96-216
r-
CF') OF C/\I<, . ,:.; E~C!<OACH~.:=.>; I'i:.~-:':<:T
DEPT. OF PUBLIC WORKS oi, (for working within the
"0 North First 51. public right -way)
~ ~pbell. CA 95008 Cf' Ie fi/, c;.1r. 1..-.
o (p. (408) 866-2150 Issued -, Application Date LI J.. '-1 ~
') . \-- 'J. ") Fax (408) 376-0958 Permit expires in 12 . Application expires in 6 mos',
& ~1\{
,J'iY APPUCATlON. Applicaticm is bereby IIIIdc for I Public Worb Pamit ia ICCOIllaDI:e wiIb CaqIbeU MuIIicipaJ Code. Scaioa 11.04. (Appl.... apinll in 6111011tbs
\J if lbe permit is DOl issued. Applicllion Fee is 1lOII-ref\mdablc.)
A. Work address or 1I'Ict' l~ ~"""' ~~~he--c") l...-/1
I
. t;;rr..n J\',).c:.\~ --2-\ G,
.J X-Ref. file
Utility lrCDclI kx:ation
c-~r r-~~1
\., l/'-i. f ~ t'":l..e;,-~' e=V---'\ 1;:'~.Jf-c-"=c,
B, NIlIIre of wort
C. Aaach four (4) copies of an qineered plans IbowiD& lbe IclCIIioII aad area of lbc wort. aad four (4) copies of lbc pnIimiaIry EDciaeer's BatimIIe of wort. Tbc
plans abaU ahow !be reIalion of !be propoaed wort to aistiDa IlIIfIcc aad 1IIIdc:rpouDd ~-.... WbaI approved by lbc City EDciaeer, aaid plan becomea I part of
Ihis permit.
D. All wort shall conform to !be City of CaqJbeU SIIIIdard Specific:IIioaa aad Details for Public Worb Coaatruaion; lbe GeoctaI Pamit C~icioaa Iiated CIIIIhc reverse
side; 11III Ibc Special Provisions for Ibis permit, listed below. Failure to Ibide by tbeIe CIIIIIdiIioas 11III provisions may result in job abut~ and/or forfcilure of Faithful
Performance Sureties 11III cash dcposiu. (See GeoctaI Pamit Conditions 111III 2.)
E. THE CONTRACTOR MUST HAVE THIS 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 PUBUCWORKS AT LEAST 24 HO~IEFORE..~ARTlN.1 G ANY WORK.
. '. ~lc..e ";;;:1~";, g~~G{.~--;.1:
Name of Applicant III -C- /) t' ...ec(-e' 71 (1,.., - De' ~IO) '11 '1- t;. / )--J-
(print 1lIlDC) 24 Jl)UR I1:MERGeO'
AcIcIrcss Z;7- 1 ~$ Att:, ~//Pc. sf,. t{2<{t/\/ ~( I elf- C;<i/ all TELEPHONE NO. (6/0) ~~-T? '7)"
I
Is Ibis wort bcin& done by Ibc property owner It their own residence? Yes V No
Tbc ApplicantlPcnnillCC hereby 8&R'CS by aff1Xin& their siplturc to Ibis permit to bold tbc City of CanIpbcll, ill oft"lCCn, IICIIIS 11III ~loyecs free, life 11III harmless from
any claim or demand for damaacs resullina from the wort covered by Ihis permit.
Tbc ApplicantlPcrmitte hereby lICknowledecs that tbcy have rad aad IIIIdcntand both tbc froIIl aod bKt of this permit, aod tbey will iaform tbeIr COIIlI'Il:fOr(s) of Ihc
information.
AccepIed
//[!c,rn~f jO/~~
(ApplicantlPermiuee) (sip)
~/I o-h (.,
'D8tc /
EN':" ')ACHMENT PERMIT ISSUANCE (" CK LIST
City of Campbell
Department of Public Works
Encroachment Permit No, 70- 2/&
~
ITEMS REQUIRED FOR PERMIT APPLICATION:
~
~
L/
~
v-
Applicant section complete
Applicant signature and date (front and back)
Permit Application Fee $225.00 paid - Receipt Number '"1 s-s-/g
Engineer's Estimate submitted ~ 0/000 "\
Plan Check Deposit paid (2 % of Engineer's Estimate, $500 min)
Receipt Number 955'19
Five sets of improvement plans submitted
ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS
V-
Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then ~ of Engineer's
Estimate, If Engineer's Estimate> $250,000, then Actual Cost + 20%. (Deposit of 8% of
Engineer's Estimate required; $30,000 minim~m eposit). 9f!'~ CJ
On~ ~4~ , -
Security for Faithful Performance and Lab and Materials, 100% each of
supplied or paid. /
Amount $ _'/0 O:JtJ Form C~ I.D. #
~ Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000
maximum)
Amount $ y#
v-
Engineer's Estimate,
I!(' (( Ipl" /1
9 S?;:2. 0
Receipt No,
yf;f/9
Worker's Compensation Insurance Information Sheet received for Applicant.
in the Conditions of Approval of the development.
,t) -
ACHMENT PERMIT:
/-1
,,-..J Contractor's signature added to the pennit application (front and back)
(i
<.---../ Worker's Compensation Insurance Information Sheet received from Contractor.
(\0"
'~\~
1-"\ ,j/
\ 0i~ l' ,.-
")
Certificate of Insurance with Additional Insured's Endorsement received from Applicant or
Contractor.
One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped
APPROVED FOR CONSTRUCTION.
j 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
City of Campbell- Refundable Deposit Check Request
Interim Check Required:
To: Finance Director
Return Check to:
Please Issue Check
Payable to:
Address - Line 1:
Department:
Rasputin Records
Line 2:
City:
2401 Telegraph Avenue
Berkeley
State: CA
Zip: 94704
Finance Use Onlv
Description:
Refund Construction Deposits
Amount Payable:
$21,300,00
(Exact Amount)
Interest Earned
Account Number:
101.2203
101.540,7448
Purpose:
Refund Plan Check Deposit, Construction Cash Deposit and Faithful Performance
Surety Cash Deposit
Rp,quested by:
95519 @ $500
95520 @ $20,000
Permit #: 96-216
98319 @ $800 98319 12/20/96
Date: 95519/955 8/15/96
Title: PW Inspector Date: 11/19/98
Title: City Engineer Date: 11/19/98
Title: Account Clerk II Date:
Title: - Date:
Voucher #:
Approved by:
Verified by:
Approved by:
Special Instructions For Handling Check
Mail As Is:
x
Mail in Attached Envelope:
Other:
fin: S:/excellchkn:q - Revised 1/98
t'.~
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.
PUBLIC WORKS DEPARTMENT RECEIPT
Effective July I. 1996
TO: City Clerk PUBLIC WORKS FILE NO. 5/.h'- .2/ ~ /"'1
PROPERTY ADDRESS ff~/7 ~ /~/-'~~
ACCT: Please collect &
.-..ne:'." ...............
