87-224
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CITY 0' CAMPbELL
n~~T. or PUbLIC WOKK~
70 Noeth 11rat fh.
CAmpbell, CA ,~OO.
/40& I 116&1-21 ~O
cY7 - 2 L Y
rJ
PUbLIC WORKS P~kMIT
TTarw-rrrnql11-rne
public Cl~htt-ot-w.~)
ruued 3 q (gg
PecaiT..,.. lr . In lL aoa.
Pelalt No.
AppliCAtion Date
..pir..
~
P:
~(,
X-lte!. tile
APPLICATION - Application ia heeeby ..de foe a Public Woell Paeait In accordanc. with Ca~pbell-
Kunlcipal Cod., aeCtion 11.04.
'l'
l.
Wock addee.. oe tnct, 251 Llewellyn Ave.
Utility tunch location Latimer Ave.
".tuu of woek; Utility trench, driveway removal, H. .c. Ramp.
,
I
l'
p,
c
I.
U'
c. Attach five /~I copies of a drawing ahowlng the location, extent and di_enllons ot the wack
The draw1ng shall 'ahow the celation ot the propO.ed work to eXiDting Durtac. and underground
hlpeovelllent.. When approved b)' the City Engine.r. .ald drawing becom.. a pAct ot thl. per.l t.
D. The General Conditions toe all permitl are li.ted on the eeVerse 81de. Special Peowl.ions tor
thl. permlt are ll.ted below. ~ailure to abide by theae c..o..n. dltlonl And. pr r.OVialon. a4~ re~ult
ln job .hut-down and/or torteituce ot r.lthtul Pertorm4nc~ 8S;!flO..fl-&.nJ1.ca.lLl!eQ9s1t... ISee
Geneeal Condl t 10n. 1 .nd J I. c.i~..Q<-.J-. ~~.-'2....'Y7u=n/nV / t"
t. An appl1cation toe 81ust accompany thill application. Thi. i. non-rtltundable. "'.."
NAme ot AppliCAnt Eastfield Children's Center Tchphone: 379-3790
Addcelill 251 Llewellyn Ave , Campbell, Ca. 95008
III this WOII belng donc'by the peopeety ownee at thele own ee~ldcncc? ___yea X no
Compl.te attachod Woelee.' CompensAtion and Conteactor foea..
The Appllcanl/~ermittee heeeby agr... by Att1xin9 thetr aiqnature to thia permit to hold the City ot
CAmpbell, tt~ ollicecli, agent. and employ".. tree, ~Ate and hArmle.~ tcom any claim oe demAnd tor
dAIIlA9t:a u:liult In'J t rOIll the woek cOv&:eod by thl. perJld t.
;:
C'
;v
't
'1..
{U
(,
y
and
X ACCt:PTED
APPROVED PLANS AND ALL APPLICAbLt CA"'~bLLL
Till: CONTRACTOR MUST IIAV!:: 'fillS PLkHIT AND APPROVED PLANS ANIJ MUST "'LET WITH THE P.W. IN5PJ::CTOk ON
TilE SITE AT LEAST TWO DAYS bEfOkt: ST.\.ItTING WORK.
NOTICE MUST Dt: GIVLN TO PUBLIC WORKS AT LEAST 24 HOURS bEFORE RESTARTING ANY WORK.
S~ECIAL PROVISIONS
~,
r
~,
1.
Street lillAll not be open Cut tor underground intitallAtion6. Minl~u~ CutM mAY be allow~d
for connections oe ..ploeation hole~. Such CUtli muut be upeclflcally Approved by tilt
IlllOpo:ctor.
~~~r-.4Y be cut tor undecqround lnwtAllAtiona And muet be rcatored in AccordAnce With
the Utillt~ TrenCh Re6torAtion StAnd_rd DrAwing.
Wurk to Oe lItoked by a licenbed LAnd Surveyoe or Civil Enqlneer and two /21 copic~ of the
cut .heel. aelll to the PubliC Work Dept. before atArting work.
The hour. of won are limited to outlilde the hour. ot 1-9 A.m. and 3-t. p.ll. tor Any woek
Atfecting a trAttlc lano.
'\"
(~
(I;
u-
P.
V2.
"V7l.
':
.'-
_4.
~.
"."J
PJ
G
u:
PEkHIT APPLICATION rEK
PLAN CHECK DEPOSIT
/a-I)
I~J~.OOI
,
....
STAHDJUtO
~)O.OO ~
~)OO.OO $
000' OJ' ENG. EST.I ~
In 01' bOND,$)OO HIi'll $
AMOUNT
bONO fOk 'AITlII'UL PEkI'OIU.....NCE
,. P. (CASUI D~POSIT
PEktUT rEI::
(1, 01 ".1'. bOND
~j).OO MI"I
~ q '='tCo -
kJ::CI::IPT NO.
L~ IV 7fS
/ '-I c; '1' ',)-
I.(V7(."})
t7J'O ~
l7<fOJ.:
)/'l<rtt
e
p,
($200 I
5tJ rtrO
s7J 0 -
\3. t':cb-
~cn --
~:
APPkOVED fOR ISSUANCE
;
(~y)/l(~
kif' 1<-
" cd y Imglnlac
----.<
t: PWPt:kHIT
lI.vi..d 1/111
r
CITY OF CAMPBELL
Department:
Public Works
WI~1C'" y
HELMS
BOLLlE:?
KRUGE~
QUINNEY
70 NORTH FIRST STREET
C AMP BEL L, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (408) 379-2572
september 6, 1991
Eastfield Ming Quong Children's Center
251 Llewellyn Avenue
Campbell, Ca 95008
SUBJECT: ONE YEAR MAINTENANCE ACCEPTANCE
PERMIT NO. 87-224
LOCATION: 251 LLEWELLYN AVENUE
Gentlemen:
We have made a one year maintenance inspection of subject
public works improvements and find that no maintenance is
required.
Your cash deposit, which was held as your maintenance bond,
will be refunded under separate cover.
Please feel free to call if you have any questions.
Sincerely,
J-e-~~
Sal Duckworth-Lanzo
Senior Civil Engineer
SDL:djr
F:86-254
REFUNDABLE DEPOSIT
CHECK REOUEST
TO: SANDY TERPKO
ACCOUNTS RECEIVABLE
Please issue check payable to:
Eastfield Ming Qllonq rhi1nrens Center
Address:
Line 1:
251 Llewellyn Avp.
Line 2:
City :
Camobell
State: c.L- Zip: QI)OOR
Description: Refundable De>>osit
Exact Amount Payable: S 3 . 450 . 00
Account Number: 905.4662
PERMIT NO: 87-224
LOCATION: 251 Llewellyn Avp.
DATE AND NO. OF RECEIPT:
1/5/88 recp.ipr *?~lq
PURPOSE:
refund maintenancp. bonn
($4,R1Fi tA7;:t~ r~"",::li~TAn nn ',/5,/ee but
$1,386 was released previously)
Requested by:
S. Duckworth-Lanzo Title: ~r ri vi 1 pngr Date:
Approved by:
D.Wimberly
Title: ni r Pllh Wk~
Date:
Verified by:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xxx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
04/18/91
-
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
EASTFIELD MING QUONG CHILDREN.S (30 spaces)
Address:
Line 1:
251 LLEWELLYN
City :
CAMPBELL
(20 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
(24 spaces)
Line 2:
Description:
Cash Deposit Refund
Exact Amount Payable:
Account Number:
$1,886.00
905.4662
PURPOSE:
Release of cash deposit for Excavation Permit No. 87-224.
See receipt #14995 dated 9/18/87 ($500.00) and also see
receipt #2319 dated 1/5/88 ($1,386.00 of the additional
$4,836.00 bond is to be released and we will retain
$3,450.00 as a one-year rnaintenanc~ bond.)
Requested by: Gregg Eaton Title: P . W. Inspector
Date: 7/6/89
Approved by:
Verified by:
Donald C. Wimberly
Title: P. Iv. Director
Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
CITY OF CAMPBELL
DATE: 1 / JP}/ cr ,I
L /e1d-1 t:; h)
TYPE OF WORK: STREET: ~ STORM:
PUBLIC WORKS INSPECTION REPORT
PERMIT/PROJECT NO., R? - c? ~TRACT
/
NO.
