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96-154 CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right-of-way) Issued 1/'1/97 Permit expires in 12 mo Permit No. q~ - rs;4 X-Ref. tile Application Date 1.2/3t Iq & Application expires in 6 months APPUCA TION _ Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code. Section 11.04. (Application expires in 6 months if the pcrmil is not issued. Application Fee is non-refundable.) A. Work address or lraCl # A- ~ ~~ c.~0''''- ~~E::- Utility trcneh 10000ion B. NalW'C of work pLJ ~ \.-\. C- ~l~ \ t-J'YP~lC:::::.l^....CE5-1-...5"L.::::.. C. AttaCh four (4) copies of an engineered plans showing the location and extent of the work, and four (4) copies of the preliminary EnginccT's Estimate of work. The plans shall show the relation of the proposed work LO existing surface and underground improvements. When approved by the City Engineer, said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard SpecificatiOns and Details for Public Works ConstrUction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit. listed below. Failure LO abide by these conditions and provisions may result in job shut-down and/or forfeiwre of Faithful Performance Sureties and cash deposits. (See General Permit Conditions I and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Name of APPlitant_-t LA K. L CJ ell ~ f) Telephone <<-to?> 3 S '3 -14 b q _ (print e) r.A.,...., q 5D-3 0 . ' Addrcs~ <1 ~ ED S 5 l.J~ /ILP 24 HOUR EMERGENCY TELEPHONE NO. 'to'!> J 53 - ( e 78 ~\A.uA.,lA...M - ',- 60-.:) ~-' ~\J I (t) Bu '^- S'll ":~'D ~ c{ <Lslcfta FA OJ 50LfLt - 57 j Is this wo~ng done by the properly owner at their own residence? Yes L.No The Applicant/Permittee hereby agrees by affixing their Signawtil@this..ittohOldtheCityofcampbell.itsofficers,agentsandempIOYees free, safe and hannless from any claim or demand for damages resulting from the work r;tfver1 b ;his permit. The Applicant/Pe' ereby acknowl ges that th~ ha";ead/~~ understand both the front and back of this permit. and they will inform their comractOr(s) of the information. / / Accepted &IA (Applicant/PcrmillCC) Dr!2..~ IJ..-J/"1G Date ign) SPECIAL PROVISIONS _1. Street shall not be open cut for underground installations. Minimum cuts.!!!!y' be allowed for connections or exploration holes... Such cutS may be soeciticallY aollroved bv the InsoecLOrllrior LO cutting. Pavement may be cut for underground installations and must be resLOred in accordance with the Utility Trench ResLOraUon Standard Details, MClhod 'A'Backfi unless otherwise approved by InspCClOr. Work to be staked by a licensed Land Surveyor or Civil Engineer and twO (2) copies of the cut sheets sent LO the Public Works Department before startingwor 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 identiflClllion number has been entered hereon. USA Phone 1"800-227"2600. USA TICKET NO. 1~l;I'"~'~~~~' ~r~.",-p.:r.;.Jf="'; . _2. _3. _4. ~. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES TYPE · ~MOUNT ... u...'t'.~"QC rt;"l..~ .~ ,-,:r.::r.,..<.!.(':;> S\Dle~ .uQ s4e::c.... c:e:.. S\~.6C> RECEIPT NC q.(oT'2..~ q."2. 4"'lc.. ~2.. ..A."'t.<';:' .~ <jt..,.1'2...L\- ~1<-~ PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR & MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK & INSPECTION FEE ... ..t.~........ -- -<=: .... ~"'- '''.--~~~-~~,,--''''''.~ (!:)'''--' \::/.:ati~'"'\,.--=- , ....~~y . ./~.\ Ii . '" --... . / ( . ./'" ./ APPROVEDFORISS~. ..))~,. '~~..... ... ,~.~,'..'.V ........... ~ . orClty ... . / ----1 ----- .- .",-~I~ /. ~7......- 37 ' .'D CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right-of-way) Permit No. qC,.,.- \S:;;:4 X-Ref. file Issued Permit expires in 12 months Application Date \0 -, -9'= Application expires in 6 months APPUCATION _ Application is hereby made for a Public Works Permit in accordance with Campbcll Municipal Codc. Section 11.04. (Application expires in 6 months if the permit is not issued. Application Fcc is non-rcfundable.) A. Work address or traCt # 4-~~ ~~ C~1>- L~~ Utility trench 10000ion S. \~b~ \..v-'\.r::.t'2...cz:)'-Le=~~ B. NalW'C of work C. AttaCh four (4) copies of an enginccred plans showing the location and extent of thc work, and four (4) copies of the preliminary Engineer's Estimate of work. The plans shall show thc relation of the proposed work LO cxisting surface and underground improvemcnts. Whcn approved by thc City Enginccr. said plan becomes a part of this permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works ConstrUction: thc General Permit Conditions listed on the rcverse sidc; and the Special Provisions for this permit. listed below. Failure to abide by thcse conditions and provisions may result in job shut-down and/or forfciwrc of Faithful Pcrformancc Sureties and cash deposits. (Scc Gcneral Permit Conditions I and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. v Name of Applicant ~~\.> c. D l'\S> '\ \W G\) t)tJ Tclephone Q I' \ - '1 O"'6D (print name) \,/"/ Address \~\...\0 c...f\~f\N.A \)~ S0- C~ ~ C\S)'l..5 24 HOUR EMERGENCY TELEPHONE NO. S~f'C\lS::: ~ Is this work being done by the propcrly owner at thcir own residence? Ycs Thc AppJicantlPermillCC hereby agrees by affixing their signawre to this pcrmit to hold the City of Campbell, its officers. agents and employees frcc, safe and harmless from any claim or dcmand for damages rcsulting from the work covered by this pcrmit. Thc ApplicantlPcrmillcc hcreby acknowledges that they have read and understand both the front and back of this permit, and they will inform their conlractor(s) of the information. _ /'---j a // /UCJ~~ (Applicant/PermillCC) (sign) Ie) '7-90 Date ~ Accepted SPECIAL PROVISIONS V-1. Strcct shall not be open cut for undcrground installations. Minimum cuts ~ be allowed for connections or exploration holes. Such cuts mav bc soecificallv aooroved bv the Inspector orior LO cuttinl!. Pavement may bc cut for underground installations and must bc restored in accordance with the Utility Trench Restoration Standard Details, Method 'A'.Backfill. unless otherwise approved by InspeclOr. Work to bc staked by a licensed Land Surveyor or Civil Engineer and two (2) copies of thccut sheets scnt LO thcPublic WorksDepanment beforc starting work. Per Section 4215 of the Government Code this permit is not valid for excavations until Underground Service Alert (USA) has been notified and !he inquiry identifICation number has been entered hereon. USA Phone 1-8()()'227-2600. USA TICKET NO. _2. V""3. ~. _5. SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES :rng · AMOUNT \>-.~,e.a. $G.~, e.c.. S~~. <WI> $\bt~()'e.. SA.C2'~' ~C S IlL"^- ~ 0","--z..\0"'2-~'2.. - ~\ RECEIPT NO. <t:t4,;. -r~ ~ qfc~ ~c.... PERMIT APPLICATION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCE/LABOR.& MATERIALS CONSTRUCTION CASH DEPOSIT PLAN CHECK.& INSPECTION FEE ..e;:::T I r.:> ~~\f- ~f!'-~~ c.~ ~~~'T'E; 0 fill 't::::lE:"~.~ APPROVED FOR ISSUANCE for City Engineer Date CITY OF CAMPBELL DEPT. OF PUBUC WORKS 70 North First St. Campbell, CA 95008 (408) 866-2150 Fax (408) 376-0958 ENCROACHMENT PERMIT (for working within the public right-of-way) 'ennit No. A-Ref. File 9b -- /5'1 Issued Permit expires in 12 mos. Application Date ~ /2,-- ,9~ Application expires in 6 mos. APPUCA nON - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code, Section 11.04. (Application expires in 6 months if the permit is not issued Application Feer-refundable). A. Work address or tract # ~~ \....~ ~ ~ Utility trench location B. Natureofwork\5"';/n:r~ ~/~~m~Q~ C. Attach four (4) copies of engineered plans 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 plans become a part of this pennit. D. All work shall confonn 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 shut-down and/or forfeiture of Faithful Perfonnance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. THE CONTRACTOR MUST HAVE TIllS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. N"", '10PPH~"", U~;..J Q,~ j ~ .J ~ 0..... ~ : 'i l...~ To!""""" X ~"1 '0 "\ q l. 0 Address l ' ( v Is this work being done by the property owner at their own residence? Y es ~ :;>.;;, ""Vr",- ~q ~ The ApplicantlPenninee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and hannJess from any claim or demand for damages resulting from the work covered by this permit. Cit-. of Campbell - Che''--A Re~uest To: Accounts Receivable Please Issue Check Payable to: Address - Line 1: Line 2: Haig Precision Manufacturing Company 187 Gilman Avenue City: Campbell State: CA 95008 Zip: Description: Amount Payable: Account Number: Finance Only: INTEREST EARNED REFUNDABLE DEPOSIT $900.00 101.2203 101.540.7448 ate and Receipt No: Pennit No: Purpose: 4/12/96 92495 and 10/7/96 #96724 96-154 Refund of Cash Deposit and Plan Check Deposit Requested by: Title: City Engineer ,~. Title: Project Inspector Date: 5/2/97 Approved by: FINANCE ONLY: Verified by: Title: Approved by: Title: Date: 5/2/97 I Dare:1 I Date: Special Instructions For Handling Check Mail As Is: xx Mail in Attached Envelope: Return To: (NAME) (Department) Other: rev: 3/25/95 TO, City Clerlc .. 4722 2203 4722 .. 2203 4760 4760 4760 4722 4920 4965 TRAFFIC 4728 4728 4728 4728 4728 4271 4728 OTHER NAME OF APPLICANT PUBLIC WORKS DEPARTMENT RECEIPT Eft'eclive July I, 1996 PUBUC WORKS FILE NO_ 4 c., - \. <' ~ q- PR4-0' E'R-TY7- -AD&D-RES.-o s--- ~ \. /', RO}oI ~ lI' C:~_/_.,.". '----./ ~ 2203 2203 2203 2203 2203 2203 4721 Parkland Dedication Fee Postaae Intenection Turn Counts rTwo-Hour Countl In_ion Turn Counts (Lm. or p.m. ....w\ Traffic Flow M";- roailv Traffic Volumes\ CamDbell Traffic Model !Full Scaoe Aueslmentl Campbell Traffic ModelrReduced Scaoe A50essmentl Truck Permits No Pmn.. SilUls ...........:...>>>::.:.::AMolJ:N'I'::.:>>>:. S bIS,~),> $325\ sn5\ S500 min) 100% ofENGILEST. \ 100% ofENGIL EST, 100% ofENGILESn 4% ofENOR.EST.lCS500 minlSlO 000 nw<\ 100% ofENGIL EST.\ . 4-c~ ,=C> . Please coiled 01: receipt for the followina monies, ACct. .......lTEM ..... ........ .................... 435.535.4921 I Pro'ect Revenue'~ 'ect\ ENCROACHMENT PERMIT 4722 Application Fee Non-Utility Enc:ro8chmenl Permit (5225) R-I First Permit (No Fee\, Subseauent PermitNr ISIOO\ UtiliiV Encroachment Permit Arterial/Collector Street Residential S~ Alas Plan Check DoDosit- 2% ofENGR. EST. Faithful Perfonnance Securitv CFPS\ Lebor and MlIlerials Securitv Monumentation Securitv Cosh Deoosit Labor and MlIlerial Securirv Plan Check At Inspection Fee (Non-Utility) EnI!l'.EsL < 5250,000 Enlrl'.Est.