435.535.4921 I Pr;;~t Revenue Isoecifv oroiect) S
ENCROACHMENT PERMIT
4722 Application Fee
Non-Utility Encroachment Pennit (S225)
R-I First PermitlNo Fee), Subseauent PennitIYrlSIOO)
Uti~ Encroachment Pennit
Arterial/Collector Street S325)
Residential Street/Other Areas S225)
2203 Plan Check De~sit - 2% of EN GR. EST. S500 min "
2203 Faithful Perfonnance Securi~PSI- 100% ofENGR.EST-:l "
2203 Labor and Materials Security . 100% ofENGR. EST-:l
2203 Monumentation Security 100% ofENGR.EST.) "
2203 Cash Deoosit 4% ofENGR.EST.)(S500 min/SIO.ooo maxI , " ~
2203 Labor and Material Secu':;;:; 100% ofENGR. EST-:l "
Plan Check & Inspection Fee 1N0n-Utility) _~ L/(.~7
4722 Engr.Est. < S250,000 (12%ofENGR. EST.)
.. 2203 En.r.Est.>S250,000 lDenosit 8% of ENGR. EST./S30,ooo min-:l"" "
4722 Utility < SIOO,ooo 18%)
Minimum Charge Per Location (SI20)
Conduits/Pipelines up to 500 Feet (Sl.6O/ft)
Above 500 Feet (SLlO/ft.)
ManholesIV aults/Etc. (SI05/ea)
Pole SetlRemoval (SI05/ea)
Street Tree Plantinu/Removal (SI05/tree)
.. 2203 Utilitv> SIOO.ooo Actual Cost + 20% .. "
4760 Proiect Plans & S"""ifications Proiect No.
4760 Standard Soecifications & Details ISllP. Sl2/Book)
4760 Copies of En.ineerin.M-;;;;S & Plans IS.50/SQ.ft.)
4722 Penalties: Failure to restore oublic imorovements ISIOO/Calendar Dav)
IMuni Code Section 11.34.010)
4722 Penalties: Failure to correct unsafe conditions IS 1 OO/Calendar DlWl
LAND DEVELOPMENT
4722 Lot Line Ad'ustInent S500)
4722 Parcel Man 14 Lots or Less") SI,06O + S251Lot)
4722 Final Tract Moo IS or More Lots) SI,380 + S251Lot)
4722 Certificate of Comoliance S5(0)
4722 Certificate of Correction S300\
4722 Vacation of Public Streets & Easements S550
4722 Assessment Segregation or Reapportionment
First Split (S550)
Each Additional Lot IS170\
4721 Stonn Drainage Area Fee Per Acre (R-I, $2.000)
(Multi-Res, S2.250)
I All Other. S2,500)
4920 Parkland Dedication Fee
4965 Postalle I - j'
TRAFFIC 7" 7'//:/7"/ t', :/ /l i/ I" < /'-Y -::? h'//
4728 Intersection Turn Counts (Two-Hour Co6'nt) / I~)
4728 Intersection Turn Counts'la.m. or n.m'-~-;l (SI25\
4728 Traffic Flow Man (Dailv Traffic Volumes) ($27)
4728 Campbell Traffic Model (Full Scooe Assessment) $2,250)
4728 CamDbell Traffic ModellReduced Scone Assessment) S740)
4271 Truck Pennits S35/trip\
4728 No Parkin. SilUls $ 1 leach or $25/1(0)
OTHER
TOTAL S -;:?L'''i/:)
~/- j d~ ~A~ } /1
NAME OF APPLICANT
)R/~ ~/a L ~ J~/~
NAMEOFPAYO ..,/ ~.J h//~ I - '.., ';H;NE 5//J.]/.f-;/JL),
'@1 _? /: '-' jJ/ ./2~ /? -- 'L/
ADDRESS c:t c, .' . ' ZIP sr- ~ /' /?
s~~ r~,L{;t){~
.. Actual Cost Plus O'i. Overh~a('i lN~n-l~
#' '-- RECEIV
FOR /' \.....lfi. VV1I1l<1 II
CITY CLERK . .. ..' .....<<<
ONLY U Recei~#o/C~BI.. .'1 DEe 2 019
Date -...."'..,.,..."
~ . ..'
)
C) t3 3~ ~
ED
96
"For Plan Check and Cash Deposits, sendyeHowoopyt<>Finance.
CITY CLERK'S OFFICE
h:\recfnn4. wk3(mp )rev7 11/96
CITY OF CAMPBELL, CA
REM BY: LISA! 01000098319 /'
PAYOR: RASPUTIN RECORDS
TODAY1S DATE= 12120/96
REGISTER DATE: 12/20/96 TIKE: 15:59:17
DESCRIPTION AHOUHl
~ 1l:PQbt~ -101.220~ ~800.00 '
----------
TOTAL DUE: .800.00 V'"
CHECK PAID:
OECI NO: SSB?
TENDERED:
CHAHtI :
saoo.oo
$800.00
t.oo
~
CITY OF CAflPBELL1 CA
RECVD BY: LISAB 01000098320 V
PAYOR: RASPUTIH RECORDS
TODAY'S DATE: 12120/96
REGISTER DATE: 12/20/96 TIfiE: 16=00:26
DESCRIPTION AttOUHT
ENGR & SIJBDIV FILING F $2,400.00 V'/'
TRAfFIC ENGINEERING FE $350.00
TOTAl. DUE:
$2,750.00
CHECK PAID:
CHECK HO: 5587
TENDERED:
CHANfI :
$2,750.00
$2,150.00 \. ~
S.OO '1 ~
I
..
!
,
f'UBLIC WORKS DEPARTMENT RECEIPT
Effective July I, 1996
TO: City Clerk PUBUCWORKSF1LENO, qb --"Ll C-
L~a, C> "'S . \~~ly
PROPERTY ADDRESS
AC::cr: . Please collect &; receiplforihe followina monies: .' .............. ;.;AMOUNT
.......;...1TEM
435.535.4921 I Proiect Revenue (""""ifv proiect) $
ENCROACHMENT PERMIT
4722 Application Fee
Non-Utility Encroec1unent Permit ($225) ~-Z%,=c::>
R-1 First Permit (No Fee), Su_uent PennitlYr (SIOO)
Utility Encroachment Pennit
Arterio1/Collector Street S325)
Ilesidentilll StreetIOther Ateu $225)
2203 Plan Check Deoosit- 2% ofENGR. EST, S500 minI . -=- ,..." ~ ~Jo c:.
2203 Faithful Perfonnance Security (FPS) 100% ofENGR.EST.) · -2.J",=>. n.. w '..~
2203 Labor and Moterillls Security 100'-' ofENGR. EST,)
2203 Monumentation Security 100% ofENGR.EST,) .
2203 Cash Deoosit 4% ofENGR.EST.XS5oo minIS 1 0 000 maxI .
2203 Labor and Moterilll Seourity 100'-' ofENGR. EST, .
Plan Check &; lnJpec:tion Fee (Non-Utility)
4722 Engr.Est. < 5250,000 (12% ofENGR, EST.)
.. 2203 Enlll'.Est.>5250 000 (Deposit 8% of ENGR. EST.1S30 000 min.).. .
