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ENC2013-00235 I I Print Form- CITY OF CAMPBELL ENCROACHMENT PERMIT Permit No OGW43 002.3.S DEPT.OF PUBLIC WORKS (for working within the public X Ref.File l 70 North First Street right-of-way) Application Date _ Campbell,CA 95008 Issued 12�23 I13 Application E piration Date tt Ph. (408)866-2150 APN �� C7r J Fx. (408)376-0958 Permit Expiration Datel 2. 2 3 1 APPLICATION-Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code,Section 11.04. (Application expires in six (6) months if the permit is not issued. Application Fee is non-refundable.) A. Work Address or Tract No.: Utility Trench Location: B. Nature of Work: 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 of work. The plans shall show the relation of the proposed work to existing surface and underground improvements. When approved by the City Engineer,said plan becomes a part of this permit. I 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.) I 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: hon PP Tele� P i: Address: ";Zw I_ E-Mail Address: 24-11 R EMERGENCY PHONE NUMBER: Is this work being done by the property owners at their own residence? YES NO The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell,itsl officers,agents,and 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 information. Applicant is advised that upon issuance of this permit, property owner,'or property owner's successors, shall be responsible for any nd all damages arising out of the condition of any private improvements in the public right-of-way. Accepted: - T (Applicant Permittee) (sign) Date I (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. I 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. Work to be staked by a licensed Land Surveyor or Civil Engineer and two(2)copies of the cut sheets sent to the Public Works Department before starting work. 4. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert(USA)has been notified and the inquiry identification number has been entered hereon. USA Phone: 1-800-227-2600. USA TICKET NO. 5. Prior to any work,the property owner shall execute an Agreement for Private Improvements in the Public Right-of-Way,which shall be recorded. 6. Public Notification Requirements: i 7, SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES AMOUNT RECEIPT NO PERMIT APPLICATION FEE $ 9 7,7- iG PLAN CHECK DEPOSIT $ Ginn SECURITY FOR FAITHFUL PERFORMANCE/LABOR&MATERIALS $2_;� SDO.00 G dam, CONSTRUCTION CASH DEPOSIT $ JT j PLAN CHECK&INSPECTION FEE $ 2 EMERGENCY PERMIT FEE $ APPROVED FOR ISSUANCE I l 2123/I'> , For City Engineer Date Permit Expires 12 Months After Date of Issuance / I �. 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. Submit project schedule 10(ten)days.prior to proposed start of work.Special provisions may be required for work within City facilities and downtown Campbell. 5. 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. 6. Maintain safe pedestrian and vehicular crossings and free access to_private driveways,bus stops,fire hydrants,and water valves. 7. 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. 8. 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. 9. Replace as directed by the City Engineer any damaged or removed improvements in accordance with City Standards and Specifications at the sole expense of the Permittee. 10. Sawcut for all PCC or AC removals. All PCC removals shall be to the nearest scoremark and shall be doweled to existing improvements. Priorapproval 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. 12. Adequate signing and barricading is required on the job site. Failure to provide,such signing and barricading may result in the City's providing signing and barricades and charging the cost(including all labor avid materials)against the cash deposit. 13. Compaction testing of subgrade,base rock,and asphalt concrete by Permittee is required unless otherwise stated by the City Engineer. 14. The Contractor or Permittee will have a supervisory representative available for contact on the project at all times during construction. Contractor or Permittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m.to 4:00 p.m. 15. No storage of materials or equipment will be allowed near the edge of pavement,the traveled way,or within the shoulderline which would create a hazardous condition to the public. 16. This permit shall not be construed as authorization for excavation and grading on private property adjacent to the work or any other work for which a separate permit may be required,nor does it relieve the Permittee of any obligation to obtain any other permit required by law. 17. This permit does not release the Permittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is not transferable.Work must be performed by the Permittee or his designated agent or contractor as specified thereon. 19. 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. 20. Pursuant to Chapter 14.02 of the Campbell Municipal Code,applicant shall not cause to be discharged any material into the municipal storm drain system other than storm water. Applicant shall adhere to the BEST MANAGEMENT PRACTICES established by the Santa Clara Valley Urban Runoff Pollution Prevention Program. 21. 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. 22. 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. Applicant Date: Contractor (Print Name) Date: JAFORMS\Templates\Encroachment Permits\Encroachment Permit STATIC form2.pdf Rev.03/13 PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT TO: City Clerk Effective July 1,2013 PUBLIC WORKS FILE NO`.��{�(\J J PROPERTY ADDRESS Please collect&receipt for the following monies: ACCT. '�` ITEM, AMOUN LAND'DEVELOPMENf, „ 722Encroacriment Permit Application Fee Non-Utility Encroachment Permit Major>$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 26/6 of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required ading &Drainage Plan Review Sinqle 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 L47221NPDES Review(C3 Requirements) For projects not required to submit numeric sizing $153.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $663.00 Impervious Area 1 Acre or more $867.00 Plan Check& Inspection Fee(Non-Utility) 4722 Enqr. Est. up to$250,000 14%of Engineer's Estimate :**2203 Enqr. Est.>_$250,000 Actual cost+20%Admin Overhead (Min$35,000 Deposit) 203 Emerqenc Cash Deposit 4%of Enqr. Est.*($500 mih/$10,000 Max) 203 Faithful Performance Security(FPS) 100%of ENGR. EST.* 203 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) $3,775.00+$82/lot 4722 Final Tract Map(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 Adjustment(Includes Certificate of Compliance) $1,785.00 4722 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 siqnature) $10.00 4722 Assessment Segregation or Reapportionment First Split 846.00 Each Additional Lot $265.00 511.7424 Postage iSCEL1ANE0`Sun ,< ; Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. $ Dv **Actual Cost Plus 20%Overhead Non-Inter t bearing deposit) TOTAL NAME OF APPLICANT NAME OF PAYOR PHONE ADDRESS ZIP FOR RECEIVED CITY CLERK ` ONLY Date l Receipt#. `A,�Dat / )nttals� i J.\FORMS1Temoletes Administ,bvkRec pt Form Lend Development 13-14 J .} CITY OF CAMPBELL RECVD 8y: CASHIER O1OOO251391 YAYDR� ATUL SHARMA TODAY`S DATE: 1Z/19/13 KEG�STER DATE� 12/19/13 TIM[: 17�15 � DESCRIPTION AMOUNT ENGR & SUBDIV FILIHG F $3,2YO.00 C8ST lD: 13-235 ' kEF DEPOSIT - 1O1 $94O.00 CUST ID: RD 13-235 ---------- TDTAL DUE: $4,23O.OD CHECK PAID: $4'23O.00 CHECK NOr 373 ` TENDERE�: �4,23O.00 CUANGE: $.00 \ \ . u / PUBLIC WORKS DEPARTMENT LAND DEVELOPMENT Effective July 1,2013 7� S— 0©� TO: City Clerk PUBLIC WORKS FILE NO. �j/l/ PROPERTY ADDRESS �• �� Please collect&receipt for the following monies: ACCT. ITEM AMOUNT LAND DEVELOPMENT 722 Encroachment-Permit Application Fee Non-Utility Encroachment Permit Major>_$10,000 $377.00 Minor Encroachment Permit<$10,000 $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 2203 Plan Check Deposit 2%of Engineer's Estimate $500.00 min Utility and R-1 Permits no deposit required 4722 Gradinq&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 projects not required to submit numeric sizing $153.00 For projects required to submit numeric sizing Impervious Area 10,000 Sq. Ft to 1 Acre $663.00 Impervious Area 1 Acre or more $867.00 Plan Check&Inspection Fee(Non-Utility) 4722 Enqr. Est. up to$250,000 14%of Engineer's Estimate **2203 Enqr. Est.>_$250,000 Actual cost+20%Admin Overhead (Min$35,000 Deposit) 2203 Emergency Cash Deposit 4%of Enqr. 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) $3,775.00+$82/lot 4722 Final Tract Map(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 Adjustment(Includes Certificate of Compliance) $1,785.00 4722 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 Segreqation or Reapportionment First Split $846.00 Each Additional Lot $265.00 511.7424 Postage MISCELLANEOUS Other(Please Specify) *Engineer's Estimate shall be as approved by the City Engineer and shall include all items of work. wwv V, **Actual Cost Plus 20%Overhead(Non-Interest bearing deposit) TOTAL $ NAME OF APPLICANT NAME OF PAYOR PHONE ADDRESS 45 . ZIP v ta2 Tr tfl, FOR RECEIVED BY( (C6 CITYONLY CLERK Date I 3�� Receipt# �� Z DEC ®� �� ATY OF Date/ Initials JIFORMS1Templ,t,o Admini:bativeRwdpt Fam Lend Development I8 U aR 7 GeRw ~ ° Ri! 7: Gglq 0 10 0e2 123 Rp7= AQMJgmg ' ' . . \ THAWS'; i md3 «SS7 +»; RZ0 2R; I +k6SI A 01 u J Ema & mgw FILING $-32ae . - q7 D; mq±«» F PHIT 101 00 mS 2: magma 7m & mAy GGmE g,kGm mA 111; 22013=235 EmRaggy SQmF wS.m mS S: ms S,Tkgm Sag» ggL +D 9,9Cm . �. . � . � mRK Gq; G,qG m mE: m: 0013-64 . »El 9.mG m PIA R: «m _ (\ � , , \�\�\ ` • � . 4 �. . 