>S2SO,OOO Utilitv < SIOO.OOO Minimum Clw!le Per t.oc.tion ConduitslPipelines up to SOO Feet Above 500 Feet ManholesIV aultsIEtc. Pole SetlRemoval Street Tree PlantinltlRemoval Utilitv> SIOO 000 Pro- ect Plans At Soecifications Standard Snecifications At Details CODies of En..ineerin.. MlIDS At Plans Penalties: Failure 10 restore Dublic imorovements lMuni Code Section 1 1.34.010\ 4722 Penalties: Failure 10 correct unsafe conditions LAND DEVELOPMENT 4722 Lot Line Adiustment 4722 Parcol Man (4 Lots or Less\ 4722 Final Tract Mon IS or More Lots\ 4722 Certificate of ComDliance 4722 Cettificate of Correction 4722 V 8C8Iion of Public Streets At Easements 4722 Assessment SO!!J'Ol!ation or RCIlIlP(lrtionment First Split Each Additional Lot SlOnn Drainage Area Fee Per Acre (12% ofENGIL EST.) CDeoosit 8% of ENGIL EST .1$30 000 min.\" (8%\ (SI20) (SL6O/ft) (Sl.I O/ft) (SIOSI..) (S I 051..) ISIOSItree\ Actual Cost + 20% .. Proiect No. (SI/PR S12IBooIc\ IS.501SQ.ft.) (SIOOlCalendar Dav\ ~~6<::~>,~> Is I OOICa1endar Dav\ S500\ SI,06O + S251Lot\ SI,380 + 5251Lot\ S500\ S300\ S550l (SS50) S170\ (R-I, S2,OOO) (Multi-Res, 52,250) (All OIher, S2.500\ 2. (....~. """("5 $60\ SI25 527 S2 '50\ S74O\ S3Sltrip\ St/each or 5251100\ TOTAL $2-C..,4- ( . ".C~ . NAMEOFPAYOR\-\.r-:;..tL.". {-==t-t.Ei.:- ~:""::.>\D ~ HLk '~U~~'l-PHONE~I.2::, -4.c-\.-2-c:::> '-k~~ c::~'= ADDRESS t ...:_ ~ -;:::::- l L _L.-L,4 rl-~ --.. 1<--..:;-* {;, __ C ,,__ ZIP 9 -::::-C'2.~.... "Actual Cost Plus 20% Overhead (Non-Interest bearin.. de1>osit\ FOR CITY CLERK ONLY RECEIVED Date .For Plan Cbeckand Cosh Deposits, send yellow copftoFi........ ... ...t6.... h:1recfnn4. wkJ(mp )rev7/1196 "",1'.... t.1k::.CE'VED OCT 0 71996 CITY CLERK'S OFFiCe . -q,,- Datei Initials CITY DF ~ :';"1: =,tL L:, C,;' RECI~.i_f.; ,., .t;(~ LI:::A~ ;!i!:; 1::1;;;:;;! ~~~~F:lnIDN '- j \ .,:,: - EtiGR ,~ "." - " STORM D~~~;:/~EES'_I_;- : TOT~; C ~,i _;1 ,-.-- ~~" - - ~'A.1. L! ~ !i!!i~~~ ~ ~MDUN1 !':;;r-- !.."_'c. .. $,- ~..:. '.;.1" {)(.i l=~~4i..6(: ~"O:) Ul(!(i(I1)Qb725 ! IM;:; ib;;~i ~55 t.67~ l" '$1~2(iG i366 .. 6(: .~. - :t '.~...,~ :~:~ 4' CITY O~ CAM~'BF_: (.-. _ _- CA RECV Ii ...., ;!!!1; ;;::1; ;:! 1 ~;j,;;~ .i.'.AriU 010000%72' TIM_~; i' 16=20:53 ~~;c~g6~i~:. ~MOUNT ;:U?lf; -:~. ~ 1. '.i j TOTAL DUE~ ~~~~~ PAID: ~~~~~~~~: .. $;..;00. GO '~~OO:G;::' $.00 $40(;" ; (;0 $400,00 ~ PUBLIC WORKS DEPARTMENT RECEIPT Effective July 1, 1995 PUBLIC WORKS FILE NO. ~ PROPERTY ADDRESS #~~..M[~/H- PleasecoUect& receipt for the ,uuUYVU'!l monies: At:X:r.:::::::::::::::-::::: J1EM 435.535.49211 Proiect Revenue (specifv proiectl ENCROACHMENT PERMIT 472 Application Fee Non-Utility Encroachment Permit ($225) R-l First Permit (No Fee) Subseauent Permit/Yr ($100) Utilitv Encroachment Permit Arterial/Collector Street Residential Street/Other Areas 220 Plan Check DeDosit 2203 Faithful Performance Surety (FPS) 2203 Monumentation Surety 2203 Cash Deposit 2203 Labor and Material Surety Plan Check & Inspection Fee (Non-Utilityl Engr.Est. < $250,000 Enor.Est. > $250,000 Utilitv < $100 000 Conduits/Pipelines up to 500 Feet ($1.60/ft.) (MIN. $105) Above 500 Feet ($1.10/ft.) Manholes/Vaults/Etc. ($1 05/ea) Pole Set/Removal ($105/ea) Minimum Charge Per Location ($120) Street Tree Plantino/Removal ($1 05/tree) Utilitv > $100 000 (Deposit 15% of ENGR. EST.)" Proiect Plans & Specifications Proiect No. Standard SDecifications & Details ($l/Po $1 2/Book) Copies of Engineerino Maps & Plans ($.50/sa.ft.) Penalties: Failure to restore Dublic imDrovements ($100/Calendar Dav) (Muni Code Section 11.34.010) 472 Penalties: Failure to correct unsafe conditions ($1 OO/Calendar Dav) LAND DEVELOPMENT 4722 Lot Line Adiustment 472 Parcel Map (4 Lots or Less) 472 Final Tract Map (5 or More Lots) 472 Certificate of Compliance 472 Certificate of Correction 472 Vacation of Public Streets & Easements 472 Assessment Segregation or Reapportionment First Split Each Additional Lot 472 Storm Drainage Area Fee Per Acre TO: City Clerk 492 496 TRAFFIC 472 472 472 472 472 427 472 OTHER ~ ~ '/...r ($325) ($225) ($500) (100% of ENGR.EST.) (100% of ENGR.EST.) (4% of FPS)($500 min.) (100% of ENGR. EST.) ...r /Yl ... 472.< 220 472 (12% of ENGR. EST.) (Deposit 15% of ENGR. EST.)" 220 476 476 476 472 ($500) ($1,060 + $25/Lot) ($1 380 + $ 25/Lot) ($400) ($300) ($550) - //111' .., ($550) ($170) (R-l, $2,000) (Multi-Res, $2,250) (All Other, $2,500) Parkland Dedication Fee (75%/25% Due Upon Cert. of OccuDancv) Postaoe Intersection Turn Counts (Two-Hour Count) ($60) Intersection Turn Counts (a.m. or p.m. peaks) ($125) Traffic Flow Map (Dailv Traffic Volumes) ($27) CamDbell Traffic Model (Full Scope Assessmentl ($2250) Campbell Traffic Model (Reduced Scope Assessm$740) Truck Permits ($35/trip) No Parkin!! SilIns ($l/each Dr $25/100) TOTAL $ /~/O / ;;0' ~/ ~-4~~;; ~d //nC/f//7// /1 -L/:. -~ p NAME OF APPLICANT // PHONE /"7. - ZIP '-7 , .A ADDRESS NAME OF PAYOR ~7 hZA. -n ~, .. Actual Cost Plus 20% Overhead (Non-Interest bearina deposit) roa cm CLEIlK ONLY - eO ttCE.'" ~ ~~ll' ~ e~ . ..~\'!\Cl r-~ ~"';",;''t .; Jt · \..;\.--" *ForPlan Check and Cash Deposits. send yellow copy to Finance. h:\recfrm3.wk3(mp)rev.l/9/96 (: , ~ ~ . , ,'"\' , , ~. , ..' ~.' ,.. . ~ . , ~, CA~?B:~~ ~ r,"'r"r '-. TC'..::r.: t\L,~i~i B.: _~ ~..~ PAYG~~~ HAIG TOD~':' S -D~i'::-: RE:.I2TE;'~ I~~'~,1E~ '.,;'--t/_,- I!ESCr::lFTIDN r.., ~ .. __ :._. {._'!. ~:.'~,~_;..! r-if 1.!EFG:;rrS .- ~\}l TC:-AL r\~~: ' 1.:_ _: ~~~f~ ~6~I;~6(il~ TEr-~I~EE ED; CHAN~E ~ ~ .; J . .~, . 3 ~....:.:::. . !", .~:'~;:' .~'jC' , ,. ~.~.. ~',- }",., '-\~"'~f1' '&"';~'\";."<~':i"~\4't.~~. ., ., '., "" '1"....)'.'.YJo','t{.::tt1<. ~~\I.~.... 'AI ~'\~. >"",\ ~(\.,.,\"~<"~" ,'. """'''''M'''''''I'~\." ');.",j,,,.C'o,..... <....,-"....\>..~.....'f ,." \"" '...."1. .1\ \ \\ ."\-l'\ ...~ \.,:~ ~\.~\,)'1. IV" ...).I.J....,~,..:, ~'\'. ....t.\".......oE. ....'..."11-/,1 ).,,,,-,'':'~'''''l .. ' ~,.,. '\- ""~ '}" I'" ~ I~. \1"1,,,...., .. ;(,..1' ').l '\~")' t :: '.i t.. '."~":'. . ,..'",..'.~ ':'."\i~':~"d: "~~\".:.,' ..'.C: -0 '; .,,;':',\.). \.", .' .\'1,. .' ';. "",'.' ~.,' )'''.' ~'" ",/,1"; p:.\,,) ,.'/ ;t......, ""'~'\'\ . . . ":. ::.' ;\\',;:::' '.' ';'. :,,':", ' .':, ")'\,'," ~.' "~".. .. ",: .!.:,. :.;/.'.7~ .'.' \r;t~~'\'I..\ I , \ -, ',... ,.f, I '11. .I."tJ,.I.r ",J... _ . .tf<~ ",' "~1I"~~ ...~.\~ ," ,....,.../ :',1'.' t "~ ,'.' ..,'!.:....,.,;..., I"" : "l~:\"}' ,.,..' ....,:. ''!;;...' ......,....,,,,.,... ..'.~./.I.)' ;~I,\.., .'.,.....,..1'.11.... "'I"".~.' ",,',r;l"~"\' '",/, ' c, ..'.;;~.,"-;';..~~..\,.',','(;,' '-;. \'/:,:,: ,'" /':" ;' ,!'. '. \....t.M'..:~\~.. I.,'" ... ..' I:.. ..I , ~'. &. Ci; :-',~ :~',(:~'O':.;2L,:95 ; ~ ~'~i . :-,~. ... -..: . ....... - :...~. .*.5;:{i ~ iJ(i $S}:~ .OC :; ~ ~ " l.,' ~ I, ~ I .' ~ \ , ,'. '" ." ~ I ','f' ,'1' , '1 /./ t, :'. I , .\\ . ~ , " ; I' , .. , , ~ ,'i . i " J , , ..",. . " "J" .,'~' ~A I : I, . 'J' r ll,,' , . , .', . I ,~>..'jjJ":~":d; ., '"I" .; ~ , ',' . . J )_ ,( , , .,' '. . .' ,"'\ ~. .' '.'l ~, . I",': \' , .} ~ II :., . , . , . , 'I' '..' , ,. " .' ,.,'. ., I '\ , . ,. ; It. I," ;;N~.~t.(. i/ ,~ I" I!: Ii "". ; .,' \ '. i,1 . l ' '~ ( , \, ':. f " ., '1\' .. .- ,'.- oW ~. ',' , ';(~bTY OF CAMPBELL) eA REC!~,'D BY: lISAB PAYOR: HAIB PRECISIuN ~;N~ TOD~Y~S DATE: 04!12!S~ 01000092"'% ',.' REGISTER DATE: 04/12/96 ! T T;";C' " 1 r.::~ . ': C i .;it.._ .i...; II............ '-'... DESCRIPTION AMDUNT ENGR & SUBDIV FILING F $225~J(: ENGR ~ BUBBlV FILING F $i~08Sc00 --------------- TOTAL DUE: $1,31C\OCi CHECK PAID: CHECK NO: 160i3 & 007 TENr!E~En: CHANGE: $1 <~10~OO -$;-: ..~, (\ tit; ,.... ..:,,;.a..... : ",,; ..' 1 $,00 .,.l ,. , . . .'. l. '. '. f . '" . ,f' ~ '" '. ..... > ,'\:, ,. ."::; (. ;~:(>~/:. . ,~\' :'~',' ~ i' {:r~!~, '.\ <.: ....' .' ;.. . ~ ..... "If ..> \ t' .~.:. ,; \ ':',1.,'; . ;\ 'j :. ... ASSIGNMENT AND RECEIPT OF INVESTMENT CERTIFICATE ro' C.rTY OF CAMPBELL, 70 N. FJ" -". STREET C~~~ELL, CALIFORNIA 95008 .08) 866-2150 P.W. Permit No. TR or YO. -';' Loc. 96-154 ix<<m/We are the owner(s) of a savings account at at its branch office at Camden Park. San Jose certificate No. 06-210252-51 in the names of and having a present balance lojzz.JC;6 ~~ln~wV . CJf"-.j ,,"Yc:\l fb .5?..rt--t..~.,"-^ Bank of Santa Clara , California, investment Daniel & Paul Sarkisian of $ 10,000.00 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 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 of the assignee without further inquiry. October 10 , 19...2.2 a ..... Assignor Executed on sign print PAUL D. SARKISIAN v Assignor ACKNOWLEDGEMENT BY ISSUER Issuer affirms that there are no other available, and that the above describ issuer. Date Orrnner ]0 ]q96 By holds on subject account, that subject monies are been noted on the Records of said ATTACH M.J.Harris NOTARY ACKNOWLEDGEMENT INSTRUCTIONS TO ASSIGNEE Please sign below for signature identification and as acknOWledgement 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: tD Ill-/q€P City [f J:J!t!J;.1 By I ",U 1), I ) /AI RELEASE BY 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: I'll' 1/ v, qfZJ Ci ty of Camp,b.ell By )4 (:, & / /1: (rA..~1 -- CALIFORNIA ALL.PURPvSE ACKNOWLEDGMENT r-""'""""""""'''''''''-''''''w.c<'.c<'''''':''~'''''''''~~-''''''''''''~'''''''''~~~~ ~ State of Co I~ f?r (/) ~ ' ~ ~ County of 8amkA (I j 0. f{'~ ~ ~ On /L) -,!L>qrp beforeme,jt/1CSJ;;C [[:r IJ(~Chs~~.vrfpr: ~ @ . Date,' _ "Nam~.and,Title of Officer (e.g.. "Jane Doe, Notary Public") @ ~ personally appeared m( GhCr: L -:r. !J~rr( S ~ g ~ ame(s) of Signer(s) @ ~ C personally known to me - OR -~roved 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 ~ ~ 'f.............----.. -^- -"- /.~ / -", A -""-...... -""- -"'-1 his/her/their signature(s) on the instrument the person(s), ~ ~ U ., ."~ ." ~ Meshell J. Dochstader~ or the entity upon behalf of which the person(s) acted, ~ ~.'. CJ..: ?NOT.2.~,n;:~SLT6?~;G~gRNIA~ executed the instrument. ~. I r: .-.