4722 Utility < Sloo 000 (8%)
Minimum ClwRe Per Loadion (SI20)
Conduit.sIPipelines up to SOO Feet (S1.60/ft)
Above 500 Feet (SUO/ft,)
ManholesIV aultsIEtc. ($105/ea)
Pole SetlRemovlll ($105/a)
Street Tree PlantinglRemovlll (SI051tree)
.. 2203 Utility> SIoo 000 Actual Cost + 20% .. .
4760 Proiect Plans &; Soecifications Pro'ect No.
4760 Standard Specifications &; Details ($IIPR SI2IBook)
4760 Conies of Engineering Maps &; Plans (S.50/sq.ft.)
4722 Penlllties: Failure to restore oublic improvements ($IOOICaIendar Dav)
Muni Code Section 11.34.0101
4722 Penlllties: Failure to correct unsafe conditions (SIOOICalendar Day)
LAND DEVELOPMENT
4722 Lot Line Adjustment $500)
4722 Parcel Map (4 Lots or Less) SI 060 + S251Lot)
4722 Finlll Tract Man (5 or More Lots) $1 380 + $251Lot)
4722 Certificate of Compliance S5OO)
4722 Certificate of Correction $300)
4722 Vacation of Public Streets &; Easements S550l
4722 Assessment Segregation or Reapportionment
First Split (S550)
Each Additional Lot {SJ70
4721 Stonn Drainage Area Fee Per Acre (R-I, $2,(00)
(Multi-Res, S2,250)
(All Other 52,500)
4920 Parkland Dedication Fee
4965 PostaRe
TRAFFIC
4728 Intersection Turn Counts (Two-Hour Count) $60
4728 Intersection Tum Counts (am, or p.m. ........1 S125)
4728 Traffic Flow Man (Daily Traffic Volumes) 527
4728 Comobell Traffic ModellFull Scope Asaessment) S2 250)
4728 Campbell Traffic Model (Reduced Scope Asaessmentl S740)
4271 Truck Permits S351trio)
4728 No Parldna SiJllls $lIeach or 525/100)
OTHER
TOTAL s-te.,~~. "'-
NAME OF APPUCANT
("2.1::.. "So \~(,j'''''''~ Qec...c:::!::;,. t~"";O",- t~~~~ '7 .
"<..-4-0 l -1;EL..G=~tJ.-.,.(.A. ~ . "'"
NAME OF PAYOR ' PHONES \/..;) -- ~~ 1.r.~
RenJ~=L~ , C-.~ , 94-'104-
ADDRESS ZIP
"Actual Cost Plus 20% Overhead (Non-Interest bearing deposit)
q 55' 11
CfS52. 0
FOR
CITY CLERK
ONLY
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uo l:.:db
.For PIanCbeckllftCl'.CIIJh. Ileposits,'lendyellow copY.tO Finallce.....
h:\recfnn4. wk3(mp )rev7/1196
CITY CLERK'S OFFICE
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INSURANCE REQUIREMENTS CHECKLIST
Permit # q (p- .;:2-/ (P 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:
I2r $1,000,000 per occurrence, and
o $1,000,000 general aggregate limit applying separately to the project, and
B $2,000,000 general aggreg,ate l~it. '. .' l 0 GiCxQ yhru 117 /q~
,[)-- Policy expiration date ~I / I JLL_ (2Qt1k~/ f1.C C 0-
(Automotive Liability - "any auto". .
l ~ $1,000,000 per acci~ntjor boclily injury and property damage
~ Policy expiration date lon1'trttLDU).. to!2f.p/q '8
--
Worker's Compensation and Employer's Liability
cE1 $1,000,000 per accident for bodily injury or disease, (l c'<-l
M Policy expiration date q /2.:B ~ c.-,' B U.rU^,,",/CL-L
.
cV
to ~C \
r\;~f'- \i
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Course of Construction (if required in Special Provisions)
o Completed value of the project
o Policy expiration date
Required Endorsement to General Liability and Automobile Liability Policies
Additional Insured Endorsement
fl The City, the City of Campbell Redevelopment Agency, its officers,
employees and volunteers are named as additional insured.
fl The insurance coverage afforded to the Additional Insured is primary
insurance,
~.
Workers' Compensation Insurance Sheet Submitted
o For General Contractor
J1 Subrogation Clause ,
Insun.ce Ce<tificate R<VrpJil~t.~
. /
'h Copy of Insuran~e Ce~;ficate placed in tickler file one month prior to expiration,
l?P-"i- I Clio
Date
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STATE fARM
.Jel..
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STATE FARM MUTUAL AUTOMOBILE I RANCE COMPANY
03-10- '8
DECLARATIONS PAGE
1b~1 V
15KY2
ER
INSURANCE
6400 STATE FARM DRIVE ROHNERT PARK CA 94926
_11
10
NX~~ftlj(
POLlCYNUMBER G73 7021-C09-05
-.
8
12
***
*c*
-A'O*
*p*
*Y*
***
05-2109-112K
THE CITY OF CAMPBELL/THE CITY
OF CAMPBELL REDEVELOPMENT
AGCY~ ITS OFF/EMP
ATTN DEPT OF PUBLIC WORKS
70 N FIRST ST
CAMPBELL CA 95008-1436
POLICY PERIODF E B 0 1 1998 TOl'tA R ~ 99 8 ~ ,
B/J ) OJ B
~~~~~~ c-
OO NOT PAY PREWJM~/?t10WN ON THIS PAGE.
SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE.
.l..
NAMED INSURED: DIEDEN, ED
DESCRIBED YEAR MAKE MODEL
VEHICLE
COVERAGES (AS DEFINED IN POLICY)
SYMBOL.PREMiUM-COVERAGE NAME-LIMiTS OF LIABILITY
BODY STYLE
VEHICLE IDENTIFICATION NUMBER CLASS
6700000
SEE REVERSE SIDE FOR IMPORT ANT MESSAGE
A
L250
U
$11.44
$11.10
$3.92
BODILY INJURY/PROPERTY DAMAGE LIABILITY
LIMIT OF LIABILITY-COVERAGE A 1,000,000 EACH ACCIDENT
$250 DEDUCTIBLE PHYSICAL DAMAGE
UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
EACH PERSON, EACH ACCIDENT
100,000 300,000
TOTAL PREMIUM FOR POLICY PERIOD FEB 01 1998 TO MAR 09 1998
CURRENT 6 MONTH PREMIUM FOR SEP 09 1997 TO MAR 09 1998
$26.46
$125.40
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
01 6028E.5 ADDITIONAL INSURED-THE CITY OF CAMPBELL/THE CITY OF CAMPBELL
REDEVELOPMENT AGCY, ITS OFF/EMP ATTN DEPT OF PUBLIC WORKS, 70 N FIRST ST,
CAMPBELL CA 95008-1436.
02 6028E.5 ADDITIONAL INSURED-OAKRIDGE ASSOCIATES OAKRIDGE MALL ATTN THE
HAHN COMPANY, 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6037F.11 CERTIFICATE OF INSURANCE-OAKRIDGE ASSOCIATES OAKRIDGE MALL ATTN
THE HAHN COMPANY, 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEHICLE,
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMEND~EHT OF PHYSICAL DAMAGE COVERAGES.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6164RR HIRED CARS.