0 INSURANCE REQUIREMENTS CHECKLIST Permit D0 3 D6,.3 S 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: $1,000,000 per occurrence, and ❑ $1,000,000 general aggregate limit applying separately to the project, or -�d, $2,000,000 general aggregate limit. C)\1, 1�4-policy expiration date O ZZ Automotive Liability: "Any Auto" checked on certificate $1,000,000 per accident for bo il` injury and property damage Policy expiration date orkers' Compensation and Employer's Liability Waiver of Subrogation clause $1,000,000 per accident for bodily injury or disease 'Policy expiration date w Z,6 l �) 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 (Description of Operations Area The City, its officers, employees and volunteers are named as additional insured. Reference Proiect Location & Permit Number) -76-.,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". f / OR Should Read �V Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. :\Documents and Settings\joannat\Desktop\Insurance Requirements.doc(Rev 03/13) Page 1 of 1 ❑ Workers' Compensation Insurance Sheet Submitted For General Contractor ❑ For Developer or Owner Acceptability of Insurer(s) ❑ Insurer(s) has current A.M. Best Rating of A:VII and is authorized to transact business in the State of California. J L4 Name:-"��e�e, sVVec , N/AIC# 2- Rating: C Authorized in CA: VVc '•onw Name: A,\,,\: ec� \�y /NAIC# ZZ-1flRating: Authorized in CA: Name: \b,CJ 1ST NAIC# .0 ft5( Rating: � 1 V - Authorized in CA: -Name: NAIC# ZCX,-.,Lau+-�Rating: ✓ Authorized in CA: ✓ aD'CA �"`p' IZLz3�i4 \c�SS Campbell Business License# Insurance Certificate Reviewed _G 7,-Z3- 3 InitialsC) Date Copy of Insurance Certificate placed in tickler file one month prior to expiration. C:\Documents and Settings\loannat\Desktop\Insurance Info\Insurance Requirements CIdist REV 4.12.doc(Rev 07/11) Page 2 of 2 ASSOC-2 OP ID: LC CERTI"II-iCATE OF LIABILITY INouRANCE P ATE(MM/°°/YYYY) 12/20/2013 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). CONTACT PRODUCER Phone:408-842-2131 NAME: Pacific Diversified Insurance Fax:408-842-0867 PHONE FAX Gilroy Office A/c E-MAIL Ext: 9015 Murray Avenue#110 ADDRESS: Gilroy,CA 95020 Bill Link INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ironshore Specialty Ins. Co. INSURED . Associated Plumbing Inc. INSURER B:Allied Insurance 23787 90 Leavesley Road INSURER C:Topa Insurance Gilroy, CA 95020 INSURER o:Berkshire Hathaway HomeState INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DDNYYY MM/DDNYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X AGS0033101 10/22/2013 10/22/2014 DAMAGE TO RENTED 50,000 PREMISES Ea occurrence $ CLAIMS-MADE J A I OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ B X ANY AUTO ACP7881880890 06/06/2013 06/06/2014 BODILY INJURY(Per person) $ - ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS -- - - NON-OWNED PeOa R DAMAGE $ X HIRED AUTOS X AUTOS - UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C X EXCESS LIAB CLAIMS-MADE XL6605709 10/22/2013 10/22/2014 AGGREGATE $ OED I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TO Y LIMITS ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 2200061357-131 04/28/2013 04/28/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job: 70 S. San Tomas Aquino Road, Campbell, CA 95008. Permit #ENC2013-00235 The City of Campbell, its officers, employees and volunteers are named as additional insured per the attached carrier endorsement as respects work performed for them by the Named Insured. D zv) .. Q(o CERTIFICATE HOLDER CANCELLATION CITYOFC 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. 70 N. First St. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i POLICY NUMBER:AGS0043100 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided underthe following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization s : Locations Of Covered Operation's Additional Insureds shown in a written contract, or written Any location. agreement that includes primary and non-contributory wording. The inclusion of one or more Insured under the terms of this endorsement does not increase our limits of liability. All otherterms and conditions remain unchanged. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. SECTION II —WHO IS AN INSURED is amended B. With respect to the insurance afforded to these to include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to "bodilyinjury" or damage" or "personal and advertising injury" caused, in whole or in part, by: property damage" pp y occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ izati on s : Location And Description Of Completed Operations Additional Insureds shown in a written contract, or The insurance afforded by this policy for the benefit of written agreement that includes primary and the additional insured does not apply to non-contributory wording where required. 'property damage'to any building, structure or appurtenant structure intended to be occupied as The inclusion of one or more Insured under the terms of a 'private residence'.The term"private residence" this endorsement does not increase our limits of includes single family homes or residences, multi-family homes or residences. liability. All other terms and conditions remain unchanged. information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ WORKERS COMPENSATION Af�r_-`�:MPLOYERS LIABILITY INS URANC-I _-tDLICY WC 99 0410A(Ed 07-07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2.00 %of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is$ q50 on Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04/28/2013 Policy No. 3300061357-131 Endorsement No. 1 Insured ASSOCIATED PLUMBING, INC. Premium $ Insurance Company Countersigned by Cypress Insurance Company WC 99 04 10A (Ed 07-07) _�• _ �, o I s v v r C DAI- .r.._. ._.oz. +4 E. CU19T Ht. DO it w 'P i) i S RED { t W N N W e f. ASSOCIATED PLUMBING, INC. 32236 y r- CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR NOTICE OF RELEASE OF RECORDED S7Ti�t?> �7�T�F9QiEJWIEF[ GR' EE:' Encroachment Permit # �^ aQ`s_ Property Address 0 Date Street Improvement Agreement recorded A l Gt Date of Final Acceptance Letter Date of One-Year Maintenance Acceptance Letter All deposits refunded (Date of last refund) Inspector's Encroachment Permit file merged with Main Permit File Date Permit archived in Permit Plan Processed by: ` L � Reviewed By: Inspector Reviewed by: Land Development Engineer Date Check Request Submitted to Finance for Recording Fee Date Notice of Release sent for recording: ct \ J:\JoAnnaT\Deposit refimds\CHECKLISTS\Checklist-Release of Street Improvement Agreement.doc(Rev. 10/11) 1 G CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR FINAL INSPECTION AND ACCEPTANCE LETTER Encroachment Permit#: ENC 2013-00235 Name: Atul Sharma Property Address: 70 S. San Tomas Aquino Rd. Date of Final ction: On File: Bonds CD Cash Faithful Performance: $ Labor and Material: $ Construction Cash Deposit to be released: $ Other overdue deposits to be released (Description): Processed by: Ad inistrator Reviewed by: l �^ Inspector Reviewed by: Land Development Engineer JAJoAnnaT\Deposit refunds\CHECKLISTS\I Checklist-Final Acceptance:doc(Rev. 10/11) VED r . 23755795 9 Regina A l comendras NOV 0 2'2017 Recording Requested By: ) Santa Clara County - Clerk-Recorder 09/19/2017 08:16 AM CITY CLERK'S OFFICE City of Campbell ) Titles: 1 Pages: 2 And When Recorded Return To: ) Fees: 23.00 Taxes: 0 City Clerk Total: 123.00 City of Campbell ) mill prof :1101 ��11111111M WHI01P.4U DNA 11111 70 N. First Street ) Campbell,CA 95008 ) APN: 404=01-032 . (Space Above This Line For Recorder's Use Only) ADDRESS. 70 San Tomas Aquino Rd.,Campbell,CA 95008 NOTICE OF RELEASE BY CITY OF CAMPBELL NOTICE IS HEREBY GIVEN concerning the real property located in the City of Campbell, Santa Clara County, California, and described specifically as follows: 70 San Tomas Aquino Rd., Campbell, CA. That whereas, ALKA MONTESSORI INC., a California Corporation, entered into a Street Improvement Agreement with the City of Campbell, recorded January 22, 2014, Document# 22502401, in the Office of the County Recorder, County of Santa Clara, State of California.. r That, whereas, said conditions of said Agreement have been met to the satisfaction of the City. That, Now Therefore ALKA MONTESSORI INC. is hereby released from all requirements contained in the agreement recorded January 22, 2014, Document#22502401, 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. CI .OF Cr PBELL ATTEST: A ay r Cit Engineer, C gi,tof Campbell Vend ood, City Clerk (Attach Notary Acknowledgment) Dated: 9AII CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE §1189 ��Y�`,'=��t-a'h.��'poi_.t�*f.�_'��`��'�' ^4k`c'}?�' }`� `��`-f -s"��"1,�'+.�. :�5�:E'fi;rK^�"rcair. "'�a^, �`,x' :�.w5�7" '�1`-��3 "r•?