ADDRESS:
;}5/
~-
SANITARY:
ELEC:
P.C.C. :
PARKWAY:
OTHER:
[] PRELIMINARY INSPECTION WITH DEFICIENCY LIST
[] FINAL INSPECTION WITH DEFICIENCY LIST
[] FINAL INSPECTION ACCEPTANCE
SIGNED PLANS ? YES
NO
COUNCIL ACTION? YES
NO
CHARGES AGAINST DEPOSIT? YES
NO
OVERTIME:
HRS. @ $
PER HOUR = S
EQUIPMENT RENTAL: TYPE:
AMOUNT: $
DATE:
/
/
REASON:
TOTAL CHARGES:$
[] ONE YEAR MAINTENANCE WITH DEFICIENCY LIST
~ ONE YEAR MAINTENANCE ACCEPTANCE
~roR
CITY OF CAMPBELL
r~V~Mi;E~1-Ly--rl' ;\.~ ~)-C'I~G"l'-j
~,.. t' . . .:'..~:~:~.~.~-- -f'---!
lrit,i,MS ' ;h:rl!(~I~:O! i
i--- .'--r---
1IO-'''''ON I O'''C "n I
.. ~.J~l l.:i ...~~~;1., : j,
'KRUGER' ' l"1
~PENOY~ t-~l
70 NORTH FIRST STREET
C AMP 8 ELL, C A L I FOR N I A 9 5 0 0 8
(408) 866-2100
FAX # (4 0 8) 3 7 9 - 2 5 7 2,
Department:
Public Works
July 6, 1989
Eastfield Ming Quong Children's Center
251 Llewellyn Ave.
Campbell, CA 95008
RE: Final Inspection and Acceptance
Permit No.: 87-224
Location: 251 LLewellyn Ave.
Maintenance Bond Amount: $3,450.00
We have made a Final Inspection of subject public works construction and
find it acceptable and in conformance with City standards. Accordingly,
the work is hereby accepted and subject to the one-year maintenance
requirement indicated below.
You are responsible for the maintenance, repair andlor replacement of all
work done should any failures occur within one (1) year of this date. To
guarantee this, you must post a maintenance bond in the amount indicated
above. We will retain $3,450.00 of the S4,836.00 cash deposit posted
1/5/88 and release the remaining $1,386.00 by a separate action,
We will inspect the work in one year and advise you whether or not
maintenance is needed.
Please feel free to call the undersigned if you have any questions.
Sincerely,
Carlos M. Jocson
Associate Civil Enginneer
CMJ : sd
cc: G. Eaton, P.W. Inspector
Suspense - 1 year
'j.O: City Clerk
PUBLI C WORKS FI LE NO. i7 -,;z ~f
Please collect & receipt
for the following monies:
ACCT.
35-3396
3372
3521
3521
ITEM
Pro'ect Revenues (specify project)
Pu. uc (~o,'l. M Exca.va.;Uon PVUn,(;t fee.4:
Ap 1 icat ion Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-] :
(S35)
($200)
3372 Plan Check & Inspection Fee
3521
Other Cash Deposit
J373
3373
Project
General
&
3372 Tentative Parcel Map Filing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
3372 Tentative Tract Map Fil ing Fee ($400)
)372 Final Tract Ma Fil in Fee (S350)
3372 Lot Line Ad.ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Split ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
AMourn
$
'r/2 -S.q 6~o"oJ
\
$ $4 ,8-3(0. ~.
J
~IL\ - ~-l:lD
ZIP Op~~-C(j ~
TOTAL
NAME
PHONE
FOR
C I TV CLERK
ClliLY
RECEIPT NO.
.;<. .3 j 9
1-/ 730 00
u/r}
/-5- rp~
~ PAID
RECE J VED BY
DATE
July, 1987
CONSTRUCTION COST ESTIMATE rOil PERMIT NO. ~"-~\-a1/Date \-cs:--~~
~~.;.~ ~~ <5~o<.....
Name & Address 'L. ~\ L\ ~ ,)~\J- 'i L ')
Surface Construction
Cl.arins and Grubbins
Sawcut Concrete
Concrete Ileaoval
Curb & Gutter Ileaoval
Inlot Drain with Pipe
Curb and Gutter
Sidewalk
Driveway Approach
Handicap Ramp
Extruded Curb
Barricade
Street Excavation
~P4e--z..' ".A.C. Pavement (j.CO":)c..~\)
~ ~'-I Adjuat Manhole to Grade
Adjust Handhole to Grade
Monument Box w Monument
v
\....~../I
Surface Subtotal "S" - $ t:>.... 4~-
Adjust. for s1&e: S~ $30,000 add 20%, S. $100,000 subtract 10% \C>IO\~- - BGC
I/i' ~'}@J / r
'/"- LrO~()(C<-'fl"IN'L ~'-ErI5E~ . #
Street Lighting Y' -- (.,.ISH .i3CNJ::. ~T":(J,... 483""
Electrol1er EA. @ 3000.00 - $
Conduit L.r.@ 12~00 - $
Conductor, pair L.r.@ '4.00 - $
Pull Box EA. @ 200.00 - $
- $ -
Street Tree (IS sallon)
Pavement Striping ($100 aio)
Pavement Lesends ($100 ain)
Stop,Street Na.. or Other Sigo
Pavement Harkers
Pavement Key Cut
/Nic,r' , ;:>tr ,r,:-/),./>
,
Storm Drainage
12" or 15" IlCP
18" .or 21" Ilep
Street Inlet
Manhole
Break and Eoter Kanhole
Ileviaed 6/85
Luap Sua Estimate
- $ -
- L.F. @ $ 4.00 - $ - 70-:: ?-8D
.4<;; s.r. @ 3.00 - $ L. '- ~~-tbB~ Sc4
~Q L.r. @ 5.00 - $ 4-s:o- ~o-;. /50
EA. @ 500.00 - $ ---
L.r. @ 15.00 - $ \"::t. -so-
s.r. @ 3.50 - $ ~q....-
S. r. @ 5. SO - $ II DO -
\ EA. @ 1000.00 - $ \ UOO-
L.r. @ 6.00 - $
L.F. @ 50.00 - $
( ---- s.r.)x($0.15)x(___") - $
('"Ll.o S.F.)x($0.45)x(~") - '$ \""\~
EA. @ 300.00 - $ -
- EA. @ 200.00 - $ - ',-.
EA. @ 500,00 - $ ~
EA. @ 200.00 - $
L.r.@ 0.65 - $ \<:'>0-
- EA. @ 40.00 - $ -
EA. @ 120.00 - $ -
--. EA. @ 15.00 . $-.
L.r.@ 8.00 - $
H__________,__.._..... _ '$
- $
~6
\,,~
""l- eo
3o~ 4-50
4B ':. I~'O
1 ~f)":. fko
/4/8
100
------'?- 300
-'-'
4..0:3 0
L.r.@ 60.00'
~~ L.r.@ 65.00
EA. @ 1800.00
\ EA. @ 2000.00
EA. @ 600.00
-$ -
- $ \ 't=.~-
-$ -
- $~60C>-
- $ -
TOTAL ESTIMATE
USE rOR BOND
- $
$'~.~~~-
$ \~I 'b 00-
/
.. ." r=JI
. ., "-'
- >r ~. "'''I:' ',."'....~,~, .;:j,:r,~~ :::t:!'ll~~. ,~. < l '4~1"_" .... -', ! 1 .
EASTFIELD MING QUONG
PER(V\~,:tf ~7-Z21-
January 4, 1989
RECEIVED
JAN 04 1989
PUBLIC WORKS
ENGINEERING
"
Mr. Greg Eaton
CITY OF CAMPBELL
Public Works Department
'TO No. 1st Street
Campbell, CA 95008
Reference:
Eastfield - Clinical Services Building
Dear Mr. Eaton:
Attached is a check for $4,836.00 submitted as a cash bond for
incompleted work as noted on your deficiency list dated December
29, 1988.
This work will be completed very soon. Thank you for your
cooperation and assistance.
Sincerely,
EASTFIELD MING QUONG
, '#it' ~DnY1
F~--Jer--- e--Do-yle -- V -~---
Pre' ent, CEO
.
Headquarters
251 Llewellyn Avenue, Carnpbell. Calilornla 95008
(408) 379 3790
Los Gatas Campus:
499 Lorna f\lta Avenue, Los Galas, Calilornia 95032
(406) 35,) 6051
.
A United Way Agency
TO: City Clerk
PUBLI C WORKS FI LE NO. J' 7-- L 2.. V
Please collect & receipt
for the following monies:
T.
35-3 96
3372
3521
dill> \
R-l :
($'35)
($200)
:t 1 V!. :
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(7'70 of FPB)
($ 35 min.)
(Cash) Deposit
Plan Check & Inspection Fee
3521
Other Cash Deposit (specify)
3373
3373
Project
General
&
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil ing Fee ($300)
- ~2 Tentative Tract Map Filing Fee ($400)
. ,2 Final TractMa Filin Fee ($350)
3372 Lot Line Ad.ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all,other, $2,250)
J395 Park Dedication In-l ieu Fee per Unit ($1,132)
3380 Publ ic Works Special Projects
3510 Postage
c,A. ~htLU
.....E 4 ; 4
ADDRESS 2- S I ~
AMourn
$
5?O 0 .--
9~~-
'Y&6-
,
379-
TOTAL
FOR
C I TV CLERK
ClN1..Y
, ~ PHONE
{1---; /~
I 7 "ZlJb
~ ,1/-6
/.....,...w .
O-m
3-~.<6?{
ZIP
RECEIPT NO.