6165AA EMPLOYERS NON-OWNERSHIP COVERAGE.
6166 USE OF NON-OWNED CARS BY BUSINESSES--PHYSICAL DAMAGE COVERAGE
(LIMIT OF LIABILITY $25,000).
6289MM SINGLE LIMIT OF LIABILITY.
------------------------------------------------------------------------------
NAMED INSURED- DIEDEN, ED DBA DIEDEN COMPANY 22938 ATHERTON ST HAYWARD CA
94541-6614
THIS IS YOUR DECLARATIONS PAGE. AGENT: NAIDA ALVAREZ
PLEASE ATTACH ITTO YOUR AUTO POLICY BOOKLET. PHONE: (510) 487-8370 2109-160
YOUR POLICY CONSISTS OF THiS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5 PLEASE KEEP TOGETHER
Pj;PI a('j;/) POI Try 1)611623-05 NEW POLICY FORM
1 ~~_Aa7~ r'''' ':l
STATE FA"M
.A..
..
6400 STATE FARM DRIVE ROHNERT PARK CA 94926
INSURANCE
12
10
~I)ttjl~~~
POLICY NUMBER G73 7022-D26-05
-
B
11
***
*C*
*0*
*p*
*Y*
***
05-2109-112K
CITY OF CAMPBEll CITY OF
CAMPBELL, RE, DEVELOP AGCY
OFFICERS & EMPS AT TN DEPT/PW
10 N FIRST ST ~"'CP""IVED
CAMPBEll CA 95008-1436 r\t: t:
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
MAR 0 6 199iEPARATE STATEMENT ENCLOSED IF AMOUNT DUE,
POLlCYPERIODFEB 01 1998TO OCT 26 1998 ~
4
l
1
.!.
NAMED INSURED: DIEDEN, ED
DESCRIBED YEAR MAKE MODEL
VEHICLE 1990 FORD F250
COVERAGES (AS DEFINED IN POLICY)
SYMBOL.PREMiUM-COVERAGE NAME-LIMITS OF LIABILITY
r '. [ ~~ . '~~.... :.~' t ~
A~'{;~'Ttlll';TIO~EHICLE IDENTIFiCATION NUMBER CLASS
PICKUP 2FTHF25HOlCB21331 6HOHOX1
SEE REVERSE SIDE FOR IMPORTANT MESSAGE
D500
G500
U
$31.07
$97.61
$83.79
BODILY INJURY/PROP~RlY DAMAGE LIABILITY
LIMIT OF lIABILITY-COVERAGE A 1,000.000
MEDICAL PAYMENTS
LIMIT OF LIABILITY-COVERAGE C
EACH PERSON
10,000
$500 DEDUCTIBLE COMPREHENSIVE
$500 DEDUCTIBLE COLLISION
UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
EACH ACCIDENT
A
C
$352.77
$55.17
U1
EACH PERSON. EACH ACCIDENT
100,000 300,000
$5.08 UNINSURED MOTOR VEHICLE PROPERTY DAMAGE
$625.49 TOTAL PREMIUM FOR POLICY PERIOD FEB 01 1998 TO OCT 26 1998
$849.84 CURRENT 12 MONTH PREMIUM FOR OCT 26 1997 TO OCT 26 1998
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
01 6028E.5 ADDITIONAL INSURED-CITY OF CAMPBELL CITY OF CAMPBELL, RE,
DEVELOP AGCY OFFICERS & EMPS AT TN DEPT/PW, 70 N FIRST ST, CAMPBELL CA
95008-1436.
02 6028E.5 ADDITIONAL INSURED-OAKRIDGE ASSOCIATES OAKRIDGE MALL ATTN THE
HAHN COMPANY, 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
603?F.11 CERTIFICATE OF INSURANCE-OAKRIDGE ASSOCIATES OAKRIDGE MALL ATTN
THE HAHN COMPANY, 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6031.3D POLICY PERIOD CHANGE-12 MONTHS.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEHICLE.
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6082AG AMENDATORY ENDORSEMENT: CHANGES-DEFINED WORDS; INSURED'S DUTIES;
COVERAGES; CONDITIONS.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6289MM SINGLE LIMIT OF LIABILITY.
------------------------------------------------------------------------------
NAMED INSURED- DIEDEN, ED DBA DIEDEN COMPANY 22938 ATHERTON ST HAYWARD CA
94541-6614
THIS IS YOUR DECLARATIONS PAGE. AGE NT: N A I D A
PLEASE ATTACH ITTO YOUR AUTO POLICY BOOKLET. PH 0 N E: (5 10 )
YOUR POLICY CONSISTS OF THIS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5
REPLACED POLICY 6170032-05 NEW POLICY FORM
MUTl VOL
ALVAREZ
487-8370 2109-160
PLEASE KEEP TOGETHER
155-4976 CA.3
b'2;~FERS NO RIIJH~ I~~~~U T~~ ~ER'TIfICc;T~'HOLDER':"THiscEt.~lFlc~~~
Arthu r J, Gallagher-P I....nton DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
4301 Hacienda Drive 1:300 POLICIES BELOW,
P,O Box 9101
Pleasanton. CA 94566-9101
510-460-9900
COMPANIES AFFORDING COVERAGE
COIFANV
LETTER A
Renublic Ind Co of America
-
dba: The Dieden Company
22938 Atherton Street
Haywud
COIIIPANY
LETTER B
Essex Insurance Co
COIIIPANY
LETTER C
R E ~ E I " IS: r~
1'\('1"" Q A__
'~:t ".'d' ~~~7
DIID. cr' 1M
tT~~~';'s"'~d'CE!~~~1i~~~I~;liife~~'~~~~k~t61~ii;~~ff!;~~~i~~i~i~i!i6ii~~1i~6i~I~~ili:~:i!~i~:~~:;~~~:~~~~~~~t';:~f~i~i!~~~~~~!~gi~!g~.I~'~~~:li;~~:~
INDICA TED, NOTWITHST ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLtv1ENT WITH RESPECT TO WHICH THIS
CERTIFICA TE MAYBE 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. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS.
00
LTlI
COIFANY 0
LETTER
CA
94541
COIIIPANY
LETTER E
TYPE or INIURANOI!
POLIOY NUhlBER
POLIOY I!PPEOTM! POLIOY !XPIRATIOfl
DAY! (MM/DD/VY) DAY! (MM/DDIVY)
L1NITS
GENERAL LIABLITY GENERAL AGGREGATE . 2000000
i--
B X C(M.1ERCIAL GENERAL LIABILITY 3CB3291 8/17/97 8/17/98 PRODUCTS-CIJ.1P/OP AGG. . 1000000
I CLAIMS MADE [Jt] OCCUR, PERSONAL & AO\I. INJURY . 1000000
- OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE . 1000000
FIRE DAMAGE (AllY ORe fire) . 50000
MED, EXPENSE {Anv ORe Dcno. I 1000
AUTOhlOBU L1ABLITY ClJIoIBINED SINGlE .
- LIMIT
- Atfi AUTO
- ALL OWNED AUTOS BOOLY INJURY I
SCHEDULED AUTOS (Per penoo!
-
- HIRED AUTOS BODILY INJURY .