-: .. ~ SANTA,vCLARA C~UNTY \: i~ g J"V · IF \ Comm. E~p. Aug. <::0,1990 l g ~ ~ _ _ _ _ ~ ~ WITNESS my hand and official seal. ~ i JV~~ t Q '1tC~~J A -=::> ~ ~~ OPTIONAL ~~.I :' '1 i<<J.1 Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent ~ ~ fraudulent removal and reattachment of this form to another document. ~ 'I ~ Description of Attached Document @ ~. :... Title or Type of Document:O~/9f YYl ct ~ ~CC ift ~ 1rf drne VJ!;: A1f'C~ ~ , '. v 'bH . C!.Q. 10 . OL (!CLr>-~ ~ Document Date: Ie) . It) . q ( J} Num er Pages: I ~ ~ Signer(s) Other Than Named Above:~ 5 ~ ~ Capacity(ies) Claimed by Signer(s) ~ ~ Signer's Name:fY11'Cha-fL T.l-..,...br rl <; Signer's Name: ~ I ~~~~~r~~~ Of/icer g ~~~~~r~~~ Officer I ~ ./ Title(s): 1/. j-J. Title(s): ~ ~. 0 Partner - 0 Limited 0 General 0 Partner - D Limited 0 General .~.I :t:<J [] Attorney-in-Fact 0 Attorney-in-Fact @ 0 Trustee 0 Trustee ~ I.: g g~h~~ian or conservator;~;b h~ g g~h~~ian or Conservator Top m Mb hore I.: ~ '~"-~~:-. ~ ~ Signer Is Representing: :r==-'~f Signer Is Representing: ~ ~ 'il.'/',~~ ~ II~ ~ 1./.,.,;1Jj,:_",-_.. ~ ~.."I I I.~ ~ ~~~'Q<;,'Q<;,'Q<;,'Q<;,~'Q<;,'Q<;,'Q<;,~'Q<;,'Q<;,'Q<;,'Q<;,~ - ;g;,.'Q<;,'Q<;,'Q<;,'Q<;,'Q<;,'Q<;,~'Q<;,'Q<;,"Q<;,'Q<;,'Q<;,'Q<;,~~'Q<;,~'Q<;,~ - ;g;,.'Q<;,~'Q<;,'Q<;,~'Q'1 Cl1995 National Notary Association. 8236 Remmel Ave.. P.O. Box 7184. Canoga Park. CA 91309-7184 Prod. No. 5907 Reorder: Call Toll-Free 1-800-876-6827 , ~/2.Z-r'\ B . lLR.{1.J,r:nt'A....J . G~~J +a ~f1t-S\~~ 3.ra * Replacement of original; wrong maturity TIME CERTIFICATE date. * OF DEPOSIT mer. Permit No. 96-154 Number: ~r. Camden Park 6 of Campbell -- IDeposit Amount Maturity Date $10,000.00 Apr. 9, 1997 INTEREST RATE INFORMATION ~e for the term of your deposit. 'Uf Account. )Unt ing index: y): . The interest rate will never change by more than: or 0 more than )sit noncash items 0 no later than the business day we receive credit for the deposit of noncash items. ce method ("Balance") to calculate interest on your Account on an interest accrual basis of days. - - and credited monthly The annual percentage yield assumes interest minimum o daily balance 0 average daily balance of $ in the account each day to obtain earnings. not receive the accrued interest. terest to the principal o Depositing the interest to an account # Interest Rate Annual Percentage Yield 4.75% 4.85% :count. TRANSACTION LIMITATIONS clrity Date. 0 You may not deposit more than <; into this account. vour Account each . 0 Minimum Deposit Amount laturity date. In addition to the minimum required early withdrawal penalty as described on the reverse, we may if closed within 6 days or 30 days loss of interest if term date. The penalty will be calculated using the interest rate in effect is less than 1 year. o on the date of your withdrawal. lave 10 calendar days (grace period) after the maturity date to withdraw funds without penalty. I do not renew the Account, your deposit will be placed in t bearing Account. OTHER INFORMATION us 0 when you open your Account, 0 on to obtain the bonus. To earn the bonus, must remain on deposit ABLE -- - ----- lara TIME CERTIFICATE OF DEPOSIT pD~ Number: ~~~~ Permit No. 96-154 :tXXX PD~ Camden Park -- 6 :Jf Campbell I Deposit Amount Maturity Date $10,000.00 Apr. 9, 1996 INTEREST RATE INFORMA nON ;e for the term of your deposit ur Account. -unt ng index: f): - The interest rate will never change by more than: or 0 more than 'sit noncash items 0 no later than the business day we receive credit for the deposit of noncash items. :e method ("Balance") to calculate interest on your Account on an interest accrual basis of days. - and credited monthly 'The annual percentage yield assumes interest minimum o daily balance o average daily balance of $ in the account each day to obtain earnings. not receive the accrued interest. 'erest to the principal o Depositing the interest to an account # Interest Rate Annual Percentage Yield 4 7<:;'7.: 4.85% count. TRANSACTION LIMITATIONS ,rity Date. 0 You may not deposit more than $ into this account. your Account each . 0 Minimum Deposit Amount 'aturity date. In addition to the minimum required early withdrawal penalty as described on the reverse, we may if closed within 6 days or 10 nRYs loss of inrPTPsr if rprm late. The penalty will be calculated using the interest rate in effect is less than 1 year o on the date of your withdrawal. lave 10 calendar days (grace period) after the maturity date to Withdraw funds without penalty. do not renew the Account, your deposit will be placed in I bearing Account. OTHER INFORMATION .IS 0 when you open your Account, 0 on :0 obtain the bonus. 0 earn the bonus, must remain on deposit \BLE INSURANCE REQUIREMENTS CHECKLIST Pennit # 9 h - /5 (/ , CIP Project # The fOIlOW~ i;.leran~f.' requ~L~f ~ ~;';;Clots 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 perfonned under an Encroachment Pennit and work being perfonned under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: 'g1 $1,000,000 per occurrence, and 13- $1,000,000 general aggregate limit applying separately to the project, and ~ $2,000,000 general aggregate limit. , 'Bl Policy expiration date 47 j ) q "7 ~ 9 Ite \;.-\. t ~ -U..v. .' ( c~. { , f L , ..( l " ... \.. !, Automotive Liability - "any auto" . 11 $1,000,000 per accident for bodily. injury and property damage ~ Policy expiration date 4/, ) c+--..---,:& OJ H\:',~ '-. f 'i: I U ,'", \' ( Cl' Worker's Compensation and Employer's Liability l!;) $ I ,?DO, ~ I";r accident fOf bodily iqjury or disease . . . kC" '.' ~" ~ Pohey exptral10n date 10/, 15 ~ (}._,' I '..'-." "~.' I .~, ' . ~ 1"1 ,d.t' 'u ~ (" \ n u v-,. '- /) (\.. l. I.. Course of Construction (if required in Special Provisions) o Completed value of the project o Policy expiration date 1-. . \.n r., (t N/G- Re uired Endorsement to General Liabilitv and Automobile Liabili Policies Additional Insured Endorsement ~ The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. ':EL. The insurance coverage afforded to the Additional Insured is primary insurance. 1i, Workers' Compensation Insurance Sheet Submitted , 0 For General Contractor . ~ . J J) "Je' ~ubrogation Clause f& (Jj J ~I (..-'-' I 7 ~I Insurance Certificate ReViewed. .. Ih ~1A a L/-.--J Initi<lls ~ . ... ,a Copy of Insurance Certificate placed in tickler file (lne month prior to expiration.e 1/1 / ~ 7 Date j:\forms\inscklst 4/96 (rev 6/96) NG STATE COMPENSA"nON INSURANCE FUND P.O. BOX B07, SAN FRANCISCO,CA94101-.0B07 CERTIFICATE OF WORKERS'COMPENSA TIO!'l...INSURANCE ISSUE DATE: 10-01-01 POLICY NUMBER: 1498899 - 01 CERTIFICATE EXPIRES: 10-01-02 CITY OF CAMPBELL ATTN:D.EPT OF PUBLIC WORKS 70 NORTH FIRST.STREET CAMPBELL CA 95008 RECEIVED SEP, S zuo, PUBL.IC .WORKS ADMINISTRATIOM 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 30 days' advance written notice to the employer. We will also give yoU 30 days'advance notice should this policy be cancelled prior to its normal expiration. This certificate of insuranc;:e is not .an insurance policy and does not amenq, extend or alter the coverage afforded by the policies listed herein. Nqtwithstar'lding any requirl;!rnent, term, or conditicln of any contract ot other document with respect to which this certificate of insurance may be jssued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ~'DE~ EMPLOYER'S LIABII.ITY LIMIT INCLUDING DEFENSE COSTS: $1;000,000.00 PEROc;ctJRRENCE. STANDARD. EXCLUSION: INDlVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. ENDORSEMENT #0015 ENTITLED ADDITIONAL XNSURED EMPLOYER EFFECTIVE 10/01/01 lS AtTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER LEGAL NAME FURLO.& FURLO 17895 EDWARDS RD LOS GATOS CA 95033 FU@I,.O, GUy Q. 09-17-01 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10265 (REV. 2-01) PRINTED: P0408 ACORlJ,. CERTIFICA- ~ OF LIABILITY INSUf '\NC~b:1 DATE (MMIDD/YY) PRODUCER 04/03/01 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. Valley Global Ins, Brokers 84 S. First street, 2nd Floor San Jose CA 95113 Phone: 408-947-7111 Fax:408-947-7115 INSURERS AFFORDING COVERAGE Furlo & Furlo 17895 Edwards Road Los Gatos CA 95030 INSURER A: INSURER B: INSURER C: Navigators Insurance Company CNA Commercial Insuranc INSURED INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N~~: I~ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY B RATIO MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH . - POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER b~flf~~~~yJ~YE P6'k+~iri~rJ~fJ~?N LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - A X COMMERCIAL GENERAL LIABILITY GL106061 04/01/01 04/01/02 FIRE DAMAGE (Anyone fire) $ 50,000 i CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 X Per proj Agg PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGG $1,000,000 I n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 - B ~ ANY AUTO C1012182629 04/01/01 04/01/02 (Ea accident) ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS c---- r- HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS =l PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ =l ANY AUTO --- OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE .$ =:J OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY L1Mris I IOJ~- EMPLOYERS' LIABILITY I E.L EA.CH ACCIDENT $ ---~ ------.--.---- .--------'-~ EL. DISEASE - EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Certificate Holder is an additional insured per attached Form CG2010 whe required on a contractual basis, CERTIFICATE HOLDER I N I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION CAMPBEL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL~AIL * 3 0 DAYS WRITTEN City of Campbell NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT~ALL Attn: Dept. of Public Works IMPOSE NO OBLIGATION OR LI~ILlTX.O~~, KIND UPON THE INSURER. ITS AGENTS OR 70 No. First Street 'I~W- '7/0.;;;;[,,,,,," .'1 /1 Campbell, CA 95008 REPRESENTATI 'I "':-~~ ." /......-v . ./{ftnLt A ~ 1/_ /7)J( I Arthu~, "J!