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96-156 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) .~ Ii D' Issued ~ 7/ 'j &~/ / Permit expi s in 12/mos. - U / ~~ lit No. 1b~/~? x-Kef. File Application Date ~// 7 / Cj it' Application expires in 6 mos. APPLICATION - 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 Fee is non-refundable). A. WorkaddressortractH uAI\. 7/) Ave - (ot 7JbJ/v;'7;or) Utility trench location B. N01ure of worl< 1" !\ vb!, C 1 +- c,+ - f 0 61"0/') 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 permit. D. All work shall conform to the City of Campbell Standard Specifications and Details for Public Works Construction; the General Permit Conditions listed on the reverse side; and the Special Provisions for this permit, listed below. Failure to abide by these conditions and provisions may result in job shut-down and/or forfeiture of Faithful Performance Sureties and cash deposits. (See General Permit Conditions 1 and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE flIARTING WOJV<:. NOTICE MUST BE GIV)iN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. lSVh~c;.lc.j e-) Jr5- ~G/O tet~ >7a -7(71 Name of Applicant/Permittee We <? t U {(.e-/ C;;CJ-VI ~ 10. +,'Cl " -l7r~ s -f Telephone "? 71 g - ;;JJI D -::r Address ~ / ,4/e. 1/ ell 1500 Is this work being done by the property wner at their own residence? >'- No The Applicant/Permittee hereby agrees by affixing their signature to this permit to hold the City of Campbell, its officers, agents and employees free, safe and harmIess from any claim or demand for damages resulting from the work covered by this permit. ACORD. CERTIFICA-~ OF LIABILITY INSUr \NC~ID CP DATE (MM/DDNV) LAGE-1 01/30/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rico Pfitzer Pires & Assoc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR POBox 129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Gustine CA 95322 COMPANIES AFFORDING COVERAGE Rico Pfitzer Pires & Assc. COMPANY Phone No. 209-854-3724 Fax No. I A Golden Eagle Insurance Company INSURED COMPANY RECEIVE D B ~i . . 'FES - 31997 John Glage Underground Constr. ! COMPANY John Glage C ,'l', P.O. Box 112492 COMPANY ~' PUu..,,- .. '- Campbell CA 95011 0 , COVERAGES 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 I POLICY EFFECTIVE ! CO TYPE OF INSURANCE POLICY NUMBER POLICY EXPIRATION I LIMITS LTR DATE (MM/DI)NY) DATE (MMIDDNY) ! GENERAL LIABILITY ! I I GENERAL AGGREGATE $2,000,000 - A X COMMERCIAL GENERAL LIABILITY CCP 46282~-00 ~2/0~/96 ~2/0~/97 PRODUCTS - COMPIOP AGG $ 2,000,000 I CLAIMS MADE [!J OCCUR PERSONAL & ADV INJURY $1,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $~, 000, 000 - FIRE DAMAGE (Anyone fire) $50,000 - MED EXP (Anyone person) $ 5,000 AUTOMOBILE LIABILITY $1,000,000 - COMBINED SINGLE LIMIT A ANY