�' `� 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 j County of ��A On 51 before me, li��rlc��c1� Date Here Insert Name and Title of the Officer personally appeared �� a� Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(4 whose name(Rris/ar-e subscribed to the within instrument and acknowledged to me that+e/she/4h-ey executed the same in#is/her/#I}&k authorized capacity0s), and that bye/her/t#-refr signature(arron the instrument the person(;or the entity upon behalf of which the person acted, executed the instrument. JOANN THOMASON I certify under PENALTY OF PERJURY under the Commission# ASON 9 laws of the State of California that the foregoing z Notary Public-California z paragraph is true and correct. z Santa Clara County n My Comm.Expires May 9,2019 WITNESS my hand and official seal. Signature Place Notary Seal and/or Stamp Above Signa ure of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer—Title(s): ❑ Corporate Officer—Title(s): ❑ Partner— ❑ Limited ❑ General ❑ Partner— ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian of Conservator ❑ Trustee ❑ Guardian of Conservator ❑ Other: ❑ Other: Signer is Representing: Signer is Representing: 02017 National Notary Association TO BE RECORDED WITHOUT FEE . SECTION6103,GOVERNMENT CODE - AT THE REQUEST OF CITY OF CAMPBELL DOCUMENT: 22502401 Pages: 10 Recording Requested by: ) No Fees Taxes. Copies. City of Campbell ) a�S—�a yD AMT PAID ) When recorded mail to: ) REGINA ALCOMENDRAS RDE # 025 SANTA CLARA COUNTY RECORDER 1/22/2014 City Clerk ) Recorded at the request of 1 .44 PM County Agency 301A0 SN9910 UO City of Campbell ) 70 North First Street ) KOZ 0� 234 Campbell, CA 95008 ) APN: 404-01-032 (Space above this line for Recorder's use only.) ADDRESS: 70 S San Tomas Aquino Road Campbell,CA 95008 STREET IMPROVEMENT AGREEMENT RECITALS THIS AGREEMENT, identified -by File No(s). PLN2013-205, 246, 266 is entered into this 2a_0 �k day of (�..pr p h�,r 1 , 2013, by and between ALKA MONTESSORI INC, A CALIFORNIA CORPORATOIN, 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 October 8, 2013 the Planning Commission granted conditional approval of a conditional use permit with site and architectural review and a parking modification permit to all for the construction of a new 2,633 square foot commercial building, for that certain real property described as Parcel B, as shown on that certain Parcel Map filed in the office of the recorder of the County of Santa Clara, on March 3, 1978, in Book 414 of Maps Page 7, and commonly known as 70 South San Tomas Aquino Road, 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 recover the full cost and expense from the Owner, or his/her successors. J:\LandDev\Farms\SI\Specific Agreements\70 S STAR St Agreement.DOC(Revl1/13) 1 r- 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 ZI 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 from the construction thereof, as well 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 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 Rev 11/13 2 i 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 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 sum 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 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 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 Rev 11/13 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 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 of indemnity or contribution shall exist between the parties in law or in equity. The provisions set forth in this section shall survive the termination"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/her/its 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 01 06 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. Rev 11/13 4 r a B. Minimum Limits of Insurance Owner shall maintain limits no less than: 1. General Liability: $1,000,000 combined single limit per occurrence for bodily, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, 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-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. Rev 11/13 5 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. 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 parry, 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. Rev 11/13 6 MUTUAL 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 70 South San Tomas Aquino Road, and the City's property, commonly described as South San Tomas Aquino Road where it adjoins Owner's property. These covenants shall be considered to affect rights in the above-described real properties, and shall be binding on the heirs, 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 — OFFSITE — 70 South San Tomas Aquino Road," which are subject to approval by the City Engineer,prepared by DB Engineering. Rev 11/13 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. ALKA MONTESSORI INC, A CALIFORNIA CORPORATOIN y Atul harma, Chief Financial Officer CITY OF CAMPBELL Michelle Quinney, City Engine City of Campbell (Notary Acknowledgment for above signator(ies) MUST be attached.) Attest: e Bybee, City Clerk Rev 11/13 8 ' CALIt ORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of On Zc). Zo�3before me, b\ c— (Here insert name and title of the office personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOANN THOMASON WI S my.hand and official seal. Commission# 1930682 "•-� Notary Public-California z �� z ` Santa Clara County (Kota Seal) NI Comm.Ex ires Mar 28,2015 Signature of Notary Pu6hq (Notary 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 document is to be recorded outside of California.In such instances, any alternative (Title or description of 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 notary in California (i.e. certifying the authorized capacity of the signer). Please check the (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. • Date of notarization must be the date that the signer(s)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 her 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. Ire/she/they;-is/ere)or circling the correct forms.Failure to correctly indicate this ❑ 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. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact 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 corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com CALI1"RNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of .:>,.�� On' before me, .— (Here insert nami and title of the of eer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOANN THOMASON Commission#1930682 SS my hand and official seal. Notary Public-California Santa Clara County Comm.Ex Iles Aber 26,201 S A � � (Notary Seal) Signatur tart'Pu lic 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 m•a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California.In such instances, any alternative E�} w`n r ¢ chedd document)'Art acknowledgment verbiage as may be printed on such a document so long as the (Tit]e or descnption of attached verbiage does not require the notary to do something that is illegal for a notary in California (i.e. certifying the authorized capacity of the signer). Please check the (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. • Date of notarization must be the date that the signer(s)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 her 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. lie/she/4ke3;-is/afe)or circling the correct forms.Failure to correctly indicate this ❑ 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. • 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 ❑ 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.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com a � 1 i . TO RECORDED WITHOUT FEE DOCUMENT: 22502402 Pages: 7 SECTION 6103 GOVERNMENT CODE AT THE REQUEST OF CITY OF CAMPBELL Fees. . . . * No Fees Taxes. . . Recording Requested By: ) Cop i es. . City of Campbell ) AMT PAID 70 North First Street ) Campbell, CA 95008-1423 ) REG I NA ALCOMENDRAS RDE # 025 SANTA CLARA COUNTY RECORDER 1/22/2014 After Recording Return To: ) Recorded at the request of -1 :44 PM County Agency -R CEE IVE'O City Clerk > FEB 2 0 2014 City of Campbell ) 70 North First Street ) CI 1 r ULMIA J UH-IGE Campbell, CA 95008-1423 ) as 5 APN: 404-01-032 (Space Above for Recorder's Use Only) Address: 70 S San Tomas Aquino Road 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, ALKA MONTESSORI INC, A CALIFORNIA CORPORATOIN (property owner) 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 as70 South San Tomas Aquino Road. The City of Campbell grants such permission to allow a private water meter and a PG&E vault under Encroachment Permit No. ENC2013-00235. All conditions of Encroachment Permit ENC2013-00235 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 attorneys. The City, in its sole discretion, may revoke the rights granted under Encroachment Permit No. ENC2013-00235 and remove the improvements installed under Encroachment Permit No. ENC2013- 00235 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. (Rev. 10113) Page 1 of 6 1 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 demands 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. mail, return receipt requested. 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. (Rev. 10/13) Page 2 of 6 This provision shall run with the land and be binding on the property owner's successors. Executed this_ _day of �)�,,n`,�.,r�� 24H-. ALKA MONTESSORI INC, A CALIFORNIA CORPORATOIN Atul Sharma, Chief Financial Officer (Attach Notary Acknowledgment For All Parties) CITY OF CAMPBELL, a municipal Corporation Todd Capurso Public Works Director, City of Campbell ATTEST- Anne Bybee,AityyClerk STATE OF CALIFORNIA COUNTY OF SANTA CLARA (Rev. 10/13) Page 3 of 6 CALIV RNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of On e-w&e< 2-3, before me, (Here insert name and title of the offs r) personally appeared (IS-\A who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOA�NN T�H�OMASON Commission#t 1930682 IL WI S my and and official seal. Notary Public-California n Santa Clara County -� M Comm.Ez fires Mar 26,2015 (Notary Seal) Signature of I4ptary P lic 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 k document is to be recorded outside of California.In such instances,any alternative 1M�O t� acknowledgment verbiage as may be printed on such a document so long as the (Title orr description of attached document) verbiage does not require the notary to do something that is illegal for a notary in ° California (i.e. certifying the authorized capacity of the signer). Please check the c - S wrx document carefully for proper notarial wording and attach this form if required. (Title or description of Attached document c tinned) ti i • 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. • Date of notarization must be the date that the signer(s)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 her 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. ❑ Individual(s) lie/she/they;-is/are)or circling the correct forms.Failure to correctly indicate this 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. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact 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. 