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ENC2012-00164 AL Print Form CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No I l li DEPT.OF PUBLIC WORKS (for working within the public X-Ref.File 70 North First Street right-of-way) Application Date Campbell,CA 95008 Application Expiration Date Ph. (408)866-2150 —Issued \, t APN :- Cjy Fx. (408)376-0958 1 Permit Expiration Date q1 ml V APPLICATION-Application is hereby made for a Public Works Permit in accor ance with Campbell Municipal Code,Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: 145 Winchester Blvd - -- ------ ---- - --- - -- - ----- - --- ----—- --- ---—- - — 1 Utility Trench Location: Winchester and Rincon B. Nature of work: Frontage improvements C. Attach four(4)copies of an engineered plan showing the location and extent of the work,and four(4)copies of the preliminary Engineer's Estimate ofwork. The plans shall showthe relation ofthe proposed workto existing surface and underground improvements. When approved by the City Engineer,said plan becomes a part ofthis 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 permit,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 1 and 2.) E. The Contractor must have this permit and approved plans at the site and must notify the Public Works Department at least two days before starting work. Notice must be given to Public Works at least 24 hours before restarting any work. Name of Applicant: Scott Plautz J(4 Telephone: 655-2326 Address: 17066 Melody Lane,Los Gatos 95033 E-Mail Address: scottplautz@gmall.com j 24-HOUR EMERGENCY PHONE NUMBER: 655-2326 15 this work being done by the property owners at their own residence? ri YES FX_I NO The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,its officers,agents,an)d employees free,safe and harmless from any claim or demand for damages resulting from the work covered by this permit. The Applicant/Permittee hereby acknowledges that they have read and understand both the front and back of this permit,and they will inform their contractor(s) of the inform n. Applicant is advised that upon issuance of this permit, property owner, or property owner' succ ssors, shall be responsible for y and all /d ma arising out of the condition of any private improvements in the public right-of-way. Accepted: ry �� (Applicant Permittee) (sign) Die (Contractor) (Print Name) Date SPECIAL PROVISIONS: 1. Street shall not be open cut for underground installations. Minimum cuts may be allowed for connections or exploration holes. Such cuts may be specifically approved by the Inspector prior to cutting. 2. Pavement may be cut for underground installations and must be restored in accordance with the Standard Details Trench Restoration Method "A",unless otherwise approved by the Engineer. 3. Workto 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 execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. 6. Public Notification Requirements: 7. E PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO. ,.PERMIT APPLICATION FEE $ 5 10'_ 6- 4 PLAN CHECK DEPOSIT $ Z. CURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $ ( _ CONSTRUCTION CASH DEPOSIT $ SZC) .36 PLAN CHECK&INSPECTION FEE 04% `�� r ` ��`�h � $ ,` ,3 O Z 36 EMERGENCY PERMIT FEE �� I �1 APPROVED FOR ISSUANCE LJ� .�0 F rtity-Engineer Date Permit Expires Months After Date of Issuance 0 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 or 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. A Construction 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 ofthe Permittee. 9. Sawcut for,all PCC or AC removals. All PCC removals shall be to the 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 thejob site. Failure to provide such signing and barricading may result in the City's providing signing and barricades 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. 16. 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 emeregencies regarding this permit shall be at the current overtime rate with a three(3)hour minimum charge per occurrence. 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. Permitttee must provide advance notification to all parties that may be affected by the permit activities. Notification shall be reviewed by the City prior to distribution and include dates of work and a contact name and phone number. Applicant shall be responsible for ensuring that all those providing services under the applicant are aware and understand all of the above conditions. Ap scant Date: Contractor (Print Name) Date: J:\FORMS\Templates\Encroachment Perm its\Encroachment Permit STATIC form2.pdf Rev.09/10 1�®►� CERTIFICATE OF LIABILITY INSURANCE 9/6/2013YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and.conditions of the.policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER C10A,E: Michelle Conrique .__..........._..........__.—..._._._..__.—..._._._ ....._..........._._ Hansen Insurance Agency PHONE ($31)722-.9666 FAjG .(831)722-2932 License #0831440 bill AL A D DRESS michelle@hanseninsurance.com 800 East Lake Avenue INSURERS AFFORDING COVERAGE NAIC 0 Watsonville CA 95076 INSURER Gemini Ins. Co. 10833 INSURED INSURER B 0avigators Specialty Ins. Co. 36056 TOU BAR EQUIPMENT CO. , INC. INSURERC:Granite State Insurance Co. 23809 P.O. BOX 254 INSURER D: INSURER E: Redwood City CA 94064 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-2014 GL, XS & ETC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE iN SUBR POLICY NUMBER. POLICY MMtDDfY YY LIMITS LTR GENERAL LIABILITY EACH OC:CURPENCE �$ 1,000,000 DANICF TO aENTFD 100 000 X COMMERCIAL GENERAL 1AAB..ILiTY PREM .ES I a xrLlrrencel I$ r A CLAIMS-MADE ®OCCUR X CGP020722 6/18/2013 6/18/2019 IMIED EEXP(Ary one person) is 5,000 PERSONAL&ADV INJURY I$ 1,000,000 GENERAL AGGREGATE j$ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PEP PRODUCTS,-COMR;CP AGG '$ 2,000 000 POLICY I X ,i LOC AUTOMOBILE LIABILITY COM,N- INGLE LIMIT EO=cciden' ANY AUTO BODILY iNJJRY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Peramident)i$ AUTOS AUTOS. NON-O ANED PROPERTY DAMAGE HIRED AUTO ............ AUTOS _Per acadent)_._..._.._....-----.._i$._.._—. UMBRELLA LIAR X OCCUR EACH OCCURRENCE :$ 2,000,000 B 1 X EXCESS LIAB CLAIMS-MADE ! AGGREGATE $ 2,000,000 rED X'RETENTION 10,O00 SE13E%G757742IC 6/18j2013 6/18/2014 .. C WORKERS COMPENSATION y VVCSTATU- OTFI-I AND EMPLOYERS'LIABILITY YIN X T Pl' IMIT ANY PROPRIETORIPARTNE(SE,xECUTIVE E.L..EACH ACCIDENT 1$ ,00Q 000 OFf9CER!METt;BER EXGL'JQED'.! u NIA 10 j3 j2012 10/3 j2013 (Mandatory In NH) t7CD0164 7490 E.L.DISEASE-EA EMPLOYEE$ 1 000 000 I`;es,decnbs under .i DESCRPPTOOP!i7F OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more.space is required) Limits at policy inception. *Except 10 days notice for non-payment of premium & *30 days NOC. City of Campbell, its officers, employees and volunteers are named as Additonal Insured's under the General Liability policy as per the attached form CG 20 33 04 13 with primary wording per the attached form CG20 010 04 013. Workers Comp. Waiver attached. CERTIFICATE HOLDER CANCELLATION dn].£ulga@verizon.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dept. of Public Works 70 N. 1st Street AUTHORIZED REPRESENTATIVE Campbell, CA 95008 M Marquez/MONIQU ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INS075 r;n+.nnslnl Thom i1[`nPn nnma nnei Innn nra raniatararl marlee of arnRr1 Policy:VCGPO20722 CG 20 33 0413 Insured Narne:TOU BAR EQUIVNIENTCO INC Number:28 Effective Datv,:06/1,812013 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATICSTATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement niodifies insurance provided under the following: Commercial General Liability Coverage Part A. Section 11—Who Is An Insured is amended to include,as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a,contract or agreement that such person or orizanization be added as an.additional insured on your policy,Such person or organization is an additional insured only with respect to liability for"bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part,by: L Your acts or omissions;or 2. The acts or omissions of those acting on your behalf: in the perfonnance of your ongoing operations for the additional'nsured. I lowever,,the insurance afforded to such additional insured.. 1. Only applies to the extent permitted by law;and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A.person's or Qrganization's. ft completed. status as au insured under this endorsement ends when your operations for that additional insured,are compl B. Withrespe6t to the insurance afforded to these additional insureds;the following additional exclusions apply: This insurance doe,;not apply to: 1. "Bodily injury",."property damage"or"personal and advertising injury'arising out of the renderingof,or the 1kilurc to render,any professional architectural,engineering or surveying services,including: a. The preparing,approving,or failing to prepare Or approve,maps,shop drawings,opinions,reports,surveys,field orders,change orders err dTa-,vings and specifications;or b. Supervisory,inspection,architectural or engineering activities. This exclusion applies to ,plies even if the claims against any insured allege or other wrongdoing in the supervision, hiring,employrnent,.training,or monitoring of others by that insured,if the"occurrence"which caused the"bodily injury" or"property damage,'!,or the offense which caused the"personal and advertising injury",involved the rendering of or the failure to tender any professional architectural,engineering or surveying services. 2. "Bodily injury"or!'property damage"occurring after: a. All work,including.materials,parts or equipment,fumished in connection with such work,on the project(Other than service,maintenance or repairs)to be performed by or on behalf of the additional insureds)at the location of the covered operations has been conipleted or b. That portion of"your work"out ofvhich the injury or damage arises has been put to its intended use by any person or orgaDilatiOu Other than another contractor or subcontractor engaged in performing'operations.For a principal as a part Of the same project_ C,G,20 33 04 13 1 cal 2 C. With respect to the insurance-afforded to these additional insureds,the-following is added to Section III—Limits Of Insurance. The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have,entered into with the additional insured,or 2. Available under the applicable limits of.Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable.1-imi-ts of Insurance shown in the Declarations. CGj,20.33 04 13 2 oft Policy:VCGPO20722 CC,10 6104 13 Insured Name:TOU BAR EQUIPMENT CO INC Number:27 Effective Date:06/18/201.3 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY, PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided imcier the following: Commercial General Liability Coverage Pail The fbilowing is added to the Other Insurance Condition and Supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance'is primary to.and will not seek contribution from.any other insurance available toan,additional insured under your policy provided that: (1) The adclitional insured isa Named Insured sander such other insurance;and (2) You.have agreed in wriling in a contract or agreement that this insurance would be primary and would not sock contribution'from any other insurance available to the additional insured. CG 20 0104 13 1 of I BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which It Is attached effective on the inception date of the policy unless a different date is indicated below, (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 10/03/2012 forms a part of Policy No. WC: 001-64-7490 Issued to TOU BAR EQUIPMENT CO. , INC. By GRANITE STATE INSURANCE COMPANY We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by- - - - - - - - - _ _ - - - - - - - - - - - - -- - -- - -- (Ed. 11/90) Authorized Representative ' 7 ®AcoDATE(MMIDDIYYYY) rzr3 CERTIFICATE OF LIABILITY INSURANCE 9/6/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the,policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Michelle Conrique -.._.__ _...... Hansen Insurance Agency PHONE . (831)722-9666 FAX .(831)722-2932 License #0831440 AODRESS:michelle@hanseninsurance.com 800 East Lake Avenue INSURE S AFFORDING COVERAGE NAIC0 Watsonville CA 95076 INSURER A:Prae't:orlan Insurance Company 02643 INSURED INSURER B: Charles F. Touchatt,CO. INSURER C: TOUCHATT TRUCKING INSURER,D: TOU BAR EQUIPMENT CO. , INC. , P.O. BOX 254 INSURERE: Redwood City CA 94064 1 INSURERF: COVERAGES CERTIFICATE NUMBER:2013-2014 Al & XS., TOUBAR REVISION NUMBER: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. IN RI IL POLICY EFF POLICY EXP LIMITS L TYPE OF INSURANCE POLICY NUMBER I M lDDlYYYY MMIDDIYY 1 GENERAL LIABILITY EACH OCCURRENCE $ IA O PENT COMMERCIAL GENERAL LABILITY PREMISE S(Ea oowrrency) Is CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL:AGGREGATE I$ .GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POL.IC! LOC -- ...._ $ AUTOMOBILE LIABILITY CO eBVE SINGLELiMIT 1,000,000 A IX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X iB000910312207 Y/28/2013 1/28/2014 BODILY INJURY(Per accident) $ ✓ �S $ AUT�r AUTOS 1 PROPERTY DAMAGE HIREDAUTOS _ AUTOS !Paraccident) Medial rmvrrsents $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE Is 1,000,006 DF..D RETENTION . �000990001003 /26/2013 /28/2014 Is WORKERS COMPENSATION VV(:STATU- OTH- AND EMPLOYERS'LIABILITY YIN T M1 T P ANY PROPRIETORIPARTNERIEXECUTIVE❑ E.L..EACH ACCIDENT OFFICERWEMBER EXCLUDED? NIA 7 (Mandatory in NH) i E.L.DISEASE-EA EMPLOYE $ If yes,descnbe under DESCRIPTION)OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more,space is required) Limits at policy inception. *Except 10 days notice for non-payment of premium.- City of Campbell, its officers, employees and volunteers are named as Additonal Insured's under the Automobile Liability policy as per the attached form AU-BUI-AS-0224-A (03/12) with primary and non-contributory wording. CERTIFICATE HOLDER CANCELLATION dnj.fulga@verizon.