{TTi'i"l chae..L Jr. /v ACORD 25-S 7/97 @ACORDCORPORATION 1988 9(0-/5 NG STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE ISSUE DATE: 10-01-99 POLICY NUMBER: 1498899 - 99 CERTIFICATE EXPIRES: 10-01-00 CITY OF CAMPBELt ATTN: DEPT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL CA 95008 NOIJ'YY~SJNI..ay S)lYOM O'18ncf 666l ~ Z d3S 03Al303l:1 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 30 days' advance written notice to the employer. We will also give you 30 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. <..1/<<4 ~ ~'DENT EMPLOYER'S LIABILITY LIMI'ttNCLUDINGOEFENse>COSTS: $1,OOO,OOO.QO PER oeClJRRENCE, STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/99 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER LEGAL NAME FURLO & FURLO 17895 EDWARDS RD LOS GATOS CA 95033 FURLO, GUY D. 09-19-99 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 102651REV 2 95) PRINTED: P0408 6--.154 NG STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94101-0807 CERTIFICATE .OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-01-98 POLICY NUMBER: CERTIFICA TEEXPIRES: 1498899 - 98 10-01~ ~Cr:-/l ~- I. ' Sfp 2 :', . !o0Ul.tc . ,) IdJe 1\1''''''8 I-'/Olf rFi/i r, I( oS ON "'~'." C CITY OF CAMPBELL ATTN: DEPT OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL CA 95008 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 30 days' advance written notice to the employer. We will also give you 30 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 wi~h 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. ....y...... ....;-/ ~ ~SIDENT EMPLOYER'S LIABILITY LIMITINCLUDINGDEFENSE.COSTS: $1,OOO,OOO.OO<PER OCCURRENCE. STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 10/01/98 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/98 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER LEGAL NAME FURLO & FURLO 17895 EDWARDS RD LOS GATOS CA 95033 FURLO, GUY D. 09-18-98 PRINTED: P040B THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10265 (REV 2-95) ~. - ?L.f PRODUCER Willis Corroon Corporation of San Jose 1735 Technology Dr. #500 San Jose CA 95110 (408) 452-7555 20682 .............. . . ..............""..."..... .................." ,....., ......................... ......................................... ...... ...........................-.- .--_............ ;ep~$~1<>~~ ~~~~~_~/~~;l 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. COMPANIES AFFORDING COVERAGE .. ...."..................................."............ ... ....."................................"............. .. ."",."".".............-...-..................... C ........................................................... \ A OqO ....e...:e......JI... .21(...... .....I..:P'........:I:m.............lI...... ...1...... '. ",",', .. ','- ...... ..... ,', ".'. ....", ........ ..... ,',. "::::: -- Till :::::..' ..: . ....:-:- :-: .-:-: .-: :-:-:-: :-:-. .." -:-:-: ':-. ..... ........---.- ................................,.. ..----,_................,......,........ ...........".,.."......."...",'...,.,.....,..,.............."",............""........... ....."..".,...............",.,...,......................."",...........,.".................. ........... ......',.....,.....,",.,',..,."...........'.,'.............................................................. ...........". - - --- -.. ........... m.......r;..........I......I...l1......I.I...m. ... ......1.............. .W. .a.7ft. ..( . , ...... ..." .. ". ... . .. ,,,.. ..... ... ... .. ,. . .., .. '" ..... ..... .... " . ........... ... ...."....... .. ........ -. ...... ... .. ,. .. .-- ,- .-- ,.,. ... . ... .' . -. ... ..-- --- -- . .. ". .. ". ,,,.. - .... ... ... ... .-- - .. . ......,. ...,. .. - ~- - -.. ... .......... ......... .-". .. .... .... ... .......... ... ......... ..... . ... ..... . .. . .......... ........... ..... .. ........ . .. ----"." ............ -,,-- - .. ..... . ...... ... , -. ... ..... . . '.' .:-:-...-:-:::-...::::::::::::-..........-:.:-:--_.:---_._-:-:::-.-:-.......-:..-::::::.-::::::::::.-::::::::::::.-:..-:::::.,'.::-:-....--:::::...-.-.:--:...-:::...,-:-:::::::..:...-::-.... Jann Forrest INSURED COMPANY Lexington Insurance Company A i COMPANY Transportation Insurance Company B FURlO & FURlO 17895 EDWARDS ROAD LOS GATOS CA 95030 COMPANY C 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. [ I co' I TYPE OF INSURANCE LTR A GENERAL LIABILITY I X COMMERCIAL GENERAL LIABILITY l CLAIMS MADE ~ OCCUR OWNER'S & CONTRACTOR'S PROT POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/yYI DATE (MM/DD/yYI LIMITS 5357005 01-APR-1998 01-APR-1999 PRODUCTS-COMP/OP AGG 2,000,000 1,000,000 1,000,000 1,000,000 50,000 5,000 GENERAL AGGREGATE PERSONAL & ADV INJURY B AUTOMOBILE LIABILITY ,X ANY AUTO ALL OWNED AUTOS BUA1012182629 o 1-APR-1998 01-APR-1999 COMBINED SINGLE LIMIT $ I 1,000,000 SCHEDULED AUTOS X HIRED AUTOS ~ NON-DWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY , THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE: INCL EL DISEASE-POLICY LIMIT EL DISEASE-EA EMPLOYEE EXCL OTHER ~EC~IPT;TTAC~AEIDNS/LOCATI;2Z:LE~~ Iv. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF CAMPBELL AlTN: DEPT. OF PUBLIC WORKS 70 N. FIRST STREET CAMPBELL CA 95008 EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ~~)()t~ MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEn, MIi\IUX:l&ucMl( It.Il109IB lIIXlX.IlIU~'tlON( XlR< IUNlJtllU X X X ~IUI ~XX .................................................,...,. ....,._,-.........".".........-......"".,.",..._..----.......................-.....,.......... . ........vt.c~~~~~N........................IB.I.I'.~.I~~.'............B......IEm.....I..fiI.It..t._.I.RI.B.............................. ~..(II~...........g..i#...i................. ISSUE1~~~~~~:~~y) 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, 20682 INSURED FURLO & FURLO 17895 EDWARDS ROAD LOS GATOS CA 95030 PRODUCER Willis Corroon Corporation of San Jose 1735 Technology Dr. #500 San Jose CA 95110 I (408) 452-7555 Jann Forrest 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. I POLICY NUMBER I POLICY EFFECTIVE I POLICY EXPIRATION I TYPE OF INSURANCE DATE MM DD YY DATE MM DD YY LIMITS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS RE: Work Performed by the Named Insured It is agreed The City of Campbell. the City of Campbell Redevelopment Agency. its officers. employees and volunteers are included as additional insureds as respects general liability. but solely regarding work being performed by or on behalf of the named insured in connection with the project described herein. PRIMARY CLAUSE: Subject to all other terms and provisions of the policy. such insurance as provided by this endorsement shall be deemed primary, but only as respects work performed by or for the named insured in connection with the above described contract. CANCELLATION CLAUSE: We can cancel the policy by sending to you. at the address shown in the Declarations. notice of the effective date of cancellation. We must also notify the person or organization shown in the schedule at the address indicated. We must do this at least 30 days prior to the cancellation date unless we are canceling because you failed to pay your premiums. In that case. we will give you and the person or organization shown in the schedule only 10 days notice. Mailing or delivery of the notice will be proof that you and the person or organization shown in the schedule were informed of the cancellation. CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORKS 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 ~~lt~ MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,' POLICY NUMBER: INSURED: 5357005 FURLO & FURLO COMMERCIAL GENERAL LIABILITY This endorsement changes the policy. Please read it carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part. SCHEDULE Name of Person or Organization: CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: WORK PERFORMED BY THE NAMED INSURED CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Qto.-/54 STATE COMPENSATION INSURANCE FUND IN REPLY REFER TO: DECEMBER 12, 1997 CITY OF CAMPBELL ATTN: DEPT OF PUBLIC WORKS 70 NORTH FIRST ST CAMPBELL CA 95008 I Iq(.p CERTIFICATE OF WORKERS' ----------------------- COMPENSATION INSURANCE ---------------------- CANCELLATION/CONVERSION NOTICE ------------------------------ RE: CERTIFICATE DATED OCTOBER 24, 1997. THE WORKERS' COMPENSATION COVERAGE PROVIDED UNDER THE POLICY LISTED BELOW IS BEING CONVERTED TO A NEW POLICY EFFECTIVE OCTOBER 1, 1997. THE NEW POLICY WILL PROVIDE UNINTERRUPTED COVERAGE. YOU WILL RECEIVE A NEW CERTIFICATE OF INSURANCE UNDER THE NEW POLICY NUMBER. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT THE CUSTOMER SERVICES UNIT AT THE NUMBER LISTED BELOW. EMPLOYER: FURLO & FURLO 17895 EDWARDS RD LOS GATOS CALIF., 95030 430-97 UNIT 0000090 CUSTOMER SERVICES UNIT SAN JOSE DISTRICT OFFICE (408) 363-7600 1275 Market Street. San Francisco. CA 94103-1410 Mailing Address: P.O. Box 420807. San Francisco. CA 94142-0807 SC I F 19102 C/b -'5~ STATE COMPENSATION INSURANCE FUND DECEMBER 17, P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE 1997 POLICY NUMBER: CERTIFICATE EXPIRES: 1498899 - 97 10-1.-9B Ie I TY OF CAivJPBELL ATTN: DEPT OF PUBLIC WORKS 70 NORTH FIRST.. STREET CAMPBELL CA 95008 ~.';~ I "? 199r L This is to certify that we have ~ssued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the poli~eriod indicated. This policy is not subject to cancellation by the Fund except upon t€tfdays' advance written notice to the employer. 30 We will also give you T~N 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 hereinis.subject to all the terms, exclusions and conditions of such policies. /7~~~ AUTHORIZED REPRESENTATIVE I(~ PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1, iZl0iZl, IZIlZlllJ PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 10/01/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER I FURLO~ GUY D FURLO & FURLO 17895 EDWARDS ROAD LOS GATOS CA 95030 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND selF 10262 (REV. 3-95) .~'" -" j'5'u,. ---1 0 I STATE COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE OCTOBER 24, 1997 POLICY NUMBER: CERTIFICATE EXPIRES: 4321...97 UNIT 00000921 121-1-98 I CITY OF CAMPBELL ATTN: DEPT OF PUBLIC WORKS 70 NORTH FIRST '. ST CAMPBELL CA 9521218 w orT' 2 7 19 .97 L ..t........." .. 4DMINlsn~A TI This is to certify that we have issued a valid Workers' Compensation insurance policy inq~orm approved by the California Insurance Commissioner to the employer named below for the poli'J',feriod indicated. This policy is not subject to cancellation by the Fund except upon t~ays' advance written notice to the employer. 