AMOlNT PAID
RECE J VED BY
DATE'
July, 1987
TO: City Clerk
PUBLIC ~JORKS FILE NO. cr7 - 22 Y
Please collect & receipt
for the following monies:
~CCT.
)~ 3396
<:ill2"
&ID
3521
ITEM
Project Revenues (specify project)
PubUc. (~o"l.fu Exc.ava:U.on PeJwl-U reM:
App I i ca t i on Fee
Plan Check Deposit
Faithful Performance (Cash) Deposit
R-l :
($'35)
($200)
OthVL:
($ 50)
'( $500)
(4% of FPB)
($500 min.)
(7~ of FPB)
($ 35 min.)
3372
3521
Plan Check & Inspection Fee
Other Cash Deposit (specify)
}373 Project
3373 General
3372 Tentative Parcel Map Fil ing Fee ($350)
3372 Final Parcel Map Fil in Fee ($300)
1372 Tentative Tract Map Fil ing Fee $ 00
72 Final Tract Ma Fil in Fee ($350)
)372 Lot Line Ad.ustment Fee/Certificate of Compl iance
3372 Vacation of Publ ic Streets and Easements
3372 Assessment Segregation or Reapportionment
First Spl it ($500)
Each Additional Lot ($150)
3372 Environmental Assessment:
Categorical Exemption
Ne ative Declaration
3370 Storm Drainage Area Fee per Acre Multi-Res.,
$2,060; all other, $2,250)
3395 Park Dedication In-lieu Fee per Unit ($1,132)
3380 Public Works Special Projects
3510 Postage
NAME
TOTAL
L~ C~~ U~
'L--)! ~~
ZIP
PHONE
ADDRESS
AMOUtn
$
s- (/ --.
50 U
$ S- S-o
FOR
C I TV CLERK
QIIL.Y
RECEIPT NO.
AMOUNT PAID
RECE 'VED BY
DATE
July, 1987
~;-12,n) /1 c. c-
DAte ~4~ Permit or Project No. ~7--224-
ACldres& 25' -- LLE0 ELLyAl
PUBLIC WORKS INSPECTION REPORT
Type of work a Stre.t ......---- Storm ___ Sani tary
Other (describe)
ElectricAl
o PRELIMINARI INSPECTION WITH DEFICIENCI LIST (attached)
o FINAL XNSPECTION WITH DEFICIENCI LIST (Attached)
~NAL INSPECTION - ACCEPTANCE
Signed plans"? , Y ~ (If
Charges against deposit? y
OVertime a hr&. @ $
Date 5.reasona
signed, Council acceptance.)
G)
/hr.
.
$
BArricade rental (attach invoice)? y
Date 5 reasona
CD
$
Other?
$
$
$
· RefunCl $
TotAl charges deClucted from deposita
(Cash Deposit $ less charges $
DONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attAcheCl)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Release'maintenance bond. Check Request if cash.)
ek. req.)
~
~n.er
~
Inspector
--
~
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
E.A. Hathaway
(30 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95054-2419
(2) (10 spaces)
(24 spaces)
Address:
Line 1:
565 Laurelwood Road
Line 2:
Ci ty :
Santa Clara
(20 spaces)
Description:
Cash Deposit Refund
, Exact Amount Payable:
$500.00
" Account Number:
905.4662
PURPOSE:
Release of cash deposit for excavation permit #87-224
See receipt #17806 dated 3/8/88.
Requested by: Gregg Eaton
Title: P . W. Inspector
Date: 7/6/89
Appro~ed by: Donald C. Wimberly
Verified by:
Title: P. vI. Director
Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
x
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
"
'\
08/24/88
-
-.
REFUNDABLE DEPOSIT
CHECK REQUEST
TO: FINANCE DIRECTOR
CITY OF CAMPBELL
Please issue check payable to:
EASTFIELD MING QUONG CHILDREN.S (30 spaces)
Address:
Line 1:
251 LLEWELLYN
Ci ty :
CAMPBELL
(20 spaces)
(30 spaces)
(30 spaces)
State: CA Zip: 95008
(2) (10 spaces)
(24 spaces)
Line 2:
Description:
Cash Deposit Refund
Exact Amount Payable:
$1,886.00
Account Number:
905.4662
PURPOSE:
Release of cash deposit for Excavation Permit No. 87-224.
See receipt #14995 dated 9/18/87 ($500.00) and also see
receipt #2319 dated 1/5/88 ($1,386.00 of the additional
$4,836.00 bond is to be released and we will retain
$3,450.00 as a one-year maintenanc~ bond.)
Requested by: Greqq Eaton Title: P. W. Inspector
Date: 7/6/89
Approved by:
Verified by:
Donald C. Wimberly
Title: P. Iv. Director
Date:
Accounts Receivable
Date:
SPECIAL INSTRUCTIONS FOR HANDLING CHECK:
Mail as is
xx
Mail in attached envelope
Return to:
(Department)
(Name)
Other:
08/24/88
r€b4:, it=" 87- ZZ ~
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RECEIVED
JUN 21988
PUBLIC WORKS
ENGINEERING
CITY OF CAMPBELL
DEPARTMENT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
JUN 0 1 1-988
Bond No.: 1147635
Subdivider: EASTFIELD MING QUONG, INC.
Tract No.: *
Description of
Improvements: UTILITY TRENCH, DRIVEWAY REMOVAL & H.C. RAMP
TO 251 LLEWELLYN AVENUE, CAMPBELL, CA.
AMWEST SURETY INSURANCE COMPANY is Surety on the above captioned
bond. We would appreciate your cooperation in providing the
information requested below. Please return the form to us so that
we may have current status information on the above captioned
improvements. A postage-paid envelope is provided. Thank you
very much for your assistance.
1.
Have-the improvements been completed?
Yes
>( No
2.
If not, what percentage has been completed?
Is the work progressing satisfactorily?
(,,0 %
x.. Yes
No
3.
4.
Has this work been accepted?
Yes >< No
5. If not, what is the anticipated date of acceptance? /998
Comments: '
6:UJ.D fD A'~m4'/:-V /AI bF~';;GI
Above information provided by:
Name 6Z€ GoG F/l''Tl:lA.f
Ti tIe fl,al../L WMLS 7;vs/J.
/
Phone No. (.2!Qg) 8~~r2/sv
Date ~0~8
F30 rev. 6/87
A
AM WEST SURETY INSURANCE COMPANY
WOODLAND HILLS. CALIFOR:':IA
BOND NO.
1147635
I'HE:\III:\!
$690.00
PUBLIC WORKS - PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
That we,
Eastfield Ming Quang, Inc.
, as Principal,
and A:\I\VEST SeRETY INSI:RA:':CE COMPA:':Y, a Corporation organized and existing under the laws of the State of
California, and authorized to transact a general surety husiness III the State of
California
, as Surety.
me Iwld and firml\' bound unto:
City of Campbell
. as Ohligee.
miliesumof**Thirteen Thousand Eight Hundred***********************************~LLARS,
($ 13 , 800.00 ), lawful money of the United States of America, for the payment whereof, well and truly to be made,
we hereby bind ourselves, our heirs. executors, administrators, successors and assigns, jointly and severally, firmly by these
presents.
THE CONDITIONS OF THIS OBLIGATION IS SUCH, that
WHEREAS, the above-bounden Prmcipal entered into a contract dated the
with said Obligee to do and perform the following work, to wit:
March 7, 1988
Utility trench, driveway removal & H.C. ramp to 251 Llewellyn Avenue,
Campbell
NOW, THEREFORE, if the above-bounden Principal &hall well and truly perform or cause to be performed, each and all of the
requirements and obligations of said contract set forth, then this bond shall be null and void; otherwise it shall remain in force
and effect.
SIGNED, SEALED AND DATED this
7th
day of
March
I 9 -----..8lL .
Eastfield Ming Quang, Inc.
PRINCIPAL
BY
STSURETYINSURANCECOMPANY
ATTO RNEY-IN-FACT
Rochelle P. Woessner
REV 7/86
A
AM WEST SURETY INSURANCE COMPANY
WOODLAND HILLS, CALIFORNIA
BOND NO.
PREMIUM
PUBLIC WORKS - LABOR & MATERIAL BOND
1147635
$690.00
KNOW ALL MEN BY THESE PRESENTS,
That we,
Eastfield Ming Quong, Inc.