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Dept. of Public Works 70 N. .1st Street AUTHORIZED REPRESENTATIVE Campbell, CA 95008 M Marquez/MONIQU " ACORD 25(2010105) ©1988-2010 ACORO CORPORATION. All rights reserved. INS075 r-minamrit TMc ArnRn name onri Innn arc rcnicfnrcrl marlre of arnpn THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - COMBINED FORM - AUTOMOBILE PRIMARY NON-CONTRIBUTORY This endorsement.mbdifies insurance provided under the:following: COMMERCIAL AUTO COVERAGE PART-Motor Carrier Coverage Form COMMERCIAL AUTO COVERAGE PART-Business Auto Coverage Form This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 09111/13 Policy Number: P000910312207 Named Charles F.Touchatt Countersigned by: _ Insured: Specifically Named Additional Insureds: Additional Insured: City of Campbell Address: 70 N.1st Street,Campbell,CA 95008 "WHO IS AN INSURED"(Section ll. A. 1.)is amended to include as an Insured the person or organization shown in the schedule above with whom you are obligated by a written contract or written agreement to provide insurance such as is afforded by this policy.The coverage afforded by this policy to the Additional Insured shall only apply as respects to liability arising out of "Motor Carrier"operations performed by the Insured for the Additional Insured. A. If the Additional Insured is a lessor of leased autos this insurance does not apply: (1) To any"occurrence"which takes place after the equipment lease expires,or when the"lessor or his or her agent takes possession of the'leased auto',whichever occurs first. B.If the Additional Insured is engaged in operations as a"Shipper".or "Motor Carrier",coverage afforded by this policy shall only apply as respects to liability arising out of hauling done by the Insured for the Additional Insured. C. If the Additional Insured owns or controls property on which you travel or perform operations related.to your business as a"Motor Carrier", but only for liability which arises from use of a covered auto on property owned or controlled by the Additional Insured. D. If the Additional Insured is a state or other political subdivision: (1) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. (2) This insurance does not apply to"bodily injury"or"property damage"arising out of operations performed for the state or political subdivision. AU-BUI-AS-0224-A(0312012) Page 1 of 2 Primary i r If the Additional Insured is an Owner, Lessee or Contractor,this coverage applies only with respect to liability caused by operations performed directly by you and/or your employees,for the Additional Insured at a location designated in a written contract or agreement. It is further agreed that such insurance as is afforded by this policy to the Additional Insured shall be primary insurance as respects any claim, loss or liability arising out of the Named Insured's "Motor Carrier"operations performed on your behalf, and that any other insurance maintained by the Additional Insured shall be excess and non-contributory with the insurance provided hereunder. It is further agreed that we will not be responsible for the payment of attorney's fees and costs in the defense of the Additional Insured that are attributable to claims that do not fall within the coverage of this endorsement, and we have the right to allocate the payment of attorney's fees and costs between covered and uncovered claims. This coverage form replaces form AU-BUI-AS-0224(03/2012) but only with respects to the Additional Insured named in the schedule above. As used in this endorsement: "Motor Carrier" means a person or organization providing transportation by"auto"in the furtherance of a commercial enterprise. "Shipper"means any person or organization who hires,contracts or directs a"Motor Carrier"to transport property for or on their behalf. AU-BUI-AS-0224-A(0312012) Page 2 of 2 Primary 0.01 LW I�NSURe NCE REQUIREMENTS CHECKLIST C Vie. 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 Commercial General Liability for bodily, personal injury and property damage: 3/, $1,000,000 per occurrence, and ❑ $1,00000 general aggregate limit applying separately to the project, or ml*' $2,000,000 general aggregate limit. a--Policy expiration date Automotive Liability: "Any Auto" checked on certificate ❑ _$1,000,000 per accident for bodily injury and property damage D/'-Policy expiration date \�z%kky Workers' Compensation and Employer's Liability o✓Waiver of Subrogation clause a/ $1,000,000 per accident for bodily injury or disease ❑ Policy expiration date Course of Construction (if required in Special Provisions) ❑ Completed value of the project ❑ Policy expiration date Required-Endorsements to General Liability and Automobile Liability Policies Additional Insured Endorsement The City, its officers, employees and volunteers are named as additional insured. (Reference Project Location/Permit Number) ❑ The insurance coverage afforded to the Additional Insured is primary insurance. Cancellation area: ❑ Cancellation area of certificate edited to delete "endeavor to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives". `OR should say: Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. C:\Documents and Settings\oannat\Desktop\Insurance Requirements Cklist.doc(Rev 07/11) Page 1 of 2 �Y/ Wf rkers' Compensation Insurance Sheet Submitted ®( For General Contractor ❑ For Developer or Owner Acceptability of Insurers) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. Name: Co • NAIC# jQY633Rating: J Authorized in CA: Name: Rating: Authorized in CA: Name: ��(��;�e_ ;�� e NAIC# Z355g Rating: x� Authorized in CA: ✓ Name: � � �'��.� „�� . NAIC#.L Ey Rating: X\,l Authorized in CA: 3�t as`t j q( Campbell Business License # s� Insurance Certificate Reviewed Initia Date V/`Copy of Insurance Certificate placed in tickler file one month prior to expiration. C:\Documents and Settings\joannat\Desktop\Insurance Requirements Cklist.doc(Rev 07/11) Page 2 of 2 23751803 iftrctiv Recording Requested By: ) Regina lara C County OC 23 2017 y — Clerk—Recorder City of Campbell } 09/13/2017 09:53 AM Cffy C"K'S 01-MU And When Recorded Return To:- ) Titles: 1 Pages: 2 Fees: 28.00 Taxes: 0 City Clerk ) Total: 28.00 Ci ty Campbell 7 } ■IIl ��N1 k��ky��iY'�i��`�1� �� „�ih1f ,11�� 0 N. First Street Campbell,CA 95008 ) ZO APN: 305-33-100 (Space Above This Line For Recorder's Use Only) UL 2 ADDRESS.2145 Winchester Blvd.,Campbell,CA 95008 pgb��c NOTICE OF RELEASE BY IPorkS4am1�%s� CITY OF CAMPBELL rar�on NOTICE IS HEREBY GIVEN concerning the real property located in the City of Campbell, Santa Clara County, California, and described specifically -as follows: 2145 Winchester Blvd., Campbell; CA. That whereas, 2145 South Winchester LLC, a California Limited Liability Company, entered into a Street Improvement Agreement with the City of Campbell, recorded August 21, 2013, Document# 22358843, in the Office of the County Recorder, County of Santa Clara, State of California. That,whereas, said conditions of said Agreement have been met to the satisfaction of the City. That,Now Therefore 2145 South Winchester LLC is hereby released from all requirements contained in the agreement recorded August 21,2013,Document#22358843,in said County Recorder's Office. IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City Clerk, who are duly authorized by Ordinance 2059 adopted September 20, 2005. " CITY OF CAMPBELL ATTEST: Todd Capurso Public Works Director, City of Campbell Wendy W od, City Clerk (Attach Notary Acknowledgment) Dated: � (z) /� r • CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this.certificate verifies only the identity of the- individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of On `1 Zptj before me, vtL _ (Here insert name ane h e bt the o cer ' personally appeared \O �� who.proved to me on the basis of satisfactory evldenee to be the person(s) whose names) is/are subscribed to.the within instrument and acknowledged to me that he/she/they executed the.same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person'(s), or the entity upon behalf of Which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State'of California that the foregoing paragraph is true and correct. JUANN THOMAsON Wirt ESS my hand and official seal. i9my Commission#2110789 2 ( Notary Pubiic-California n Santa Ctara County �' Comm,Expires May 9,2019 Notary Public Signature (Notary Public Sea() e 1 ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies Leith curreiu California stances regarding notary•wording and, DESCRIPTION OF THE ATTACHED DOCUMENT heeded,should be completed and attached to the document Aclaw+eledgments from otherstates may be compietedfordocusrents being sent to that state so tong as the wording does not require the California notar v to violate California notary Z�LA S law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. - Date ofnotarization must be the date that the signer(s)personally appeared which (T11e or description of attached document continued) must also be the same date the acknowledgment is completed. - The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). - Print the name(s)of document signer(s)who personally appear at the time of notarization. FCAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. #rarshelikey,is/are}or circling the correct forms.Failure to correctly indicate this individual(s) information may lead torejection of document recording Corporate Officer The notary seal impression must be clear and photographically reproducible. iinpression must not corer text or lines.If,seal impression smudges,re-Seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. CI Partner(s) Signature of the notary public must match the signature on file with the office of the couhty clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this 0 Trustee(s) acknowledgment is not misused or attached to a different document ❑ Other . Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the.title(i.e.CLO,CFO,Secretary). 20 i a ji!:,nor.�z�r�r:.ttic a yCtasses.co~t 800-P73-986, • Securely attach this document to the signed document with a staple. om rlccdunt 0iV .1.. .... ........ Imun,&,::X. e.r n 0 -.T U 101 12203 CR080*317 7,520.00 ECD REFUND 10014§22 1145 S WINCHESTER BVLD LLC ----- --------- --------------- --- ---------- ---------------------------------------------------------------------------- - -- --- ---- --- -W. MUM UMV . ' • . C.HEC.K DATEi �-"C,HEC I,NQCITYy 0ASO &-EANk; N.A 13-24 : .2 63978 'b"NOT.U.-HTIRST STREET 1210 -�A*ZD--'.'M0NTG0MERY STREET 08/ .7. 'CA, 4104 CAMPBELL FCALIFORNIA 96.008,BEEL 7 2,0`,.��q z 0 AMOUNT it ....... C) > " FAY THE- S UM-`0 F. S27VE;N, `TH THOUSAND, ;FIVE: HlJNbREb,-TWENTY. DO ro 2 1 4 WINCHESTER BVLD IbLC. _ ORDER,'. n'l 17, "A Lb GATO ''CA. Y, S' 'S�5'0 3 3 Z; wj V2 7 .. ... ---------- --------- ---------- ------------------------------- -------- ...................... ................................... ..................... ............ ............................... ...... :--......... .............................. .............- ...................... ........... .................. ....................................... ..................................... .................. ... ....... .... ............................. *See Reverse Side For Easyopening Instructions* -- -------- - - -------------------- - --------- CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 2145 S WINCHESTER BVLD LLC 17-0-66 MELODY LN LOS GATOS CA S�5033 ES __........_...........: `.. ...._.._....... __ ............. __..._..._............. _......_._......._._ .........._.._._.....:...... i I i CITY .OF CAMPBELL VENDOR No. 10014516 CHECK No. 264028 Account Parchase:Order Invoice Number; A'inount...,..::. Descri rian 101 2203 CRO80317 2,91$.00 2145 WINCHESTER REF - I I I rn N 1 10014516 - SCOTT PLAUTL J ' I 1• • • • �1 1 1 • • 1 � 1 • I I ��r M�""7�j� CI�� Q�C��iJLL - WELLS F,ARGO,.BANK N,:A 11 24 FIRST STREET �� moN�coMEaY smxEST lzlo 08�21�17 264028 V SAt�f PRANCISCO CA 94104 I �' Cf#IVIPBELi;CALIFORNIA 95008 i �?+t unRp•� � f � �� VOID,7�FTER 9'0 DAYS; �j I� ;a I FAY THE SUM' OF TWO THOUSAND, NINE EIGHTEEN- DOLLARS & ZERO mI /� CENTS P SCOTT ;PLAUTZ 0,i1>x 17 0 6 6 MELODY LN _ $ � u LOS GTOS� CA_ 95.033 �' 9' rk ' 2640 28i1' �: L 2 ,OOD 248��. 4 L 2�18 5 •...: •• :• , • _� • • • .• 1 1 • • •• 1• . •1 1. - - - - -- -- --- - ---------- --------------- ----------------------------------...------------------ I ... ... ....�. a _ ! :....:.: _ I I � *Sep Rev-6rse Side For Easy Opening Instructions*:' CITY OF CAMPBELL l 70 NORTH FIRST STREET )CAMPBELL, CALIFORNIA 95008 j i i _ I jl SCOTT PLAUTZ 17066 MELODY LN LOS GATOS CA 95033 OF ' C9,y ��• � A r � U O O yF �� •08 CH ARO' CITY OF C,AMPBELL Public Works Department August 23, 2017 Mr. Scott Plautz 2145 S. Winchester LLC. 17066 Melody Lane. Los Gatos, CA 95033 SUBJECT: PERMIT NO. ENC 2012-00164 2145 S. Winchester Blvd., Campbell, CA FINAL INSPECTION AND ACCEPTANCE Dear Scott: The City of Campbell has made the final inspection of the subject Public Works improvements and finds that no remedial work is required. Your warranty requirements and any surety,therefore, are hereby released. Your Construction Cash Deposit in the amount of$7,520.00, your Plan Check Deposit in the amount of$2,918.00.and the copies of your CD Receipts are enclosed. Sincerely, Syed Wah' i Public works Inspector 70 North First Street Campbell, California 95008-1436 •TEL 408.866.2150 •FAx 408.376.0958 TDD 408.866.2790 8-I=413b2 Time Account Receipt/Disclosure Banker Name: Officer/Portfolio Number: Date: RADEI-KA SRINIVASAN JA1153 105/12/2014 Banker Phone: - Store Number: Banker.ALI: Banker MAC: �: j408/370-4570 104306 0000502 A0512-011 Customer/Account Information Primary Customer Name: Customer Number(ECN): 12145 SOUTH WINCHESTER, LLC -- _ 1556398622245214 COID: Product: Account Number: Open Date: Term: Maturity Date: j0011.4 jCDA 18122241352 105/12/2014 112 months 105/12/2015 Time Account Opening Deposit: Interest Rate: Annual Percentage Yield: Fixed Rate: Variable Rate: Renewal Term: $4477, 000.00 0.05% ; 0.05% IYes jNo 112 months Interest will be paid: The method of payment will be: EVERY 01 MONTHS AND AT WITHDRAWAL IBY ADDING TO PRINCIPAL o Renewability: `YOU WILL AUTOMATICALLY RENEW MY TIME ACCOUNT AT MATURITY UNLESS I NOTIFY YOU OTHERWISE ----- ... --------— —--- --- --- — N Account Title and Mailing Information Customer(s)Listed on Account: Mailing Address: '2145 SOUTH WINCHESTER, -LLC 17066 MELODY LN Address Line 2: City. — State: LOS GATOS MCA - -----•---------- - - --- ---- -------------- — --- TP/Postal Code: Country: 95033-8406 This is a receipt. It need not be presented at the time you obtain payment from the Bank. , - VU60168(5-11 5VP) Page i of 1 c' 8147717865 Time Acc®unt Receipt/Disclosure ' Banker Name: Officer/Portfolio Number: Date: IRADHIKA SRINIVASAN IA1153 I07/31/2013 Banker Phone: Store Number: Banker ALI: Banker MAC: 1408/370-4570 104.306 I0000502 (IA0512-011 Customer/Account Information Primary Customer Name: Customer Number(ECN): 12145 SOUTH WINCHESTER, LLC 1556398622245214 COID: Product: Account Number. Open Date: Term: Maturity Date: I00114 ICDA 18147717865 I07/31/2013 16 months I01/31/2014 Time Account Opening Deposit: Interest Rate: Annual Percentage Yield: Fixed Rate: Variable Rate: Renewal Term: I$188, 000.00 J 0.05% J 0. 