44- 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 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com CALIVORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of So before me, (Here insert name and title of the officer) personally appeared c\sA who proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. JOANN THOMASON Commission*t 930662 SS my hand and official seal. -• Notary Public-California z Santa Clara County 172 Mi Comm.Ex Tres Mar 26,2015 ��rt~s � I�.' `�1� (Notary Seal) Signature of Notary Pubiip 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 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 Q California (i.e. certifying the authorized capacity of the signet). Please check the document carefully for proper notarial wording and attach this form if required. (Title or description of attach d document continued 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. • Date of notarization must be the date that the signer(s)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 her 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. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. he/she/the)--is/are)or circling the correct forms.Failure to correctly indicate this ❑ 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. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact ev, 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 corporate officer,indicate the title(i.e.CEO,CFO,Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com Exhibit A Recording Requested By: ) City of Campbell ) When Recorded Mail To: ) City Clerk ) City of Campbell ) 70 N. First Street ) Campbell, CA 95008 ) APN: Space above this line for Recorder's use only Address: CLAIM OF LIEN I, MICHELLE QUINNEY, 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 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 , 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 the work 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 , 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. (Rev. 10/13) Page 5 of 6 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) (Rev. 10/I3) Page 6 of 6 OF C4 let U v F G� •'kCHAR0• CITY OF CAMPBELL Public Works Department August 14, 2017 Mr. Atul Sharma 70 S. San Tomas Aquino Rd. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00235 . 70 S. San Tomas Aquino Rd., Campbell, CA - -FINAL INSPECTION AND ACCEPTANCE Dear Atul: The City of Campbell has made the final inspection of the subject Public Works improvements and finds that no remedial work is required. s Your warranty requirements and any surety, therefore, are hereby released. The signed CD Release Form for your Maintenance CD #046882858 is enclosed. Sincerely, Syed Wahidi Public works Inspector Enc: CD#046882858 /Release of Assignee 70 North First Street'- Campbell, California 95008-1436 TEL 4b8.866.2150 FAX 408.376.0958 TDD 408.866.2790 1 ASSIGNMENT AND RECEIPT OF IN VESTIAIENI'LERTIMCATE P W.Permit No. ENC20I3--00235 TO CITY OF CAMPBELL,70 N.FIRST STREET TR or DEV CAWBELL,CALIFORNIA 95008 (408)866-2150 Loc. 70 San Tomas Aquino Rd. I am/We are the owner(s)of a savings account at at its branch office at j California, investment certificate No. in the names of Ad AA, HFf and having a present balance of$5 875.00 I hereby grant, transfer and assign said account, said investment certificate, said balance(including interest which -accrues thereon),,and-all other Tights in connection therewith to the CITE'-OF-CAMPEELL, assignee, for. -good and valuable consideration, receipt of which is.hereby acknowledged, for the purpose of insuring construction described as follows: I have physically delivered verification of said investment certificate and duplicate of this Assignment and Receipt to said assignee. I understand that assignee can withdraw from said account any time-on-his signature alone upon presentation of a written order to the issuer. I also understand that I may not withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee . and may-act-on the-signature-erf-the-assignee without further.inquiry. Executed on d T ,20 ,at said office of the issuer. (sign) C1�j.-T 1 P'l' '. Assignor (print} ACKNOWLEDGMENT BY ISSUER Issuer affirms that there are no other holds on subject account,that subject monies are available,and that the,above-described assignment has been noted on the Records of said issuer. Date /Zas N/ZO 1 C Authorized Signature) ATTACH NOTARY ACKNOWLEDGMENT Title Ocr CUll- INSTRUCTIONS TO ASSIGNEE --Please signbelo-w-for-signature_identification and ac aclmowledgment ofyoouriiotice_ofAssigmment.—Return this Assignm nt_ anal Receipt to the issuerat its address above. Retain one copy of this A and Receipt for your files. Date / City of Camp Il By RELEASE OF ASSIGNEE f Said assignee hereby releases and relinquishes all his right,title and interest in and to said account,said investruezAreertificate,. said balance -all other rights in-conned therewith. Date City of C pb 11 By C:\Users\Atul\AppDatalLocallTempNew-Maint Mdoc(Rev.03108) CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 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 tZ � before me, Date Here Insert Name and Title of the Officer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be th a c�n(s) whos (s)�.3ihre �scribed to:the with' ument and ackno dged to r /she/they executed the��e in er/their authorized ca aci (ies), a►}dAfmt,,b ,his er/their signature s)on the instrument the e�rs�(s), or the entity upon behalf of which the perso 's) acted, execute- t t}e instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. SEBLE DEMISSIE Commission.#2080097 —-�--�, 'Notary Public,=California _ Santa Clara County Signature . Comm. ices Aug30'2018t ure ofNotary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. _ _ Description of Attached Document 4/j fY✓I ��_ __ ___ Title or Type of Document: /�� 6 J�f st��l� Document Date: Number of Pages: I Signer(s) Other Than Named Above: �- Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer. — Title(s): ❑ Corporate Officer — Title(s): ❑ Partner —_ ❑ Limited ❑ General ❑ Partner — ❑ Limited ❑ neral ❑ Individual ❑Attor eyin Fact ❑ Individual ❑Attor y in Fact ❑Trustee ❑ G rdian or Conservator ❑Trustee ❑ Guardian or Conservator ❑ Other: ❑ Other: Signer Is Repres ting: Signer Is Representing: 02014 National Notary Association - www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 BANK WEST' CERTIFICATE OF DEPOSIT RECEIPT Branch Name: 00015-Stevens Creek-Saratoga Date of Deposit: 12/8/2016 Account Number: 046882858 Amount of Deposit: 5875.00 Today's Date: 12/08/2016 Maturity Date: 12/8/2017 Branch Approval: Seble Demissie Initial Interest Rate: 0.12 Customer Name ' ALKA MONTESSORI INC Initial Annual Percentage Yield: 0.12 and Address: FBO CITY OF CAMPBELL 70 S SAN TOMAS AQUINO RD Interest Payment Method: Redeposit CAMPBELL, CA 95008 Pay Interest to Account#: Interest Payment Frequency: At Maturity Term: 12 Months Phone#: Deposit receipt not needed for redemption. Renewal: Automatically Renew Thank you for opening a Certificate of Deposit with Bank of the West.Your account has been opened for the amount and terms shown above. Any questions regarding your Certificate of Deposit can be answered by your branch or by calling the Bank's Telephone Banking Center(800)488-BANK. INFORMATION REGARDING CERTIFICATE OF DEPOSIT ACCOUNTS Minimum Opening Balance$ Minimum balance required to earn APY$ ADDITIONAL DEPOSITS- If you wish to add funds to your Certificate,you may do so during the 10 calendar day ggrace period following the accounts ma tun date or - clays Certificates,you may add funds during the 1 calendar day grace period following the mafuri date. Interest on the additional funds, oth cash and non-cash, begins to accrue on the business day you deposit.it and at the same rate in effect or the renewed Certificate. The' additional funds will mature at the same time as the renewed Certificate. The minimum amount for an additional deposit is$100.00. WITHDRAWALS- Interest which has been reinvested may be withdrawn at any time, if the account term and interest rate have not changed since the renewal. i tonal withdrawals without penalty are permitted during the 10 calendar day grace period following maturity(1 calendar day grace period for 7-31 days Certificates)for automatically renewable Certificates,or upon the death or mental incapacity of the depositor.Accounts closed during the grace period will forfeit any interest accrued during the grace period. Withdrawals at any other time may be permitted at the Bank's discretion and are subject to early withdrawal penalties. INTEREST-Interest is accrued on the daily balance. The annual percentage yield assumes that interest earned is reinvested in the account monthly and a unds remain on deposit for one year from the date of deposit and the interest rate does not change. Interest withdrawn.during the term of the account will reduce the annual percentage yield earned. TERMS OF 32 DAYS OR LONGER-You may choose the frequency of interest payments. Interest can be paid as frequently as monthly,but must be Paid at least once a year.Interest may be reinvested into the account,credited to another Bank of the West checking or savings account, or paid by check.TERMS OF 7-31 DAYS-You will receive interest at maturity only. Interest may be reinvested into the Certificate of Deposit,or as a deposit to a Bank of the West checking or savings account. MATURITY-Automatically renewable Certificates of Deposit renew automatically at the rate in effect on the maturity date,for the same term and under the same conditions last disclosed (unless we tell you otherwise). We will mail a maturity notice approximately 15 dayys prior to the maturity date(except for 7-14 days terms). The notice will include a phone number you can call on the maturity date (or shortly after) to find out the interest rate and annual percentage yield on your renewed Certificate of Deposit. A non-renewable Certificate of Deposit will not earn interest beyond the maturity date,and will not renew automatically at maturity. _____ EARLY WITHDRAWAL PENALTIES The penalty assessed may reduce the balance remaining on our account after the withdrawal. For terms of 7-31 ays an mon s+, a pens is calculted at