NON-OWNED AUTOS (Per accident)
-
- GARAGE LIABILITY PROPERTY DAMAGE I
!XO!II L1ABLITY EACH OCCURRENCE .
==1l.tv1BREllA FOPM AGGREGA TE .
OTHER THAN 1MBREllA FOPM ~ ~ ~ ~ ~ ~ ~ 11 ~ j j ~ j j [~~ ~ ~ ~ ~ ~ ~ 1 ~ 1 ~ 1 ~ 1 i 1 i ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 ~ ~ ~ ~ ~ 1111111 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 ~ ~ ~ 1 ~ j ~ ~ ~ ~ ~ ~ i
WORK!R'S OOhF!NSATION xl STATUTORY LIMITS ; ~; ~ ~ ~ ~ ~ ~ ~ 1 ~; ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~; ~ ~ ~ ~ ~ ; ~; ~ i ~
A 010525-10 9/28/97 9/28198 EACH ACCIDENT I 1000000
AND
DISEASE-POLICY LIMIT . 1000000
!hlPLOY!Al'LIABLITY . 1000000
DISEASE-EACH EMPL OYEE
OTHER
D!SORPTION or OPERATIONIILOOATIONIIVEHIOLEIIIPI!OIAL ITE...
See attached M/E-009(03/95) as respects GL. coverage is primary
Re: al I work in publ ic right-of-way 1830 S Bascom Ave Encrochment Permit
1:96-216: waiver of subroaation aDDlies to workers' comDensation
::::~l:!:~~~~~!:!;:::,.,.,:":",,::,,:;,,,j:,::,,:<:::,,:::,.;.,:,.,."",,11111::::11ii11ittttttttttttf:t:::::1::i:11if1;;;11111;;;iiiiii,.::/:::::"::,,,::,,:.:.,.::;.,,;';:,:,\.;.,::.;,::,.",?tttttti1fHi1::::1:tti1iti1itiitffltf11it@:::::@1it::ifi1itiiiiiiiiiiiiiiiitfimmt:::i::fiH
:1\:\ SHOULD ANY OF T HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
II EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL [t~BE"'&lR TIi
\\\t\ MAIL 30 DAYSWRITTENNOTlCETOTHECERTIFICATEHOLDERNAMEDTOTHE
Ci ty of Campbel I + \\\iI LEFT, i~T r 'IU:JRE T51.ljI,IL St:J8111Jel18E 811"!.l '.llles!:: 146 6eLl~,I(TlelJ 8R
At t n: Dept. of Pub I i c Wo rks \i\iii\\ h.I'Ql:,IT'!Qr 'tlYI~ltJBtJPerHlIE eel. I' ""4. ,IT3...SEIH3eRREPREBE:rJU TI.1:':3.
THI515 I~!~I;!J,_~! A MA I I t.K Vr- .nn'_,!m~,I_!,!"'_~~~! _ A~p
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Arthu r J, Gllllgher-P lu..nhn DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
4301 Hlciendl Drive '300 POLICIES BELOW,
POBox 9101
PleaSlnton, CA 94566-9101
510-460-9900
Cot.f'ANIES AFFORDING COVERAGE
COIlPANY
LETTER A
ReDubl ic Ind Co of America
COIlPANY B
INSUR9 LETTER
dbl: The Dieden Complny COIlPANY C
22938 Atherton Strut LETTER
Haywa rd COIlPANY D
LETTER
CA 514541 COIlPANY E
LETTER
Essex Insurlnce Co,-
~!(i:Cf'VED
OCT 8 1~1'
A,:UiJUC WORKS
. .. . .
"'THIS IS' TO 'cERi IFY TH'A'i THE'poi::'iCies OF INS'URA'NCE L1STEO'BEL6;;/H';;:'VE"'BE'E'N''issuEo'roTHEtiNsUREDNAME6"Aso'VitFO"R"THTtpo"Ltcy PERioo"
INDICA TED, NOTWITHST ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOClMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS,
co
Ln
TVPt: Off INSUII_
POLIOY MlhIB!R
POLIOY I!I'nOTIVE POLIOY nPllATION
DATE (MM/DO/VY) DATE (MIoI/DO/VY)
LIMITS
GENERAL LlABLITY
-
B X CCM.IERCIAL GENERAL LIABILITY 3CB3291
.:':.:. I CLAIMS MADf [XJ OCCUR.
_ OWNER'S & CONTRACTOR'S PROT,
8/17/97
GENERAL AGGREGA IE .
8/17/98 PRODUCT5-Ctt.lP/OP AGG, .
PERSONAL & ArN. INJURY .
EACH OCCURRENCE .
FIRE DAMAGE (Any OIlC fire) .
MED. EXPENSE (AIN OIlC Dcrson .
ClMllNED SINGLE .
LIMIT
2000000
1000000
1000000
1000000
50000
1000
AUTOMOBLI! LlABLITY
-
_ At<< AUTO
_ ALL OWNED AUTOS
_ SCHEDULED AUTOS
_ HIRED AUTOS
_ NON-OWNED AUTOS
_ GARAGE LIABILITY
EXCESS LIABLITY
HWBRELLA FORM
OTHER THAN WBRELLA FOPM
BODILY INJURY .
(Per person!
BODlLY INJURY .
(Per accident)
PROPERTY DAMAGE .
EACH OCCURRENCE .
AG6REGA IE .
., .. ... " .
; ~ ~ ~ ~ ~ ~ ~ ~ ~ 1 ~ 1 ~ 1 ~ 1 ~ ~ i ~ 1 H ~ ~ ~ ~ ~ ~ 1 ~ 1 ~ 1 ~ 11 j ~ j ~ j ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~; H~ j ~ 1 ~ 1 ~ ~ ~ ~ ~
A
WORK!R'I OONPENlATION
AND
I!JoI'LOYl!lll'LlAIILITY
9/28/97
X I STATUTORY LIMITS
9/28/98 EACH ACCIDfNT
DISEASE-POLICY LIMIT
OtSfASE-EACH EMPLOYEE
~ ~ 11 ~ 1 ~ 111111 ~ 1 ~ ~ ~ ~ ~ 1 ~ 11 ~~ H n 1111 ~ ~
010525-10
. 1000000
. 1000000
. 1000000
OTH!R
Dl!lCRFTION Off OPI!AATIONIILOOATIONIIVI!H IOLI!SIIPECIAL ITI!....
The City of Campbell, The City of Campbel I Redevelopment Agency, its officers.
employees and volunteers ue Idded IS add'l insureds per CG2.010(11/85) IS re-
SDects GL coveraae is Drimuv RE: All work in Dubl ic riaht-of-wav,
m:*~mi~i~~:,:lt;:,:+::.:.::::;,:;:,::::::,.::;::,:,:::.:.i,:::,::m:tttt;'tttt:f:t:fff't::t:fmtttmf:::tt::::::::::t::::ttt:::::ftIft:::/:::::,:::,,::::::,:,:,::;,:,;:;:::::ii:,i,:::,i,:::,::Jt:f:tt:::fff;t:;t::::::t:::f:t:::::::::::::ltttt:::::::llfflt::t:fffffltWffflltNlfl:::fM
tt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFQRE THE
~::::~:~ EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL Tn
rr MAIL 30 DAYSWRITTENNOTICETOTHECERTlFICATEHOLDERNAMEDTOTHE
City of Clmpbell + ;:{:: LEFT,aHfAILut<c IUMAIL~U\,.,MI~01'l8[~H'b.I"'1PQ.IiNQ9QbIS^Tl9UeA
Attn: Dept: of Publ ic Works 1111111~IABLlT.O"AI~',(;)UU",ul"'~OI\llllAI4.,IT3A6E:14"361"1!:::I'''ESEUTATI'IEGt.