30 We will also give you T~l<I days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which tbiscertificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein iS$ubject to all the terms, exclusions and conditions of such policies. ;7~~~ AUTHORIZED REPRESENTATIVE I(~ PRESIDENT EMPLOYER'S LIABILtTYLIMIT INCLUDING DEFENSE COSTS: $1,000,21021 PER OCCURRENCE. ENDORSEMENT #21015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 10/01/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL ENDORSEMENT #22165 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10/01/97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER I FURLO, GUY D FURLO & FURLO 17895 EDWARD RD LOS GAT OS CA 9521321 ,~." THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10262 (REV. 3-95) L .. PRc:iDUCE~ Willis Corroon Corporation 1735 Technology Dr. #500 San Jose CA 95110 (408) 452-7555 of San Jose 16049 .. - , ... . ........................................................-.-.---............,............. ...................... ..... ................ ......... .... ... ..................................... .0.... .1'. ... ..M. .M." ....0.. .y......... . ...... ,,-- ...... .. ............. ..... ............................................ :\ A E ( ID 1 Y) ......... P.AGE. ...1.. OF..... ..2... 25 - APR -1997 .. '" ..... ...... ..... . ,",...., ,... ... "'. THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORM A TION ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE !;;MPANY Transcont inental Insurance Company A .. '" .- - .. . --- - - ... . ...... ACORQ. ...........lllmlllllll.:.".'.....11.....IIIIIII......I_I_~........ Jann Forrest INSURED -- COMPANY Transportat ion Insurance Company B FURLO & FURLO 17895 EDWARDS ROAD LOS GATOS CA 95030 COMPANY c COMPANY THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THEINSURED POLICY PERIOD INDICA TED,NOTWITHS TANDING ANY REQUIREMENT ,TERMOR CONDITION OF ANY CONTRACT OR OTHERDOCUMt=:NT WITH RESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ co .1 - 1,1 POLICY EFFECTIVE "I POLICY EXPIRATION,.I TYPE OF INS'Ji:ANCE POLICY NUMBER L TR I DATE (MM/DD/YY) i DATE (MM/DD/YY) I A IB112182601 ! 01-APR-1997 01-APR-1998 IGENERAL AGGREGATE ,$ COMMERCIAL GENERAL LIABILITY '. PR. .ODUCTS-COMP/OP. AGG .i.. .....$ i CLAIMS MADE W OCCUR FRSONAL -&~-ADv--iNJURY - $~ OWNER.S & CONTRACTOR.S PROT I~AC~ OCCURRENCE $ u______~ I I FIRE DAMAGE (Anyone fire) i $ ,MED EXP (Anyone person) ! $ 01-APR-1997 01-APR-1998 :COMBINED SINGLE LIMIT 1$ I' LIMITS 2,000,000 2,000,000 1,000,000 - --- -. 1,000,000 50,000 --------_.._~-_..- 5,000 B : AUTOMOBILE LIABiliTY B112182629 1,000,000 X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON.OWNED AUTOS I foooILYINJURY--- I (P~~ per son) rB-~~~~~ --I~JURY : (Per accident) 1 $ I ~-- i I PROPERTY DAMAGE ANY AUTO GARAGE LIABiliTY EXCESS LIABILITY I UMBRELLA FORM ! OTHER THAN UMBRELLA FORM i WORKERS COMPENSATION AND , EMPLOYERS' LIABiliTY AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ I WC STATU. TORY L1M:T$ L EL EACH ACCIDENT THE PROPRIETOR/ , PARTNERS/EXECUTIVE : nFFICERS ARE: 1 OTHER DISEASE.EA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAl ITEMS SEE ATTACHED C){o --1St! Non.Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL IlNlIlllVflOla)(Jf>> MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, 8IXJ(1f"XlUfMl(I.*"XXIII~MlIl.IIOEl(I"lW()(NII'JCHIB(J(.l<<lIIKIOtICDl.IIl<<llIl)O(J(IKlmt ~X~ 1111 XXXklX XIlIIlIlIl.IlNIXI~ AUTH I TATI CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORKS 70 N. FIRST STREET CAMPBELL CA 95008 W C~~~~.~S..N.....................................I.................:._...............I................J............1.........&.......:....1...1111..11:..:1111111.1:.!:: ....... ..:....:.....:....::...:.l.....................(..e:.....::..:.........::..........2.:.:..:..................^. .....~..:..;:.....:.......................:2.H..!................ ISSUE DATE (MMlDD/YY) .;.;...;.;.;.;.;.......'.;...;.....,...;... ...'........;.....;.;...;.;.....;.;.;.;.....;.;.;.;.;..._.............;...;.......;...;..;...;...;...;..;.;.;.......;.;.;.;.;.;-..;...............;.......;...;.;.;.;.;.;.;.: ..~ :UIr:: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM A TION ONLY AND CONFERS NO RIGHTS UPON HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE INSURED 16049 PRODUCER Willis Corroon Corporation of San Jose 1735 Technology Dr. #500 San .;ose CA 95110 (408) 452-7555 25-APR-1997 THE CERTIFICATE POLICIES BELOW. FURLO & FURLO 17895 EDWARDS ROAD LOS GATOS CA 95030 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 MA Y 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER I POLICY EFFECTlVEipOLICY EXPIRATION I TYPE OF INSURANCE DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS RE: Work Performed by the Named Insured It is agreed The Cit of Campbel I, the City of Campbel I Redevelopment Agency, its officers, employees and volunteers are included as additional insureds as respects general I iabi I ity, but solely regarding work being performed by or on behalf of the named insured in connection with the project described herein. PRIMARY CLAUSE: Subject to al I other terms and provisions of the pol icy, such insurance as provided by this endorsement shal I be dee~.ed pr imary, but only as respects work performed by or for the named insured in connection with the above described contract. CANCELLATION CLAUSE: We can cancel the pol icy by sending to you, at the address shown in the Declarations, notice of the effective date of cancellation, We must also notify the person or organization shown in the schedule at the address indicated. We must do this at least 30 days prior to the cancellation date unless we are cancel ing because you fai led to pay your premiums, In that case, we wi I I give you and the person or organization shown in the schedule only 10 days notice. Mai I ing or del ivery of the notice wi I I be proof that you and the person or organization shown in the schedule were informed of the cance I I at ion. CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORKS 70 N. FIRST STREET CAMPBELL CA . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WI..M$cP~ji:tQQN?:~WP~...(~l:~~)> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL lIIIIOtHKI04l<)(tt) MAIL _3JL_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. ft1{lN1lIlallll[l(XI(llMDGl(llQ08(JICMlt\O[lItHHXXUJalllHCXlOlKll.lmOlIlOfI(XlHGXlIlt' GlKXltlAliKXKlftIXX Uf0$X~X XI"Xlll..IlIl...I~lIU. ....1x}.:m~~k 95008 POLICY NUMBER: INSURED B1l2182601 FURLO & FURLO COMMERCIAL GENERAL LIABILITY This endorsement changes the policy. Please read it carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part. SCHEDULE Name of Person or Organization: City of Campbell, the City of Campbell, Redevelopment Agency, It's Officers, Employees & Volunteers Re: Work Performed by the Named Insured (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or orgar.ization shown in the Scehdule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 ...... ....-..",., .... .. .... ..... A CORD,"OER11~IQlr PRC:;lUO.;R ~illis Corroon Corporation of San Jose 1735 Technology Dr. #500 San Jose CA 95110 (408) 452-7555 Jann Forrest INSURED FURlO & FURlO 17895 EDWARDS ROAD LOS GATOS CA 95030 . ...... ... ."",... DAtE (MM/DD/VV) <>/'PAQlilQfF>g. 23-DEC-1996 THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMA nON ONl Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Al TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE .. .. . ,., ..... .--. .. . . .." . . .3..;.;....;....1...........;..>.;1.1....;.;.;.;.1.;.;81. .;&..;.;.1.'...."(...... ...;;;.;1....11.;..;....;...1..1.;;;........;.0........;..;..;;;...'.. .. ... .. .. .. . .... ..... ....... ... .. .. ,. . .." - ... ." .. .." ... - - ..... . --... ...... .. . .. ...... .... .. . '.' .-.. .'-' ...... .... '.' '.' '-'.' -'.' ..... ,....... ',',.. . '.' .' .. ...... . ..... ... ....,. ..... . . . . . , . .' . - . . . . . . . . . '. . ' . . .' . .. ...",' ..- .- .., "', " .- . .. ......-.... ". . -'. -.'. ....'.' ..'.'.... . '.' . '.' . ...". .. .." ..... . . . ..... . . .. .., ...... - ..". . ........ .. .." ..... .. .. .. .. . ... . ". "",.. .._'..... ." . ..._..-,...,.,',............. ....'"..,,,-,,.............,,.......... .""""""'" -. ............. . -- .............. . . .""""",,-,,- -.. ...............""...... 13820 "IiI(;::::::::: .. ,::-:-:. COMPANY Tr anspor tat i on I nsur ance Company A COMPANY Tr anscont i nenta I B COMPANY C COMPANY o InsurMtc~~a~ , ~ DEtll4S96 PlJDUC W \Jidb THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA VEBEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED, NOTWITHS T ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHERDOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co n_-;POLICY EFFECTlveTpOLICY EXPlRATION--- - .- L TR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS B GENERAL LIABILITY !B112182601 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X' OCCUR ':'WNER.S & CONTRACTOR'S PROT A . AUTOMOBILE LIABILITY X ANY AUT':' ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTo.>S X fJON.OWNED AUTOS ,A 112182629 GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM ,:'THER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PR(~IPRiE I':IRI PARTNERS/EXECUTIVE OFFICER::; ARE: , OTHER INCL EXCL: '01-APR-1996 01-APR-1997 GENERAL AGGREGATE 01-APR-1996 ! 01-APR-1997 SEE ATTACHED DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS PRODUCTS.COMP lOP AGG ~--~----_.~ ""'j"- PERSONAL & ADV INJURY ! $ EACH OCCURRENCE FIRE DAMAGE (Anyone fire) $ . ! MED EXP (Anyone person) '$ COMBINED SINGLE LIMIT BODIL Y INJURY (Per person) ,$ 2,000,000 2,000,000 1, 000 , 000 1,000,000 50,000 5,000 1,000,000 CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORI<S 70 N. FIRST STREET CAMPBELL CA 95008 BODIL Y INJURY (Per accident) PROPERTY DAMAGE ' $ AUTO ONLY. EA ACCIDENT t------ OTHER THAN AUTO ONLY: EACH ACCIDENT ~_._--------_._._------+----- I AGGREGATE '$ EACH OCCURRENCE $ EL DISEASE.PC.L1CY LIMIT , EL DISEASE.EA EMPLOYEE, $ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL llNlllXlflllltlOrlll MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, IllXJ(lllUllUM(XIDlftIIJIIXXIIIICM)Ql(IIXI09lIMJIIIQ()(NIII!'lOEI&(NID><<XIlICIOtI(I)(IDMl<<XIl>OlllllllXltll ~X~ 1111 ~XXW>>X XIlIllllllIINXllX~ TATI .. -- -""..-.---- ...",---- - ....... ....- ---- .. '.. ... .... .. ..... ,. ............-..-...."."."..