the interest rate in effect on the account at the time of the withdrawal. The penalties on the amount withdrawn are: 7-31 DAYS TERM: $25 + 31 days simple interest; 32 DAYS-11 MONTHS TERM: $25 + 1%a of the amount withdrawn; 12-59 MONTHS TERM:$25+3%of the amount withdrawn;60-MONTHS OR LONGER TERM:730 days simple interest. CHANGES IN TERMS&CONDITIONS-When you open a deposit account with us,you agree to abide by the terms and conditions detailed on this page and in the Account Agreem—efff-y—ousign. We can change these terms and conditions at any time. We'll notify you in advance of any'changes that affect your rights and obligations to the extent required by law. You indicate that you accept a change we make by continuing your account relationship with us or,if the change affects your certificate of deposit,by allowing the certificate to renew after the change becomes effective. DISCLOSURE OF YOUR ACCOUNT -Account Information may be disclosed to third parties when it is required for governmental reporting for legal processes, or o persons or companies who the Bank believes would legitimately use such information. Certain transactions are also automatically reportable to the government. OTHER INFORMATION REGARDING DEPOSIT ACCOUNTS-Additional information pertaining to the rules & regulations governing deposit accounts can a provided it you request a current copy of the bank of ifie West Deposit Account Disclosure which is available by phone or in person at any of the Bank's branch offices. You may also call our Telephone Banking Center and request that we send you a Deposit Account Disclosure. NON-NEGOTIABLE NOT TRANSFERABLE MEMBER FDIC 120-01820(Rev.12/12) TimeDepositReceipt .HkCHARo CITY OF CAMPBELL Public Works Department September 6, 2016 Mr. Atul Sharma 70 S. San Tomas Aquino Rd. Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00235 70 S. San Tomas Aquino Rd. .FINAL INSPECTION AND ACCEPTANCE Dear Atul: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins on August 12, 2016. The permittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. Your Construction Cash Deposit refund for $940.00 and your Plan Check Deposit refund for$500.00 are enclosed. The Faithful Performance Bond in the amount of$23,500.00 will be kept in force for the duration of the one-year maintenance period unless you wish to replace it with a Maintenance Bond for 25% of the original amount ($5,875.00) If you have any questions,please call me at(408) 866-2165. Sincerely, Syed Wahidi Public Works Inspector Cc: Inspector(Suspense Files Permit File: Enc2013-00235 70 North First Street • Campbell, California 95008-1436 •TEL 408.866.2150 •Fax 408.376.0958 TDD 408.866.2790 Encroachment Permit Final Sign Off Encroachment Permit# Address: Date of Final Inspection and Acceptance: Inspected by: OK to release deposits: 100% IV/ 75% Comments: (C'Mt\eA of CgMA Ck CHAR' CITY OF CAMPBELL Public Works Department September 6, 2016 Mr. Atul Sharma 70 S. San Tomas Aquino Rd. ,Campbell, CA 95008 SUBJECT: PERMIT NO. ENC 2013-00235 70 S. San Tomas Aquino Rd. .FINAL INSPECTION AND ACCEPTANCE Dear Atul: t The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins on uust 12, 2016: The permittee is responsible for the repair and/or replacement of any e ective wor 'or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. Your Construction Cash Deposit refund for$940.00 and your Plan Check Deposit refund for$500.00 are enclosed. The Faithful Performance Bond in the amount of$23,500.00 will be kept in force for the duration of the one-year maintenance period unless you wish to replace it with a Maintenance Bond for 25% of the original amount ($5;875.00) If you have any questions, please call me at(408) 866-2165. Sincerely, e . Syed Wahidi Public Works Inspector Cc: Inspector/Suspense Files Permit File: Enc2013-00235 70 North First Street • Campbell, California 95008-1436 .TEL 408.866.2150 •FAX 408.376.0958 TDD 408.866.2790 Joy Francois To: JoAnna Thomason Subject: Atul Atul came in with his new CD (notarized) and I took it and had Amy sign that one and the old one and I returned the old one by mail. Copies of all are in the encroachment file. Let me know if you have any questions. Joy Francois Executive Assistant City of Campbell Public Works Department 70 N. First St. Campbell CA 95008 iovf@citvofcampbell.com 408 866 2150 1 OF C44f Al A U ' •�RCHARO, CITY OF CAMPBELL Public Works Department December 15, 2016 Mr.Atul Sharma 14600 Westcott Dr. Saratoga, CA 95070 Subject: Permit No. ENC 2013-00235 70 S. San Tomas Aquino Rd Release of Faithful Performance Bond,.Receipt of Maintenance Bond Dear Atul: Please find attached your original Investment Certificate,No.034093377 in the amount of$23,500. This Certificate has been released by the City of Campbell on December 15, 2016. We are in receipt of your Certificate No. 046882858 in the amount of$5,875.00 r the one year maintenance period (copy attached). e Thank y8u. . r i / Joy Francois �V V Executive Assistant Public Works Dept. Cc: ENC 2013-00235 -Suspense 12 months 70 North First Street• Campbell, California 95008-1436 •TEL 408.866.2150 •FAx 408.376.0958 •TDD 408.866.2790 ASSIGNMENT AND RECEIPT-OF 1NVESTWNT CERTIFICATE P. V.Permit No. ENC2013--00235 TO CITY OF CAMPBELL, 70 N.FIRST STREET TR or DEV CAMPBELL,CALIFORNIA 95008 (408)866-2150 Loc. 70 San Tomas Aquino Rd. I am/We are the owner(§)of a savings.account at o 4 it/:, �(' �t- �S at its branch office at M_ C--, C JL , California, investment certificate No. in the names of and h 7 aving a present balance of-&5-85:00 - I hereby grant, transfer and assign said account, said investment certificate, said balance(including interest which -accrues thereon),-and all other-rights in connection therewith to the CITY-OF CAMPBELL, assignee, for;a good and valuable consideration, receipt of which is hereby acknowledged, for the purpose of insuring construction described as follows: I have physically delivered verification of said investment certificate and dupTicate of this Assignment and Receipt to said assignee. I understand that assignee can withdraw from said account any time on his signature alone upon presentation of a written order to the issuer. I also understand that I may not withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may-act-on the-signature-of the assignee without further-inquiry. Executed on O t ,20 ,at said office of the issuer. Assignor (sign) C'�.' L� f//�'1�,/�-' (print) ACKNOWLEDGMENT BY ISSUER Issuer affirms that there are no other holds on subject account,that subject monies are available,and that the above-desefibed assignment has beennoted on the Records of said issuer. Date /Z/as C 7- XW B3'�'� Authorized Si�naiure) ATTACH NOTARY ACKNOWLEDGMENT Title 1-0� / INSTRUCTIONS TO ASSIGNEE Please sign below for signature identification and as acknowledgment of your notice of Assignment. Return this Assignment and Receipt to the issuer at its address.above. Retain one-copy Af this A and Receipt.for your files. ��Date City of Camjp11 By j k i { RELEASE OF ASSIGNEE' Said assignee hereby releases and relinquishes all his right,title and interest in and to said account,said investment certificate, said balance.and all-other-rights in-connection therewith. Date City of Campbell By C'.\Users\;Atul\AppDatd\Local\Temp\New-Maint Mdoc(Rev.03/08) P t ' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 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 74�YS [___� On Mt��-y►t_Q � 21_� before me, Date Here Insert Name and Title of the Olficer personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be thee a n(s) whos (s)jj re r�scribed to the withi ument and acknowledged to /she/they executed th a in er/their authorized c (ies), arld�tfr 3 _h� er/their signatur s)on the instrument the erso s), or the entity upon behalf of which the perso (s) acted, execute tt e instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. SEBLE DEMISSIE Commission#2080097 i .�� _Votary Public=California z = Santa Clara County > Signature7� r ,�- MY Comm.Expires Aug.30'.2018 t Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document iy.tY✓Icz G Title or Type of Document: Y1/'i/ f �L Document Date: Number of Pages: Signer(s) Other Than Named-Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑ Corporate Officer — Title(s): ❑ Corporate Officer.— Title(s): ❑ Partner = ❑ Limited ❑General ❑ Partner — ❑ Limited ❑ Vneral ❑ Individual ❑Atto�pey in Fact ❑ Individual ❑Attor in Fact ❑Trustee rdian or Conservator El Trustee ElGua dian or Conservator El Other: Other: ❑ Other: / Signer Is Repr ting: Signer Is Representing: ©2014 National Notary Association •www.NationalNotary.org - 1-800-US NOTARY(1-800-876-6827) Item #5907 ASSIGNMENT AND RECEIPT OF INVESTMENT CERT-TICATB P.W.Perzn.it No. - TO CITY OF CAMPELLL,70 N.FIRST STREET TR or DEV � CAMPBELJ,CALIFORNIA 95008 (408)866-2150 n n I�;�,� -(��,a m r��cc� Loc. - I amfWe are the owner(s)of a savings.account at U' 3 -�� at.its branch office at �lg` MCalifornia,investment certificate No. ©3<{-0�i 33 ate- in the names of �- and having a present balance of I Hereby grant, transfer and assign said account, said investment certificate, said balance (including interest which accrues thereon), and all, other rights in connection therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration, receipt of which is hereby acknowledged. for the purpose of insuring construction described as follows: I have pbv§ically delivered verification of said investment certificate and dupjicate of this Assignment and Recei t to said assignee. T understand that assignee can withdraw from said account any time on his signature alone upon presentation of a written order to the issuer. I also understand that I may not withdraw fTorn said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may act on the signature of the assignee without further inquiry. Executed on ,�0 ,at said office of the issuer. Assignor. (si.go) V-T-C� L_ q h-tl A A-) (print) ACKNOWLEDGMENT BY ISSUER Issuer affirms that there