AUTO CCP 462821-00 ~2/01/96 12/01/97 - ALL OWNED AUTOS BODILY INJURY - (Per person) $ X SCHEDULED AUTOS - I BODILY INJURY HIRED AUTOS - I : (Per accident) $ NON-OWNED AUTOS I - I - I PROPERTY DAMAGE $ ! i I I GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ - i ANY AUTO OTHER THAN AUTO ONLY: - ! EACH ACCIDENT $ - I AGGREGATE $ EXCESS LIABILITY I EACH OCCURRENCE $ ~ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBREI.LA FORM II $ WORKERS COMPENSATION AND IWCSTATU- I IOTH- TORY LIMITS ER EMPLOYERS' LIABILITY $1,000,000 ~INCL I ,I EL EACH ACCIDENT A THE PROPRIETORl EL DISEASE - POLICY LIMIT $1,000,000 I PARTNERSIEXECUTiVE OFFICERS ARE: I I EXCL NWC 338465-03 I 12/01/96 12/01/97 EL DISEASE - EA EMPLOYEE $1,000,000 OTHER I A BUB. Pers. Prop CCP 462821-00 12/01/96 12/01/97 BPP $52,000 Inland Marine IM $95,000 DESCRIPTION OF OPERA TlONS/LOCA TlONSNEHICLESlSPECIAL ITEMS Contractors License #504668. City of Campbell, Public Works Dept.,it's officers, emEloyees and volunteers are named as Additional 7nsured as respects Lia ;11ta per C~ 2009. Project 33 Sunnyside Avenue Permit #96-156. Coverage des1gne as Pr1mary CERTIFICATE HOLDER CANCELLATION CERTIFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Campbell 2JL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Public Works Dept. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 70 North First Street OF ANY J<IND UPON THE C~MPAfil(,ITS AGENTS OR REPRESENTATIVES. Campbell CA 95008 AUT~WEPRESENT1:L fl 1.J.-h, 9,,, ~ R' n ~ I , ~ 1C~ ~ . j~CORD CORPORATION 1988 ACORD 25-5 (1195) · 4 FROM RICO PFITZER PIRES and As~n(. JAN. 30. 1997 1:09PM P 2 PH- -: NO. : 2098542520 ACORD. CERTIFICATE OF LIABIl.ITY INSURANC~~i!l ~~--.. I 01/30/97 I'ftOOUCEft THIS CERTIFICATE IS ISSUED A8 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rico l"fit:ser l"ire. I: A..oc. l'fOLDER. THIS CERTIFICATE DO!!! NOT AMI!ND, I!!XTeND OR ~ 0 Box 129 ALTER TliE COVERAGE AFFORDED BY THE POLICIES BELOW. Guatiu. CA 953~~ COMPANIES AFfORDING COVERAGE --. Rieo Pfit..r pir.. i Assc. C(IMPANY ....__ 209.81;4_1'724 Fa NIL A Golden Bagle Insurance Compauy INIURIO COMPANY B 301m <J1age t1cdergrouncl Con.tr. C47lMPANY John Glasre C l".0. Box l1~U~ COMPANY Campbell CA 95011 D COVERAGES THI8 IS TO CEItTlFY THAT THE POLICIES OF INSURANCE U&TI;D lJEI.OW HAVi lJEEN !&SUED ",~ 1'Hi INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOMlTHtTNilOING AHY lilEQUIAeMENT. TElIIM em CONDITION 01' ANY CONTAACT I'" OTHE~ ooeUMENTWITH RE8peCT TO WHICH THIS CERTIFICATE ~y .1 "SUED OR MAY I'QlTAIN. THE INSURANCE AFFOIUlEO IIY THE POLICIf S DESCRIBED H!!REIN IS SUBJECT TO ALL THIi TIRNlS. !XClU810Nl1 AND COMDmoN8 0' SUCH POI.ICIEt. I.IMITS SHOWN MAY HAVi lJEEN REDUCl:r;. &Y PAID ClAIMS. CO TTPIOI' INIUIIAHCE ItOLlCV NUMBER I'OllCY EFfiECmll; POuCT Pl'lRATION UMITlI I.'"' DA'" IMlllIDDI'fYI DATE (MMlDDIYY) .!