05% JYes INo 16 months Interest will be paid: - The method of payment will be: (EVERY O1 MONTHS AND AT WITHDRAWAL IBY ADDING TO PRINCIPAL o Renewabilityc . . IYOU WILL AUTOMATICALLY RENEW MY TIME ACCOUNT AT MATURITY UNLESS I NOTIFY YOU OTHERWISE N — zAccount Title and Mailing Information Customer(s)Listed on Account: Mailing Address: 2145 SOUTH WINCHESTER, LLC 17066 MELODY LN Address Line 2: C/O CITY OF CAMPBELL City: State: LOS GATOS ICA ZIP/Postal Code: Country: - 95033-8406 JUS This is a receipt. It need not be presented at the time you obtain payment from the Bank. Page 1 of 1 ke. r �N60r 168(5 11 SIxV ) eS9 ergo et nf 1d p nti2f P➢.1 i t a 0 r� a 0 a 0 a v - 0 o 0 n rn - N z Z U 23 200611■ ....._ _,........._l _....... ..............._............... ` - -- ---------- -- - -------- ------ ------ ----- - -'' CITY OF .CAMPBELL VENDOR NO 10014516 CHECK No 264028 i �1 ccount Purchase.Order .::<'. Invoice Number: Amount Descri tion 101 2203. `CR080317 2,9D8.00 2145 WINCHESTER REF \' i u I ) � I I 1001.4516 SCOTT PLAUTZ t� I i I GAWBELL _,< wE ms EARGO,arNx, NA i 2a CHECK DATE CHECK NO 42.0 MONTGOMERY STREET 1210 0 8/21/17 2 64 0 2 8 i 7C)NORTH FIRST STREET y : SAS}FRANCISCO CA 94104 1 t y p iL r CAMPBELL;CALIFQRNIA 95008 C Eo o *****2 p* N 0 AMOUNT 918 0 I V ID.AETER''9 OytcuKtto ` 0 DAYS D I r.> FAY THE SUM OF, TWO THOUSAND, NINE HUNDRED EIGHTEEN DOLLARS & ZERO m'g J .CENTS �I t � To'T E -•SCOTT ;:PLAUTZ f I 17 0 6 6 'MELODY `Lk r F LOS GATOS CA 95 033 t v 2640 ZB�I' �. L 2000 248�. 4 2L8 5 54 L 51i' � _ -- ---- - - H .. I ...: .:..... i.. ... .._...... .:: _ ...._...._ *See Reverse Side For Easy Opening s r ion *1 --F' ---- ----- ----- ---- ------------------ CITY OF CAMPBELL 70 NORTH FIRST STREET ICAMPBELL, CALIFORNIA 95008 SCOTT PLAUTZ 17066 MELODY LN LOS GATOS CA 95033 ................................... ................. ................ .............................. ................................... ........... ....................................... ........... ............................. ------------------ ------ ----------- - --- --- -------------------- --------------------- CITY OF CAMPBELL VENDOR NO. 10 6,14 522 CHECK NO. 263978 101 2203 CRO80317 7,520.00 ECD REFUND O 10014522 2145 S WINCHESTER BVLD LLC --------------------- - ---- -- ---- -------- ------ -- -- -------------- ----- mi -1. 1170 ll m,1111441:8601 111108110, CHECK DATE CHECK.N L 11-24 TY-.�ii:;0E- XAMPBEL_, WElt9i FARGO BANK, N.A. 42.. 1219 08/2i/17 263978 .:�jjVgNTGOMERY STREET -.7-O'NORTH"FIRST STREET , * , FRANCISCO, CA 94 0 C�NIVIPB -CALIFORNIA 95 008 ; 520 0104 ,0 c)l AMOUNT ........... VOID AFTER 90- DAYS 81" C IPAY THE' SUM bio� SEVEN THOUSAND, FIVE HUNDRED TWENTY DOLLARS E! m -'CENTS:-' T�O�'Mb "2145 S -WINCHESTER .BVLD: LLCORDER 17066'MELODY LN LOS- GATOS CA 95033 - --------- ----------- --------- - ------------------- --------------- ............. .......................................... .................................. ................................... . ...................... ................................... ............. ..................... .................. ........................................ . ............).. .......................... ........................................ ...................................... ............................ ............. ............. ............................... *See Reverse Side For Easy Opening Instructions* +- -- ---- ---- -------- ------------ ------ ---------- - -------- ------- CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 2145 S WINCHESTER BVLD LLC -17-0-66 MELODY LN LOS GATOS CA 9�5033 Time Account Receipt/Disclosure 8122241352 Banker Name: Officer/Portfolio Number: Date: 1RADHIKA SRINIVASAN IA1153 105/12/2014 Banker Phone: Store Number: Banker ALI: Banker MAC: 1408/370-4570 04 3 6 000 051 -011 0 10502 A2 J -- .------ -.-- --- - - ---- ----- -------------- Customer/Account Information Primary Customer Name: Customer Number(ECN): 12145 SOUTH WINCHESTER, LLC 1556398622245214 COID: Product: Account Number: Open Date: Term: Maturity Date: 100114 JCDA 18122241352 105/12/2014 112 months 105/12/2015 Time Account Opening Deposit: Interest Rate: Annual Percentage Yield: Fixed Rate: Variable Rate: Renewal Term: L$47, 000.00 L- 0.05% 0.05% IYes INo 112 months Interest will be paid: The method of payment will be: EVERY 01 MONTHS AND AT WITHDRAWAL BY ADDING TO PRINCIPAL_ o Renewability: ':,YOU WILL AUTOMATICALLY RENEW MY TIME ACCOUNT AT MATURITY UNLESS I NOTIFY YOU OTHERWISE rn z Account Title and Mailing Information U Customer(s)Listed on Account: Mailing Address: '2145 SOUTH WINCHESTER, LLC 17066 MELODY LN Address Line 2: I -- City:--------------------- State.--------- LOS GATOS ICA ZIP/Postal Code: Country: 95033-8406 JUS This is a receipt. It need not be presented at the time you obtain payment from the Bank. W60168(5-11 SVP) Page 1 of 1 8147717865 Time !Account Receipt/Disclosure M Banker Name: Officer/Portfolio Number: Date: IRADHIKA SRINIVASAN IA1153 107/31/2013 Banker Phone: . Store Number: BankerALI: Banker MAC: 1408/370-4570 104306 10000502 IA0512-011 Customer/Account Information Primary Customer Name: Customer Number(ECN): 12145 SOUTH WINCHESTER, LLC 1556398622245214 COID: Product: Account Number: Open Date: Term: Maturity Date: 100114 JCDA 18147717865 107/31/2013 16 months 101/31/2014 Time Account Opening Deposit: Interest Rate: Annual Percentage Yield: Fixed Rate: Variable Rate: Renewal Term: 1$188, 000.00 1 0.05% 0.05% lYes INo 16 months Interest will be paid: The method of payment will be: EVERY 01 MONTHS AND AT WITHDRAWAL IBY ADDING TO PRINCIPAL LID Renewability: YOU WILL AUTOMATICALLY RENEW MY TIME ACCOUNT AT MATURITY UNLESS 1 NOTIFY YOU OTHERWISE Lo N z Account Title and Mailing Information Customer(s)Listed on Account: Mailing Address: 2145 SOUTH WINCHESTER, LLC 17066 MELODY LN Address Line 2: C/O CITY OF CAMPBELL City: State: LOS GATOS ICA ZIP/Postal Code: Country: 95033-8406 JUS This is a receipt. It need not be presented at the time you obtain payment from the Bank. Page 1 of 1 1060.166(5-11-SVP) VJe!Is Fargo.Cenfidentia!_ i, - �r -- _ �l (C _ .. �--- - ------ - - — ---------- � 4 .. _ - a rn o 0 a 0 o 0 LL O n W N z Z U 2 3 200 bun Refundable Deposit Check Request To: Finance Director Check Payable To: 2145 S.Winchester, LLC. Address-Line 1: 17066 Melody Lane Line 2: City: Los Gatos State: CA Zip: 95033 Description: 2145 Winchester Account Number: 101.2203 Amount: $7,520.00 Account Number: 101.2203 Amount: Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose; 2145 Winchester Blvd. ECD Refund Permit M ENC2012-00164 Receipt M 249367 Date: 8/1/2013 Receipt M Date: 2 Requested by: Title: Office Spec Dater 8/312017 JoAnna o son Approved by: Title: Sr. Engineer Date: g Roger Storz Finance Dept Only: Verified by: Title: Accounting Clerk II Date: Approved by: Title: Accountant Date: Spec-i�VNl �ructi-on_c For Handling Check - Mall ASA: Mail In Attachea Envelope: 1 Interim uneCK: / o Needed By: % C Re urn To: JoAnna Thomason Public Works i (Name) (Department) Other: Please return check to JoAnne Ref undnble Deposit: Check Request To- .Finance Director- ; Gheck;Payable`To: Scott Plautz' \� = Address.-Lihe 1: 17066 MelodyLahe Line 2: _ - City: Los-Gatos State:.CA, Zip: 95033 . : . Descr;iption. .2146_Winchester . Account;Number: 101.2203 Amount: $2,99"13:00• Account Number: 101:2203 . Amount: ` -Account Nurl.66r. ;101 546.7448 Amount: = (Finance Dept only) _,7nterest,Earned (Finance Dept only.) Total Payable: :; (Exact Amount) Puepose: ' . -.2145.Winche"st&Blvd. PC Refund Pe�rnit M ENC2012-06164 Receipt'# 24554.7 _ Dater 11%5/2012 Receipt# Date: - Requested ty' Title: Office'S;pec- _ ' Date: : JoAnn fio , son, d_by Title: Sr.. Engineer Approve Date: ` . ::Roger.Storz: Finance Dept Only:' Verified by` ., Title:, Accounting-Clerk ll Date: :Approved b' Title: Accountant : Date: SpecialT. ::Inst uctioris For- Handling Check ma11:AS' d.: ter" IImwin Attachetl Envelope- interim'UfiddK: Retut To:, JoAnria.Thomason. Public;Works' i '(Name)' (Depaitment) - Other :Please return check to-JoAnna CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2012-00164 Name: Scott Plautz Property Address: 2145 S. Winchester Date of Final Inspection: On File: Bonds %Opp,, Cash Faithful PerformarL'ce: $ Labor and Material: $ 6onstruction Rash_.Deposu - o be-re eased: Other overdue deposits to be released (Description A Processed by: �� vzk Administrator Reviewed by: nspector Reviewed by: Land Development Engineer I .1:UoAnnanDeposit refunds\CHECKLISTS\Winchester2145..doc(Rev. 10/1 1) ' f TO BE RECORDED WITHOUT FEE Ce SECTION 6103 GOVERNMENT CODE E 2. AT THE REQUEST OF CITY.OF CAMPBELL ter 0i;;RK6 OFFICE Pages: 10 DOCUMENT: 22358843 Recording Requested by: ) r I Fees. it No Fees 1 Taxes. City of Campbell , ) I 1 Cop i es. . AMT PA]D, When recorded mail.to: } REG1_NA ALCONENDRAS RDE # 011 City Clerk ) SANTA CLARA COUNTY RECORDER 0:39 A013 City.of Campbell ) Recorded at the request of 10'39 AM 70 North First Street } City Campbell, CA 95.008 ) APN: 305-33-100 (Space above this line for Recorder's use only.) ADDRESS: 2145 Winchester Blvd., Campbell,CA 95008 STREET IMPROVEMENT AGREEMENT RECITALS THIS,AGREEMENT, identified by File No(s), PLN 2011-318, is entered into this day of 2013, by and between 2145 SOUTH WINCHESTER, LLC, A CALIFORNIA.LIM1TED LIABILITY COMPANY, hereunder refer ed to 'as "Owner," and the CITY OF'CAMPBELL, a municipal corporation of the County of Santa Clara, State of California, hereinafter referred to as."City.." On June 197 2012 the City Council granted conditional approval of anew commercial building for that certain real property situated in the City of Campbell, County of Santa Clara,- State of California described as Parcel A, of the Parcel Map filed for record on June 27, 2007 is the Recorder's Office of Santa Clara County, State of California, in Book 815 of Maps,Pages 38 and 39, and commonly known as 2145 Winchester Boulevard, which property is hereinafter referred to as"-said real property." TERMS AND CONDITIONS Now, therefore, in consideration.of the above referenced approvals, and in satisfaction: thereof, the parties to this Agreement shall comply with the following terms and conditions: (1) The Owner shall provide, construct and install at his/her own proper cost and expense, street improvements as described in Section 11.24.040 of the City Code within. 12 months from the date first mentioned hereinabove; provided, however, that in,the computation of said 12 month period, delays due to, or caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of the Owner or his/her successors shall be excluded. (2) If the Owner fails to complete the work required by this Agreement within the said 12 month period, the City, after giving ten (10) days written notice to the Owner, or his/her successors, may construct and/or install said improvements and recovery the.; ullec Irc�A TRUEE expense from the Owner, or his/her successors. WAD CORRECT COPY OF THE ORIGINAL ON FILE IN THIS OFFICE -, =E CrFY CLERK r'i'f` : C PBELL,CA DATE' �L r r STREET DaROVEMENT PLANS (3) The Owner, shall cause to be prepared at Iris/her cost and expense street improvement plans for the construction and installation of said improvements prior to such construction or installation. Said plans shall be prepared by a civil engineer registered by the State of California and submitted to the City Engineer for examination and,approval. (4) All of said improvements embraced in this Agreement shall be constructed and installed in accordance with the plans approved by the City Engineer and shall be made under the inspection and to the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and -all applicable plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes. Upon completion and acceptance of the improvements by the City, the Owner, shall provide reproducible as- built plans to the City Engineer. PLAN CHECK AND INSPECTION FEE (5) . Prior to 'approval of the plans by the City Engineer pursuant to Section (3) of this Agreement, Owner, or his/her successors, shah pay the City for plan checking of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in accordance'with kesolution No. 10494 as adopted by the City Council on May 3, 2005, or as may subsequently be adopted by the City Council. FAITHFUL PERFORMANCE SECURITY (6) The Owner, or his/her successors, shall file with City, prior to beginning construction, security acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure full and faithful performance of the construction of all the aforementioned improvement work.. Said security shall guarantee that Owner, and his/her successors, will correct any defects which may appear in said improvement work within one (1) year from the date of acceptance of the work by City and pay for any damage to other work resulting from the construction thereof, as weIl'as pay the cost of all labor and materials involved. This security shall remain in effect until one(1) year after date of final acceptance of said improvements