are no other holds ow subject account, that subject monies are available, and that the above-described assignment has been noted on the Records of said issuer. f Date AD13 By F kAuthorized ign ,t re) ATTACH NOTARY ACKNOWLEDGMENT Title ( ��` �� `` x�� 'Qr-- r 'win siEI:IENS CrR EK BLVD.OFFICE 3388 STEVRJS CREEK BLVD. INSTRUCTIONS TO ASSIGNEE SAN JOSS,CA 95117 Please sign below for signature identification and as acknowledgment of your notice of Assignment. Return this Assignment and Receipt to the issuer at its address above. Retain one copy of this Assignment and Receipt for your tiles. Date City of fampK IZ, y RELEASE aF_ASSIGNEE Said assi grace hereby releases and relinquishes all his right,title and interest in and to said accc)uitt,said investment ecrtificatc, said balance and 911 other rights in connection therewith. Date �_ fa city Of c t 11 % '? By L•lfermslnesignmcnt&Trcciprofinvcsi:mcntecrtiftc lte.doc 11/10/05 BANKTOHFEWEST a, Certificate of Deposit Receipt Branch Name: 000 1 5-Stevens Creek-Saratoga Date of Deposit: 12/19/2013 Account Number: 034093377 Amount of Deposit: $23,500.00 Today''s Date: 12/19/2013 Maturity Date: 06/17/2014 Branch Approval: Seble Demissie Initial Interest Rate: 0.10 Cust Name/Address: ALKA MONTESSORI Initial APY 0.10 FBO CITY OF CAMPBELL Interest Payment Method Redeposit 70 SOUTH SAN TOMAS AQUINO RD Pay Interest to Acct#: 000000000 CAMPBELL,CA95008 Interest Payment Freq. At Maturity Phone#: Term: 180 Days Renewal: Automatically Renew Deposit receipt not needed for redemption. Thank you for opening a Certificate of Deposit with Bank of the West. Your account has been opened for the amount and terms shown above. Any questions regarding your Certificate of Deposit can be answered by your branch or by calling the Bank's Telephone Banking Center(800)488-BANK. INFORMATION REGARDING CERTIFICATE OF DEPOSIT ACCOUNTS Minimum Opening Balance$ Minimum balance required to earn APY$ ADDITIONAL DEPOSITS—If you wish to add funds to your Certificate,you may do so during the 10 calendar day grace period following the account's maturity date.For 7-31 day Certificates,you may add funds during the l calendar day grace period following the maturity date. Interest on the additional funds,both cash and non-cash,begins to accrue on the business day you deposit it and at the same rate in effect for the renewed Certificate. The additional funds will mature at the same time as the renewed Certificate. The minimum amount for an additional deposit is$100.00. WITHDRAWALS — Interest which has been reinvested may be withdrawn at any time, if the account term and interest rate have not changed since the renewal.Additional withdrawals without penalty are permitted during the 10 calendar day grace period following maturity (1 calendar day grace period for 7-31 days Certificates) for automatically renewable Certificates, or upon the death or mental incapacity of the depositor.Accounts closed during the grace period will forfeit any interest accrued during the grace period. Withdrawals at any other time may be permitted at the Bank's discretion and are subject to early withdrawal penalties. INTEREST—Interest is accrued on the daily balance. The annual percentage yield assumes that interest earned is reinvested in the account monthly and all funds remain on deposit for one year from the date of deposit and the interest rate does not change.Interest withdrawn during the term of the account will reduce the annual percentage yield earned. TERMS OF 32 DAYS OR LONGER — You may choose the frequency of interest payments. Interest can be paid as frequently as monthly, but must be paid at least once a year. Interest may be reinvested into the account,credited to another Batik of the West checking or savings account,or paid by check. TERMS OF 7-31 DAYS— You will receive interest at maturity only. Interest may be reinvested into the Certificate of Deposit, or as a deposit to a Bank of the West checking or savings account. MATURITY—Automatically renewable Certificates of Deposit renew automatically at the rate in effect on the maturity date, for the same term and under the same conditions last disclosed(unless we tell you otherwise). We will mail a maturity notice approximately 15 days prior to the maturity date(except for 7-14 day terms).The notice will include a phone number you can call on the maturity date(or shortly after)to find out the interest rate and annual percentage yield on your renewed Certificate of Deposit.A non-renewable Certificate of Deposit will not earn interest beyond the maturity date,and will not renew automatically at maturity. EARLY WITHDRAWAL PENALTIES—The penalty assessed may reduce the balance remaining on your account after the withdrawal, For terms of 7-31 days and 60 months+,the penalty is calculated at the interest rate in effect on the account at the time of the withdrawal.The penalties on the amount withdrawn are: 7-31 DAYS TERM:$25+31 days simple interest;32 DAYS—I I MONTHS TERM:$25+1%of the amount withdrawn; 12—59 MONTHS TERM:$25+3%of the amount withdrawn;60-MONTHS OR LONGER TERM: 730 days simple interest. CHANGES IN TERMS AND CONDITIONS—When you open a deposit account with us,you agree to abide by the terms and conditions detailed on this page and in the Account Agreement you sign. We can change these terms and conditions at any time. We'll notify you in advance of any changes that affect your rights and obligations to the extent required bylaw.You indicate that you accept a change we make by continuing your account relationship with us or, if the change affects your certificate of deposit,by allowing the certificate to renew after the change becomes effective. DISCLOSURE OF YOUR ACCOUNT— Account information may be disclosed to third parties when it is required for governmental reporting for legal processes, or to persons or companies who the Bank believes would legitimately use such information. Certain transactions are also automatically reportable to the government. OTHER INFORMATION REGARDING DEPOSIT ACCOUNTS — Additional information pertaining to the rules & regulations governing deposit accounts can be provided if you request a current copy of the Bank of the West Deposit Account Disclosure which is available by phone or in person at any of the Bank's branch offices. You.may also call our Telephone Banking Center and request that we send you a Deposit Account Disclosure. NON-NEGOTIABLE NOT TRANSFERABLE MEMBER FDIC 120-01820(Rev. 12/12) JoAnna Thomason From: JoAnna Thomason Sent: Tuesday, December 06, 2016 10:48 AM To: 'atul@sbcglobal.net' Subject: CD information Attachments: Current CD.pdf, New Maint CD.doc Hi Atul, per our phone conversation, I am attaching a new CD Assignment Form for a Maintenance CD. We require the amount of$5,875.00 which is 25%of your original CD. Once you bring in your new signed and notarized CD assignment, we will release your current one which I am also attaching a copy of. Please let me know if you have any questions. Thank you, JoAnna JoAnne Thomason I Office Specialist Public Works Department Joannat@cityofcampbell.com Phone 408.866-2150 Fax 408.376-0958 70.N. First Street I Campbell,CA 95008 www.cityofcampbell.com 1 } _._..............: ............................_.....; ................................._._..__ ..............._. ..................._..._...... .......................... II CITY OF CAMPBELL VENDOR NO., 10013988 CHECK NO. 258858 erbunt Parchase:Order .... .: Descry tlan , . 101 2203 CR082516 500.00 PLAN CHECK DEP RETURN I ! I � , c • �,in i �� tt I' N I 10013988 ALKA MONTESSORI I CHECR DATES CHECK NO CITY U ' CAIVIPBELL %Als FARGO aANx N A ii z4 �� n 7?NOfi Eii FIRST STREET 42L MONTGOMERY STREET 1210 0 91 0 5 16: 2 5 8 8 5 8 '� �' SAi3 FRANCISCO CA 94104 r" CA.MPbELL CALIFORNIA 95008 AMOUNT * *5 0 0^ 0 0 + ��+runBO Y' VOID AFTER 9`0 DAYS{ I PAY THE SUM: OF FiVE HUNDRED DOLLARS & GERO CENTS W!{ L S "'�oxxE ALKA MONTESS,ORI ; �, s ' OFDER ]O SWWI- SAN TOMAS AQUIN,O RD V CAMPBELL CA 95008 % . 214,8� S --------------- ---- - -- - ------ --- - __._ _............ _...:....._... _ 1 f See Reverse Side For Easy Opening Instructions*. I -1- ------- -- ------ ------ ------ ---- - - _ - - -..._. CITY OF CAMPBELL - 70 NORTH FIRST STREET CAMPBELI;, CALIFORNIA 95008 i I' ALKA MONTESSORI 70 S. SAN TOMAS AQUINO RD CAMPBELL CA 95008 1 I ..................... ------------------------------------- - / _._-----' ----------- - ------ - --- - - - . - ...... ------------------------------- - F.� `CITY OF CAMPBEIT VENDOR NO. 10013992 CHECK NO. 258881 101 �. 2203 CR08251G 940..00 DEPOSIT RETURN 10013992 ATUL SHARMA I ' i I I i ' 1/ 1 1 1 1 1 � 1 • / 1 1 1 - CHECK DATE. CHECK 'NO. o G' i CITY OF CAMPBELL W$' FARGO BANK, N.A. 11-24 . 429:MONTGOMERY STREET 1210 0 9/0 5/16 �p NORTH FIRST STREET 1 SAN FRAN, CISCO CA-94104 r' OA3VIPBEL CZFORNIA 95008 AMOUNT r** **94�0. 0 0�* i, UOID,AFTER,90 DAYS o;l PAY THE SUI 1 OF NINE'.HUNDRED FORTY'`DOLLARS "& ZERO "CEN.TS m zo`mxE ATUL SHARMA ,- it ORDER, z, � � 7 0 S:. STAR j�¢1 CAMPBELL C-A 9 5008 �I ' (ram II' 25:888L'il' �: L i0,00248�: 4121.65,`5415II■ w ___....... .................................... .................. . See Reverse Side For Easy Opening Instructions* F CITY OF CAMPBELL 70 NORTH FIRST STREET CAMPBELL, CALIFORNIA 95008 I ATUL SHARMA 70 S. STAR CAMPBELL CA 95008 }{ x .. w f � � Ref undable tDe osi.t Check_Re uest � � y � i � 1 '� To Finance Director r 2 r , Check Payab i To r, Atul"Sharma ' f�' ' r z n ' Address L'ij�e 1 70'S STAR y r r c Llne z t 4l t4 Yi 4 a r i :City Campbell' State CA, Zip 95008 , s. r M , Y r _ ''{ Account Number r y 101 2203 Amount Account Number ?t , Amount ' 4kY ,Account Number 101 54077448 �ti Amount (F708nceDept Only) � (F�nance Dept only) • Interest Earned �; _ � (ExaC�tAmouflt) Qurpose COnstruCfilOn deposit return 5 a + � ��` { tTty �� +t � •�� *rt '. 3%;� +.�,t t'� �lF`s K fi� - i <i, ;-. _, t 4 +,� � t� � 1 � i�L� .