-,-----......... W WILLIS '>0.....13.. .........:,..........I....:P.........I.....C.':-.":I<'}r............ J..'.'.'e<:I....,....::s:.....,..,'..'."'I>,.:C..............::::.>.':::::::::::}:'.>:>> . :':,:,::.':>.>>:.....,::.,::::.:::::.:.. ISSUE DATE (MM/DD/YY) .::.."': '..,...... .>:: , .,.. ,:,::, "}}. ....: . <' .'... .::-..:,::.,.:,:>.:::".":- . . ... ... . ... . .. ...... I CORROON,/ . ........ :.,>/, .., ../i, ,....}:-: . . (Q$2:QP <2< ' THIS CEiHlFICA TE IS ISSUED AS A MAHER OF INFORM A TION ONLY AND CONFERS NO RIGHTS UPON HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE INSURED 13820 PRODUCER Willis Corroon Corporation of San Jose 1735 Technology Dr. #500 San Jose CA 95110 (408) 452-7555 23-DEC-1996 THE CERTIFICATE POLICIES BELOW. FURLO & FURLO 17895 EDWARDS ROAD LOS GATOS CA 95030 Jann Forrest 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE i POLICY EXPIRATION I I DATE (MM/DD/YY), DATE (MM/DD/YY) , LIMITS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS RE: Work Performed by the Named Insured It is agreed The Cit of Campbel I, the City of Campbel I Redevelopment Agency, its officers, employees and volunteers are included as additional insureds as respects general I iabi I ity, but solely regarding work being performed by or on behalf of the named insured in connection with the project described herein. PRIMARY CLAUSE: Subject to all other terms and provisions of the pol icy, such insurance as provided by this endorsement shal I be deemed primary, but only as respects work performed by or for the named insured in connection with the above described contract. CANCELLATION CLAUSE: We can cancel the pol icy by sending to you, at the address shown in the Declarations, notice of the effective date of cancellation. We must also notify the person or organization shown in the schedule at the address indicated. We must do this at least 30 days prior to the cancellation date unless we are cancel ing because you fai led to pay your premiums. In that case, we wi I I give you and the person or organization shown in the schedule only 10 days notice. Mai I ing or del ivery of the notice wi I I be proof that you and the person or organization shown in the schedule were informed of the cance I I at ion. CITY OF CAMPBELL ATTN: DEPT. OF PUBLIC WORKS 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 ~XPtl MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. ~JNlGlUlllI[lOQ(JMal(l8QQtf(N:CMXU:JetHIW(IlIllIIO:ll.llNCXlOlKlI.UJOlllOfl(J(,Ml8GXJG)t' .I(X~XK~X llMl$X:neCX X."XJRIIlRIl8.1~IlK.. POLICY NUMBER: B112182601 COMMERCIAL GENERAL LIABILITY This endorsement changes the policy. Please read it carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part. SCHEDULE Name of Person or organization: City of Campbell, the City of Campbell Redevelopment Agency, Its Officers, Employees & volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: Work Performed by the Named Insured. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 STATE COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 DECEMBER 16, 1996 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICY NUMBER: 430-96 UNIT 90 CERTIFICATE EXPIRES: 10/01/97 r CITY OF CAMPBELL DEPT. OF PUBLIC WORKS 70 NORTH FIRST STREET CAMPBELL, CA ~ lECESVED OECaOmB L .'Ui;I.IC W()Ri(~ ADMINISTRA TfON 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. 30 This policy is not subject to cancellation by the Fund except upon:lID days' advance written notice to the employer. 30 We will also give you TKJij 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. Notwithstaf1ltilhg'any requirem~nt, terrn, or conditionof any contractor other document with respect to which Jhis certificate of insurance may beissuE100r may pertain,. the inSUrance afforded by the policies described herein is subject to all tMterms, exclusions and conditions of such policies. ;7~~~ ~ AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 10/01/96 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF CAMPBELL ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDER'S NOTICE EFFECTIVE 10/01/96 IS ATTAC;llED TO AND A PART OF THIS POLICY. ENDORSEMENT 12/13/96 IS THIRD PARTY EMPLOYER r FURLO, FURLO & 17895 EDWARDS ROAD LOS GATOS, CA ,95030 12-23-1996 3,24PM FROM HAIG_PRECISION_MFG 4083785995 12-23-1996 2, 33PM FRCJ.1 CAto'PBELL r Ie WKS 408 3760958 P.1 p 2 WORKER'S COMPENSATION INSURANCE INFORMAnp~ 4c...e... ~1--'\. C~-...../~ ~e The following worker's compensation insurance information is required for all Applicancs and Contractors. One of the folJowina i1ems for eadl Applicallt and ComnIclor must be submitted prior to working undec a Public Works. permit or contract. RECE'''ED oEe!8.. PUOI./C v 4.DMINISTRvV,(/(S AT/ON WORKERS' COMPENSATION INFORMATION: Name of ContrlCtorlApplic:ant ~J.-)\'eL.. h.~ Cl...l'>\.. ~t"llc...\<<J..'~ o A CeniflC8tC of Consent to Self-Insure issued by the Director of Industrial Relations; QR CI A Certificate of Worken' Compensation Insurance Insurance Co. Policy No, Expiration Date ;QR CI A si.ned CertifICate of Exemption from . the Workers' Compensation laws as printed below" CEIlT1FlCATE OF EXEMPrION 1 cenify that in the performance of the work for this ooutract, I shall DOt employ any penon in a manner so as to become subject to the Workers' Compensation Laws"of ~ _%~6 Titl~ ~_ NOTICE TO APPUCANT/CONTRACTOR; If after sipiu& this CertifICate of Eltcmption, you should become subject to Che Workers' Cpmpensation provision of the Labor Code. you must forthwith comply with such provisions or the Permit or Connet will be cancelled or revoked. j: lfonns\worltcomp(rcv6l96) Of' C;t..tt 4,' ..o~ ~ ~ ... ~ U t'" '" "- -So '" ~ ,-' .01/ C H A ,,\l CITY OF CAMPBELL Public Works Department October 20, 1998 FurIo & FurIo 17895 Edwards Road Los Gatos, CA 95030 SUBJECT: PERMIT NO. 96-154 LOCATION: 426 Sam Cava Lane ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE Dear Mr. FurIo: The City of Campbell has made the final one year maintenance inspection of subject Public Works improvements and fmd that no remedial work is required. Your warranty requirements and any surety, therefore, are hereby released. Your time certificate of deposit of $10,000 will be sent directly to Daniel and Paul Sarkisian. Alan Horn Public Works Inspector MQ Y'^-- cc: Permit 96-154 Public Works/Maintenance Division Daniel and Paul Sarkisian, 426 Sam Cava Lane, Campbell, CA 95008 Haig Precision, 187 Gilman Avenue, Campbell, CA 95008 Bank of Santa Clara, 2061 Camden Avenue, San Jose, CA 95124 H: \ WORD\PERMITS\96154ACC(JD) 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790 Of.C,4Jtf .... A~ " ~ U ~ '" .. 1- " ~ c' .OJ('CH,\ \\.Q April 24, 1997 CITY OF CAMPBELL Public Works Department FurIo & FurIo 17895 Edwards Road Los Gatos, CA 95030 SUBJECT: PERMIT NO. 96-154 LOOCATION: 426 Sam Cava Lane FINAL INSPECTION AND ACCEPTANCE Dear Mr. FurIo: The City of Campbell has made a fmal inspection of subject Public Works improvements and fmds 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 as of the date of this acceptance letter, 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. According to permit requirements, the City will continue to hold 25 % of your Faithful Performance Surety ($2,500.00) as a Maintenance Surety. Please note that your initial Faithful Performance Surety cash deposit in the amount of $10,000.00 was posted in the form of a certificate of deposit. As banking regulations do not allow for the division of such instruments, the City will require that you submit $2,500.00 in the form of cash or c.d. prior to the release of the $10,000.00 initial deposit to you. Additionally, your cash deposit of $400.00 and plan check deposit of $500.00, plus any interest due, is now being processed and will be sent to you under separate cover. If you have any questions, please call me at (408) 866-2168. Sincerely, ~-o . ~ --=---- Robert Phillips Project Inspector MQ ~Jv:i cc: Suspense - 11 months Permit #96-154 Daniel Paul Sarkisian, 426 Sam Cava Lane, Campbell, CA 95008 Haig Precision, 187 Gilman Avenue, Campbell, CA 95008 H:\ WORD\PERMITS\96154FIN(JD) 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790 ENe lACHMENT PERMIT ISSUANCE CI ;K LIST Encroachment Permit No. ct<:.....- \s:.4 City of Campbell Department of Public Works ipj 4 -l ,-crt- \e;. --" -9<';"" ""S - \1. -'1A.:... 4-\,-9 tc.. 4-\"z'-Qk> UlRED FOR PERMIT APPLICATION: Applicant section complete Applicant signature and date (front and back) Permit Application Fee $225.00 paid - Receipt Number q~,- ~(ct~.~ l\ ~~ "'\~-1',C:::::- Engineer's Estimate submitted Plan Check Deposit paid (2 % of Engineer's Estimate, $500 min) Receipt Number 9r'L.. ~~ Five sets of improvement plans submitted ITEMS REOUlRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS \0-'-"1.-<0. Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then 12% of Engineer's Estimate. If Engineer's Estimate > $250,000, then Actual Cost + 20%. (Deposit of 8 % of Engineer's Estimate required; $30,000 minimum deposit). <n; \~C;;C;,;;. o>c ~tlP1.t.\:::.. '9.<c..,~ \b..J"2A~q,- Security for Faithful Performance and Labor and Materials, 100% each of Engineer's Estimate, Suppll'ed or pal'd ~i,~ r.z\LI'_'t.~ c:>\?"- ~~";..\\:" , ...~'--"""- C> vP-- ~"-'.,.,. G'-f!... '-__"- Amount $ \ <.? t C:>CC>. CH!,I Form 1. D. # e::.co'2 l e:>l.. "':;.'2.. - \ ~ \..e:..'"1.--4-Gh, Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount $ ~. A C"~ Receipt No. q Co L- <2. + '''2. - '2-~~ Worker's Compensation Insurance Information Sheet received for Applicant. \ 6 - '-r-CL<.=. All other Public Works requirements listed in the Conditions of Approval of the development. ~~.(PC:> -S"'\CJ~ t::J~\~ ^",'n-EY~ ~e:~ ITEMS REOUlRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: ;{j( - ~/ -f'~ Contractor's signature added to the permit application (front and back) '-Z":''I..C:>4'- Worker's Compensation Insurance Information Sheet received from Contractor. tL-. - \ "2. - Ctk,. Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. \ -,- "'t-r One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped APPROVED FOR CONSTRUCTION. Permit signed by City Engineer. WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial and date and file with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j: \mq\ld\pmtcklst rev. 6/96 At...III.~ CEll'lP:ICJ.