by City. Said security amount may be reduced by the City Engineer in his/her sole discretion after the date of final acceptance to not less than twenty-five (25)percent of its full value- (7) Upon final release of said security by City, the obligations of Owner, and his/her successors, contained in this Agreement shall be considered mull and void, except as otherwise provided by applicable law, or Sections 12 or 13 of this Agreement. FORMATION OF A SPECIAL ASSESSMENT (8) The Owner, when called upon by City to do so,'shall execute a petition for the formation of any special assessment district created pursuant to any special assessment act as provided in the Streets and Highways Code of the State of California created for the 2 purpose of constructing and/or installing any or all of said improvements. Owner, or his/her successors, shall participate in and become a part of any special assessment district as described in Section(S) of this Agreement. (9) The Owner's, or his/her successors' obligations contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district shall be considered to satisfy those obligations. RIGHT-OF-WAY ACQUISITION (10) Owner at his/her own cost and expense, shall acquire any easement and right-of-way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans. It is provided, however, that in the event eminent domain proceedings are required for the purpose of securing said easement and right-of-way, Owner, shall deposit or cause to be deposited with City a sum covering the reasonable market value 'of the land proposed to be taken and to be included in said suin shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and_costs, engineering and other incidental costs shall be deposited with the City. (11) The Owner, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his/her own cost and expense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation lines within or without the boundary of said real property. INDEIt=Y AND INSURANCE (12) The Owner, and his/her successors, to the fullest extent permitted by law, shall indemnify, defend and hold the City of Campbell; its agents, employees, attorneys; officers, officials and assignees harmless from any .and all claims, actions, causes of action, liabilities, damages, losses and expenses, including, but not limited to, attorneys'fees, arising put of, or resulting from, or alleged to arise out of or result from any negligent or intentional act or omission (including - misconduct) of said Owner, or his/her successors, or any subcontractor, or anyone directly or indirectly employed by hiiri, or anyone for whose acts any of them may be liable in the course of performance of the Agreement; except for any claims, actions, causes of action, liabilities, damages, losses and expenses proximately caused by the sole negligence or willful misconduct of.the City. (13) The Owner, and his/her successors, shall also indemnify, defend and hold the City of Campbell, its agents, attorneys, employees, officers, officials, and assignees harmless against and from.any and all claims, actions, causes of action, liabilities, demands, losses, lawsuits,judgments, damages, costs and expenses (including, but not limited to, attorneys' fees and court costs,whether incurred at trial, appellate or administrative levels)which the City of Campbell may incur or suffer, or to which the City of Campbell may be subjected resulting from, or'alleged to result from the failure of Owner, or his/her heirs; assignees, successors, grantees, agents, employees, subcontractors, or anyone performing services 3 under him, to fulfill any of the obligations imposed under this Agreement, except for any claims, actions, causes of action, liabilities, judgments, damages, costs and expenses proximately caused by the sole negligence'or willful misconduct of the-City. (14) The Owner and his/her successors shall also indemnify, defend and hold harmless the City, its agents, officers and employees from any claim, action, or proceeding against the City or its agents, officers or employees to attach, set aside, void or annul an approval of the City, its City Council, Planning Commission, Community Development Director, Public Works Director, Building Official, City Engineer, or other such City official concealing a subdivision, which action is brought within the time period provided for in California Government Code Section 66499.37. (15) In the event that this contract is subject to California. Civil Code section 2782(b), the foregoing indemnity provisions shall not apply to any liability for the active negligence of r the City. The foregoing indemnity provisions are intended to fully allocate all risk of liability to third-parties. No other rights of indemirity or contribution shall exist.between the parties in law or in equity. The provisions set forth in this section shall survive the tem.unation of this Agreement. (16) The City will promptly notify the Owner of any claim, action or proceeding to attack, set - aside, void or annul any approval concerning a subdivision of said real property, and will cooperate fully in the defense. (17) . Owner and his/herfits successors shall maintain insurance for injuries to persons or damage to property conforming to the following specifications: A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office (ISO) CGL form CG 00 01 11 85;and 2. ISO form G0009 11 88 Owners and Contractors Protective Liability Coverage Form Coverage for Operations of Designated Contractor; and 3. Course of Construction Insurance covering all risks of loss; and 4. ISO CA 00 0106 92 including symbol I (.Any Auto); and .5. Workers' Compensation insurance as required by the Labor Code of the State of California and Employer's Liability insurance. B. Minimum Limits of Insurance Owner shall maintain linnits no less than: 1. General Liability: $1,000,000 combined single Emit per occurrence for bodily; personal injury and property damage. If Conunercial General Liability Insurance or other form with a general aggregate limit is used, 4 r either the general aggregate limit shall, apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily hajury and property damage. 3, Workers' Compensation and Employer's Liability:Workers' Compensation limits as required by the Labor Code of the State of California and Employer's Liability limits of$1,000,000 per accident. C. Deductible and Self-Insured Retention Any deductibles or self-insured retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City, its agents, officers, attorneys, employees, officials and volunteers; or the Owner shall procure a bond guaranteeing payment of losses related to investigations, claim administration, and - defense expenses. D. Other Insurance Provisions The policies are to contain, or be endorsed to contain,the following provisions: 1. General Liability and Automobile Liability Coverage: a. The City, its agents, officers, attorneys, employees, officials and volunteers are to be covered as insureds as respects: liability arising out of activities related to this Agreement performed by or on behalf of the Owner, products and completed operations of the Owner, premises owned, occupied or used by the Owner, or automobiles owned, leased,hired or borrowed by the Owner. b. The. Owner's insurance coverage shall be primary insurance 'as respects the City, its agents, officers, attorneys,employees, officials and volunteers. Any insurance or self insurance maintained by the City, its agents, officers, attorneys, employees, officials and volunteers shall be excess of the Owner's insurance and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its agents, officers, attorneys, employees, officials, and volunteers. d. The Owner's insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. e. Coverage shall not extend to any indemnity coverage for the active, negligence of the City in any case where an agreement to indemnify the City would be invalid under Subdivision (b) of Section 2782 of the California Civil..Code. 5 2. Workers' Compensation and Employer's Liability Coverage: The insurer shall agree to waive all rights of subrogation against the City, its agents, Officers, attorneys, employees, officials, and volunteers for losses arising from work performed by the Owner for the City. 3. Course of Construction Coverage: Course of Construction policies shall contain the following provisions: (a) the City.shall be named as loss payee; and (b)the insurer shall waive all rights of subrogation against the City. 4. All Coverages: Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or in limits except after thirty (30) days. prior written notice by certified mail, return receipt requested, has been given to the City. E.. Acceptability of Insurers Without limiting Owner's indemnification provided hereunder, Owner shall take ® out and maintain at all times during the life of this contract, up to the date of acceptance of the work by the City,-the policies of insurance listed in.Paragraphs 12 through 16 of this Agreement, Insurance is to be issued by an issuer with a current A.M. Best Rating of ANH and be authorized to transact business in the State of California, unless otherwise approved by the City. F. Verification of Coverage Owner shall furnish the City with certificates of insurance evidencing coverage required by this clause. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf The certificates are to be on forms provided by the City. Where by statue, the City Workers' Compensation related forms cannot be used, equivalent forms approved by the Insurance Commissioner are to be substituted. All certificates are to be received and approved by the City before work commences. G. Subcontractors Owner shall include all subcontractors as insured under its policies or shall furnish separate certificates by each subcontractor. All coverage shall be subject to all of the requirements stated herein. MUTUAL BENEFIT COVENANTS B1ND]NG ON HEIRS, ASSIGNEES SUCCESSORS AND GRANTEES OF OWNER (18) It is acknowledged that the provisions of this Agreement constitute covenants for the improvement of the subject real property for the mutual bezzefit of Owner's property, commonly known as 2145 Winchester Boulevard, and the .City's property, commonly described as Winchester Boulevard and.W. Rincon Avenue where it adjoins Owner's . property. These covenants shall be considered to affect rights in the above-described real 6 properties, and shall be binding on the heirs, assignees., successors, grantees and agents of . the Owner to said real property. LTNVESTED INTERESTS (19) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. BREACH OF CONTRACT (20) The City, upon breach any of the terms, conditions, or covenants of this Agreement by the Owners, shall be entitled to recover from the Owner, in addition to any other relief available in law or equity, all costs and compensation incurred in attempting to obtain enforcement of the Agreement, including reasonable attorneys'fees and court costs. ENTIRE AGREEMENT BINDING (21) This is the entire Agreement between .the parties, and there are n.o representations, agreements, arrangements *or understandings that are :not fully ''expressed herein. This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement, binding on all parties. PRELIM 1NARY PLANTS (22) Owner.shall provide and construct public street improvements per preliminary plans-titled "STREET IMPROVEMENT PLANS — OFFSITE — 2145 Winchester Blvd, which are subject to approval by the City Engineer,prepared by Hanna Brunetti Civil Engineers. 7 IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City Clerk, who are.duly authorized by Ordinance 2059 adopted September 20, 2005, and said Owner has caused his/her name to be affixed the day and year-first above written. 2145 SOUTH WINCHESTER, LLC, A CALIFORNIA LIMITED LIABILITY COMPA,NY Signature Printed Name and Title CITY OF CAMPBELL 1 Michelle Quinney, City Enginegp/' � City of Campbell (Notary Acknowledgment.for above signator(ies) MUST be attached.) Attest: I Zj 'XI Ann ybee,City Clerk I 9 -CALfFORNIA ALL PURPOSE !' CERTIFICATE OF ACKNOWLEDGMENT I �i State of Califoznia I I County of C� On�_ ,_��rt Z.��,fll� before me, (Here insert name and title of the officer) personally appeared t who proved to me on the basis of satisfactory evidence ti be the person(s) whose name(s) is/are subscribed to 1 the within instrument and'acknow-ledged to me that lie/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their Signature(s)on the instrument the person(s), or the entity upon behalf of � which the person(s) acted,executed.the instrument. I 11 I certify under PENALTY OF PEI2JCJR�r under the laws of the State of California that the foregoing paragraph is true and correct. 1 .H UZZ THOR=OAi ] Commission;#19310662 Vi ESS my hand and official seal. Notary Pak-California Santa Clam,County :fin fi31 ' Conlm�Wxsffiar 29,2015 M (Notary Seal) Ll Signahrire of No Public ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Jf I Any aclotowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section ar a separate acknowledgment form must be +!! properly completed and attached to that document. The only exception is if a { ; i document is to be recorded outside of California.in such nt) instanc (Title or description of attached docttn es,atry alternative ]j rtcbrawledgment verbiage.as may be printed on such a document so long as the ie verbiage does not require the notary'to do something that is fllegal for a notary in California (i.e. certifying the authorized capacity of the signer),Please check 1F,e document care)u11y forproper notarial warding and attach Mir farm ifrcieuired. �441 (Title or description of attached document.continued !