� ;t Receipt# > 2513, #t � EfC 2013 00235 h. •. y Receipt# r.. Date a Requested by ` , _ Y Title> DPW Insp eta r Date1�23 l(� � <t � APPr'oued by D �� ,� Title Sr Engineer 1_ ate Roger St`orz ` t• ha r t Fir 7 -' ! �' ':.� t :`k ' ,^ r j t 1 €K7 tp ).: t +] Y{M•:? A�.+.,� �`, F .'t {t ... y Fv } F 1 f Finance Dept.Only: �' �� F J ' � � J Verified by, �Accountmg Clerk II .Date f � � t t. W ~� Approvetl byAccountant �f { y 4 3H• __ F _ � E Z ' �4' � H. L .t 'i t yw5 ecial_ ' �y�ristr_uct�io�� s. =Fa�Ha=n�dln `�=Ch�ec'k� 5 f r t 2 Mail As Is xad in Attached Envelope> Interim Check , s Needed By �'� Return JoAnna Thomason { fi r ► Other Please return check to JoAnna 3 ti:� I y l l• �Je} \ J} d. F,F .!� y,,.,. _.�'.!.. rA J..." ; >i .>! }. -Y fIn Farmslezcel/chkreq' ReJised 05100s a CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT CLEARANCE FOR ONE YEAR MAINTENANCE ACCEPTANCE LETTER Encroachment Permit # ENC2013-00235 Property Address: 70 S. STAR Date of Final Inspection: 8/12/16 On File: Bonds CD Cash Faithful Performance $ Labor and Material $ Construction Cash Deposit to be m4eae $9' O. d Other overdue deposits to be released (Description): �CLV� C\\";C_1, Processed by: AIministrator Reviewed by: Inspector Reviewed by: Land Development Engineer( ( `O JAJoAnnaT\Deposit refunds\CHECKLISTS\STAR70.doc(Rev. 10/11) ' , From: SyedWahidi ' Sent: Wednesday, August I0, 2Ul68:10AM To: 'atu|@sbog|obainet' Cc: Doris QuoiHci; Bob Siudzinski Subject: RE:Trees punch list � Hi4tuL As per City arbohst, the following need to be done to accept the tree: . \ ° Acmss brace. ° 2-4 inches of Mulch. Bye8Wubidi I Public Works Inspector City of CumpUeU I Public Works Dept. 2408.866.3105 A 408.376-0950 71N. First Street I Campbell,CAg50U0 From: SvedVVahidi Sent: Tuesday, August D3, 3O1S11:S3AM To: 'atu|@sbcoloba|.net Cc: Doris QuaiHoi; Bob Siuddnski Subject: Trees punch list HiAtu[ ' Here are the items that need to be corrected for the new tree.Apparently contractor did not follow City tree detail. - Two stakes needed instead of4 - Cross brace ismissing - Size of stakes shall be 3" ' ' Remove nursery stakes Once all items are taken care of, please let me know and I will send the arborist again. Thanks There is tree detail on plans. ' Sy«d Wubidi I Public Works Inspector Cdy of Campbell I Public Works Dept. 2- 408.006.2165 A 408.376-89-58 70. N. First Street I Campbell,(]A0500 - / 1 / 70S ST*AK Syed Wahidi From: Syed Wahidi Sent: Tuesday,August 02, 2016 11:53 AM To: 'atul@sbcglobal.net' Cc: Doris Quai Hoi; Bob Siudzinski Subject: Trees punch list Hi Atul, Here are the items that need to be corrected for the new tree.Apparently contractor did not follow City tree detail. - Two stakes needed instead of 4 - Cross brace is missing - Size of stakes shall be 3" - Remove nursery stakes Once all items are taken care of, please let me know and I will send the arborist again. Thanks There is tree detail on plans. Syed Wahidi I Public Works Inspector Catty of Cattnpbell I Public Works Dept. svedw-,�citvofcampbell.com 0408.866.2165 1,A 405.376-09S$ 70. N. first Street j Campbell,CA 95008 www.CityofCampbell.cotn 1 e-C e,:6 ance, -U'rector" IA a, on essp 6 Rd., iII1 rip ion-,,:,.- ES,I 'A.�iAcCoUhtl, U A m o u n�n uib CCOUO um e MOL nterest? a r ned-E inanceb PPj R1 X T aya. e:P II...............UOce i pt If:Iw hSO_ecto..R' IiiY.-pprove'd'b"', ngine II7 Iftancovept verffiec A 1; Mal 11h Attache nve ope:-,,,:k., k"B IoAh M IIR U n iIbasure urw Othef IL 7777777777TP��',",`,II100 W,Vq �'I�e i f��I"Forms exce c ENCROACHMENT PIOT ISSUANCE CHECK LIST INTERN ONLY City of Campbell Encroachment Pernu o.ENC 2013-00?-3S Department of Public Works Tract No. Address: 11AUwaA ITEMS REQUIRED FOR PERMIT APPLICATION: 0 Encroaclunent Permit Application complete,with applicant signature and date(fi-ont and back) 1�� 113 2. Permit Application Fee aid$ 1 pp p Receipt Number&Date 3 Plan Check Deposit Paid(2%of Engineer's Estimate,$500 min)$ Receipt Number 4. Grading Plan Review Fee paid $ t Receipt Number&Date � 3 l 5. City Engineer's Estimate Completed and Submitted 6. Four(4) Sets of Street Improvement Plans 7. Four(4) Sets of Grading and Drainage Plans 8. Check Lists (Grading and Drainage, Street Improvement) MS REQUERED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS 9. Plan Check&Inspection Fee:Engineer's Estimate(EE)_$ v Q ; if EE is<$250,000,then fee is 14%of EE. If EE>$250,000 fee is Actual Cost+20%. $35,000 minim inn Je os t. / Amount$ � Receipt No.&Date �2 S, Security for Faithful Performance.and Labor and Materials, 100%each of Engineer's�stimate, supplied o-paid. Amount$ 10 Form-C—D� Receipt No. &Date / � _ r 11. Security for Monumentation Amount$ Receipt No. &Date 12. Construction Eme gency Cash Deposit: 4%of Enginee-s i a p.($500 mini $10,000 maximum) Amount$ 4W� Receipt No. &Date �1 27/ /G�/(q,71-j 13 <— Storm Drainage Area Fee Amount$ Receipt No. &Date ' 1 Street Improvement Agreement signed and notarized(proof of ownership submitted) 15. Right of Way Documents Completed and Fees Paid. cauatc',� 16 All other Public Works requirements listed ui the Conditions of Approval of the developmen7 t. 17. Other Fees,Payments, Deposits Amount$ Receipt No. &Date 18. SWPPP+NOI 19. C3 Certification 20. Covenant AAareemen 21. Geotecb Letter 22. Storm Water Management Plan ITEMS REQUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: 23 Contractor's signature added to the permit application(front and back) 24. Contractor's City of Campbell Business License# 25. Worker's Compensation Insurance Information Sheet received from Contractor. GCertificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. 4 8a/10 Q�7 _ Ott r set and six(6) or less sets of off-site plans signed by engineer,stamped APPROVED FOR CONSTRUCTION. QEontractor, t/Inspector _PW Superintendent(Service Center) P File T-ID File _Signals&Lighting Supervisor(Service Center) 28. Permit signed by City Engineer, 29. INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE,PERMIT MAY BE ISSUED. Issuer:Initial aid date aid file with permit J:\FORMS\Templates\Land Development\Street Improvements\Encroachment Permit Issuance Checldist.doc(Rev.07/11) ASSIGNMENT AND RECEIPT OF INVESTMENT CERTIFICATE F.W.Permit No. lel C'Z 1 5-00Z35 TO CITY OF CAMPBELL,70 N.FIRST STREET TR or DEV CAMPBELL,CALIFORNIA 95008 (408)566-2150 Loc. l.'cyY a-'S I am/We are the owners)of a savings.acc unt at d 3 �t 3 � at its branch office at California,investment certificate, No, ©342 2 332-7- in the names of ALKA sSGR� -1=?0 Cf TL_coF CAMP b-P�- and having a present balance of I hereby grant,'txansfer and assign said account, said investment certificate, said balance(including interest which accrues thereon), and all other rights in connection therewith to the CITY OF CAMPBELL, assignee, for a good and valuable consideration, reecipt of which is hereby acknowledged, for the purpose of insuring oonstruction described as follows: I have pbysically delivered verification of said investment certificate and duplicate of this Assn ument and RecqiJ3t to said assignee. T understand that assignee can withdraw from said a.ocount any time on his signature alone upon presentation of a written order to the issuer. I also understated that I may not withdraw from said account unless I present a signed release from the assignee. The issuer of the certificate assumes no responsibility for the conduct of the assignee and may act on the signature of the assignee without further inquiry. Executed on i� ,20 , at said office of the issuer. Assignor (si.gu) V-rt, L F�a 2 K A-) (print) ACKNOWLEDGMENT BY ISSUER Issuer affirms that there are no other holds on subject account, that subject,monies are available, and that the above-described assignment has been noted on the Records of said issuer. Date �� uthorize tgn t re) ATTACH NOTARY ACKNOWLEDGMENT Title [(a rQ�Y1C� LAL �!.� � u.�; -xgg IV—�-8 Si ,FENS CPIEEKI BLVD.OFFICE 3038 STIEVENS CREEK BUID, INSTRUCTIONS TO ASSIGNEE SAN;IuSE.CA gar 17 Please sign below for signature identification and as acknowledgment of your notice of Assignment. Return this Assignment and Receipt to the issuer at its address above. Retain one copy of this Assignment and Receipt for your files. Date t" �' y City of amp el �,/ �) By`7 ! 'i� (�`� c`'� t�l�'� ]ZELEA51~_QF.ASSIGNEE Said assignee hereby releases and relinquishes all his right, title and interest in and to said account,said investment certificate, said balance and all other rights in connection therewith. Date City of Campbell By ,L•lrnrms\asaignmcnc&rccciprofinvcstnuutcettiftcate.doe 11/10/05 } BANKTONEWEST : ., Certificate of Deposit Repeipt Branch Name: 000 1 5-Stevens Creek-Saratoga Date of Deposit: 12/19/2013 Account Number: 034093377 Amount of Deposit: $23,500.00 Today's Date: 12/19/2013 Maturity Date: 06/17/2014 Branch Approval: Seble Demissie Initial Interest Rate: 0.10 Cust Name/Address: ALKA MONTESSORI Initial APY 0.10 FBO CITY OF CAMPBELL Interest Payment Method Redeposit 70 SOUTH SAN TOMAS AQUINO RD Pay Interest to Acet#: 000000000 CAMPBELL,CA 95008 Interest Payment Freq. At Maturity Phone#: Term: 180 Days Renewal: Automatically Renew Deposit receipt not needed for redemption. Thank you for opening a Certificate of Deposit with Bank of the West. Your account has been opened for the amount and terms shown above. Any questions regarding your Certificate of Deposit can be answered by your branch or by calling the Bank's Telephone Banking Center(800)488-BANK. INFORMATION REGARDING CERTIFICATE OF DEPOSIT ACCOUNTS Minimum Opening Balance$ Minimum balance required to earn APY$ ADDITIONAL DEPOSITS—If you wish to add funds to your Certificate,you may do so during the 10 calendar day grace period following the account's maturity date.For 7-31 day Certificates,you may add funds during the 1 calendar day grace period following the maturity date. Interest on the additional funds,both cash and non-cash,begins to accrue on the business day you deposit it and at the same rate in effect for the renewed Certificate. The additional funds will mature at the same time as the renewed Certificate. The-minimum amount for an