70 North FI rst Street iti,iAUTHORIZI!D ATIVE "'L
Campbell, CA 95008 lilllil! 7. ~ l.ujA-'. 500062000
mi9'9;~B:IF~1ffftll:tffimttmgmB:mmffi;;B:;r::::!:;:mlm:nfm;;;:r::rmI::::;mt;:::::;E;;::;_.:;:m:mmmm:::Ir:tmwmmmllJlI'....III.Ittlm::
POLICY NUMBER: 3CB32~1
COMME:t<CIAL 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 and
volunteers.
RE: All work in public rigt of way,
(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 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.
This insurance is PRIMARY with respect to the additional insured. Any other insurance
available to that person or organization is excess and noncontributing.
CG 20 10 11 85
Copyright, Insurance Services Office, Inc" 1984
D
CG 20 10 11 85
f4MENDED
· ~"4.. -..~"'~I'~I""I'~I""I'~..~.l'~I':E"-.Y'~I"'-.'"'~':I""~U'~"R"~.~'~."Y':B?"~I"'m~-_~_~~~(~~W)
"'~j ...............,"',......................,"",.,"'"""".."..........,.."""."........
.::::~:~:::::::::::::~:::::~J!!:::::;:i;::::;;;::::::;:i:::;::;::::::::::~::i::::::::b::\::::~;L+::::;::::i::;::::::;!::::::::!:i)::~::::idl::!:::::::i::::::::}::::,::::::::::::;::::::;::::::::}::;:!;:::::::::::;::):::::)::;:;:;:;:;:::::::;:j::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::i::::::::::::::: 8/21/91
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
CfG' "".1- J &
Art h u r J. G a I I a g her -P leu an to n
4301 Hacienda Drive #300
P .0, Bo x 910 1
Pleasanton. CA 94566-9101
510-460-9900
C~ANIES AFFORDING COVERAGE
CA
94541
COMPANY A
LETTER
COMPANY B
LETTER
COMPANY C
LETTER
COMPANY D
LETTER
COlf>ANY E
LETTER
Re ubi ic Ind. Co. of America
Essex Insurance Co,
ED
dba: The Dieden Company
22938 Atherton Street
Haywa rd
::1~~::~~T:'8::CE:~:~::I~:~:::~:~:~:~:;:~:~~::!8:~~gi~:~:::8:t::i~:~~!;r:~g:~:::t:i:~:~::~:g;~~t8:!::~~*~~:~~~~:;~tB~bl~g:;~:!~:::I~:~:j:t~ili~;:~:~U~:g:::;.;I"ttJ!~J~:~:g6::
INDICA TED. NOTWITHST ANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLMENT WITH RESPECT TO WHICH THIS
CERTIFICA TE MAY BE ISSUED OR MAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
TVPEOf INSURANCE
POLICY NUMBER
POLICY EffECTIVE POLICY EXPIRATIO
DATI! (MM/OO/VV) DATE (MM/OO/W)
LIMITS
COMMERCIAL GENERAL LIABILITY 3CB3291
CLAIMS MADE [i] OCCUR.
OWNER'S & CONTRACTOR'S PROT,
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
EXCESS LlABILIT Y
1MB RELLA FORM
OTHER THAN 1MBRELLA FORM
WORKER'S COhlPENSATION
A AND 03524281
EhlPLOYERS' LIABILITY
OTHER
8/17/97
GENERAL AGGREGATE $
8/17/98 PRODUCTS-COMP/OP AGG, $
PERSONAL & AlJII, INJURY $
EACH OCCURRENCE $
FIRE DAMAGE IAn one fire) $
MED, EXPENSE IA one erson $
COMBINED SINGLE
LIMIT
2000000
1000000
1000000
1000000
50000
1000
BODILY INJURY
{Per person!
BODILY INJURY
(Per accident!
PROPERTY DAMAGE
EACH OCCURRENCE
AGGREGA TE
. ....... .. ................. . ....
;nnnnnn~ H HnHn~nnnHn ~ ~ ~ ~ ~ ~ ~ H ~ nH~~~~;nn~;~HHHH H ~ nnn~H
9/28/96
X STATUTORY LIMITS
9/28/91 EACH ACCIDENT
01 SEASE-POll CY LIMIT
DISEASE-EACH EMPLOYEE
:-:-:-;.;.;.;.;.;.;.:.:-:-:.:.:.;.:.
;:::::::::::::::::;:;:;:;:::::::::;:
$ 1000000
$ 1000000
. 1000000
DESCRIPTION Of OPERATIONS'LOCATIONSlVEHICLf:S'SP~CIAL ITE....
The City of Campbell. The City of Campbel I Redevelopment Agency, its officers,
employees and volunteers are added IS add'l insureds per CG2010(11/85) IS re-
sects GL covera e is rimar RE: AI I work in ubi ic ri ht-of-wa .
II EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL E- U-
;:;:;:;: MAIL 30 DAYSWRITTENNOTlCETOTHECERTlFICATEHOLDERNAMEDTOTHE
Ci ty of Campbell + ::::i:i: LEFT. n _ _ _ . - -- .l?JIf
Attn: Dept. of Public Works ::::::::". ~-...,..,..,- .--- - l --.
70 No r t h Fir s t St r ee t It AUTHORIZED REP TATIVE
Camp be I I, CA 95008 :11:!:I:' ~ ... 500062000
::::i:i9P:~R;~I']:~Itll:]Wmllflm:;:miiiiiiir;nml;:::]:i:::?;nWtilm@:@:::::::i:i)::::::::;:::?rF...::::::>)mlr~m@]n::f:tg::JiI)fmillll[,,"p:"Jl:S9J(~9:~timp:~:]I{t:i]:
POLICY NUMBER: 3CB3291
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
The City of Campbell and the City of Campbell Redevelopment Agency, its officers, employees and
volunteers
RE: All work in public right-of-way
(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 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.
This insurance is PRIMARY with respect to the additional insured, Any other insurance available
to that person or organization is excess and noncontributing,
08/22/97 11:04 FAX 510 847 ~831
~001/003 ,
Telefax
ARTHUR J. GALLAGHER & CO.
INSURANCE BROKERS OF CALIFORNIA, INC.