-ENEAAL UAIlUTY GENERAL AGGREGATE 52.000,000 A~ COMMERCIAl. GENERAL I.IAIIUTY CCP "2821-00 :12/01/96 12/01/97 PIIlODUCTS . COIIIPIO" ~ 52,000,000 L :::J. ClAMS MAD!! [!] OCCU" PERSONAl. I ADV INJURY 11,000,000 ~ O'Mft!R'S & CoNTlllACTOR'll PRO'!' EACH OCCURRENCE S 1,000,000 i FIRE DAMAGE (Any _ rore, S 50,000 MEO EXP (Any.,.,. -.an' 15.000 ~TOMo.u IJAIIILlTY 32/01/96 12/01/97 COMBINED SINGl.E I.NIT 11,000,000 A - /tN'fAVTO CCl" 462821-00 AU OWNED AUT08 BODIlY INJURY - (1'81_1 1 ~ ~"1iDUL&D AUTOS ~ "IRED AUTOS lJOOI~ Y INJURY . (,..,.~) ~ NOH-OWNiO AUTOS I I'ROPflUY DAMAGE S i <WIAGI UAIA.lTY AUTO ONI. Y - EA ACCIDENT , - ANY AUTO OTHER THAN AUTO ONlY: f-- EACH ACCIDENT 1 I - I , AGGREGATE S I Pcna UAlIlLITY I EACH OCCURRENCE S R UMBRELLA FORM ! AGGREGATE S I OTHER TI1AN UMlREUA FORM 1 I WOlUCERI CO"'ENlATION AND ~lli;!1 I IOJ~- I EMPLOYERS" UAIlUTY Ei. EACH ACCIDENT 51,000,000 A I Tl41i PIIIOI'RIETORI R~l IiL DISEASE. POLICY l.IMIT 11,000,000 pAATNEA8IPEC~ Ul01/96 12/01/97 OFFICERS ARe: EXCL If1fC 338465-03 ,I. CISIiASi . EA IiMPLOYlili S 1,000,000 I OTHER A BU8. Per.. Prop cel" 462821-00 12/01/96 12/01/97 Bl"P $52,000 I Inland Karine III $95,000 i DUCIVTION OF OPEM'TlC)NM.0CA1JONIIVEHICU!llal'1CIAL ITlllIa c~iirac~oZ". LiCeA.. .506668. City of campbeal, l"~a.1C Work. D.Pt:.ait'. o d.~., I5!lyte.. and vOluni.er8 jr. u~. .. Ad itional ,n.~ J. r.spect. L 1 ta ~.r CQ 200 . Pro ect 33 8unny~14. Avenue Pe t 96-156. Coverage .. gn. s primary CERTIFICATE HOLDER GANCELLA TION CER'1'IFI 8NCUlD ANY OF THE A80Yt DESCRlBEn POUClES It CANCEU.EO I!~ THI! EXPIMllON DAn; THEIWlF. THe ISSUING COM'ANY Wll.L D1DEAVOR TO M""- City of campbell .ll.-DAY8 WRITTEN NOlla; TO llIE CERllFlCATE H<X.DER HAMEl) TO lM& LEFT. public Works Dept. lIUT FAILURE TOIIIlAIL SUQi ND~ SHAUoIMPO$e NO O.uOA'nON Oft UAlIIUTY 70 Bo~tb ~1r.t Street OF ANY <JNO UPON llIE CQIIPAI\l.ITS AGENTS DR REPRI!'lIENTAllYU. campbell CA 95008 ~,IJ SENTT/ _ rJ}J-J\ 9.. ~ i \l!rlA lU '" II ACORD 25-8 (1/1&) n C77 ~ A@RD CORPORATION 1.'81 ACORD. CERTIFICA' - OF LIABILITY INSUr ".NC~i~G~l DATE (MMIDDNV) . - 12/23/96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rico Pfitzer Pires (MOD) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 220 Standiford, Suite C ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Modesto CA 95350 COMPANIES AFFORDING COVERAGE COMPANY Phone No. 209-579-7426 Fax No. A Golden Eagle Insurance Company INSURED COMPANY B John Glage Underground Constr. COMPANY John Glage C P.O. Box 112492 COMPANY Campbell CA 95011 0 COVERAGES 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DDNV) DATE (MMIDDNV) GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 I-- A X COMMERCIAL GENERAL LIABILITY CCP 373550 02 12/01/96 12/01/97 PRODUCTS - COMP/OP AGG $2,000,000 I-- ~ CLAIMS