additional deposit is$100.00. WITHDRAWALS — Interest which has been reinvested may be withdrawn at any time, if the account term and interest rate have not changed since the renewal.Additional withdrawals without penalty are permitted during the 10 calendar day grace period following maturity (1 calendar day grace period for 7-31 days Certificates) for automatically renewable Certificates, or upon the death or mental incapacity of the depositor.Accounts closed during the grace period will forfeit any interest accrued during the grace period.Withdrawals at any other time may be permitted at the Bank's discretion and are subject to early withdrawal penalties. INTEREST—Interest is accrued on the daily balance.The annual percentage yield assumes that interest earned is reinvested in the account monthly and all funds remain on deposit for one year from the date of deposit and the interest rate does not change.Interest withdrawn during the term of the account will reduce the annual percentage yield earned. TERMS OF 32 DAYS OR LONGER — You may choose the frequency of interest payments. Interest can be paid as frequently as monthly, but must be paid at least once a year. Interest may be reinvested into the account, credited to another Bank of the West checking or savings account,or paid by check. TERMS OF 7-31 DAYS— You will receive interest at maturity only. Interest may be reinvested into the Certificate of Deposit,or as a deposit to a Bank of the West checking or savings account. MATURITY—Automatically renewable Certificates of Deposit renew automatically at the rate in effect on the maturity date,for the same term and under the same conditions last disclosed(unless we tell you otherwise). We will mail a maturity notice approximately 15 days prior to the maturity date(except for 7-14 day terms). The notice will include a phone number you can call on the maturity date(or shortly after)to find out the interest rate and annual percentage yield on your renewed Certificate of Deposit.A non-renewable Certificate of Deposit will not earn interest beyond the maturity date,and will not renew automatically at maturity. EARLY WITHDRAWAL PENALTIES—The penalty assessed may reduce the balance remaining on your account after the withdrawal, For terms of 7-31 days and 60 months+,the penalty is calculated at the interest rate in effect on the account at the time of the withdrawal.The penalties on the amount withdrawn are: 7-31 DAYS TERM:$25+31 days simple interest;32 DAYS—I I MONTHS TERM:$25+ 1%of the amount withdrawn; 12—59 MONTHS TERM:$25+3%of the amount withdrawn;60-MONTHS OR LONGER TERM: 730 days simple interest. CHANGES IN TERMS AND CONDITIONS—When you open a deposit account with us,you agree to abide by the terms and conditions detailed on this page and in the Account Agreement you sign. We can change these terms and conditions at any time. We'll notify you in advance of any changes that affect your rights and obligations to the extent required by law.You indicate that you accept a change we make by continuing your account relationship with us or,if the change affects your certificate of deposit,by allowing the certificate to renew after the change becomes effective. DISCLOSURE OF YOUR ACCOUNT — Account information may be disclosed to third parties when it is required for governmental reporting for legal processes, or to persons or companies who the Bank believes would legitimately use such information. Certain transactions are also automatically reportable to the government. OTHER INFORMATION REGARDING DEPOSIT ACCOUNTS — Additional information pertaining to the rules & regulations governing deposit accounts can be provided if you request a current copy of the Bank of the West Deposit Account Disclosure which is available by phone or in person at any of the Bank's branch offices. You may also call our Telephone Banking Center and request that we send you a Deposit Account Disclosure. NON-NEGOTIABLE NOT TRANSFERABLE MEMBER FDIC 120-01820(Rev. 12/12) _ Joy Francois � , � 1 OV•CA4f ,, A � City of Camp] �. Department o..-..•aVic Works U ' r 70 North First Street 0 0 Campbell,CA 95008 y� Phone:(408)866-2.150 o R Fax:(408)376-0958 CH A.AD s Transmittal To: Bank of the West January 9,2014 Address: Stevens Creek Blvd Office,3888 Stevens Creek Blvd., San Jose CA 95117 Re: Assignment for CD#034093377 ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply x For Information&Use Enclosed please'find the Assignment and'Receipt for the above mentioned CD. Thank you. Joy Francois NDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY Complete items 1,2,and 3.Also complete A SI nature 4 item 4 if Restricted Delivery is desired. ' - El Agent �Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. jceiv,o by(Pnnte amw C:Date of Delivery Attach th'iscard to the back of the mailpiece, nt f or on the fro space'permits. D. Is delivery address different from item 1? ❑Yes Article Addresse o If YES,enter delivery address below: ❑No f - tnk of thee5t`: l evens Creek,_;"Blvd. Office :88 Stevens Creek Blvd. j 3. Service Type r r in.Jose CA 95117 . CertiffedMai) Express r,r xk� ❑Registered 6]Return Recefpf#or Merchandise - _ -- ❑Insured Mail � 'C 0 D ?t r�r>Y, I 4. Restricted.Dei%e `(rFxtra`Fee� 7 Yes I 4rticle Number %i-- --_ - - Transfer from service laben 7 012 3460 0001 6 5 6 2 -5110 Form,3811.,. ebruary 2004.,._ Domestic Return Receipt'-:_ __:.� _u_ 102595-0, -M•1540-I F CITY OF CAMP7BELL DEPARTMENT OF PUBLIC WORKS APPLICATION FOR ME/�REMOVAL Date Submitted 1 Application No. Pursuant to the terms of Chapter 11.08 of the'Campbell Municipal Code, an application is hereby made for a permit to remove C F� 1. The location of the j b in the public right o way is as follows: �. } ` The ns.for the emoval�are follows: 42 (use other side of sheet if necessary) 3. The applicant hereby agrees, by affixing his signature to this application,'to hold the City of Campbell, its officers, agents and.employees free,-safe and harmless from any claim or demand for damages to third persons relating from the work herein proposed. Name of Applicant (signature) &UL 9111XIn6 (print your name) r_ r Address of Applicant Check One: Residence ( ) or Business � Telephone Number j08 FOR OFFICE USE e ' Date Ripgornmendation ` �P-eea -, • X 5 (use other side of sheet'if n essary) Applicant contacted in field:' ��_ By Date of-CA41'06� 1211912013 r r' U r © O F G�l �kCHAR� Public Works Department Development Fees & Outstanding Information Project: 70 S San Tomas Aquino Road ENC 2013-00235 Fees &Deposits: ' Encroachment Permit Application Fee..................$377.00 Paid Plan Check Deposit ...... ... ...................... ..... ...$500 Paid Engineering Plan Check& Inspection Fee 14% $3290.00 ✓ � ' Grading and Drainage Plan Review Fee..................$1060 Paid NPDES Plan Review Fee.......................................$153.00 Paid (This is a fee for staff review of conformance with the requirements of the NPDES permit, C.3 provisions as they pertain to storm water discharge and Low Impact Developmrt.) .� Faithful Performance Security..................................$23,500.00 V Labor&Material Security........................................$23,500.00 (These securities are retained by the City to insure the work is completed per the permit. Once the work is completed and the City accepts the improvements, the applicant may elect to have 75%of the deposit returned. 25% is retained for a 1 year maintenance period. After 1 year, if there are no issues with the installed improvements, the rest is refunded. See security options in the Notes.) / I w w V/ l Emergency Cash Deposit (4%)......................................$940.00 (This is a deposit in case there are any emergencies that City staff is required to respond to during construction of the off-site improvement. i.e. a night time accident, weather affecting the site, etc.) *Note: Security can be provided in one of three options: 1. Provide a Faithful Performance bond for$23,500.00and a Labor and Materials bond for$23,500.00. (The City has the actual bond forms to use.) 2. Provide one CD for$23,500.00.The CD will be required to be assigned"for the benefit of the City via a City provided assignment form. 3. Provide the City with a cash deposit in the amount of$23,500.00. OutgQ inginformation: 1. Street Improvement Agreement(Owner to sign.City to prepare once item 3 is received). 2. Corporate signature resolution identifying who,with name(s)and title(s),is authorized to sign on behalf of Owner for Alka Montessori. 3. Street Improvement plans complete. 4. Grading plans finalized. Sign Tree Removal Permit in Public ROW per City Arborist. C:\Documents and Settings\dorisgh\Local Settings\Temporary Internet Files\OLK617\DEVELOPMENT FEES.docPage 1 of 1 CITY OF CAMPBELL DEPARTMENT OF PUBLIC WORKS APPLICATION FOR PLANT REMOVAL Date Submitted w l g-e l,3 Application No. E Jwa yoz�5 Pursuant to the terms of Chapter 11.08 of the Campbell Municipal Code, an application is hereby made for a permit to remove 17� , 1. The location of the j b in the public right o way is as follows: 0 6ov . The reasqns.for the emoval�are follows: U'/" (4 7 , (use other side of sheet if necessary) 3. The applicant hereby agrees, by affixing his signature to this application, to hold the City of Campbell, its officers, agents and employees free, safe and harmless from any claim or demand for damages to third persons relating from the work herein proposed. �1 Name of Applicant (signature) 97-UL 6�11A�lnl� (print your name) Address of Applicant Check One: Residence ( ) or Business) Telephone Number 7119. g0 — S 0 FOR OFFICE USE r Date I / 2-0/3 7 Repommendation - - Q X 5 , (use other side of sheet'ifF_ H_ aryApplicant contacted in field? �' ByDate I l �� ca EEff Saimp 0 CO3 -z- "g"p-La aw, ow o uj UJ 4C co t k W19d 0* uj to C.3 cc to -mr g -o ire fp Co CD Jill Lu x ditef-i % cc a Cc U. Sto N 0 cm t:! 00 00 --tr C.") m co co 00 C\j 0 C-) CD U— C) C-3 r--. 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