D Part I - Wprkers Compensation -Statutory Effective Date ~ Expiration Date xXxxxxxxXXxxxxxx Workers' Compensation xxxxxxxxxx xxxxxxxxxx part II -Employers Liability xxxxxxxxxxxxxxxx and Employers Liability xxxxxxxxxx ~ xxxxxxxxxx Each Accident $ xxxxXXXxxxx xxxXxxxxxxxxxxxx xxxxxxxxxx xxxxxxxxxx Disease -Each Employee $ xxxxxxXxxxx Disease -Policy Limit $ xxxx.XXxxxxx POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD Effective Dat®; Expiration Date LIMITS OF UABII,ITY (at beginning of policy period) D$1 2430-D07-05C COMMERCIAL AUTO 09 /07/2D06 ~ 10/07/2006 1„ OOO,OQO SINGLE LIMIT 092 3630-A15-05 COMMERCIA..L AUTb 01{2Q/2006 07/2D/2006 1,OQp,000 SINGLE LIMIT THE CERTIFICATE OF INSURANCE IS NOT A CpNTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR MEQATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIEED HEREIN. Name and Address of Certificate Holder GITY OF" CAMPBELL ATTN: PUBL.T.C WORKS DE~'ARTMENT 70 N. ET.RST STiZEET CAMPEELL, CA 95008 ENCROACHMENT pERMIT# 2006-00$3 A.DpITIONAL~ INSURED: ALL GVOFtK IN PUBLZG RIGHT OF WAY. G7TY OE" CAMPBELL, CITY OF C1IMPHELL REDEVEI~gFMENT AGENCY, ITS OFFICERS, EMPLOYEES & VbLUNTEERS ARF NAMEb AS 11S ADDITIONAL INSUREDS AS RESPECTS LTABII,TY. ''SUBJECT TO ALTS OTHER TERMS A.ND PROVISIONS OF THE POLICY, SUCH INSURANCE AS PRbVIDEA BY THIS ENDORSEMENT SHA,T,,L LSE DEEMED PRINIA.RY, BUT ONLY WITH RESPECT TO WpRR PER$ORMED SY OR FOR TH$ NAMEb INSURED IN cpNNECTTON wzTH ABOVE DBSCRIaEr~ CaNTRACT_^ If any of the dQSCrlbed policies are canceled before their expiration date, State Farm will try to mail a written notice to the Certificate holder days before cancellation, e~atetiMes-- w ~.. Slgn6ture ofAuihOr' Repre6 tative AGENT _ D6/06/06 TitlB beta ',r,[-IELMA F.'}Tpy~ICK Agent Name TelaphOneNumber 4D8.7~3.22b8 Agcnt's Code Siamp Agent Gade 05 zF37 AFD Code F1.55 556-894 a.s R04. 11-06.2Qpq Printed In U,3,A. 0`f'0612006 09:20 4082667760 STATE FARM PAGE 01 ~~~~~' ~C'~~"I'1'1 ~nSL~~`c~nC~ Thelma ~,. Fedrick, A~en~ 1777 Hamilton Ave. Ste#10Z San Jose, Ca 95125 Office 408,723.2Zb8 Fax 4U8.2b6.7760 ~-mail. thelma.fcdrirk.ehle ~-statefarm tom Web Site: www.insurancebythelma.lrom ~~`~'11 ..I~~f f~ ~ lQ~~ pu~~lc Vv©~Ks A~MINISTRAT-Q~ ~'ax Transnnittal Pa e Today's Date: ~ I ~ I ~ ~D Company: ~/~~ O~ ,~~-. /~ Attention: ~~~,:°~~ ~'ax # sent to: ~~~-~~.~~' T~Otat # pa~e5 (including cover): imam: -~tS'r~l'~. ~. Notes: ~~ ~'~~ `V' Tf this fax is incorr,pleto or difficult to rend, please caT1 ~106.723.22bR The information cpnrnlderl in thin }kcsfmile transrrunaion is lagnlly privileRad and ConFdcntial, lntet}ded only fbr the addrenr7aa. Any use, review, d1R3Clnrnattnn, distribution nr copying ofi thin trntasmiASion by any0rle Other than Nte NddtCRpC@ is Rtrita1y ptnhihited afld it not q. wa9var of nny applicable privi}~Qe aRnfnnt d;aatam,re. Tf you have rGCeived this transmission in error, please ca13 the number about and immediately return the origins] Uf the 8tato Farm Tnaurancc. ,..~ ~. r ;~r=; _._ , _. girt; ....}__L: ,_,. t ... _ ~'k~i~S~3Yi-0 t~Gi.YiJ ~~ TRFICTL}4. y; .;, Ij~~.nr~.rr' - a:::, .. L_~~:: +`.l: ~ ~ svlit !ii l11~3~~1 ~ '~i_"~ a~l~J ._.. 4: f'!~i" !fir ~~~_.~ ~~ ~: tip i.~ }. = _ ~_i ~~ _ 1"' ' , J~''~ /r..:F i' 1N' GENERAL PERMIT CONDITIONS 1. A Construction Cash Deposit is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed to the Permittee. 2. A one-year maintenance period and surety are required. Such period will begin on date of written acceptance by the City. 3. Refund of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the written acceptance of the work by the City. 4. The Permittee must request in writing a final inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to the Permittee. 5. Maintain safe pedestrian and vehicular crossings and free access to private driveways, bus stops, fire hydrants and water valves. 6. A Construction Traffic Control Plan and a Construction Schedule are required for all lane closures, detours and street closures. This plan must be reviewed and approved prior to any lane closures. 7. The Conswction Traffic Control Plan shall conform to the Caltrans Manual of Traffic Controls for Construction and Maintenance Work Zones, dated 1990, available at Caltrans. Traffic control equipment shall include Type II flashing arrow signs if required. 8. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 9. Sawcut for all PCC or AC removals. All PCC removals shall be to nearest scoremark and shall be doweled to existing improvements. 10. Prior approval of inspector is required for any work done after normal working hours, on weekends or holidays and may require reimbursement of inspection costs at the current overtime rate. 11. Adequate signing and barricading is required on the job site. Failure to provide such signing and barricading may result in the City's providing signing and bamcades and charging the cost (including all labor and materials) against the cash deposit. 12. Compaction testing of subgrade, base rock, and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 13. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. to 4:00 p.m. 14. No storage of materials or equipment will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition to the public. 15. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required, nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 1 G. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 17. This permit is not transferable. Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 18. Call back (call out) due to emergencies regarding this permit shall be at the current overtime rate with a three (3) hour minimum charge per occuRence. 19. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 20. If the public interest requires a modification of, or a departure from, the plans and specifications, the City shall have the authority to require or approve any modification or departure and to specify the manner in which the same is to be made for City-owned or maintained facilities. 21. Permittee must provide advance notification to all parties that may be affected by the pemtit activities. Notification shall be reviewed by City prior to distribution and include dates of work and a contact nom and phone number. Applicant shall be responsible for ensuring t a 1 those p vtding services under the applicant are aware of and understand all of the above conditions. 87/~ G C Date Contractor (Print Name) Date .T~forms~pwperm Rev. 11 /9/05