4301 Hacienda Drive, Suite #300
Pleasanton. California 94588-2768
P.O. Box 9101
Pleasanton. California 94566-9101
(510) 460-9900
FAX (510) 847-8831
Voice Mail (510) 460-9995
~
o
Hard copy to follow by regular mail
Hard copy to follow by Federal Express
No hard copy will follow
Date:
Fax #
Attn:
Certificates
Company Name:
From:
AE:
Message:
JV ()~ 'LJ~
g:J? d~~~~U~~-0
~ ct'. uP' C(~. /' -yo ,
,{to ~/ < \ ~ CjJV ~'
~~) OJcl"de~ ~
fJ (. \ .WO\5'
NonCE OF COHFlOENllAUTY: It tho feDder or 1hl. man.go I. not lho Inlanded roelplon\, Plo'asa be Ddvi~od th.' any
dlcS01111n;aUOI\ dlcutblltlon Of copying 0' thlc communlcaUon 1$ prohtblted. II you hayo re<:olvad thl5 communication In
error, pl..c. nollry the sondor Immediately by COUeettal.Dhon. Call~, fn 'n.._" u_.. "u ..
08/22197
11:04
FAX
5l0AMtNUtU
III 0021003
Arthur J. G.II'gher-Pleaslnton
4301 Hlciendl Drive .300
p ,0, hx 9101
PlelSlnto~, CA 94586-1101
510-4&0-9900
CONFERS NO RIGHTS UPON THE CERTlFICA TE HoLDER, THIS CERTFlCA TE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICES BELOW.
COM'ANlES AFFORDING COVERAGE
CA
94541
COIFANY A
LETTER
c;ollPAHV B
LEfTER
COliPANY C
LETTER
CDIFANV D
LEflER
COII'ANY E
LfJTER
Re ublic Ind. Co. of Amerie.
Generll Ins CG of
dbl: The Dieden Comp.ny
2213. Atherton Street
HIYWI rd
Essex Insurance Co.
',,~~~<~~:~<~~.:~~~A~~)(~~l~i~k~fii~~~l~t~dt~~~!w~ik!~~~L?&;yt~&itft~tfJl~~;~~~tff~f~:~i~~liiiir~~~!"-I~~~~~~~~~~!iM[l~~~~;~~~~ ~)
THIS IS TO CERTFY THA T THl; POL.ICES OF INSuRANCE LISTED eELOW IolA vE BEENJSSUED TO T~ INSURED NAMED ABOVE FOR THE POLICY PERIOD
NlICA TED. NO TWIT HST Al'ONG ANV REOlJREMENT. TE~ OR CDMJlTlON OF ANY CO.....T RACT OR 0 THER OOC\JIENT WIT H RESPECT TO WHICH TIolIS
CERTFICA TE: MAY BE ISSUED OR MAY PERT olIN, THE lNSUflANCE AFFORDED By THE POLICIES OESCRlBEO HEREIN 1$ SUBJECT TO ALL HE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMTS SHOW~MAY HAVE BEEN REDUCEO BY PAlO CLAMS.
00
L
,'"... -....
POLlOY._
-.IDY II!P'PPJIR _.Y UP.
DAft (MIllCOIYV) DIlTE (lIIlIIXl/YV)
LIMn.
_.. UIIILITY
C X ctMwItl\CJAl OfNfUL UAIILI1Y 3C!32511
.:...;. Cl'lMS ...... ~X ...
"';;;; .......... ~ ....CUII
OIIMfR'S" CONT"'CTOR'S PlIOf,
8/17/517
IltIlliMl AGGREGA If
1/17/88 PAOIlUCfS-CCIlolP/Dl' ADCl,
'fllSD*l & /I.W, 1Ii.Allr
flP,Ctt IICCUllMtoH:f
F1RI 0AMA6f fA
MED. fxl'fNSf fA
CtJ'tIBINfD SINGlE
LMT
ZDDOOOO
1000000
10DODOO
1000000
5DOOO
1000
MITO_U: L..LIlY
ANr AUTO
All OWIjEP AUTOS
SClIfOlllfO AuTOS
ItII1tD AUTOS
NllliJ-OwliEb AUTOS
GARAGE lIABllIfv
.
BOlIllV INJUllV
I1et jIC'llIIlI
BOIIILY IIlJUIll'
(P.. _'dcnll
.
PllOI'ERTY DAMAGE
.
INBRfuA FOIN
OfHfA TItAN lMIlltLLA lOIN
WORUR'S __'ION
",.
EIIFLO'IU8' LNIIL'"
tACH OCCUAROltl .
ABOIlCUA TE .
~H ~Hm~~~m~; ~~?~W ;1; ~i~~;~:~~ ~;~m~r ~~ ~~~~~~~~~~~~ fi~ ~~~~~H~m ~~~E1~i~
A
03524217
.IIIIIG
X STA TUTORY lIMHS
1128191 fACIl ActlllfNT
llISlAS{-PlIlll:Y lM r
U1SfASHACIl EMPlll'(ff
~~H~m~~~;~ ~~~~~ !~mHi ~;: ~;~~~~;
. 1000000
. 1000000
. 10000DD
OntIR
IlDCIIFT... ... ....TIClNIII.OO.TJIlNIIWHICLIIIIlItOIllL In'"
The City of C.mpb.ll. Th. Ci,V of C..pbell Redevelop.en, Agency, its officers,
employees and volunteors Ir. Idd.d IS .dd'l insureds per CGZ010(11/85) 'S re-
sects GL covera e is rim.r AE: All work in ubi ic ri ht-of-wa .
~~~~:<-~";\-~;~;~::;:::~v.~::.,: ":;;:':'-'-\':\':~:~~v-~;~~]lI~~!!~~~~~~~;r.t~~;~~~~~t~K_i~~~~~t~tt~~ v ~~)W\~~~-x~;~~:i;~:x,'~-~- ~,;..1~lt'rt4 t;~%t~~~~;[i~~t~~~~i~~J~~;~~~~~d: t~~t!iJ~~~drJ:
SHO~D ANY OF T HE ABOvE DESCRI8l;O POLICIES BE CANCELLED BEFORE THE
;@ IOXPIRA lION OATE THEREOF, TI€ ISSUING COMPANY Wl.L ~~
tJ MAIL. 30 DAyswRlTTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOT~
;.'~,~ L.EFT~~~~~~fiH~~~5'&ft~
1i l~~WH~~ttR~~~~~~~m
~
~'L Ml'lll1IIR12:t>> __1:
Calnpb.1 I. CA 95001 t~i
l:~
~~;~_ll~{~~~mqt~l~t~:~~~tfs$.}r:f~fl~rj~~q~~fi*i~~~@f~~~~r.
Ci ty of Cllllpbell
Attn: Dept. of Public Works
70 North First Stre.t
+
ij0006200D
08/22/97 11:05 FAX 510 847 8831
III 003/003
POLICY NUMBER: 3C83291
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
The City of Campbell and the City of Campbell Redevelopment Agency, its officers, employees and
volunteers
RE: All work in public right-of-way
(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 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,
This insurance is PRIMARY with respect to the additional insured. Any other insurance available
to that person or organization is excess and noncontributing,
· ~.~~Itl ~.7""':I"'~I""'m':""I"."".Y'~I'E""'~.7'~I'"'~."'~~B".'~"'~."'~I'~"."~E"_NW~W.@.@N.~~~D~(MWOO/VY)
"""AItt'lll., · ,...... .... ... .... ... . . ..... ......... ' . ....,..., ..... .,..... ..........................................."",..........