� State and County information must be the State and Counly where the document Number of pages Document Date signer(s)personally appeared before the notary public for acknowledgment. I' l - Date of notarization must be the date that the signmjs)personally appeared which must also be the same date the acknowledgment is completed. (Additional information) - The notary public must print his_or_her name as it appears within his or h--r �I commission followed by a comma and then your title(notary public). l; JI - Print the name(s) of document signer(s) who personally appear at the time of i notarization. I I CAPACITY CLAIMED EY THE SIGNTER • Indicate the correct singular dr plural fonns by crossing off incorrect forms(i.e. Wshc/43 ey is/ere)or circling the correct forms.Failure to correctly indicate this 1 ❑ Individual�s} information may lead ro rejection of document recording. �! J ❑ Corporate Officer - The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines.If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. Ij ❑ partners) Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attome -in-Fact I 3` Additional information is not required but could help to ensure This ❑ Trustee(s) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type of attached document,number of pages and date. Indicate the capacity claimed by the signer,if the claimed capacity is a I corporate officer,indicate the title(Le.CEO,CFO,Secretary), Securely attach this document to the signed document 14 2008 Version CAPA v12.)0.07 S00-873-9865 wwtv.N'otaryClasses.com CALIFORNIA ALL-PURPOSE -CERTIFICATE' OF ACKNOWLEDGMENT i 1 State-of California r County of 5a'Atoms I� On 10G before r e, u�i✓i`«�(` �� R ` ` �ram! �t1� I i (Here insert name and t the of the officer) I "1: I personally appeared �G I who proved to me on the basis of satisfactory evidence to be the person(s)whose namc(s)is/are subscribed to the within instrument.and acknowledged to me than he/she/they executed the same in his/her/their authwized capacity(ies), and that by His/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which theperson(s) acted,executed the instrument. �I I certify under PENALTY-OF PERJURY under the laws of the State of California that the foregoing•paragraph � is.true and correct. I JOANN THOMASON �I i i Commission S 1930682 z rESS my hand and official seal. Notary Public-Gardomia z Santa Glary County ' lay"Comm.Exo3s VX 28.2d15 j f � i { (Notary Seal) Ili +I =,n Public 4 t ADDITIONAL OPTIONAL INFORMATION �! INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California trust contain verbiage exactly as DESCRIPTION OF'THE ATTACHED DOCUMENT appears above in the notary section or a separate adrnowlcdgment form must be t proper]) completed and attached to that document The only erceptfoa is if a r t document is to be retarded ouside of California.In such instances,ant,aller•nadve -��!»�V '1`W acknowledgment verbiage as may be printed on such a document so long as the (Tide or description f attached ocument) verbiage does not require the notary to do something that is illegal for a no")in l �� (�� California (Le. certifying the authorized capacity of the signer,l Please clerk the I efully for propernotarial wording and attach this fonn if required (Title or description of attached datum - continued) doa=enf car Number of Pages DoCutnent Ddte th- State and County information must be e State and County where the document signer(s)personally appeared before the notary public for acImbwledgment. - bate of notari7ation must be the date that the signu(s)personally appeared which i musf.-Jso be the same date the acknowledgment is completed. I j (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notary public). it • Print the name(s) of document signer(s) who personally appear at the time of I! t h, notarization. !! CAPACITY CLAIMED BY T:?E SIGNER l - Indicate the correct singular or plural forms by crossing off in arse r forms(.e: l'I i helshelt4wj--is/are)or circling the correct forms.Failure to correctly indicate tbis' �I ❑ Individual(S) information may lead to rejection of document recording, ❑ CorpoTate Officer The notary seal impression must be clear and photographically reproducible, Impression must not cover tcrt or lines.If.seal impression smudges,re-seal if a lif sufficient area permits,otherwise complete a different acknowledgment fonn. (Title) ❑ Partners) Signature of the notary public must match the signature on file with the office of it l the county clerk. {' j ❑ .gftolTley-1J?-Fact Additional information is not required but could help to ensure this ` ❑ TrusLee(S) acknowledgment is not misused or attached to a different document. I Indicate:title ortype of attached document,number of pages and date. ❑ Other Indicate the capacity claimed b the signer.If the.claimed capacity is a I 1, p l; corporate officer,indicate the title(i-e•CEO,CFO,Secretary). lit. Securely attach this document to the signed document It 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasscs.com Tv BE RECORDED WITHOUT FEE DOCUMENT: 2 2 5 9 D 41 0 Pages: 7 SECTION 6I03 GOVERNMENT CODE yy�.. lug . * AT THE REQUEST OF CITY OF CAMAgg Ca Fees. No Fees Taxes. . . Recording Requested By: JUN 1� 2014 AMT I PAID 6U� City of Campbell L"ITY CLEHkb U,I REGINA ALCOMENDRAS RDE # 006 SANTA CLARA COUNTY RECORDER 5/08/2014 Recorded at the request of 11 :33 AM After Recording Return To: } City City Clerk ) City of Campbell ) 70 North First Street ) Campbell, CA 95008-1423 APN: 305-33-100 (Space Above for Recorder' s Use Only) Address: 2145 Winchester Blvd. Campbell, CA 95008 AGREEMENT FOR PRIVATE IMPROVEMENTS IN THE PUBLIC RIGHT-OF-WAY - In consideration for granting permission to construct improvements in the public right-of-way, 2145 South Winchester LLC., enters into this Agreement with the City of Campbell. The improvements contemplated under this permit are for the benefit of the real property commonly known as 2145 S. Winchester Boulevard. The City of Campbell grants such permission to install a metal fence along the Winchester frontage of the property under Project File No. PLN 2011-00318. All conditions of Project File No. PLN 2011-00318 remain in full force and effect. The property owner shall be solely responsible for maintaining the improvements in a good and safe condition at all times; and the property owner shall indemnify, defend, and hold harmless the City of Campbell, its officers, officials, agents, volunteers, employees and attorneys from any and all claims, actions, losses, liabilities and costs (including reasonably incurred attorney's fees) arising out of or connected with, or alleged to arise out of-or be connected with the installation, design or condition of the improvements, except for any claims, actions, losses, liabilities and costs proximately caused by the sole negligence or willful misconduct of the City of Campbell, its officers, officials, agents, volunteers, employees or attorneys. This provision is intended to be the dispositive of.all rights of indemnity and contribution between the parties, and property owner waives and releases any and all rights to indemnity or contribution from the City of Campbell, in law or equity, arising out of, or connected with any and all claims, actions, losses, liabilities and costs (including reasonably incurred attorney's fees) for which property owner is obligated under this paragraph to provide . indemnity or defense to the City of Campbell, its officers,. officials, volunteers, employees or �atiorneys. The City, in its sole discretion, may revoke the rights granted under Project File No. PLN 2011-00318 and remove the improvements installed under Project File No. PLN 2011-00318 at any time, without liability.to the property owner, or require that the improvements be removed, and property owner shall have no right to compensation from City in any form. Page 1 of 3 L , In the event that Owner fails to reimburse the City for the costs of removing the improvement ("default") as required by this Agreement, the City shall have and may execute the absolute right, at the City's option and without demand or notice to Owner,to claim and impose a lien, attached as Exhibit A and incorporated herein by.this reference ("Lien"), on said real property (also referred to herein as "Collateral"). City's failure to exercise this option will not constitute a waiver of the right to exercise it in the event of any subsequent default. (a) Amount of Lien: The Lien shall be for the entire amounts then owing under this Agreement. (b) Recordation: City is authorized to record the Lien in the appropriate Recorder's Office(s). (c) City shall have full authority to perform all acts and things that City may consider necessary or advisable to impose, maintain and enforce the Lien. (d) Debtors' Warranty: OWNERS WARRANT that they are the owners of the Collateral and Owners have the right to make this Lien Agreement. (e) Debtors' Covenants: Owners agree: (i) To pay City all amounts payable pursuant to this Agreement on or before the due date when due and payable, and to perform all terms of this Agreement; (ii) To defend the Collateral against claims and de ands of all persons and entities; (iii) To keep the Collateral in good condition; to perform other acts that may be necessary to preserve the Collateral and protect the Collateral against unreasonable loss and all'hazards, and; (iv) To immediately notify the City in writing when Owners become aware of any event that substantially affects the value of the Collateral, or the rights and remedies of City in relation to the Collateral. (f) Prohibitions: Without the prior written consent of the City, Owners will not permit any liens or security interests (other than the City's Lien) to attach to the Collateral;permit the Collateral to be levied on under legal process; dispose of the Collateral; or permit anything to be done that may impair the value of the Collateral or of the Lien, which is the subject of this Agreement. (g) Notices: Any notice, demand or request required hereunder, or by law, shall be given in writing(at the addresses set forth below) by any of the following means: (a) personal service; (b) facsimile; (c) overnight courier or delivery service; or (d) registered or certified, first class U.S. snail,return receipt requested. n.,..., . Ch'FILE IN 1 HSS OFFit;.r-. ATTEST: ANNE BYBEE,CITY CLERK CAPage 2 of 3 J.4)LFU,)1PEB1ELaL, DATED d , Property owner agrees to maintain homeowners or general liability insurance with a limit of at least $100,000 for damages arising from the installation, design or condition of the improvements. This provision shall run with the land and be binding on the property owner's successors. Executed this day of /��f�Y , 20 5 I� 2 45 S. Win0ster, ikC colt Plautz (Attach Notary Acknowledgment For All Parties) CITY OF CAMPBELL, a municipal Corporation Todd Capurso Public Works Director, City of Campbell ATTES e Bybee, City Clerk Page 3 of') Exhibit A Recording Requested By: . ) City of Campbell ) When Recorded Mail To: ) City Clerk ) City of Campbell ) 70 N. First Street ) Campbell, CA 95008 ) Space above this line for Recorder's use only CLAIM OF LIEN I, City Engineer for the City of Campbell, a California Municipal Corporation("City"), do hereby certify: A. On or about , 20_, ("Debtors") executed an Agreement for Private Improvement in the Public Right of Way with the City of Campbell ("Agreement"). B. The Agreement was recorded in the Santa Clara County Recorder's Office on or about 20_Document Number C. The Agreement allowed the Debtor's to provide, construct, and/or install certain private improvements in front of their property at Oip6if63)y Campbell, California, at their own costs and expense. Pursuant to the terms of the Agreement, the Debtors expressly agreed that if they failed to comply with the Agreement, the City was authorized to remove said improvements and recover the full cost and expense thereof from the Debtors or their successors. D. The Debtors did not remove the improvements after being notified to do so. Therefore, the City removed said improvements. E. In _ , 20_,,the City informed the Debtors about the improvements that would be removed pursuant to the Agreement. F. The City subsequently completed the work. On or about , 20_, the City sent the Debtors an invoice for said work in the amount of$ G, Pursuant to the terms of the Agreement, the Debtors expressly agreed that the City is authorized to, at the City's option and without demand or notice to the Debtors, immediately claim and impose a lien on the real property commonly known as ZI q S, R� v/'Campbell, California, APN Number. for the entire amounts then owing under, or incurred pursuant to, the Agreement, including without limitation, the entire unpaid principal amount. Page 1 of 2 J WHEREFORE, the City of Campbell, A California municipal corporation, pursuant to the Agreement, hereby claims a lien upon the work of improvement and the land upon which it is situated, namely, the real property commonly known as Campbell, California, APN Number in the amount of $ and said amount shall constitute a lien against said property until paid in full. IN WITNESS WHEREOF the City of Campbell, California, a California Municipal Corporation, has duly authorized the undersigned to execute this instrument in its name. Dated: By: for the CITY OF CAMPBELL, a California municipal corporation (Notary Acknowledgement Required for Signatures) Page 2 of 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of On before me, JA461c� Date H4re Insert Aame and Title of the fficer fi personally appeared S C-v� 14 t _Z- Name(s)of Signer(s) ------------------------ who proved to me on the basis of satisfactory evidence to be the person) whose name( ; islare fi subscribed to the within instrument and acknowledged fii to me that he/sheffhey executed the same in his/heir_-authorized capacjty(ae*, and that by his/heOtht+r signature(s) bn the instrument the person(,s}, or the entity upon behalf of which the ANNE BYBEE person(-P4 acted, executed the instrument. fi C011111111iffiSSiOn V 1971054 Notary Public-Caldornia z I certify under PENALTY OF PERJURY under the R Z sAn"ta Lcollatra Countyfi My Comm.Ex ire i0aar 2016 laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand a'nd official seal. Signature: 2 Place Notary Seal and/or Stamp Above Signature of-D—otary Putiiic OPTIONAL Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. 