~..'EOFIIJSl..JRANCEi .i ISSUE DATE (MM/DD/YY) OPS'l'OMER#J.'7J.73 10 09 96 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. SON BL. #200 PRODUCER FRANK R. OLMO & 2005 DE LA CRUZ P. O. BOX 58152 SANTA CLARA, CA COMPANIES AFFORDING COVERAGE 95052 ~~~~YA CARLISLE INS. CO. INSURED PRATS CONSTRUCTION FRANK PRATS, DBA: 1942 CABANA DRIVE SAN JOSE, CA E~#~~Y B ~~r~~NY C "r" f" "-, !q9f ~~~~NY D 95125-5609 ~~~~NY E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE OLlCY EXPIRATION DATE(MMIOD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY OMMERCIAL GENERAL LIABILIT LAIMSMADE [TIOCCUR. WNER'S & CONTRACTOR'S PROTo CON 0001403 GENERAL AGGREGATE $ 07/24/96 07/24/97 PRODUCTS-COMP/OPAGG. $ PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MOD.EXPENSE (Anyone person) $ 2,000,00 1,000,00 1,000,00 1,000,00 50,00 2 00 . AUTOMOBILE LIABILITY ------, I ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS COMBINED SINGLE $ LIMIT BODIL Y INJURY $ (Per person) BODIL Y INJURY $ (Per accident) PROPERTY DAMAGE $ EACH OCCURRENCE $ AGGREGATE $ STATUTORY LIMITS EACH ACCIDENT $ DISEASE -POLICY LIMIT $ DISEASE-EACH EMPLOYEE $ [-- NON-OWNED AUTOS . GARAGE LIABILITY I EXCESS LIABILITY II UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY I OTHER I DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS JOB: HAIG ADDITIONAL IG PRECISION MANUFACTURING LICENSE #494951 INSURED: CITY OF CAMPBELL, PUBLIC WORKS DEPARTMENT CANCELLATION FOR NON-PAYMENT OF PREMIUM IS TEN 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ~ 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. CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT 70 N. FIRST STREET CAMPBELL, CA INSURANCE REQUIREMENTS CHECKLIST Permit # CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: .E $1,000,000 per occurrence, and .0 $1,000,000 general aggregate limit applying separately to the project, and 6 $2,000,000 general aggregye limit. ~ Policy expiration date "7 d-4/C,'7 ~~t/"j ~ Automotive Liability - "any auto" . o $1,000,000 per accident for bodily injury and property damage o Policy expiration date . r ?\A'\J Worker's Compensation and Employer's Liability ~ 0 $1,000,000 per accident for bodily injury or disease o Policy expiration date Course of Construction (if required in Special Provisions) o Completed value of the project o Policy expiration date ~r-. tV , "("Ii'" ('u - . 'L#' ~!ll'C I Required Endorsement to General Liabilitv and Automobile Liabilitv Policies Additional Insured Endorsement -7 0 The City, the City of Campbell Redevelopment Agency, its officers, employees and volunteers are named as additional insured. ~ 0 The insurance coverage afforded to the Additional Insured is primary insurance. Workers' Compensation Insurance Sheet Submitted o For General Contractor o Subrogation Clause {II-"! L-f. t.. ( ~.fl...,",).,. C!..l....A_A..A,.,-'~_<...< PV1" -h::<J'Yt...a Insurance Certificate Reviewed /~~~ , - Ini. 1 -~ UOl S o /t.,.!J- (Z1.-iJ)'(CcL CJ)"j- IOp'/t:iJo 'Date o Copy of Insurance Cenificate placed in tickler file OIie month prior to expiration. j:\forms\inscklst 4/96 (rev 6/96) ...... At..IIIII" qe:F1~IF=I~~7Iitlftl~~l.IFl.ll\lCS]E:. ..i ISSUE DATE (MM/DD/VV) ....... ... ... .......... .... ............<<....................CU$'r01YIE::R.#I.'7.:l.'73 n 10 /08 /96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND FRANK R OLMO & SON CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 2005 DE LA CRUZ BL #200 POLICIES BELOW. P 0 BOX 58152 COMPANIES AFFORDING COVERAGE SANTA CLARA, CA 95052 COMPANY A LETTER CARLISLE INS CO COMPANY B INSURED LETTER ,~..".. PRATS CONSTRUCTION ""'~." !f' COMPANY C I'i"" ,.-,,--\. FRANK PRATS DBA: LETTER , 1942 CABANA DRIVE COMPANY D ir-:- 0 SAN JOSE, CA LETTER Fa 19q{:; 95125 -5609 COMPANY E LETTER ...... ................,...' ','"......... .........,. < .......... <....... .c... ......,.' ......'.........'.. .,....,.,...... ........,................. ......."...... .,.......................................... .....,.,. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWfTHSTANDING 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. L1M ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ 2 , 000 , ooc -- A X ~OMMERCIAL GENERAL L1ABILIT CON 0001403 07/24/96 07/24/97 PRODUCTS-COMP/OP AGG. $ 1 , 000 , ooc . .,.... LAIMSMADE [K] OCCUR. PERSONAL & ADV. INJURY $ 1 , 000 , ooc X pWNER'S & CONTRACTOR'S PROTo EACH OCCURRENCE $ 1 , 000 , OOC -- OOC FIRE DAMAGE (Anyone fire) $ 50 , - to/ED .EXPENs:: (Anyone personi $ 2 OOC AUTOMOBILE LIABILITY COMBINED SINGLE $ - ANY AUTO LIMIT ----- ALL OWNED AUTOS BODIL Y INJURY $ -- SCHEDULED AUTOS (Per person) -- HIRED AUTOS BODIL Y INJURY $ ---- NON-OWNED AUTOS (Per accident) - GARAGE LIABILITY -----. PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ -~ UMBRELLA FORM AGGREGATE $ i OTHER THAN UM BRELLA FORM . WORKER'S COMPENSATION I STATUTORY LIMITS .< ...............,.'...... AND EACH ACCIDENT $ EMPLOYERS' LIABILITY DISEASE-POLICY LIMIT $ DISEASE,EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS ALL CALIFORNIA OPERATIONS AND LOCATIONS LICENSE #494951 IG CANCELLATION FOR NON-PAYMENT OF PREMIUM IS TEN (10 ) DAYS .."< <> .'...'. < ",....'",...." .,'.',', ..............................', ..'......,.... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF CAMPBELL EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO PUBLIC WORKS DEPARTMENT MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 70 N. FIRST STREET - LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR CAMPBELL, CA LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 95008 ^ ,~ IIjIORI D REPR~NTATIVE .... 1/ II. ,. ~ lWI ~2 .A / ---- ...,.,...,.,.,.,., " '.'.,.,.........' ...'.'. ...."...., " of-'CA-it !..~.' .o~tt'> .... r'" U r'" o 0 ~ ... '$0 ... ~ c.,' '0 "'CHA"O MEMORANDUM CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT TO: Frank Mills, Acting Building Official DATE: September 12, 1996 FROM: Cruz S. Gomez, Assistant Engineer ~ SUBJECT: 426 Sam Cava Lane, PM 96-01, PD 96-01, Permit 96-154 The Public Works Department has no objections to the issuance of the building permits for the property. The applicants are not authorized to perform any work within the public right-of-way until they have obtained the encroachment permits for the work. The applicants shall not be allowed any building occupancy until all of the work within the public rigm-of-way is completely constructed and accepted by the Public Works Department. cc: Harold Housley Michelle Quinney Randy Westfall H: \96154BLD.MEM(wp)(JD) - MHY-1_7::-'9~ fRJ. 15:42 ID ~ HlLl ED ENG It~EER It~G TEL ~~O: 408-241-3047 tt511 P02 ---.- '-' V QlY 0,. CAMI'IEU. PQIUC woau IIBI'dDIEI'IJ CITY ENGINED'S CONSTRUCTION SURETY COST ESTIMATE ~ ~(, ~t DIll Tln/,,, Ill... .. [ .... Me. ND. l1lIU NO. J)i3CJUJI'11Ofi S AMOUNf ), 1- G A GUllING U 2. 7Z.Ju: ..,SO SUO S:.OO 3~c;' c/ .If 6 ./ 5. n 1'0.00 s.n.00 110_00 I '('to ,/ 4. 3~ ,/ U' ..00 11.00 $2.00 , ''1, J s. SP $4.SO U.2S 11.2S - 6. - EA II- DL\INAGE / ,. :r-Ile". (CUSS 'V) II LP $60.00 MIl.OO S:tO_OO '-"0 2 ~.I.C.P. (C'1.US DO U' "5.00 "'.00 DUO 3. S. LC,'. ca.us JD) LF frO.GO ..00 152.00 4 . a.c.p. (ClASS III) u: 110.00 16&.00 1511.00 S. ~.LC3~~ - U' $90.00 175.00 .5.00 , Y JNSJ'ECDON (12") - u: 11.30 10.7' 10.60 ,. E~OOD EA $1.600.00 $1,)00.00 11,000.00 - C.C. DErAJI. 9) . . :r OJtATE JNU:1' IlA $J .MIlUlO $I.JOOOO $lIUO.oo - C.C. DErAD..) P. TANDMI) MANHOUi EA $2.00000 11.600_00 $1.300.00 - C.'.J, DETAL 0.11) INCLUDES faAME & 1m) ~ 10. AND PNlllIl MB.m.L I IV< J700.00 ./ S>>O.OO "'11.00 1'H~ / m. I. ..~aJ' S6.SO $4.50 $:l.T' J~- . ~::. C.~.) ~\ 4-~-= ;1. - sF 17.50 "'.SO n.n 30-Aug-9S Page 1 of 4 t1AY-17-'96 FRI 15:42 ID:ALLlED ENGINEERIt~G TEL ~~O:408-241-3047 l:t511 P03 .. lIIW tOOT IIlCIS Poll 1'IOJBt"f AKOVNT !'f0. DI!SCJD"I1ON <nol S J: > 1150 X l,UfnmJT S. ~ ANDCM'ID 1200 ./ LJI 122.00 11'.00 $15.00 7Q"I / 4. "AU.ST 0Vl'ID SP 112.ft IlV.1IO ".35 - - 5. RAMDlCAtIlAMP - IA 11._.00 '-.110 l'IIIO.110 -- :rrn &.1 ctlII - 6. - IJl IU.OO IUO IUO ~A1'" CUD - 7. - LP 115.00 111.00 SIO.OO .. MEDIAN SUlPAC'E - JP UUlO ".00 ".00 - II. P.C.C. DllVEWAY CONl'ODl SP S7.00 ".50 $&.50 - - . 10. ~C. IIlMl'IiAY CONJIOJDI - Sf ".50 SU5 SUO - IV, ~~ ./ 1. dPIIAI.Tt>>lGOUT Nfl) ~ 32. C7 ".00 suo S:Z.ft 1'-.0 -/ 2- iAV1iNIMTWIDOI ~ (f., - IS ".00 12.50 1..50 - S. 'AVDaNt' ORDIDDlG 31.. SF SO.IO SO.5O SO. 55 .c- ./ 4. t'AV!MENt I'AIIIUC (l'EDQ.MAl) , SY $2.00 11." 11.50 -1'2-/ 5. IUIHALT COKCR!t!. (1'YP5Al , r sto.oO 150,00 135.00 rO/ e. lIS lASi (CLASS 21 ~ T S40 .00 no.OO SI2.00 gu ..../ 7, ~UDY SEAL cTYI'E D) - SF $O.G1 SO.06 IO.~ - I. OLlJDY SEAL ('1T1'E 111) --- n: SUI So.uV SO.cr7 - Y. IIGI'IAUIUGIII'I 1. DErIlC'ftIIl 1.00. <f' llOUND) - EA $450.00 5JOG.00 WO.OO - ~. LOOF (6' I 30') -- I!A $650.00 ~.OO IiMO.OO - - J. LOOP (6' I 50') ..- fA StOO.OO 1"50.00 S640.oo ~ " .--. IlA 11.600.00 11.200.00 11.100.00 5. 1I2"JUQ1D CONDurr - LP SIUIO S'7.00 ".00 - - It" 'IICJD) CONDurr - Lf St?OO SlO.OO - 6. sn.oo ~ v 30-Aug-9S Page 2 of 4 , .. " 30-Aug-95 Page 3 of 4 ---,.--~. ..J1RY-17-'% FRI 15:43 ID:ALLlED EN5HjEERING TEL ~jO:408-241-3047 tt511 P05 . . '- J11iW UNn' PmaS FOR PROIIIC1' AMOUNT NO. DI!SCR1P1'ION UANTmI!S < mIC 10 JC TO '1~ It 1150 It . AMOUNT vn. 1. -u 2. .... IA IU'-OO 1100.110 SI~.OO 3. M S650.00 S5OO.00 1400.00 4. - 11' DUO 110.00 16.00 5. - LP 11S.00 115.110 110.110 / $')l) -/ 6. ,.. Qt" BOX) I k $150.00 1335.00 1250.00 7. ~ IA S1OO.00 USO.OO 1400,110 - . CY YIIL 1. Lf S'7~. 00 160.00 150.00 2. - 11' IlS,lIO 111.~ S9.15 3, EA S3OO.00 S2OO.00 SI15.00 4. - JlA s.oo.1lO 1275.00 S2OO.00 ,. - :fA $450.00 .,50.00 $JOG.GO 6. - a SI9.00 SI7.00 S15.50 4f":S~ I/:.E~ ' SUlm7TAL ., ,,-<Or -- C'-~ rurAalDJY: A- t..(.,/ {};} ~<;'-..Je'E"INC:. CONllNCllNCW " \,<0 TOTAL CO~N llS'l'INAT! UVJIWED ft: rlD.DGNAIll' IlNOJNIiIiIINO " COlmKVCJ1OlIl' !l'fGJmiIIN(j I ~Il': TOTAL ESmIA"IE fAmD'UL l"JlIlPCIlNANC'E SuerT H:\CF.COS1'EST.\VC()Cp)713019$ 30-AuB-9S Page 4 of 4 O,,'CAJIt . A :"t- -~~. ~~ :: .', ,."" _ t'" U """.';. l"'" . :lC.." "'<;.:i;;;,. . ;. ... 