, as Principal,
and AMWEST SURETY INSURANCE COMPANY, a Corporation organized and existing under the laws of the State of
California, and authorized to transact a general surety business in the State of
California
, as Surety,
are held and firmly bound unto:
City of Campbell
. as Obligee,
in the sum of ***Thirteen Thousand Eight Hundred***********************************-- DOLLARS
($ 13,800.00 ), lawful money of the United States of America, for the payment whereof, well and truly to be mati we
hereby bind ourselves, our heirs, executors, administrators, jointly and severally, firmly by these presents,
THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH, that
WHEREAS, the above bounden Principal has been awarded and has entered into a contract dated
with the Obligee to do and perform the following, to wit:
March 7, 1988
Utility trench, driveway removal, & H.C. ramp to 251 Llewellyn Avenue,
Campbell
NOW, THEREFORE, if the above-bounden Principal or his subcontractors fail to pay any of the persons named in Section 3181
of the Civil Code of the State of California, or amounts due under the Unemployment Insurance Code with repect to work or
labor performed by any such claimant, the Surety will pay for the same, in an amount not exceeding the sum specified in this
bond, and also, in case suit is brought upon this bond, a reasonable attorney's fee, to be fixed by the court.
This bond shall insure to the benefit of any and all persons, companies or corporations entitled to file claims under Section 3181
of the Civil Code of the State of California so as to give a right of action to Hl.em or their assigns in any suit brought upon
this bond.
SIGNED, SEALED AND DATED this
7th
day of
March
1988
Eastfield Ming Quong, Inc.
S RETYINSURANCECOMPANY
2_:t~12~:J
Attorney-in-Fact
Rochelle P. Woessner
(Revised 7/86)
CONSTRUCTION COST ESTIMATE FOR PERMIT NO. ~1-7,,\4y/Date \-~-'2::.~
~,;.~ R~ ""5~-tC('..><-
Name & Address ""Z.. ~\ L\ ~ 'JE-\-\..... "-f L J
Surface Construction
Clearing and Grubbing
Sawcut Concrete
Concrete Removal
Curb & Gutter Removal
Inlot Drain with Pipe
Curb and Gutter
Sidewalk
Lump Sum Estimate
Pavement Key Cut
--- L.F. @ $ 4.00
-'4~ S.F. @ 3.00
qO L.F. @ 5.00
EA. @ 500.00
L.F. @ 15.00
S.F. @ 3.50
S.F. @ 5.50
\ EA. @ 1000.00
L.F. @ 6.00
L.F. @ 50.00
( - S.F.)x($0.15)x(_")
('"l.l.o S.F. )x($0.45)x(\.~")
EA. @ 300.00
EA. @ 200.00
EA. @ 500.00
EA. @ 200.00
L.F.@ 0.65
EA. @ 40.00
EA. @ 120.00
---, EA. @ 15.00
L.F.@ 8.00
an
\ C;~
"., eo
Driveway Approach
Handicap Ramp
Extruded Curb
Barricade
Street Excavation
'''-t.P~-Z ~.C. Pavement UCx:>"::>(.,\)
S ~'-I Adjust Manhole to Grade
Adjust Handhole to Grade
Monument Box w Monument
Street Tree (15 gallon)
Pavement Striping ($100 min)
Pavement Legends ($100 min)
Stop,Street Name or Other Sign
Pavement Markers
, ,/
,.
"
. $ -
. $ -
5U")
· $LL..~~-'
· $ 4-so-
- $
;, ')
- $ \ ~ "St> -
- $ ~C\1t..,-
-$\\00-
- $ \ (.>~O -
- $
- $
- $
-"$\....\~
- $ -
. $-
- $--'
- $
· $ '00-
/1
)
- $-
. $-
- $-,
- $
. $
- $
./
Surface Subtotal "s" - $ e>":. 4"--
Adjust. for size: S~ $30,000 add 20%, S ~ $100,000 subtract 10%\C>,0\<-;'-
",
-$-
- $
$ ,~, ~~~-
$ \~, ~OO-
,,-
~ / "
<.-1-" r
I ./
Street Lighting
Electrolier
Conduit
Conductor, pair
Pull Box
EA. @ 3000.00
L.F.@ 12.00
L.F.@ 4.00
EA. @ 200.00
Storm Drainage
12" or 15" Rep L.F.@ 60.00
18" .or 21" RCP (..~ L.F.@ 65.00
Street Inlet EA. @ 1800.00
Manhole \ EA. @ 2000.00
Break and Enter Manhole EA. @ 600.00
TOTAL ESTIMATE
USE FOR BOND
Revised 6/85
~
~ ',c.
- $
- $
. $
- $
- $ --
-$ -
- $ \ ~"7-0-
-$ -
- $ ~6Q:>-
-
30
'",an !FICA.:f. HOLDER NAMED TO THE
~k::t~KKMR.!XX>~~~)l:El~j(~x~~~~}Qflx
".~~~:l6J!lX,~~"~.~~~~Ill9EJIfXArJ:WESX
i:!' jCHi~' !~'-F'R":SHFrO,. ~
Be~Chmitt
t,.. ... ,,-
~-, O'Ccn1oJ: ~.J:ac~
225 Sarato&a Awa.1a
U. ~,Q\ 95030
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
,.EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
r..tfield HlDg ~.I:nc.
251 IJR.1JD....
~11. Ca1ifaad.a 9SOO8
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
,
COMPANY D
LETTER
COMPANY E
LETTER
Cf.pa m-,~ ~
GeoI:ral Star Jtd ~1 ty
INSURED
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED,
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 CONDI-
TIONS OF SUCH POLICIES,
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
OA TE (MM/OOIYY)
POLICY EXPIRATION
OA TE (MM/DDIYY)
LIABILITY LIMITS IN THOUSANDS
OCCG~~~NCE AGGREGATE
GENERAL LIABILITY
COMPREHENSIVE FORM
PREMISES/OPERATIONS
UNDERGROUND
EXPLOSION & COLLAPSE HAZARD
PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT COr-;TRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
BODILY
INJURY
$1000
PROPERTY
DAMAGE
$1000 $1000
INP DI6470831
7/1/87
7/1/88
~~t~~ED $
$
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED AUTOS (pRIV PASS)
ALL OWNED AUTOS (~~~JRpl~~N)
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
1NP Vl6470831
7/1/87
7/1/88
PERSONAL INJURY
BODilY
INJURY $
!PfR PfRSONI
BODilY
INJURY $
!PfR ACCIDENT)
PROPERTY
DAMAGE $
BI & PD
COMBINED $1 000
BI & PD $5,000 $
COMBINED
lI!:U - 0268MA.
7/1/87
7/1/88
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY
$
$
$
(EACH ACCIDENT)
(DISEASE.POLlCY LIMIT)
(DISEASEHCH EMPLOYEE)
OTHER
DESCRIPTION OF OPERA TIONS/LOCA TIONSNEHICLES/SPECIAL ITEMS
Ccaatroctiat of ClJn1c:a1. Sen1ces Ildg. b)cated at; 251 Ll..11}'ll AwIue.~ll.CA 95008
City of ~11
70 N. FiDt: Stnet
~U, Ca11.fom1a 95008
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAll 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
'"
9..9-87...tt
A......r . A....r of Callfoml. Inc.
1530 Meridian
p.o. Box 5700 ,',d ,:'.,: .'1';" ,
San Jose. .c~lforl)lf 951~
Telephone 408 264-6700 ' ,
TWX 9100338-023&
r4llf' ~,,~~i~ t.
\ . THIS CERTifiCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
"
" ; ~ fr.'.
COMPANIES AFFORDING COVERAGE' ~"..; \'.
!', .',~.", ..,'~
INSURED
WATTIl;i, cO~St~CTION CO., INC.
964' Stockton. 4v~lll.1e .P,
San:Jo'~e: j'CA "95l:l0 ,,'
; , . tf..,'\ '. dl" (, ,
COMPANY A
LETTER ARGONAUT INSURANCE COMPANY
COMPANY B
LETTER
.:. ~
~ ',' f
COMPANY C , "
, " LETTER '. ,.' , , ~ -
COMPANY P ; : . ~ ) ~' '. J .. .., ;'\" i
LETTER, ; ;, , "
TYPE OF INSURANCE POliCY NUMBER POliCY Hf H: r :VE POLICY E ~PIRA liON
DAlE IMM/OUIYY) DAlE (MM1Oll1YY)
GENERAL LIABILITY UODIL Y
X COMPREHENSiVE FORM INJURY $
X PREMISEs/OPERATIONS PAOPEAll' $ $
UNDERGROUND CL76461002932 12-31-86 12-31-8 DAMAGE
x EXPLOSION & COLLAPSE HAZARD
X PROOUCTS/COMPLETEO OPERA liONS
CONTRACTUAl BI & PO $ 1,000, $
X COMBINED
X INDEPENDENT CONTRACTORS
X BROAD fORM PROPERTY DAMAGE
X PEASONAlINJURY PERSONAL INJURY
AUTOMOBILE LIABILITY IIOOIlY
It<JU/lY $
X AAY AUTO II'{ R PlRSOhI
AlL OWNED AUTOS (PRIV PASS) CA76461002933 12-31-86 12-31-87IlOO1lY
AU OWNED AUTOS (OTHER THAN) lhJuRY $
PRIV PASS IPER ACOOfNTl
X HIREO AUTOS, PROPERll'
A . ; , ' DAMAGE $
X NON-OWNED AUTOS
GARAGE L1ABILI TY BI & PO
COMBINED $ 1 000
EXCESS LIABILITY
UMBRElLA fORM BI & PO $ $
COMBINEQ
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION WC76-463-002939 2-1-87
AND
A EMPLOYERS' LIABILITY
OTHER
DESCRIPTION OF OPEAATIONSlLOCATIONSlVEHICLESlSPECIAL ITEMS
Project 83-9 Union Avenue Street Improvements
. .