MADE ~ OCCUR PERSONAL & ADV INJURY $1,000,000 I-- X OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $1,000,000 I-- I-- FIRE DAMAGE (Anyone fire) $50,000 MED EXP (Anyone person) $5,000 AUTOMOBILE LIABILITY I-- COMBINED SINGLE LIMIT $ 1000000 A ANY AUTO CCP 373550 02 12/01/95 12/01/96 I-- ALL OWNED AUTOS BODILY INJURY I-- $ X SCHEDULED AUTOS (Per person) I-- X HIRED AUTOS BODILY INJURY I-- $ X NON-OWNED AUTOS (Per accident) I-- I-- PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ I-- ANY AUTO OTHER THAN AUTO ONLY: I-- EACH ACCIDENT $ I-- AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ R UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND . _I r&R3-~d~~;:sJ JOTH- EMPLOYERS' LIABILITY _ __{OR ------------ EL EACH ACCIDENT $1,000,000 A THE PROPRIETORl ~INCL EL DISEASE - POLICY LIMIT $1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE: X EXCL CCP 338465 03 12/01/96 12/01/97 EL DISEASE - EA EMPLOYEE $1,000,000 OTHER , A Bus. Pers. Prop. CCP 373550 02 12/01/96 12/01/97 BPP $52,000 Inland Marine IM $95,000 DESCRIPTION OF OPERA TlONSlLOCA TlONSNEHICLES/SPECIAL ITEMS Contractors License #504668. City of Campbell, it's officers! employees and volunteers are named as Additiona~ Insured as respects Liabi ity per CG 2099. project 33 Sunnyside Avenue Permit #96-156. Coverage designed as Pr1mary CERTIFICATE HOLDER CANCELLATION CERTIFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Campbell EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Building Department ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dept. of Public Works BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 70 North First Street Campbell CA 95008 OF ANY KIND UPON THE COMPANY, IT OR REPRESENTATIVES. /7 ~REPRESENTATIVF~~ .... . ~ ACORD 25-S (1/95) <: 22/$b~~~PORATION1988 At~.JIII.. cERTIFlcAT~ OF INSURANCE OP 10 DV DATE (MIIIDDIYY) GLAGE-1 04/18/96 PRODUCER THIS CERTIFICATE IS . _ ~UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rico Pfitzer Pires (MOD) HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 220 Standiford, Suite C ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Modesto CA 95350 COMPANIES AFFORDING COVERAGE David H. Fry COMPANY 209-579-7426 A Golden Eagle Insurance Company INSURED COMPANY B John Glage Underground COMPANY '" ...... Constr. '.-J; ., - .~ .. " John G1age C , , . P.O, Box 112492 COMPANY Campbell CA 95011 0 A.F.~ .2 .) ?()flr. COVERAGES ,oCJ<./L: 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. CO TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTlVE i POLICY EXPIRATION' LIMITS LTR DATE (MMIDDIYY) i DATE (MIIIDDIYY) GENERAL LIABILITY GENERAL AGGREGATE i $ 2000000 - PRODUCTS. COMP/OP AGG : $ 2 0 00000 A X COMMERCIAL GENERAL LIABILITY CCP 373550-01 12/01/95 12/01/96 I CLAIMS MADE [!] OCCUR PERSONAl & ADV INJURY : $ 1000000 A ~ OWNER'S & CONTRACTOR'S PROT CCP 373550-01 12/01/95 12/01/96 EACH OCCURRENCE i $ 1000000 - FIRE DAMAGE (Any one fn) 1$50000 MED EXP (Any one person) ~ $ 5000 AUTOMOBILE LIABILITY I f- COMBINED SINGLE LIMIT i $ 1000000 X ANY AUTO f- I AlL OWNED AUTOS f-- BODILY INJURY .