10 "- t!:'. c..' O.CHA"O. CITY OF CAMPBELL City Clerk's Office April 19, 1996 Dan Sarkisian Haig Precision Manufacturing 186 Gilman Avenue Campbell, CA 95008 RECEIVED APR 2 a 1996 ~ublic: W orb! Enginearing Dear Mr. Sarkisian: At its regular meeting of April 16, 1996, the City Council held a public hearing to consider approval of a Planned Development Permit to allow construction of a 5100 sq. ft. office/manufacturing building on properties located at 420-430 Sam Cava Lane in a Planned Development Zoning District. After due consideration and discussion, the City Council adopted Resolution No. 8967 approving a Planned Development Permit and Development Schedule for this project, subject to the attached Conditions of Approval. Please find certified copy of this Resolution attached for your records. Please do not hesitate to contact this office (866-2117) or Tim Haley, Community Development Department, should you have any questions in regard to the City Council's action. Sincerely, Anne Bybee City Clerk cc. Larry Sparling, Tiny Tots Tim Haley, Community Development Department Enc. jh 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2117 . FAX 408.374.6889 . TOO 408.866.2790 RECl:i'~" ..J APR 2:; 19~b RESOLUTION NO. 8967 "ublac W 0'"' Engineering BEING A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CAMPBELL APPROVING A PLANNED DEVELOPMENT PERMIT AND DEVELOPMENT SCHEDULE TO ALLOW THE CONSTRUCTION OF A 5,100 SQUARE FOOT OFFICE/MANUFACTURING BUILDING ON PROPERTY LoeA TED AT 420, 426 & 430 SAM CAVA LANE, IN A PD (PLANNED DEVELOPMENn WNING DISTRICl'. FILE NO. PO 96-01. After notification and Public Hearing, as specified by law, on the application of Mr. Dan Sarkisian, on behalf of Haig Precision Manufacturing, and, after presentation by the Oty Staff, proponents and opponents, the hearing was closed. Mer due consideration of all evidence presented, the City Council did find as follows with respect to Flle No. PD 96-01: 1. This proposal to construct a new industrial building on this site is consistent with the General Plan and the South of Campbell Avenue Development Policies. 2. The project site is adequately improved and sized to accommodate the proposed building. 3. The proposal complies with the development standards of the M-1-S Zoning District in relationship to building heights, landscaping and setbacks. 4. The proposal will not hinder further redevelopment of this area due to the size of the project, the building placement on the site and the proposed floor area ratio. 5. The proposed parking will adequately address the parking demand for the proposed use based upon the availability of on street parking and the lower employee demand for this use. 6. The proposed project, subject to the imposed oonditions of approval, will not have a significant effect on the environment. 7. The proposed project will not have a significant effect on plant and animal life or resources. City Council Resolution No. PO 96-01 - 420, 426 & 430 Sam Cava Lane Page 3 B. Provide details of decorative entry patio, low screen walls, trellis, fencing and other pedestrian amenities. Four copies of landscape and irrigation plan to be submitted and approved prior to the issuance of building permit. 4. Performance Bond / A~eement: Bond in the amount $7000.00 or a landscaping agreement to be provided to be insure installation of landscaping fencing and striping of parking area prior to issuance of building permits. (Community Development) 5. Trash Enclosures: Appropriate trash enclosure facilities to be provided to service new manufacturing use. Any new facilities to be approved by the Community Development Director and Central Fire District. (Community Development) 6. Building Usage: Applicant to submit to a letter in a form acceptable to the City Attorney restricting the use of this building to a manufacturing process and to 10 employees and/or customers at this site on a regular basis. (Community Development) 7. Fire Flow: Required fire flow for this building is 1,850 GPM at 20 pis. residual pressure. This required flow is available from area public fire hydrants. (Central FlI'e District) 8. Public Street Improvements: Prior to issuance of any, building permits for the site, the applicant shall prepare plans, pay fees, post securities and provide insurance as required to obtain an encroachment permit to construct public street improvements as required by City Engineer. Public street improvement plans shall be prepared by a registered Civil Engineer licensed in the State of California and shall include the following: City Council Resolution No. PO 96-01 - 420, 426 &t 430 Sam Cava Lane Page 4 A. Sam Cava ~: Remove existing driveway and construct curb, gutter and sidewalk. Install one street tree and tree well. Construct irrigation system for the new tree. Inigation shall tie into the on- site landscape irrigation system to ensure consistent maintenance of landscape improvements. Construct storm drainage facilities as required by grading and drainage plans. Install off-site striping and signage to create eight spaces for public parking along the Sam Cava Lane frontage. The two spaces closest to Railway A venue shall be painted with green curbs and signed for one-hour parking. (Public Works) 9. Completion of Public Street Improvements; Prior to issuance of occupancy for the site, all public street improvements as required by the encroachment permit must be complete and accepted by the City Engineer. (Public Works) 10. Grading and Drainage Plans: Prior to issuance of any building permits for the site, the applicant shall prepare grading and drainage plans and conduct hydrology studies as necessary to determine the adequacy of the drainage of the site with the proposed changes and submit to the City Engineer for review. All storm runoff shall be collected on-site and conveyed underground to the City's existing public storm drain system using 12" minimum pipe. (Public Works) 11. Storm Drain Area Fee: Prior to issuance of a building permit, the applicant shall pay all unpaid storm drain area fees. The current fee is $2,500 per acre. A credit of $338.40 will be applied for storm fees paid with LID #30(Public Works).(e ,c..b';i.. A.c.., ') c."'\. ~i::7~':)C"i .<l6~ ::.'"\\.-, b"'::', .CO 4&.,.,o"'S.oo - .:s~. .+0) ~ 'l\'f..:,(p, '-0 12. Underground Utilities: Install new on-site utilities underground per Section 20.36.150 of the Campbell Municipal Code for any new building additions. Provide evidence from all utility companies that the proposed modifications can be served. Comply with the plan submittal, permit and fee requirements of the utilities associated with new or modified service connections. (Public Works) 13. Parcel Map: Prior to issuance of a building permit for the site, file a parcel map to combine the lots into 'one parcel. (Public Works) City Council Resolution No. PO 96-01 - 420, 426 &: 430 Sam Cava Lane Page 5 14. F-I-Occupancy: Openings not permitted less than five feet from a property line. Openings protected less than ten feet. UBC TS-A. (Building Division) 15. Screenini of Utilities: All utility meters and mechanical roof mounted equipment to be screened as approved by the Community Development Director. Specific screening proposal to be reviewed and approved prior to the issuance of building permits. (Community Development) 16. Lighting: Lighting plan to be approved by the Community Development Director for any proposed exterior or parking lot lighting. Plan to be approved prior to the issuance of building permits. Lighting shall not create unreasonable glare to adjace~t uses. (Community Development) PASSED AND ADOPlJID this 16th day of April following roll call vote: . 1996, by the A YES: NOES: ABSENT: ABSTAIN: COUNCILMEMBER: COUNCILMEMBER: COUNCIL'dEMBER: COUNCILMEMBER: Burr, Conant, Watson, Furtado, Dougherty None None None APPROVED ATIESr: (L~ Anne Bybee, Oty Clerk ~UMENT IS A TRUE TttE FOREGOtNGCOINpy OF THE ORIGINAL AND CORRECT F1\.E IN THIS OFFICE. ON CLERK CITY :nEST' ANNE BYBEE, CITY , ~~~4~~~~ BY ~\ 7 ~ .Of'CA-i-tA f..:~ .. J. ~ . ":~. dlo(\ 404.... "-.-;f . .... "'111 _,' -!: ....{_ r- ~ .~:i-~':::-j- ~ .. . ... ~ -........- .... ... , " 1)-"HAIl" CITY OF CAMPBELL Community Development Department. Current Planning March 18, 1996 Mr. Dan Sarkisian 186 Gilman Avenue Campbell, CA 95008 Re: PM 96-01 - 420, 426 & 430 Sam Cava Lane APN: 412-08-015, -058, 064 Dear Mr. Sarkisian: Please be advised that the Community Develop~ent Director and the City Engineer have approved the above-referenced Tentative Parcel Map based upon the mandatory findings that this Tentative Parcel Map, together with the provisions for its design and improvement, is consistent with the General Plan of the City of Campbell. The Parcel Map shall be filed with the City Engineer for examination, approval and recordation in accordance with the provisions of the Subdivision Map Act. This approval is subject to the following Conditions of Approval: 1. Final Parcel Map: Prepare a final parcel map for approval by the City Engineer. 2. Filing Fee: Submit an application for processing of the parcel map. The current application fee is $1,060 plus $2S per lot. 3. Local Improvement District 30: Subinit an application for processing of assessment segregation and reapportionment related to Local Improvement District No. 30. The current fee is $550 for the first lot and $170 for each additional Lot. 4. Taxes & Assessments: Comply with Sections 66494 and 66493 of the Subdivision Map Act regarding taxes and assessments. 5. Monuments: Furnish the City with cash security guaranteeing the cost of setting all monuments shown on the par.cel map. 6. Title: Comply with Section 66436 of the Subdivision Map Act regarding existing record title interests of others. 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.:2140 . FAX 408.379.:2572 . Tim 408.866.:2790 Mr. Dan Sarkisian Re: PM 96-01 - 420, 426 & 430 Sam Cava Lane Page 2 7. Building Removal: All existing buildings on the site must be removed prior to recordation of the final parcel map. (Community Development) This approval is valid for 24 months from the date of approval. H you should have any questions regarding the above information, you may contact Tim Haley, Associate at (408) 866-2144, or Harold Housley, Land Development Engineer, at (408) 866-2158. Sincerel y, Steve Piasecki Community Development Director i1lttltlft ')~<-1 Michelle Quinney / City Engineer cc: Lester Ikegami Allied Engineering Company 3170 Williams Road San Jose, CA 95117 Bruce Johnson Architect 80 Alice Avenue Campbell, CA 95008