.
~~TY OF CAMPBELL
70'N~ First Street
Campbell. CA 95008
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 1 n DAYS WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT,llDT FAILURE TO MAIL SUCH NOTICe SHALL IMPose NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE; COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHQRllED REPRESENTATIVE'
Rosalie E. Williams
t'
. .. ~
/
* II ,. ...
~
,,'a
J. ~
. '.
Ila4
ENDORSEMENT
. Thi5 .ndon'"l,nt, .ffectly, 12: 01 a. Me 9-9-87
~JjCVN~Clt.194pi002932 i5.WCdto Watt is Construction Co., Inc.
. .lORN. "It 01
.~.., ,.. . ..,
. .
'b1. ~rgonaut Insurance Co.
IT 'IS HEREBY AGREED THAT THE CITY OF CAMPBELL AND ITS RE~PECTIVE OFFICERS, AGENTS AND
EMPLOYEES ARE 'NAMED AS ADDITIONAL INSURED FROM AND AGAINST ANY CL4IMS, LOSS LIABILITY,
COST OR EXPENSE ARISING OUT OF OR IN ANY WAY CONNECtED WITH THE CONSTRUCTION OF THE
PROJECT. . THIS COVERAGE SHALL BE PRIMARY AND ANY COVERAGE CARRIED .BY ADDITIONAL '
INSURED SHALL BE EXCESS INSURANCE ONLY.
~
IT IS ALSO AGREED THE THE CITY OF SAN JOSE, ITS OFFICERS, AGENTS AND EMPLOYEES, ARE
NAMED AS ADDITIONAL INSURED.
.'
I .
project.83-9 Union Avenue Street Improvements
, .
.;' '.,r.d "
.~.~:.u)~...._...........~.....__.._
"'vthO"JCCI Rcp,..,nt.tiwl
Rosalie E. Williams
'''fI'''' .'
PACIFIC
-
INSURANCE, COMPANY
HOM!! OI"I"ICf:. TACOMA, WA5H1N<3TON
Bond # U 68 84 71
Premium: $22,446.
PERFORMANCE BOND
The American Institute of ArchItects. AlA Document A3". February 1970 Ed,tlon,
KNOW ALL MEN BY THESE PRESENTS: that (Here Insert full n,Jme and address or "'gal title of Contractor)
E.A. HATHAWAY & COMPANY, P.O. Box 5100, San Jose, CA 95150
as Prinr.i~}ill. hereinafter called Contractor, and., UNITED PACIFIC INSURANCE COMPANY, a corporation of the State of Washington,
with its Home Office at Tacoma, Washington, 'lS Surety. hereinafter callP.d Surety, are held and firmly bound unto (Here insert full name
,lnd Jd'drcss or legal title of Owner)
EASTFIELD-MING QUONG, 251 L1ewllyn Ave., Campbell, CA 95008
as Obligee, hereil')after called Owner, in the amount of Two Mill ion Nine Hundred Forty Thousand Nine Hundred
Eighty Two and No/l00------------------ 00llars($2,940,982.00--- ),forthepaymentwhereofContractor
and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents,
W'HEAEAS, Contractor has by written agreement dated January 20 1988 ,entered into a contract with Owner for
Construction of Eastfield Clinical Services Building
/
/
, d '0' d S "f' , / I
,n ",cor "ce w"h raw,ngs an pee, "at,ons p"p,,'" tH'" ;n~" '0" n.m' .nd "'d,=" '"'' ,;", 0' A"";'~"
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract,
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform
said Contract, then this obligation shall be null and void; otheN.'ise it shall remain in full force and effect,
The Surety hereby waives notice of any alteration or extension of time made by the Owner.
Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Owner having performed Owner's
obligations thereunder, the Surety may promptly remedy the default, or shall promptly
1) Complete the Contract in accordance with its terms and conditions, or
2) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination by Surety
of the lowest responsible bidder, or, if the Owner elects, upon determination by the Owner and the Surety jointly of the lowest responsible
bidder, arrange for a contract between such bidder and Owner, and make available as Work progresses (even though there should be a de-
fault or a succession of defaults under the contract or contracts of completion arranged under this paragraph) sufficient funds to pay the
cost of completion less the balance of the contract price: but not exceeding, including other costs and damage~ for which the Surety may
be liable hereunder, the amount set forth in the first paragraph hereof. The term "balance of the contract price," as used in this paragraph,
shall. mean the total amount payable by Owner to Contractor under the Contract and any amendments thereto, less the amount properly
paid bY' Owner to Contractor,
Any suit under this bond must be instituted before the expiration of two (2) years from the date on which final payment under the
c )nt(act falls due,
No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named herein or
the heirs, executors. administrators or successors of Owner,
Signed and sealed ;his
25th
day of
January
19 88
E.A. HATHAWAY & COMPANY
(Seal)
(Witness)
{ By:
(Principal)
(Title)
(WItness)
~\~;fF5A~)~ANY
B . (Title)
o y . Johns n Attorney-in-Fact
p"rformancp. Bond
R"vl~ t" F"bruary, lc:j70
--_._.-~
~,:~~t,~lf5'.,i~~.~~:-:IO~,~;,~~'~~-:J,3f~~ COMPANY
P AYMEHT BOHD
PRIVATE CONTRACT - CALIFORNIA
Bond # U
Premium:
68 84 71
Included in
FP Bond.
KNOW ALL MEN BY THESE PRESENTS: That we,
E.A. HATHAWAY & COMPANY
(hereinafter called the Principal), os Principal, and UNITED PACIFIC INSURANCE COMPANY, incorporated under
the laws of the State of Washington, and duly authorized to transact the business of surety in the State of Califor-
nia (hereinafter called the Surety), as Surety, are held and firmly bOund unto any and all persons performing labor
upon or furnishing materials to be used in or fumishing appliances, teams or power contributing to the work contrac-
ted to be performed under the contract hereinafter mentioned, in the sum of Two Million Nine Hundred Forty
Thousand Nine Hundred Eighty Two and No/100-----:-----~-.{$ 2,940,982.00 ) DOLLARS,
lawful money of the United States, for which payment, well and truly to be mode, the Principal and the Surety bind
th'emselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these
presents.
WHE REAS, on the
wri tten con tract wi th
as Owner
20th day of January
EASTFIELD - MING QUONG
, 1988 , the Principal entered into a
Construction of Eastfield Clinical Services Building
o copy of which contract is or may be attached hereto, and is hereby referred to;
NOW, THEREFORE, the condition of this obligation is such that if the Principal sholl payor couse to be paid
in full 011 claims for labor, or materials, or appliances, or teams, or power, or either or all, performed, furnished or
contributed in connection with such work, then this obligation sholl be null and void; otherwise, to remain in full
force and effect,
THIS BOND is executed for the purpose of complying with the laws of the State of California as contained in Title 15,
Works of I mprovement, of the Civil Code of the State of California and all acts amendatory thereof, and this bond shall inure
to the benefit' of any and all persons who perform labor upon or furnish materials to be used in or furnish appliances, teams or
power contributing to the work described in said contract in accordance with the provisions of said statute.
No suit or action on this bond shall be maintained unless the same shall be filed within six months after the completion
of said structure or work described in said contract, as "Completion" is defined under applicable sections of Title 15, Works
of Improvement. of the Civil Code of the State of California.
SIGNED, sealed and doted this
25th
day of January , 19 88.
E.A. HATHAWAY & COMPANY
By:
THIS BOND MUST BE FILED AND RECORDED
IN THE OFFICE OF THE RECOROER OF THE
COUNTY IN WHICH THE CONTRACT IS TO BE
PERFORMED IN ORDER FULLY TO COMPLY
WITH THE STATUTE AND FULLY PROTECT ALL
PARTIES AS PROVIDED IN SAID STATUTE.
PRINCIPAL
UNITED PACIFIC INSURANCE COMPANY
~~~,
Jo A. 0 nso ,
BDU.2856 ED. 8/72 (CALI F.l
8-2039
~,~1' ,
,
~., :
,;t'
UNITED PACIFIC INSURANCE COMPANY
HEAD OFFICE. FEDERAL WAY. WASHINGTON
POWER OF ATTORNEY
: ~~
KNOW ALL MEN BY THESE PRESENTS, That the UNITED PACIFIC INSURANCE COMPANY, a corporation duly orOllnized under the laW1 of the
Stat. of WHhington. does hereby nvka. connitute and appoint
.,~
JODY A. JOHNSON of SAN JOSE, CALIFORNIA---
"
: ~
),;
Its true WId lawful Attorney-in-Fact, to make, execute, ..al and deliv... for and on its behalf, and 8t its act and deed
'i~~; ,
T;
't" I
/!