'Description of Attached Document Title or Type of Document: hhI Document Date: Numb r of Pages: Signer(s) Other Than Named Above: fi Capacity(ies) Claimed by Signer(s) fi Signer's Name: Name: fi El Corporate Officer Title(s): 0 Corporate Officer—Title(s):fi fi 0 Individual El Individual 1'.1 V fiID Partner—0 Limited 0 General Too of thumb here El Partner—El Limited 1:1 General Top Of thumb here fi El Attorney in Fact 0 Attorney in Fact fi El Trustee El Trustee fi fi El Guardian or Conservator 0 Guardian or Conservator fi F-1 Other: 0 Other: fi fi fi Signer Is Representing: Signer Is Representing: T — (D 2008 National Notary Association-9350 De Soto Ave.,P.O.Box 2402-Chatsworth,CA 91313-2402-www.NationalNotary.org Item#5907 Reorder:Call Toll-Free 1-800-876-6827 CALIFORNIA ALL-PURPOSE i CERTIFICATE OF ACKNOWLEDGMENT �I , I State of California i i I County of li On W. S �3(C before me, �� `�`�� IV� .��► �� (Here insert name and title of the officer) i personally appeared IC I I who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to (I the within instrument and acknowledged to ire that he%she/they executed the same in his/her/their authorized 1 capacity(ies), and that by his/her/their signatures) on the instrument the person(s), or the entity upon behalf of iwhich the person(s) acted, executed the instrument. I I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOAIM UtOMASON ESS m hand and official seal. NotaConry Publsionic �193©s82 I y � Ptotary Pubfic-California s Santa Clara County Comae ExOirWs�4ar 2®,2016 (Notary Seal) Si `ature of ary u is I I I ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be properly completed and attached,to that document. The only exception is if a I document is to be recorded outside of California.In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the (Title or description of attached document) verbiage does not require the notary to do something that is illegal for a notary in I �� \` ` California (i.e. certifying the authorized capacity of the signer). Please check the �w\�(�CCvc'y`AFv i (Title or description of attached document continued) document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document Number of Pages Document Date signer(s)personally appeared before the notary public for acknowledgment. i I • Date of notarization must be the date that the signer(s)personally appeared which j must also be the same.date the acknowledgment is completed. j • The notary public must print his or her name as it appears within his or her (Additional information) commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of i notarization. { CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/diey;is/are)or circling the correct forms.Failure to correctly indicate this i ❑ Individual(s) information may lead to rejection of document recording, ❑ Corporate Officer The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. El Partner(s) Signature of the notary public must match the signature on file with the office of i the county clerk. I ❑ Attorney-in-Fact Additional information is not required but could help to ensure this j ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Indicate title or type of attached document,number of pages and date. ❑ Other Indicate the capacity claimed by the signer. If the claimed capacity is a i i ! corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document �I I l I it 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com JoAnna ----Jason OF'CA` io Office A,_ �_nt �k 10 City of Campbell _ U ismr, Department of Public Works r 70 North First Street ° ° Campbell,CA 95008 y� c` Phone: (408)866-2701 °It c H n ao' Fax: (408)376-0958 E-Mail:Joannat@cityofcampbell.com Transmittal To: Scott Plautz. Date: June 20, 2014 Address: 2145 Winchester Blvd. Re: Agreement for Private Improvements in the Public Right-of-Way ❑ Urgent ❑ For Review ❑ Please Comment -❑ Please Reply ❑ For Information &Use Please find enclosed your copy of the recorded Agreement for Private Improvements in the Public Right- of-Way for your property located at 2145 Winchester Blvd., Campbell, CA 95008 Thank you, J a Th on Office ssistant cc: Project File No. ENC2012-00164 LD File J:\JoAnnaTlRecording Requests\Recorded Docs Sent\Winchester 2145.PHv1mpr.DOC(Rev.03/08) TO RE RECORDED WITHOUT FF-P K-P ',rt 2013 Pages: SEC170N6103GOVEftIV WSrrCODE �°°'f ` `' 22358844 AT THE REQUEST OF CTfY OF C ,� _ i)0 M T '�f i ;LCYiI f I I �IIf �} Fees. . . . No Fees Recording Requested by: } I 1 41 I coX i es. . CITY OF CAMPBELL } AMT PA 1 D When Recorded Mail To ) RDE # 011 City Clerk ) REGlNA ALCGMENDRAS - g/21/2013 City of Campbell � SANTA CLARA COUNTY RECORDER 10 i 39 AM Recorded at the request Of 70 North First street > City Campbeil,CA 95008 APN• 305-33-100 (Space Above This Line For Recorder's Use) ADDRESS: 2145 Winchester Blvd.,Campbell,CA 95008 GRANT OF PUBLIC SERVICE EASEMENT 2145 South Wmrhester,LLC,a Califomia limited liabMY company m hereby GRANTS to the City of CampbeA,a municipal corporation,of the County of Santa Clara,State of California,an.ewen=t for public services,over,through and upon that certain real property widun said City more particularly described as follows: SEE EXE DIT A ATTACHW MME170 AND MADE A PART HEREOF BY REFERENCE Said property contains Square fcet,more or less,and is generally shown on the attached Plat Map. STATE OF CALWORNIA )SS DATED 2-0) COUNTY OF SANTA CLARA ) On "!Sy c . �o��+J bef..me, (SI TURE)` A Notary Public in and for aid State,personally appeared G0, ' (PR1r4T 1 NAME AND TME) 2145 South Winchester:,11C-a California who proved to me on the basis of satisfactory evidence limited liability compan to be the person(s)whose name(s)Wave subscdW to the within instrument and acknowledged to me that he/shelthey executed the same in his/her/theirauth(rized caplia ty(ies). and that by hWher/their signatures)on the instrument the person(s),or the entity upon behalf of which the person(s) JDMN THOMASON acted,executed the instrument. commission#193ON2 Nouq t'um-cantornis a I certify under PENALTY OF PERJURY under the laws of Sub Cilia cowo h is true "Mat 28,2015 the State of California that the foregoing paragrap and correm my d d official seat - Sigma Name _ or printed) Place Notary Seal Above. E,NMBIT`A' LEGAL DESCRIPTIONS TO ACCOMPANY OFFERS OF DEDICATION TO THE CITY OF CAMPBELL FOR PUBLIC SERVICE EASEMENTS 2145 WINCHESTER BLVD.,CAMPBELL,CA PUBLIC SERVICE EASEMENT NO.1 Being a 5 foot wide easement for the installation and maintenance of any and all public service facilities including but not limited to water, sanitary sewer,storm drain,telephone, gas, electricity, cable t.v., etc., and any appurtenances thereto lying under, over, on and across a portion of Parcel `A' as shown on that Parcel Map filed June 27, 2007 in Book 815 of Maps, at Pages 38-39, Records of the County of Santa Clara, State of California, being more particularly described as follows: BEGINNING at the northwesterly corner of said Parcel `A', thence along the northerly boundary of said Parcel South 890 53' 00" East 90.08 feet to a point of curvature; thence leaving-said boundary.South 00" 07' 00" West 5.00 feet to a point; thence North 890 53' 00" West.90.06 feet to a point on the westerly boundary of said Parcel; thence along said westerly boundary North 00' 06' 26"West 5.00 feet to the POINT OF BEGINNING. Containing 450 square feet,more or less. PUBLIC SERVICE EASEMENT NO.2 Being a 5 foot wide easement for the installation and maintenance of any and all public service facilities including but not limited to water,sanitary sewer, storm drain,telephone, gas, electricity, cable t.v.,etc., and any appurtenances thereto lying under, over, on and across a portion of Parcel `A' as shown on that Parcel Map filed June 27, 2007 in Book 815 of Maps, at Pages 38-39, Records of the County of Santa Clara, State of California, being more particularly described as follows: BEGINNING at the- southeasterly comer of said Parcel `A', thence along the easterly boundary of said Parcel North 00' 06' 26 West 160.12 feet to a point of curvature; thence leaving said boundary South 89" 53' 34" West 5.00 feet to a point; thence South 000 06' 26" East 160.10 feet to a point on the-southerly boundary of said Parcel; thence along said southerly boundary South 89'53' 00"East 5.00 feet to the POINT OF BEGINNING. Containing 801 square feet,more or less.- These legal description ®p by me and are based on record data. R. Arnold R. Brune , C.E. 1 CA:� I See Exhibit`B' a hereto and d part hereof. CIVIL Basis of Bearinms: Theeo` W. Rincon Avenue as shown as S.89°53'00"E. on that parcel map filed in Book 81 o waps, at Pages 38-39, S.C.C.R. THE FOREGOING INSTRUMENT 18 A TRUE AND CORRECT COPY OF THE ORIGINAL Page 1 of 2 ON FILE IN THIS OFFIcr. ATTEST.ANNE BYb a,Cr i Y CLERK BYCI a _ TY�CF "€PB= .CA DATED a4lI f `I� i Basis Of Bearings S89-53'00"E Centerline E. RINC®N W. RINCON AVENUE �.-- AVENUE c,a Rpr-ESO^ (A PUBLIC STREET 60 FEET WIDE) � S89'53'00"E 90.08' •O� 17186 ` M m U, N89'53'00"W J, 90.06' Exp. •!r II „w - a W C o C SEGO-1 soo o-7,C) `Pq�; civil_ O1� 01 WE�50 01 ., y0 o a rn rn PQ� N N D LANDS OF 2145 S. WINCHESTER LLC. a> ai DOC, # 21826223 m m 0 ° PARCEL A_ � m 815 MAPS 38-39 N U) 801 54, ,5ph 45 D 1 PQ� /1p0 0 Basis of Bearings note �� o IM The bearings- shown on 'y� � C > this map are based on PQ� j m r— En o the centerline of W. o o M Rincon Avenue as shown C ;0 as S.89'53'00"E. on 815 n' Q yo Maps 38-39, Records n of Santa Clara County. S89'53'00"E 1 f MISSION WAY o 5•00'-� ~P.O.B. (Private) `1' P.S.E. NO. 2 LEGEND EMAREA OF OFFER OF DEDICATION TO THE CITY OF CAMPBELL FOR PUBLIC SERVICE EASEMENT EXHIBIT B --- BOUNDARY OF EASEMENT ALONG PROPERTY LINE BEING A PLAT TO ACCOMPANY OFFERS -- BOUNDARY OF EASEMENT OF DEDICATION FOR PUBLIC SERVICE P.S.E. PUBLIC SERVICE EASEMENT EASEMENTS TO THE CITY OF CAMPBELL, P.O.B. POINT OF BEGINNING COUNTY OF SANTA CL.ARA, CALIFORNIA Hanna & Brunetti 2145 WINCHESTER BLVD. 9N ■Civil Engineers - Land Surveyors - CAMPBELL, CALIFORNIA -■Construction Managers■ Gilroy, California (408) 842-2173 PAGE 2 OF 2 L n ACCEPTED ON THIS__ _ .day of for and on behalf of the City of Campbell,a Municipal. Corporation,of the State of California,pursuant to Resolution No. 749, recorded in Book 4509 ge-180 Santa Clara County Records. Anno Bybee, City Clerk City of Campbell., California 9/22/2016 D.L. Falk Construction, Inc. Labor and Material $29,700.00 Bond for Faithful Performance $29,700.00 Liberty Mutual Insr. Company ENC2012-00164 Scott Plautz 2145 Winchester/Blvd CD#81477 78 55 Wells Fargo Bank $188,00d To 7A/It 8/1/13 Joy 1677 S. Bascom Ave. Campbell Apartment properties, LLC �. 4-Story 160 Unit Mixed-Use Apartment Complex Labor and Material $236,000.00 Faithful Performance$236,000.00 International Fidelity Ins. . To Vault 6/25/13 —JoAnna ENC2012-00164 2145 S. Wine ster Blvd. CD $47/.12r2241352 00,.00 214nchester, LLC. Wel CD, To/Vault 5/23/147 JOAnna ENC2013-00175 Aron Developers;LLC. Street Improvements at 1201 Campbell Ave. Labor and Material $73,200.00 Faithful Performance$73,200.00 Suretec Insr. Company. To Vault 11/18/13 per JoAnna Change Rider to Bond Additional $5,000.00 addition to bond. Aron Developers, LLC. Street Improvements at 1201 Campbell Ave. Suretec h-isr. Company. To Vault 12/6/13 per JoAnna J:\Miscellaneous Files\SURETYDEP.DOC CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR NOTICE OF RELEASE OF RECORDED STREET IMPROVEMENT AGREEMENT Encroachment Permit # Property Address Date Street Improvement Agreement recorded Date of Final Acceptance Letter Date of One-Year Maintenance Acceptance Letter f All deposits refunded (Date of last refund) l',� (��'r �� I� I k� Inspector's Encroachment Permit file merged with Main iPermit File Date Permit archiv d in ermit Plan Processed by: Reviewed By: Inspector Reviewed by: Land Develop menft n veer b 0 1 Date Check Request Submitted to Finance for Recording Fee Date Notice of Release sent for recording: \\Honouliuli.cityball.ci.campbell.ca.us.local\Profile_Data$\joannat\Desktop\My FormsUlecklist-Release of Street Improvement Agreement.doc(Rev. 10/11) t TO BE RECORDED WITHOUT FEE rF i= SECTION 6103 GOVERNMENT-CODE �- AT THE REQUEST OF CITY.OF CAMPBELL GUERK S OFFICE Pages: 10 Recording Requested by: ) DOCUMENT: 22358843 Fees. . . . * No Fees City of Campbell ) ! i I Cap ees. . } AMT PAID When recorded mail to: ) REGiNA ALCOMENDRAS RDE # 011 City Clerk ) SANTA CLARA COUNTY RECORDER 8/21/2013 City of Campbell ) Recorded at the request o{ 10:39 AM 70 North First Street } City Campbell, CA 95008 ) APN; 305-33-100 (Space above this line for Recorder's use only.) ADDRESS: 2145 Winchester Blvd.,Campbell,CA 93008. STREET IMPROVEMENT AGREEMENT RECITALS THIS GREEMENT, identified by File No(s), PLN 2011-318, is entered into this day of V(uS,` , 2013, by and between 2145 SOUTH WINCHESTER, LLC, A CALIFORNIA L1MYMD LIABILITY COMPANY, hereunder referred to'as "Owner," and the CITY OF CAMPBELL, a municipal corporation of the County of Santa Clara, State of California,hereinafter referred to as "City," On June 19, 2012 the City Council granted conditional approval of anew commercial building for that certain real property situated in the City of Campbell, County of Santa Clara, State of California described as Parcel A, of the Parcel Map filed for record on June 27, 2007 in the Recorder's Office of Santa Clara County, State of California, in Book 815 of Maps,Pages 38 and 39, and commonly known as 2145 Winchester Boulevard, which property is hereinafter referred to as "said real property." TERMS AND CONDITIONS Now, therefore, in consideration of the above referenced approvals, and in satisfaction thereof, the parties to this Agreement shall comply with the following terms and conditions: (1) The Owner shall provide, construct and install at his/her own proper cost and expense, street improvements as described in Section 11.24.040 of the City Code within 12 months from the date first mentioned hereinabove; provided, however, that in the computation of said 12 month period, delays due to, or caused by acts of God, viz., unusually inclement weather, major strikes, and other delays beyond the control of the Owner or his/her successors shall be excluded. (2) If the Owner fails to complete the work required by this Agreement within the said 12 month period, the City, after giving ten (10) days written notice to the Owner, or his/her successors, may construct and/or install said improvements and recouery,the., Il 1 gsr.