$ A ~ SCHEDULED AUTOS CCP 373550-01 12/01/95 12/01/96 (Per perIClI1) ~ HIRED AUTOS BODILY INJURY I (Per ac:eidenl) $ X NON-oWNED AUTOS - 1$ - PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ - OTHER THAN AUTO ONLY: ! ANY AUTO - EACH ACCIDENT : $ - AGGREGATE i $ EXCESS LIABILITY EACH OCCURRENCE ;$ ==1 UMBRELLA FORM AGGREGATE 1$ OTHER THAN UMBRELLA FORM I !$ A WORKERS COMPENSATION AND STATUTORY LIMITS I EMPLOYERS' LIABILITY EACH ACCIDENT i $ 1000000 THE PROPRIETOR! ~INCL NWC 249846-01 12/01/95 12/01/96 DISEASE. POLICY LIMIT 1$1000000 PARTNERSJEXECUTIVE DISEASE - EACH EMPLOYEE i $ 1000000 OFFICERS ARE: X EXCL SUBROGATION CLAUSB INCL. OTHER A Bus. Pers. Prop. CCP 288261-00 12/01/95 12/01/96 BPP 52000 A Inland Marine CCP 288261;-00 12/01/95 12/01/96 IM 95000 DESCRIPTION OF OPERATlONSlLOCATIONSlVEHICLESlSPEClAL ITEMS Contractors License # 504668. City of C~bell, its officers! ~loyees and volunteers are named as Additi~na Insure s as respects Liab lity ~er CG 200 9. Project 33 Sunnyside Avenue Permit #96-156. Coverage is designa ed as pri mary . CERTIFICATE HOLDER CANCELLATION CAMPBEL SkOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Campbell EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Building Department ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Dept. of Public Works !~~~ft~~",*~~~7\'5^'70.RX'~ 70 North First Street Campbell CA 95008 "'-"'-ATtf - ) A"A David H. Fry {.-Z ~ ACORD 25-5 (3/93) . @A R CORPORATION 1993 ,~ At.t'lllt. CERTIFICATE OF INsuRANce/f)j4& r&~G~l DAC:7~~ THIS CERTIF~A"ErI'1 W AS A MATTER OF INFORMATION ONLY AND C ~. ~TS UPON THE CERTIFICATE HOLDER. THIS CERTlRCATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. COMPANIES AFFORDING COVERAGE PRODUCER Rico Pfitzer Pires (MOD) 220 Standiford, Suite C Modesto CA 95350 John Glage Underground Constr. John Glage P.O. Box 112492 Campbell CA 95011 COVERAGES I CO~ANY I I I I Golden Bagle Insurance Company David H. Fry 209-579-7426 INSURED COMPANY B COMPANY C '" ,.." - ".: .,-J.: S ,": '\ COMPANY D AFfi .2 ." ";()flr. "~ql.. 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 i LTRI TYPE OF INSURANCE POUCY NUMBER I ' , ! POUCY EFFECTIVE i POUCY EXPlRAT10N I UMITS I DATE(MMlDDIYV) : DATE(MMlDDIYV) I GENERAl AGGREGATE 12/01/96 PRODUCTS - COMPIOP AGG PERSONAl. & ADV INJURY 12/01/96 EACH OCCURRENCE FIRE DAMAGE (/Vry one fire) MED EXP (/Vry one per80Ill 12/01/95 GENERAL UABlUTY - A X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE ~ OCCUR A ,X OWNER'S & CONTRACTOR'S PROT - - CCP 373550-01 12/01/95 , $ 2000000 $2000000 $ 1000000 , $ 1000000 $ 50000 : $ 5000 CCP 373550-01 AUTOMOBILE UABIUTY - X ANYAUTO - ALL OWNED AUTOS e- A X SCHEDULED AUTOS l- X HIRED AUTOS l- X NON-DWNED AUTOS I- - COMBINED SINGLE LIMIT : $ 1000000 CCP 373550-01 BODILY INJURY 12/01/95 12/01/96 (Perper8Oll) $ BODILY INJURY (Per 8CCidenl) I PROPERTY DAMAGE $ i$ A Bus. Pers. Prop. A Inland Marine CCP 288261-00 CCP 288261-00 12/01/95 12/01/95 AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT ' $ AGGREGATE $ EACH OCCURRENCE , $ AGGREGATE ; $ :$ I STATUTORYLlMITS I EACH ACCIDENT I S 1000000 12/01/96 DISEASE-POUCYLlMIT 'i $ 1000000 DISEASE - EACH EMPlOYEE ! $ 1000000 12/01/96 \ BPP 52000 12/01/96 I ~ 95000 GARAGE UABlUTY - ANY AUTO - - EXCESS UABlUTY I UMBRELlA FORM I OTHER THAN UMBRELLA FORM A WORKERS COMPENSAT10N AND EMPlOYERS" UABIUTY THE PROPRIETOR! PARTNERSlEXECUTIVE , OFFICERS ARE: OTHER n INCL I NWC 249846-01 tx1 EXCL I SUBROGATION CLAUSE INCL. 12/01/95 I DESCRIPTION OF OPERA T10NSILOCA T10NSlVEHICLESlSPECIAL ITEMS Contractors License # 504668. City of C~bell, its officers! ~loyee. and volunteers are named as Additiqna~ Xnsureas as respects Liab lity per CG 200 9. Project 33 Sunnyside Avenue/Permit #96-156. Coverage is designated as pri mary . CAMPBBL CAN~ELLATION SkoULD ANY OF THE ABOVE DESCRIBED POUClES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOT1CE TO THE CERT1F1CATE HOLDER NAMED TO THE LEFT, CERTIFICATE HOLDER City of Campbell Building Department Dept. of Public Works 70 North First Street campbell CA 95008 ~~~"~~~,*~~~R~R~ ur AUTHORIZED REPRESENTAT1VE f\i ~ ) A:6c David H. Fry {,., ~ , CA RD CORPORATION 1993 ACORD 2508 (3193) "~ I Non-Utility Encroachment Permit ($22S) I R-1 First Permit (No Fee), Subsenuent Permit/Yr ($100) ! Utilitv Encroachment Permit I Arterial/Collector Street ($32S) ! Residential Street/Other Areas ($22S) I 220 Plan Check Deoosit ($SOO) 220 Faithful Performance Suretv (FPS) (100% of ENGR.EST.) 220 Monumentation Suretv (100% of ENGR.EST.) 220 Cash Denosit (4% of FPS)($SOO min.) 220 Labor and Material Suretv (100% of ENGR. EST.) Plan Check & Inspection Fee (Non-Utility) TO: City Clerk PUBLIC WORKS DEPARTMENT RECEIPT Effective July 1, 1995 PUBLIC WORKS FILE NO. I ACCT. i * * 472~ 2203 47221 Utility < I I I ($1.60/ft.) (MIN. $10S) ($1.10/ft.) ($10S/ea) ($10S/ea) ($120) ( $1 OS/tree) osit 1S% of ENGR. EST.)" Pro'ect No. ($l/P $12/Book) ($.50/5 .ft.) (12% of ENGR. EST.) (Deposit 15% of ENGR. EST.)" 220 476 476 476 472 ($100/Calendar Da 472 ($SOO) ($1,060 + $25/Lotl ($1,380 + $25/Lotl ( $4()Q) ($300) ($55()) ($550) ($170) (R-l. $2,000) (Multi-Res, $2,250) (All Other, $2 SOO) on Cert. of Occu anc ) 9& -;5(0 3 S )Y-J5;~ AMOUNT $ ,;y ':). Do . . ! i I i ! I I I I .;;1./ 0 . 0 () TOTAL h:\recfrm3. wk3(mp)rev .1/9/96 $ 35 0 \:) PHONE ZIP RECEIVED APR 1 71996 CITY CLERK'S OFFICE