"
:,
ANY AND ALL BONDS AND UNDERTAKINGS OF SURETYSHIP------
;/:
.nd to bind tM UNITED PACIFIC INSURANCE COMPANY thereby es fully and to the same extent IS if such bonds and undertakings and other wrlllngs
obliQlltory ,n the nature thereof were signed by an Executive Officer of the UNITED PACIFIC INSURANCE COMPANY and sealed and alleste,J hy one
other 01 such officers, Ind hereby ratifies and confirms all that its SlIid Anorneyls)-in.Fact may do in pursuance hereof.
'.,;
Th,s Power of Attorney is l)l'anted under and by authority of Article VII of the By.ulIII1 of UNITED PACIF IC INSURANCE COMPANY whIch
t>>came effective ~ptember 7, 1978, which provisions are now in full force and effect, reading as follollll1:
;,:A;
: .~
, ;\
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKINGS
.'
1, The Board of Directors, the President, the Chairman of the Board, any SenIor Vice PreSIdent, any VIce PreSIdent or ASSIStant Vice Prem1ent
or ~ther officer deSignated by the Board of Directors shall have power and authority to (a) appoint Attorneys-ln.Fact and to aUlhor"e 'h.'m to ".~cute
on behalf 01 the Company, bonds and undertakings, recognIzances, contracts of indemnity and other writings obll9ltory In lhe nature fhereof. and (bl
to remove any such Artorney-in-Fact at any time and revoke the power and authority !jiven to hIm.
2, Attorney!.in-Fact !hall have power and authority, !ubject to the terms and limitatIons of the power of attorney ISSUed 10 them. to execute
and deliver on behal I of the Company, bondS and undertakings, recoonizances, contrllCts of indemnity and other wrIllngs obligatory In lhe nature thereof
ll\e corporate seal IS not necessary for the validity of any bonds and undertaking_, recognizances, contracts of IndemnIty and other wrllln'ls obllgalory
,n the nature thereof,
J, Atlorneys-in.Fact shall have power and authority to execute affidavits reqUired to be attached to bonds, recognIzances, contraclS of Indem-
nity or other cnndltlonal or oblioatory undertakings and they shall also have power and authority to certify the financIal statement of the Comp.llly "nr!
to copIes of the By- UtWS of the Company or any article or section thereof,
ThIS power 01 atto(O~ is signed and sealed by facsimile under and by authOrity of the follOWIng ResolutIon adopted by the Board of Ooreclllls of
UNITED PACIFIC INSURANCE COMPANY at a meeting held on tM 5th day of June, 1979, at which a Quorum was present, and said Resolution has 1101
been amended or repealed:
URe!olved, that the signatures of such directors and officer! and the seal of the Company may be affIxed to any such power of
atlorney or any Cl'rtificate relating thereto by faCSImile, and any such power of attorney or certif,cate bearing such 'a~lmole
s'gnature! or facsimile seal !hall be valid and bindIng upon the Company and any such power so execuled and certlfoed by
!acsimlle signatures and facsimile seal shall be valid and bInding upon the Company ,n the 'ulure wllh respect to dny bonn or
undertaking to which it IS attached."
UNIT~:lt7;JJ~!~_G-_
Vice President
STATE OF
COUNTY OF
Washington
King
}IS'
August
,1984, personally appeared Charles B. Schmal z
On thIS
6th
day of
to me known to be the Vice-President of the UNITED PACIFIC INSURANCE COMPANY, and acknowledged that he executed and artested lhe tore
going Instrument and affixed the seal of said corporation thereto, and thet Article VII, Section ',2, and 3 of the By.Laws of SlId Company, and the
Resolution. set forth therein, are still in full force,
July 20
,19
86
/.;.,;':-.~
, ~7;::'~"\
. ~r8""".~\ 't~.
T ...--.. t
.;;..~ '~~t~)
'. .<:..:~~:,,~
~--GL-7p~~-
~liC in and for State of W:l~;hinr:tnn
r.LL.1 ton
Residing at
My Commlulon Expores:
I, Charles J. Fe.lskow , IIIsinant Secretary of the UNITED PACIFIC INSURANCE COMPANY, do hereby certIfy th,lt the
above and forl!j)olng IS a true and correct copy of a Power of Attorney executed by said UNITED PACIFIC INSURANCE COMPANY, whIch IS stIli ,n tull
force Ind effect,
j .~~.
BOU.1431 Ed, 4/80
~yof January 19 88
Au_. s......., CL....L~.X~
'il
m"
':!
"~i.i '
:ill
STATE
COMPeNSATION
INSURANCE
FUNO
P,O, BOX 807, SAN FRANCISCO, CALIFORNIA 94101
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
MARCH 2, 1988
POLICY NUMBER:
CERTIFICATE EXPIRES:
I
CITY OF CAMPBELL
ATTN: PUBLIC WORKS DEPT.
75 NORTH CENTRAL
CAMPBELL, CA 95008
L
0665809-87
07-01-88
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California
Insurance Commissioner to the employer named below for the policy period indicated,
This policy is not subject to cancellation by the Fund except upon ten days' advance written notice to the employer.
We will also give you TEN days' advance notice should this policy be cancelled prior to its normal expiration,
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the
policies listed herein, Notwithstanding any requirement, term, or condition of any contract or other document with
respect to which this certificate of insurance 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,
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE
03-02-88 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL
EMPLOYER
I
THE HOME OF BENEVOLENCE OF SAN JOSE, INC.
A NON-PROFIT CORPORATION
251 LLEWELLYN AVENUE
CAMPBELL, CA 95008
L
Cr-II::' , n'11:., IDC'\/ 1 n_Dt::.\
~~
PRESIDENT
01 n ?E;?A
P.2
QOMMIROW. QENeRAL. UAltU'1
PLEAI. READ IT CAREFULLY.
MAR 03 '88 16:02 ALEXANDER & ALEXANDER 5J TOT. 02
0'\ ,__. ~cJe IIAPlT NUMli'Ri
THIS ENDORSEMENT CHANQ!S THE POLICY.
.. REVISED ADDITIONAL INSURED-OWNERS. LESSEES OR CONTRACTORS
(FORM B)
RICIIVID
Tnl$ endor.ement modlfl.. Insurllnoe pro"lded under 1he following:
COMMERCIAL GENERAL. LIABILITY COVIRAQI'ART MAR 41988
PUBLIC WORKS
WHO Ie ,ANINSUREC (8ec1lon II) I, amtnded to lnohldt .. .n inaured tho ~lME6RllNIanlz.tlon Ihown In tl
Schedul.. but only wIth '..pect to lIablllty.rlllng gut of lIyaur work" for th.t infured by or for you,
8CHIDULl
tiMa1!J)F PERQQtj ga~R~6~1~
It is hereby agreed that the
CITY OF CAMPBELL AND ITS RESPECTIVE OFFICERS. AGENTS AND EMPLOYEES
are named as Additional Insured from and against any claims. loss. liability. cost
or expense arising out of or in any way connected with the construction of the
project.
.
J02 DESCRIPTION PERMIT NO. 87-224
_ h. r I
....
~
\,". ' i,.')
11,'.. I'
IT
Joa No.
....m..
I
-.......
COST
ADDITIONAL PROVtlION:
This cove~age ahall be primary and any coverage carried by Additional Insured
shall be excess insurance only.
PERMIT NO. 87-224
INSURED E. A. HATHAWAY AND COMPANY
COMPANY : THEAETNA CASUALTY AND SURETY COMPANY
POLICY NUMBER: 05 CO 5252154 CCA
END. EFFECTIVE: 03/02/88
),
'.,
...
..
CQ-201o-A
03/03/a8 bs
CAT. 1euoo
Permit No.
Applicant
71- ~24-
INFORMATION SHEET FOR PUBLIC WORKS PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
CONTRACTORS INFORMATION
Note that all contractors must have current City
License, State Contractor's License and Workers'
Name of Contractor.e;4 xld'Ateara.y c:b
/ . ~ t2
Address~~ ~ uL .....J~~
of Campbell Business
Compensation Insurance.
State Contractor License NO.~;?~~
Telephon4af.... 9J?f-4Z<<J
~~ d q~(JfJ(J
City Business License No~~~~~~~~t~~
,
Expiration Date
Will do the following types of work:
'''"''
_____underground _____P.C. concrete ~A.C. paving _____electrical
_____other (specify),dp<---' --$ ~~~ ~d~
WORKERS' COMPENSATION INSURANCE INFORMATION
Name of Contractor/ApplicantC.4. w~ a.
One of the following must be on file with the Public Works Department:
A Certificate of Consent to Self-insure issued by the
Director of Industrial Relations; OR
A Certificat~~~rance ~. /
Insurance Co. , "'.. ~1-. Policy No ~?~ e.<: O?Y?31f';,..t..