� cS FU1 expense from the Owner, or his/her successors. MD CORRECT OOPY OF THE ORIGINAL ,r!FrLF.IN THIS OFFICE. '' �( :•�' E CYN CLERK PcELL,CA DATED `_'L STREET IMPROVEMENT PLANS (3) The Owner, shall cause to be prepared at his/her cost and expense street improvement plans for the construction and installation of said improvements prior to such construction or installation. Said plans shall be prepared by a civil engineer registered by the State of California and submitted to the City Engineer for examination and,approval. (4) All of said improvements embraced in this Agreement shall be constructed and installed in accordance with the plans approved by the City Engineer and shall be made under the inspection and to the satisfaction of the City Engineer. Said construction and/or installation shall be in accordance with the existing ordinances and resolutions of the City of Campbell and all applicable plans, specifications, standards, sizes, lines and grades approved by the City Engineer, and all State and County statutes. Upon completion and acceptance of the improvements by the City, the Owner, shall provide reproducible as- built plans to the City Engineer. PLAN CHECK AND INSPECTION FEE (5) Prior to approval of the plans by the City Engineer pursuant to Section (3) of this Agreement, Owner, or his/her successors, shall pay the City for plan checking of improvement plans, field inspection of construction of improvements and all necessary expenses incurred by City in connection with said improvements, a sum calculated in accordance with.Resolution No. 10494 as adopted by the City Council on May 3, 2005, or as may subsequently be adopted by the City Council. FAITHFUL PERFORMANCE SECURITY (6) The Owner, or his/her successors, shall file with City, prior to beginning construction, security acceptable to the City in amount equal to the City Engineer's estimated cost of the street improvements to ensure full and faithful performance of the construction of all the aforementioned improvement work. Said security shall guarantee that Owner, and his/her successors, will correct any defects which may appear in said improvement work within one (1) year.from the date of acceptance of the work by City and pay for any damage to other work resulting fi om.the construction thereof, as well•as pay the cost of aU labor and materials involved. This security shall remain in effect until one(1) year after date of final acceptance of said improvements by City. Said security amount may be reduced by the City Engineer in his/her sole discretion after the date of final acceptance to not less than twenty-five(25)percent of its full value. (7) Upon final release of said security by City, the obligations of Owner, and his/her successors, contained in this Agreement shall be considered null and void, except as otherwise provided by applicable law, or Sections 12 or 13 of this Agreement. FORMATION OF A SPECIAL ASSESSMENT (8) The Owner, when called upon by City to do so, shall-execute a petition for the formation of any special assessment district created pursuant to any special assessment act as provided in the Streets and Highways Code of the State of California created for the 2 purpose of constructing and/or installing any or all of said improvements. Owner, or his/her successors, shall participate in and become a part of any special assessment district as described in Section(8) of this Agreement. (9) The Owner's, or his/her successors' obligations contained in this Agreement that are accomplished to the satisfaction of said City Engineer by said special assessment district ,shall be considered to satisfy those obligations. RIGHT-OF-WAY ACQUISITION (10) Owner at his/her own cost and expense, shall acquire any easement and right-of--way within or without said real property necessary for the completion of the improvements shown upon aforesaid improvement plans. It is provided, however, that in the event eminent domain proceedings are required for the purpose of securing said easement and right-of-way, Owner, shall deposit or cause to be deposited with City a sum covering the reasonable market value of the land proposed to be taken and to be included in said smm shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto such sums as may be required for legal fees and_costs, engineering and other incidental costs shall be deposited with the City. (11) The Owner, shall carry out any and all negotiations with all interested parties and shall perform or cause to be performed at his/her own cost and expense and to the satisfaction of the City Engineer any and all work required to abandon, remove, raise, lower, relocate and otherwise modify irrigation lines within or without the boundary of said real property. INDEMNITY AND 1NSUR.ANCE (12) The Owner, and his/her successors, to the fullest extent permitted by law, shall indemnify, defend and hold the City of Campbell, its agents, employees, attorneys, officers, officials and assignees harmless from any .and all claims, actions, causes of action, liabilities, damages, losses and expenses, including, but not limited to, attorneys'fees, arising out of, or resulting from, or alleged to arise out of or result from any negligent or intentional act or omission (including misconduct) of said Owner, or his/her successors, or any subcontractor, or anyone directly or indirectly employed by him, or anyone for whose acts any of them may be liable in the course of performance of the Agreement, except for any claims, actions, causes of action, liabilities, damages, losses and expenses proximately caused by the sole negligence or willful misconduct of.the City. (13) The Owner, and his/her successors, shall also indemnify, defend and hold the City of Campbell; its agents, attorneys, employees, officers, officials, and assignees harmless against and from any and all claims, actions, causes of action, liabilities, demands,losses, lawsuits,judgments, damages, costs and expenses (including, but not limited to, attorneys' fees and court costs, whether incurred at trial, appellate or administrative levels)which the City of Campbell may incur or suffer, or to which the City of Campbell may be subjected resulting from, or alleged to result from the failure of Owner, or his/her heirs, assignees, successors, grantees, agents, employees, subcontractors, or anyone performing services 3 under him, to fulfill any of the obligations imposed under this Agreement, except for any claims, actions, causes of action, liabilities, judgments, damages, costs and expenses proximately caused by the sole negligence or willful misconduct of the City. (14) The Owner and his/her successors shall also indemnify, defend and hold harmless the City, its agents, officers and employees from any claim, action, or proceeding against the City or its agents, officers or employees to attach, set aside, void or annul an approval of the City, its City Council, Planning Commission, Community Development Director, Public Works Director, Building Official, City Engineer, or other such City official concerning a subdivision, which action is brought within the time period provided for in California Government Code Section 66499.37. (15) In the event that this contract is subject to California Civil Code section 2782(b), the foregoing indemnity provisions shall not apply to any liability for the active negligence of the City. The foregoing indemnity provisions are intended to fully allocate all risk of liability to third-parties. No other rights ofindei nrity or contribution shall exist between the.parties in law or in equity. The provisions set forth in this section shall survive the temmination of this Agreement. (16) The City will promptly notify the Owner of any claim, action or proceeding to attack, set aside, void or annul any approval concerning a subdivision of said real property, and will cooperate fully in the defense. (17) Owner and his/herlts successors shall maintain insurance for injuries to persons or damage to property conforming to the following specifications: A. Minimum Scope of Insurance Coverage shall be at least as broad as: 1. Insurance Services Office (ISO) CGL form CG 00 01 11 85; and 2. ISO form G0009 11 88 Owners and Contractors Protective Liability Coverage Form Coverage for Operations.of Designated Contractor; and 3. Course of Construction Insurance covering all risks of loss; and 4. ISO CA 00 0106 92 including symbol 1 (Any Auto); and .5. 'Workers' Compensation insurance as required by the Labor Code of the State of California and Employer's.Liability insurance. B. Minimum Limits of Insurance Owner shall maintain limits no less than: 1. General Liability: $1,000,000 combined single Emit per occurrence for bodily, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate lin- t is used, 4 r r either the general aggregate limit shall. apply separately to this project/location or the general aggregate limit shall be twice the .required occurrence limit. 2. Automobile Liability: $1,000,000 combined single limit per accident for bodily injury and property damage. 3. Workers' Compensation and Employer's Liability:Workers' Compensation limits as required by the Labor Code of the State of California and Employer's Liability limits of$1,000,.000 per accident. C. Deductible and Self-Insured Retention Any deductibles or self-ins&ed retention must be declared to and approved by the City. At the option of the City, either: the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City, its agents, officers, attorneys, employees, officials and volunteers; or the Owner shall.procure a bond guaranteeing payment of losses related to investigations, claim administration, and defense expenses. D. Other Insurance Provisions The policies are to,contain, or be endorsed to contain, the following provisions. 1. General Liability and Automobile Liability Coverage: a. The City, its agents, officers, attorneys, employees, officials and volunteers are to be,covered as insureds as respects: liability arising out of activities related to this Agreement performed by or on behalf of the Owner, products and completed operations of the Owner, premises owned, occupied or used by the Owner, or automobiles owned, leased, hired or borrowed by the Owner. b. The. Owner's insurance coverage shall be primary insurance as respects the City, its agents, officers, attorneys, employees, officials and volunteers. Any insurance or self-insurance maintained by the City, its agents, officers, attorneys, employees, officials and volunteers shall be excess of the Owner's insurance and shall not contribute with it. C. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its agents, officers, attorneys, employees, officials, and volunteers. d. The Owner's insurance shall apply separately to each insured against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. e. Coverage shall not extend to any indemnity coverage for the active negligence of the City in any case where an agreement to indemnify the City would be invalid under Subdivision (b) of Section 2782 of the California Civil.Code. 5 j 2. Workers' Compensation and Employer's Liability Coverage: The insurer shall agree to waive all rights of subrogation against the City, its agents, officers, attorneys, employees, officials, and volunteers for losses arising from work performed by the Owner for the City. 3. Course of Construction Coverage: Course of Construction policies shall contain the following provisions: (a) the City.shall be named as loss payee; and (b)the insurer shall waive all rights of subrogation against the City. 4. All Coverages: Each insurance policy required by this clause shall be endorsed to state that coverage shall not be,suspended, voided, canceled by either party, reduced in coverage or in limits except after thirty (30) days. prior written notice by certified mail-, return receipt requested, has been or given to the City. E. Acceptability of Insurers Without limiting Owner's indemnification provided hereunder, Owner shall take out and maintain at all times during the life of this contract, up to the date of acceptance of the work by the City,-the policies of insurance listed in Paragraphs 12 through 16 of this Agreement. Insurance is to be issued by an issuer with a current A.M. Best Rating of ANH and be authorized to transact business in the State of California, unless otherwise approved by the City. F. Verification of Coverage Owner shall furnish. the. City with certificates of insurance evidencing coverage required by this clause. The certificates for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificates ate to be on forms provided by the City. Where by statue, the City Workers' Compensation related forms cannot be used, equivalent forms approved by the Insurance Commissioner are to be substituted. All certificates are to be received and approved by the City before work commences. G. Subcontractors Owner shall include all subcontractors as insured under its policies or shall furnish separate certificates by each subcontractor. All coverage shall be subject to all of the requirements stated herein. MUl UAL BENEFIT COVENANTS BINDING ON HEIRS ASSIGNEES SUCCESSORS AND GRANTEES OF OWNER (18) It is acknowledged that the provisions of this Agreement constitute covenants for the improvement of the subject real property for the mutual benefit of Owner's property, commonly known as 2145 Winchester Boulevard, and the City's property, commonly described as Winchester Boulevard and W. Rincon Avenue where it adjoins Owner's property. These covenants shall be considered to affect rights in the above-described real 6 e properties, and shall be binding on the heirs, assignees, successors, grantees and agents of the Owner to said real property. UNVESTED INTERESTS (19) Nothing contained herein shall be construed to transfer any unvested interests in real or personal property for purposes of the rule against perpetuities. BREACH OF CONTRACT (20) The City, upon breach.any of the terms, conditions, or covenants of this Agreement by the Owners, shall be entitled to recover from the Owner, in addition to any other relief available in law or equity, all costs and compensation incurred in attempting to obtain enforcement of the Agreement, including reasonable attorneys'fees and court costs. ENTIRE AGREEMENT BINDING (21) This is the entire Agreement between the parties, and there are no representations, agreements, arrangements 'or understandings that are .not fully expressed herein. This Agreement can be executed in counterparts by the parties hereto, and as so executed shall consist of one agreement,binding on all parties. PRELIMINARY PLANS (22) Owner shall provide and construct public street improvements per preliminary plans titled "STREET IMPROVEMENT PLANS — OFFSM — 2145 Winchester Blvd, which are subject to approval by the City Engineer,prepared by Hanna.Brunetti Civil Engineers. . 