Expiration date / .. /- ;' ; OR
The Certificate of Exemption from the Workers'
Compensation laws printed below (certificate must be
signed).
CERTIFICATE OF EXEMPTION
I certify that in the performance of the work for this permit, I shall not
employ any person in any manner so as to become subject to th~ Workers'
compe~aws of California.
Signe~7'l"~
NOTICE TO CONT CTOR/APPLICANT: If, after signing this Certificate of
Exemption, you should become subject to the Workers' Compensation
provision of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Dat~d!uL ~/ /C;N
f:PERMINFO
REV. 11/87
Z.,w
"
..;-.........;
Permit No. P,7-??!..J.
Applicant FA ~'T'lnFT.n MTNe:: QnONG INC.
INFORMATION SHEET FOR PUBLIC YORKS PERMITS
A separate form must be completed for the applicant and each contractor
that will work under this permit.
CONTRACTORS INFORMATIOti
Note that all contractors must have current City
License. State Contractor's License and Workers'
Name of Contractor_t A \.H\1tH-\Wt\'-?
Address 5(00 lAU(lE: LtAJOOD 'QD.
State Contractor License No. ctC\'2.S1
of Campbell Business
Compensation Insurance.
Telephone qe~-,y ZOG
Ci ty Business Licel}se No. f-WPu E:. D (:OfL
Expiration DateJ '(1;1\(\ ~rf\ t~SuE OI\TE.
Will do the following types of work:
_underground '_P.C. concrete _A.C. paving
electrical
_other (specify) L()NSTnUC.T NEl)J
~ YORKERS' COMPENSATION INSURANCE INFORMATION
2. '- \ \-j \ C PI L t;t: JL\J \ C. E S '6 L 0 (:, .
Name of Contractor/Applicant F.A ~'T'FTFT ,n MING QUONG INC.
One of the following must be on file with the Public Works Department:
A"Certificate of Consent to Self-insure issued by the
Director of Industrial Relations; OR
-XX-
A Certificate of Workers' Compensation Insurance
Insurance Co. State Comp Insurance Policy No. 665809-87
Expiration date 07-01-88 OR
The Certificate of Exemption from the Workers'
Compensation laws printed below (certificate must be
signed).
CERTIFICATE OF EXEMPTION
I certify that-in the performance of the work for this permit. I shall not
employ any person in any manner so as to become subject to the Workers'
Compensation Laws of California.
,Signed
Date
.~OTICE TO CONTRACTOR/APP~ICANT: If, after signing this Certificate of
Exemption, you should become subject to the Workers' Compensation
provision of the Labor Code, you must forthWith comply with such
provisions or this permit shall be deemed revoked.
f:PERMINFO
REV. 11/87
i-d
.'
. ,
NORMAN O'CONNOR AGENCY
225 Saratoga Avenue
P.O. Box 665
Los Gatos, California 95031
(408) 354-9520
Insurance Brokers · Surety Bonds · Employee Benefits
A Subsidiary of CURTIS DAY & CO,
March 3, 1988
Nora Valdez, Pkg. Underwriter
CIGNA Insurance Canpany
P.D.Box 13342
Sacramento, CA 95813-1920
RE: Eastfield Mi.ng Quang, Inc.
Policy # INP D16470831
Dear Nora:
Enclosed is a Certificate of Insurance for the City of
Campbell. The insured is having a Clinical Services Building
built at 251 Llewellyn Avenue,Campbell, CA 95008, built by
E.A. Hathaway Construction. The City of Campbell requires
that Eastfield Ming Quong provide them with a Certificate of
Insurance, and that they be named as an additional insured.
Please provide us with an additional insured endorsement
on a rush basis, or send us a blank endorsement to type if you
are in a backlog situation with the following wording:
"It is hereby agreed that the City of Campbell and its
respective officers, agents and employers are narned as additional
insured fran and against any claims, loss liability, cost of
expense arising out of or in any way cormected with the construction
of the proj ect. This coverage shall be primary and a."1.y coverage
carried by additional insured shall be excess insurance only."
As;;~~
Jo1m Dineen
Resident Vice President
JD/dl
encl.
00_', \)1\"c\~ SQY\{cs \ COf\..{RcllleR-
NORMAN O'CONNOR AGENCY
225 Saratoga Avenue
P.o. Box 665
Los Gatos, California 95031
(408) 354-9520
Insurance Brokers · Surety Bonds · Employee Benefits
A Subsidiary of CURTIS DAY & CO,
fFl~ t~y.\~~
b-1-L.-<-4-
March 22, 1988
.'-2<:::\. L,--~e'-L.--C ~
City of Campbell
70 N. First Street
Campbell, California 95008
Attn: Mr. Ganez
RE: Construction of Clinical Services Bldg at: 251 Llewelyn Avenue
Campbell,CA 95008
Dear Mr. Ganez:
In reference to the above captioned, enclosed herewith please
find the Additional Insured-State or Political Subdivisions-Permits
Endorsement which you have requested.
Sincerely,
(J d :J<<~rn
~:hn Dineen
/' Resident Vice President
JD/dl
encl.
cc: Minda Santos
Eastfield Ming Quang
RECEIVED
MAR 2 3 1988
PUBLIC WORKS
ENGINEERING
'I
POLICY NUMBER: INP D16470831
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-
STATE OR POLITICAL SUBDIVISIONS-PERMITS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART,
SCHEDULE
State or Political Subdivision: City of Campbell
70 N. First Street
Campbell, California 95008
with respect to: Construction of Clinical Services Bldg., located at:
251 Llewelyn Avenue, Campbell, California 95008
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured any state or political subdivision shown in
the Schedule, subject to the following provisions:
1. This insurance applies only with respect to operations performed by you or on your behalf for which the state
or political subdivision has issued a permit.
2. This insurance does not apply to:
a. "Bodily injury," "property damage," "personal injury" or "advertising injury" arising out of operations
performed for the state or municipality; or
b. "Bodily injury" or "property damage" included within the "products-completed operations hazard,"
CG 20 12 11 85
Copyright. Insurance ~ervices Office, Inc" 1984
o
NORMAN O'CONNOR AGENCY
225 Saratoga Avenue
P.O. Box 665
Los Gatos, California 95031
(408) 354-9520
Insurance Brokers · Surety Bonds · Employee Benefits
A Subsidiary of CURTIS DAY & CO,
April 1, 1988
Mr. Ganez
City of Campbell
70 N. 1st Street
Campbell, Califomia 95008
RECEIVED
APR 4 1988
PUBLIC WORKS
ENGINEERING
RE: Construction of Clinical Services Building located at:
251 Llewelyn Avenue, Campbell, CA 95008
Dear Mr. Ganez:
Enclosed is a revised additional insured endorsement with
necessary wording as per requirement of the City of Campbell.
Sincerely,
rJ~ ~~11
)jolm Dineen
j> Resident Vice President
JD/dl
encl.
cc: Minda Santos, CFO,
Eastfield Ming Quong,Inc.
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
INP D16470831
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-
STATE OR POLITICAL SUBDIVISIONS-PERMITS
This endorsement modifies insurance provided under the following:
REVISED 3/31/88
COMMERCIAL GENERAL LIABILITY COVERAGE PART,
SCHEDULE
State or Political Subdivision: It is hereby agreed that the City of Campbell and it's
respective officers, agents and employees are named as Additional Insured from and
against any claims, Loss liability, cost or expense arising out of or in any way
connected with the construction of the Clinical Services Building located at:
251 Llewelyn Avenue, Campbell, CA 95008. This coverage shall be primary and any
coverage carried by Additional Insured shall be excess insurance only.
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured any state or political subdivision shown in
the Schedule, subject to the following provisions:
1. This insurance applies only with respect to operations performed by you or on your behalf for which the state
or political subdivision has issued a permit.
2. This insurance does not apply to:
a. "Bodily injury," "property damage," "personal injury" or "advertising injury" arising out of operatiuns
performed for the state or municipality; or
b. "Bodily injury" or "property damage" included within the "products-completed operations hazard,"
CG 20 12 11 85
Copyright. Insurance Services Office. Inc,. 1984
o
Pentit/ProJfd No.'
Weefc of
LrationlNa.
Cotrt/"'ictOl'"
1
a7~
07106/&&
251 LLewll)'ft
Iriim
7161&8 - Wednesde)' - AHcNecf P.CoCo at tM northerl)' &/11 ~ and at the
rfttlt"ft at Wi..... IMtr'Ut'ttd t"- to _kit tM ....., plldnt,..ilift saf.. and piU-
abl.. Also il'l5tr"lded t"- to install liFted bi"..iCiCles at the lip of gutt....,
2
J
..
5
6
7
a
9
10
11,
12
13
14 '. /i?n(
Cit)' Engi~ ~:""J '
ProJeCt Engil'lftt"~<<'t/ ,
ProJ. ' II'I5p.~
Perttit/ProJect ~
Week of
Lc.ation/N.ille
C<mtr-act<ll"
1
a
J
~
5
6
7
8
'3
1~
11
la
13
14 {!^~
City Engil'ltel" \~zy q
Project E"9~JL/
ProJ. IMp'.
87 -22.1,
~7111/88
:51 I.lewellyn
ZanIlidt
1115 - Friday - Okayed gl"l1de arid forttS for H. Co l'l1ltt9 and 5Ititll section of side-
HIilk, curt- and gutter'. Poured saR. Sat"I"iCildE- f<ll" the ~ aftCl pr'O\'ides ped
access iiI"Ollnd HOrll.
;, 'u2 -
.~"r:<<8 7-2Z4
-
.....
.: ,\r ~
.~. ."'.... ~.
~~. ~~
,.-:
,.
':-,'
....
~
,.,,'1iO
.'~
SE~ O() ,selQ
'NQR\\S
~~~~\~tt\\\t\G
SEP 0 rt\-1988
.. ..... ,.
'.- ~... :::.: .~.:. .........
,-'" -'~-" ~ ';'.;~ ~::,. :......~'...l.:.... ,~~~~-~/ ~A
..: ~ -.' ..::-: ..~ -,..." ~~, ~. ~''':-: ....
'" .... ~,: :.... ....... ~ -,..,~. ...,
CITY OF CAMPBELL
DEPARTMENT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
Bond No.: 1147635 .
--Subdivider: EASTFIELDHMING QUONG, INC:
Tract No.: *
Description of
Improvements: UTILITY TRENCH, DRIVEWAY REMOVAL & H.C. RAMP
TO 251 LLEWELLYN AVENUE, CAMPBELL, CA.
AMWEST SURETY INSURANCE COMPANY is Surety on the above captioned
bond. We would appreciate your cooperation in providing the
information requested below. Please return the form to us so that
we may have current status information on the above captioned
improvements. A postage-paid envelope is provided. Thank you
very much for your assistance.
l.
Have the improvements been completed?
Yes ./ No
2 .
3 .
If not, what percentage has been completed?
70 %
Is the work progressing satisfactorily?
/" Yes
No
4 .
Has this work been accepted?
Yes ,../ No
5.
If not-1 what is the anticipated date of acceptance? 1'~(.v~",,/tt..I-.
Comments:
~A./.o 7f) ;j'E:/YJ,:?,:V ,,,/ P.cF~1
, Above information provided by:
Name 6~G ~AJ
Ti tle ~~ ~0It-1(5 -Z/},L>.
Phone No. (~) ,.96"~ -2/$0
Date ~~h?g
F30 rev. 6/87
'~
CITY OF CAMPBELL
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
(408) 866-2100
Department:
Public Works
December 29, 1966
Eastfield Children's Center
251 Llewellyn Ave.
Campbell, CA 95006
RE: FINAL INSPECTION- DEFICIENCIES
PERMIT NO. 87-224
LOCATION: 251 Llewellyn Ave.
You have requested a final inspection on subject construction work. There
are deficiencies in the work which are indicated on the enclosed list,
These deficiencies must be corrected to the satisfaction of Public Works
Inspector Gregg Eaton before we can make final inspection for acceptance
of the work.
Upon completion of the corrective work, please submit a written request
for a final inspection and acceptance.
Sincerely,
Gregg Eaton
Public Works Inspector
GE/sd
encl.
cc: R.S. Long, Sr. Lighting & Traffic Tech
f:def1tr (p. 1)
December 29, 1988
Permit 87-224
251 Llewellyn Ave.
DEFICIENCY LIST
1. Finish storm drain including trench restoration on Latimer
(install temporary A.C. immediately).
2. Install slurry as per plan on Latimer.
3. Backfill parkway (Llewellyn) so that it is flush with
sidewalk and top of curb.
4. Clean and repair crack in driveway approach es and sidewalks
to prevent displacement.
5. Repair cracks in curb, gutter, sidewalk and driveway approaches
as discussed with Bernie.
6. General clean up (street, curb, gutter & sidewalk).
F L~ jJe7lmI'r~ 81--2.2.Lf
RECEIVED
JAN 041989
PUBLIC WORKS
ENGINEERING
~ J' #> t'fo
9,ii rt ~ ~
~~ ~ .~ ~
~ (;0 ~ o~ "10 ~
~~ vO f' ~ #t\OJ ~
C::)G ~ (). &' ~~()A
~ ~.:S ~ (\c;:,.~, o<:-OJ~, ~ aT J'
~(jj ~r ~":J ,,~- if.~ ~<:-~ ~ ~o
$~ ~ J' # 'Q)OJ .&> _",,-& 0 rf ~
~ ~ CV C::) () ~. \)r ~. ~' C::) ...
CITY OF CAMPBELL
DEPARTMENT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CALIFORNIA 95008
JANUARY 3, 1989
Bond No.: 1147635
Subdi~rder: EASTFIELD MING QUONG, INC.
Tract No.: *_ -".
Amount ,/13,800.00
Description of"----.---.
Improvements: UTILITY TRENCH, DRIVEWAY REMOVAL & H.C. RAMP TO
251 LLEWELLYN AVE. CAMPBELL
AMWEST SURETY INSURANCE COMPANY is Surety on the above captioned bond.
We would appreciate your cooperation in providing the information
requested below. Please return the form to us so that we may have
current status information on the above captioned improvements. A
postage-paid envelope is provided. Thank you very much for your
assistance. '
1.
Have the improvements been completed?
If not, what percentage has been completed?
Yes
../ No
2.
"'0 %
3.
Is the work progressing satisfactorily?
Has this work been accepted?
.,.,.., Yes No
4.
Yes ~ No
5. If so, what is the date of acceptance?
6. If not, what is the anticipated date of acceptance? ~?89
Comments:
/~r::vdD --rZJ ?~&?.4/.d 4IiiFFEcI"
The above information is provided by:
Name &~6 ~
Title ~L'JG-"~ J~.u:s ~y.
Phone No. (~) 8~C, -2/50
Date ~~~7
30 6/88
E /\ S T FIE L[) i\;11 N l~ l2 U l' N ("- ~
Pt::R(Vt(r .:t:t B7 ~ ZZ4-
,j a n u a r y 4 1 92, 9
RECEIVED
JAN 04 1989
PUBLIC WORKS
ENGINEERING
Hr. Greg Eaton
CITY OF CAHPBELL
Public Works Department
r! 0 No. 1 s t S t r e e t
Campbell, CA 95008
Reference:
Eastfield - Clinical Services Building
Deat' Hr. Eaton:
Attached is a check for $4,836.00 submitted as a cash bond for
incompleted work as noted on your deficiency list dated December
29, 1988.
This work wilJ be completed very soon. Thank you for your
cooperation and assistance.
Sincerely,
QUONG
.
A United Way Agency
Date /~~~
, ,..
Address ZS/ eo. L~uc./~
,/
1'ype of work I Street."..- Storm ..---- Sani tary
Other (describe)
~MINARY INSPECTION WITH DEFICIENCY LIST
PUBLIC WORKS INSPECTION REPORT
~ 'L- 224-
Fermit or Project No. ~. =g <[
ElectricAl
(attached)
[JFINAL INSPECTION WITH DEFICIENCY LIST (attached)
o FINAL INSPECTION - ACCEPTANCE
Signed plans.? y ,(!) (If signed. Council acceptance.)
Charges against deposit? y
Overtime I hra. @ $
Date , rea5on.
'@
/hr.
-
$
BArricade rental (attach invoice)? y
Date , reallon.
CD
$
Other?
$
$
$
- Refund $
Total charges deducted from deposita
(Cash Deposit $ less charges $
[JONE YEAR MAINTENANCE WITH DEFICIENCY LIST (attached)
o ONE YEAR MAINTENANCE - ACCEPTANCE
(Relea.e'maintenanee bond. Check Reque5t if cash.)
ek. req.)
Engineer
~
Inspector
.'......".
..~,_....",...........~.'r_. .
~.~~ L,is-r
f~~'zzg:i~~,;j
,l)er;.e;n~~ ~"'J ~~~
~ ~~~ .
}) nN;~H ~ ~e.-rf~',./~(ifr",vC-/-/ ~t:iJ'5~T7b~ E)-.) CA-T7/Y1"E:1t-
(~~. ~~~ A. '- - /~"""~'.~~7)
~ ~~ .s ~ ~ ;:J~ r ~ '6..0 LA-n"n?8Z.
~ ~~n'-<., ~#7UW:Y' Ct,,~~(.,';7,(/~ ..50 ~ >r /S r~..YI WIn..,.
~~~K- ~LJ n).r'D~ C~ ~lJ.5/&~US
:P ~ 4rP> ~..e C~K- J ~ b,e, V6'W'!:J 4-rf=R-~rE:>
--
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