7 IN WITNESS WHEREOF, said City has caused its name to be affixed by its City Engineer and City Clerk, who are.duly authorized by Ordinance 2059 adopted September 20, 2005, and said Owner has caused his/her name to be affixed the day and year,first above written. 2145 SOUTH WINCHESTER, LLC, A CALIFORNIA LLVaTED LIABILITY COMPA 7 Signature Ca! 12. l Printed Name and Title CITY OF CAMPBELL 6 Michelle Quinney, City Engine City of Campbell (Notary Acknowledgment:for above signator(ies) MUST be attached.) Attest: Z� Ann ybee, City Clerk 8 1 CALIFORNIA IA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of CaIifomia Ali County of C" i 4 On before me, •�L �v� cr�v�ri� ! � c� titv4,i�� > �i (Here insert name and title of the of6c r) personally appeared '(WN6��' \.twee who proved to me on the basis of satisfactory evidence t be the person(s)whose name(s)is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/herltheu'signature(s)on the inst=ent the person(s), or the entity upon behalf of III which the person(s) acted,executed.the instrument. I l� I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph I is true and correct. IIt JOAP�N THOMASOAt Cwnmissian 1930652 j W ES my hand and official seal. Notary Public-Calitorida Santa Clara County Comm.d x es Mar 28.2015 M (Notary seal) it i Sign attve of No Public ,1 ti ADDITIONAL OPTIONAL INFORMATION I! - INSTRUCTIONS FOR COMPL=1 G THIS FOM4 tl i Any acknowledgment completed in California must contain verbiage exactly as DESCRIPTION OF THE ATTACHED DOCUNdENT appears above in the notary section or a separate acknowledgment form must be 1=' ( com lcted and attached to that document. Me only exce lion is i a { properly P' Y P f .f document is to be recorded outside of California.fin such instances,airy alternative j acknowledgment verbiage as may be printed on such a document so long as the II (Title or description of attached document) verbiage does not requb-e the notary to do something that is illegal for a notary in k California (i.e. certifying the authorized capacity of the signer). Please check the — a � document carefullyfor proper notarial wording and attach this farm ifrequired. I (Title or description of attached document.continued Number of Pages Document Date State and County information must be the State and County where the document Ij g signer(s)personally appeared before the notary public for acknowledgment. f Date of notarization must be the date that the signer(s)personally appeared which ! must also he the same date the acknowledgment is completed. f (Additional information) The notary public must print his or her name as it appears within his or her I commission followed by a comma and then your title(notary public). �I �i • Print the name(s) of document signer(s) who personally appear at the time of jl I( notarization. CAPACITY CLAIMED BY THE SIGNER l • Indicate the correct singular or plural fonns by crossing off incorrect forms(i.e. i helshe/4Hey,is tare)or circling the correct forms.Failure to correctly indicate this lI ❑ Individual(s) information may lead to rejection of document recording. [ ❑ Corporate Officer • "The notary seal impression must be clear-and photographically reproducible. Iti Impression must not cover text or lines.If seal'impression smudges,re-seal if a ill (Title) sufficient area permits,otherwise complete a different acknowledgment form. I j I • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this it ❑ Trustee(S) acknowledgment is not misused or attached to a different document. ❑ Other Indicate title or type of attached document,number of pages and date. I Indicate the capacity claimed by the signer.if the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document ZOOS Version CAPAvi2.10.07800-873-9865 www.NotaryClasses.com CALIFORNIA AEE-P OSE- ! ] CE TIFICATE• OF ACKNOWLEDGMENT i State of California County ofpS��a` i IOn v�yS� 101..3 before me, a`(�r. n ' >` .c �N I� T (Here insert name and title of the officer) personally appeared �0.b;j2 who proved to me on the basis of satisfactory evidence to be the-person(s)whose name(s) is/axe subscribed to the within instrument.and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that-by his/her/their signature(s)on the instrument the person(s), or the entity upon behalf of Which the person(s) acted,executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. I� I t JOANN THOMA50N i! Commission#1930682 Z ESS my hand and official seal_ a -� F Notary Public-California I z Santa Clara County tdy Comm.Uphsr Mat 28.2015 (Notary Seat) fgnature otaryPublic i ADDITIONAL OPTIONAL INFORMATION ' 1 INSTRUCTIONS FOR COMPLETING THIS FORM t! Any acknowledgment completed in Calffornia must contain verbiage exactry as DESCRIPTION OF-THE ATTACHED DOCUMENT appears above in the notary section or a separate acknowledgment form must be j properly completed and attached to that document. The only exception is if a n t,g document Zr to be recorded outside of-California.In such instances;any alternative (Title or desc�rip on bf attached document) acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notay in California (Le, certifying 1he authorized capacity of the signer). Phase check the (Title or description of attached docum nt continued) doctartertt carefully forpropernotarial wording and attach this form.if required Number ofPages Document Date - state and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment, - Date of notarizatibn must be the date that the signer(s)personally appeared which + must also be the same date the acknowledgment is completed, i (Additional information) • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title(notan,public). F� - Print the name(s) of document signer(s) who personally appear at the time of �! II nofari anon. 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Indicate the capacity claimed by the signer.If the claimed capacity is a ill Lcorporate officer,indicate the title(i.e.CEO,CFO,Secretary),Securely attach this document to the siped document 2008 Version CAPA v12.10.07 800-873-9865 w-w.NotaryClasses.com '--� Y ' PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2012 TO: City Clerk PUBLIC WORKS FILE NO. d(Z �r� �T PROPERTY ADDRESS Please collect&receipt for the following monies: ACCT.: w..°ITEM AMOUNT '` LAND-DEVELOPMENT :'e 4722 Encroachment Permit ApplicationFee Non-Utility Encroachment Permit Major>_$10 000 $370.00 '— Minor Encroachment Permit<$io 000 $210.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $205.00 Street Tree Planting/Removal N/C 2203 $500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min 2F Utility and R-1 Permits no deposit required 4722 Gradinq& Drainage Plan Review Single Family Lot $260.00 Site< 10,000 s.f. $780.00 Site>_ 10,000 s.f. <0.5 Acre $1 040.00 d Site }-- Site>_0.5 Acre $1 560.00 4722 NPDES Review(C3 Requirements) For projects not required to submit numeric sizing $150.00 For projects required to submit numeric sizing Impervious Area 10,000 S . Ft to 1 Acre $650.00 Im ervious Area 1 Acre or more $850.00 Plan Check&Inspection Fee(Non-Utility) 4722 En r. Est. up to$250 000 14%of Engineer's Estimate **2203 En r. Est. >_$250 000 Actual cost+20%Admin Overhead Min$35 000 Deposit) 2203 Emerqency Cash Deposit 4%of En r. Est." $500 min/$10 000 Max 2203 Faithful Performance Security FPS 100%of ENGR. EST." 2203 Labor and Materials Security 100%of ENGR. EST." 4721 Storm Drainage Area Fee Per Acre R-1 $2,120.00 (Multi-Res$2,385.00) All Other$2 650.00 4722 Parcel Map (4 Lots or Less) $3,700.00+$80/lot 4722 Final Tract Ma 5 or More Lots $4 500.00+$110/lot 2203 Monumentation Security 100%of ENGR. EST. 4920 Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adjustment Includes Certificate of Compliance) $1 750.00 4722 Vacation of Public Streets&Easements $2 340.00 4722 Certificate of Compliance $1 765.00 4722 Certificate of Correction $520.00 4722 Appeal Filing Fee $200.00 4722 Notary Fee(per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $830.00 Each Additional Lot $260.00 511.7424 Postage MISCELLANE US•; , Other Please Specify) "Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. ""Actual Cost Plus 20%Overhead(Non-Interest bearing deposit) TOTAL $ NAME OF APPLICANT NAME OF PAYOR PHONE ADDRESS ZIP S FOR RECEIVEb BYE; ; r " CITY CLERK { ONLY DateRecei'"t.# DatelAnitials< _ J.WORMS\TemplatesWdM,1,1,ativeVRe ipt Fo WW Oevebp—t12-13 � Qy OF G+EHE± Rqa BY. Uglq 0.10190 2451-5q eqm: mu»IRAQ gy«S #S; bGyg REGISTER G£: g± 2 TIME; S61 SkRy2q qm« EmR & mgD FILING 1pGm my S; m1 m!w ;y DEPOSIT - ±! 9JG.m 7# D; 1.000 EmRamniv QbkE $11,040.00 qQ S= 37 WI£&yR £2 AL Da w,£a m CHECK PAD: h.122.m CHECK NO: m£+A Iq&;q; S,28.00 CHANGE,-, $m PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2013 TO: City Clerk PUBLIC WORKS FILE NO. C c (:) Q 0�l PROPERTY ADDRESS Please collect&receipt for the followin monies x�ACCT" ITEM LAND�DEVE 40P,<MENT 4722 Encroachment ermiApplication..Fee Non-Utility Encroachment Permit Maior z$10 000 $377.00 Minor Encroachment Permit<$to 000 $215.00 Initial R-1 Permit N/C Subsequent R-1 Permits within Two Year Period $209.00 Street Tree Planting/Removal N/C 2203 $500 per Tree Planting Deposit Required) $500.00/tree 22031 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Grading&Drainage Plan Review Single Family Lot $265.00 Site<10,000 s.f. $795.00 Site_>10,000 s.f. <0.5 Acre $1 060.00 Site>_0.5 Acre $1 590.00 4722 NPDES Review C3 Requirements) For proiects not required to submit numeric sizing $153.00 For proiects required to submit numeric sizing Im ervious Area 10,000 S . Ft to 1 Acre $663.00 Im ervious Area 1 Acre or more $867.00 Plan Check&Inspection Fee Non-Utili 4722 En r. Est. up to$250 000 14%of Engineer's Estimate **2203 En r. Est. 23250,000 Actual cost+20%Admin Overhead Min$35 000 Deposit) 2203 Emergency Cash Deposit 4%of En r. Est.* $500 min/$10 000 Max 2203 Faithful Performance Security FPS 100%of ENGR.EST.* 2203 Labor and Materials Securi 100%of ENGR. EST.* 4721 Storm Drainage Area Fee Per Acre R-1 $2 120.00 (Multi-Res$2,385.00) All Other$2 650.00 4722 Parcel Ma 4 Lots or Less $3 775.00+$82/lot 4722 Final Tract Ma 5 or More Lots $4 590.00+$112/lot 2203 Monumentation Security 100%of ENGR. EST. 4920 Parkland Dedication Fee 75%/25% Due Upon Cert. of Occupancy) 4722 Lot Line Adiustment Includes Certificate of Compliance) $1 785.00 47221 Vacation of Public Streets&Easements $2 386.00 4722 Certificate of Compliance $1 764.00 4722 Certificate of Correction $530.00 4722'.- Appeal Filing Fee $200.00 4722 Notary Fee(per signature) $10.00 4722 Assessment Segregation or Reapportionment First Split $846.00 Each Additional Lot $265.00 511.7424 Postage Other Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. Obi **Actual Cost Plus 20%Overhead(Non-interest bearing deposit) ( TOTAL $ NAME OF APPLICANT NAME OF PAYOR G' � �� PHONE ADDRESS W-V6>° LDS GAS zip FOR RECEIU� .BY " u ti CITY CLERK .... ONLY Date r E.[ FRecei t#. r` J:IPoRMS1TemplahaWdM WaWe1Rece!0 Porn Land Dmbpmerd 1114 -, 8147717865 Time Account Recei t/®iscl®sure p Banker Name: Officer/Portfolio Number: Date: IRADHIKA SRINIVASAN IA1153 I07/31/2013 Banker Phone: - Store Number: Banker AU: Banker MAC: 1408/370-4570 104306 10000502 IA0512-011 Customer/Account Information Primary Customer Name: Customer Number(ECN): 12145 SOUTH WINCHESTER, LLC 1556398622245214 COID: Product: Account Number: Open Date: Term: Maturity Date: 100114 ICDA 18147717865 107/31/2013 16 months 101/31/2014 Time Account Opening Deposit: Interest Rate: Annual Percentage Yield: Fixed Rate: Variable Rate: Renewal Term: I$188, 000.00 0. 05% 0.05% IYes INo 16 months Interest will be paid: The method of payment will be: EVERY 01 MONTHS AND AT WITHDRAWAL IBY ADDING TO PRINCIPAL o Renewability: IYOU WILL AUTOMATICALLY RENEW MY TIME ACCOUNT AT MATURITY UNLESS 1 NOTIFY YOU OTHERWISE N o Account Title and Mailing Information Customer(s)Listed on Account: Mailing Address: 2145 SOUTH WINCHESTER, LLC 17066 MELODY LN Address Line 2: C/O CITY OF CAMPBELL City: State: LOS GATOS ICA ZIP/Postal Code: Country: 95033-8406 IUS This is a receipt. It need not be presented at the time you obtain payment from the Bank. Page 1 of 1 1N60168(5-11,SVP)„. ., _. V!Jells Fargo Confidential o 0 v 0 v 0 a N cT O LL O a 0, N Z U 23 2006nm CITY OF CAMPBELL RECVD BY: CASHIER 01000249367 PAYOR: 2.145 S WINCHESTER TODAY'S DATE: 08/011113 REGISTER DATE: 08/0V13 TIME: 17:23 DESCRIPTION AMOUNT ENGR R SUDDIV FILING F $26,320.00 CUST ID: 2145 WINCHESTER 12-164 REF DEPOSIT - 101 $7,520.00 CUST ID: 2145 WINCHESTER 12-164 ---------------- TOTAL DUE: $33,840.00 CHECK; PAID: $33,840.00 CHECK NO: 2043 8 2044 TENDERED: $33,840.00 CHANGE: $.00 ' ` � ,,CITY OF CAMPBELL � REND BY: CASHIER 01000249961 PAYOR: AXISCON LLC TODAY`S DATE: 109/11/13 8EGISTER DATE O9/11/1J TIME 16/18 DESCRlPT}OM AMOUNT uuSOLO 101 , in TOITAL DIUEEL DUE: $93.5O TENDERED. $93.5O CHANGE: $.00 \ , f J - f CITv OF-CAN,9EtL CLERK 70 N FIRST ST 010 LUL CARBELL, CA 95006- - TERMINAL I0: 088601763 MERCHANT 0., 225180862990 UISA #xxxickxxxxxxx8559 SAL BATCH:=un' % INUOICE) 8863050100 DATE; 11, 13 RUTHIHUI 1�0651 TOTAL t9s.56