:::::~:::::::~::~::::::::~::::~~~::~;~:i::;:::;L;:;:::::i:::;;;~:::~bd::::::\:::;::;fu:t:::;:~::::illx;;::::::::::::::~~::;:::;kd::::::::!::::::::::;:::::::::::::;;:::;::::::::::::::::::::::::::::::::::::::::::;~:::::::\:::::::;::~:::::;:;j::::::::::::::::::::!:::::::::!:::::::::::::::::::::::I::::::::::::::::::::::::::::::::::::::::::::::::::: n 8/25/97
!. t!1~, lit I_Itiiil,lt:!-7,_~~ ~_ MA I I t:ft ut' UNL Y ANI)
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Arthu r J Gallagher-P leas anton DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
4301 Hac i end a 0 rive :1300 POLICIES BELOW,
P . 0 Bo x 91 0 1
PI.I~lnton. CA Q4566-Q101
510-460-9900
Cot.f>>ANIES AFFORDING COVERAGE
~T'fE~NY A
ReDubl ic Ind Co of America
COll'ANY B
- LETTER
dba: The Dieden Company COll'ANY C
22938 Atherton Street LETTER
Haywa rd COll'ANY D
LETTER
CA 94541 COli' ANY E
LETTER
Essex Insurance Co
__..."t:O
'R t: '- .. 11 ..
...
t\UG Z {)
~
;;!fi~!~~:~;~:~~::~::~:~:~::~:~~:::~g:e1~~:!tg!~::1~:~~G~!!8:~i~~:~~:g::!~:~g:!I!::~~::~~~~::i~~:J~:g:::~:~m~:!~:::i~:!~!~:~::!-tfu'tl:~2.ilf!~::~8t!!:::t~~;8:~m
INDICA TED. NOTWITHST ANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER D~~WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS,
co
LTI
TYPI!Of INSURANCE
POLICY MlMBER
POLICY UfECTIVE POLICY I!XPIRATIOfI
DATI! (MM/OO/YV) DATI! (MM/OO/VY)
LINITS
GENERAL LIABLITY
f---
B X C(}.1MERCIAL GENERAL lIABllITV 3CB3291
.. I CLAIMS MADE [KJ OCCUR,
_ OWNER'S & CONTRACTOR'S PROf.
8/17/97
8/17/98
GENERAL AGGREGATE'
PRODUCTS-CCJI,1P/OP AGG, .
PERSONAL & AIJII, INJURY .
EACH OCCURRENCE .
FIRE DAMAGE IAnv one fire) .
MED, EXPENSE (Anv one Dcrson .
CCJI,1BINED SINGLE .
LIMIT
2000000
1000000
1000000
1000000
50000
1000
AUTONOBLI! L1ABLITY
-
_ Am AUTO
_ ALL OWNED AUTOS
_ SCHEDULED AUTOS
_ HIRED AUTOS
_ NON-OWNED AUTOS
_ GARAGE LIABILITY
BODILY INJURY
(Per person!
BODlLV INJURY
(Per accident)
PROPERTY DAMAGE
DCESS L1ABLITY
IlMBREllA FORM
I OTHER THAN 1MBRELlA FORM
EACH OCCURRENCE .
AGGREGA TE .
:::;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;:;: :;:;:;:;:;:::;:::;:;:;:::;:::;:;:;:;
::::;:::::;:::::::::::::::;:::::::;:::;:;::::::;:;:::::::::::::::::::::::::;:::::
A
WORKI!R'S COhlPl!NSATIOH
N>/D
9/28/96
X I STATUTORY LIMITS
9/28/97 EACH ACCIDENT
DISEASE-POLICY LIMIT
DISEASE-EACH EMPLOYEE
....................................
~: ~:;:;:;: ~: ~: ~: 1:;:;:;:;: ~:;: ~:;:;:
035'-4287
. 1000000
. 1000000
. 1000000
EhlPLOYERS'LIABLITY
OTHI!R
Dl!SCAIPTIOH Of OPI!RATIONSILOCATIONSIVI!H ICLI!SISPI!CIAL ITI!h1S
The City of Campbell. The City of Campbel I Redevelopment Agency. its officers.
employees and volunteers are added as add'l insureds per form M/E-009(3/95) as
reSDects GL coveraae is Drimarv RE: All work in Dublic riaht-of-wav,
::::,.,~:~/~~:::.:::::::::::.:::.:::.:.:(.:.::::,:::,;::,:::::.:.::::.)tt::::::::t::::::::::t::::::tff::::t:::::~::::::::f:(:ftt::::::::::::::::::::::::::::::::::::::::ft:f:m::::\::::.:.::;::.;.:::.:::.:.:.:.:.:.::;.:::::::,:::,:::,:::::::,:::.::::::::::::t::tm:::t::tttt:f:::t:mII:::f:::::ttlt:f::::mtt::::II:f:::::::::::::::::::::I:f::::::::::::::::::ffff:::::::::lt:f::::::::::::
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRA TlON DATE THEREOF. THE ISSUING COMPANY WIlL Ii~JQ[^V9R T9
MAIL 30 DAYSWRITTENNOTICETO THECERTlFICATE HOLDERNAMEDTOTHE
Ci ty of Campbell + MM LEFT.Iil"Tr'ILblR[ TO 1.1AIL 3UGII t40TlG[ GIIALLt1P9~~ ~Jg OBlIC,\TlmJ ~
Attn: Dept of Public Works ft - '...M ,~,.~ IV=>:
7. Nor'h Firs' S'ru' I.....~"..
~~
"
II " ~
. E:sSEX INSURANCE CuMP ANY
MADEl
~.,:
ADDITIONAL INSURED ENDORSEMENT
-....
:
.
OATTA~ TO AND FQfIIMNQ
PART Of PCUC:V NO.
Od~_ 1M
o~DATE
~~
08/17/97
IIfflf1w.... "IN ~I' !II ~ __ .. IAIIIIM#t, .
o.S3U(D TO
3CB3291
THE DIEDEN COMPANY
THIS ENDORSEMENT CHANGES TliE POLICY 0 READ IT CAREFULLY 0 ~/
SECTION II . WHO IS AN INSURED of the Commercial General Liability Form is amended to include:
Person or Entity:
':'.
CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS,
EMPLOYEES AND VOLUNTEERS
as an addjtional insured under this policy. but only as respects negligent acts or omissions of the
Named Insured and only for occurrences. claims or coverage not otherwise excluded in the policy.
It is further agreed that where no coverage shall apply herein for the Named Insured. no coverage nor
defense shall be afforded to the above identified additional insured.
Moreover, It is agreed that no coverage shall be afforded to the above identified addltionallnaured fOl
any bodily injury. personal injury, or property damage to any employee of the Named Insured or to any
obligation of the additional insured to indemnify another because of damages arising out of such Injury.
Additional Premium:
FeRM M/E-009 (3/95)
~.~'J &Lv
8/25/97
I
AUTHORIZEO REPRESENTATIVE DATE
:\
6/t~dOO8 iO'fS"oN
s ~ ] NYJIHNY
NY90: 8 ~66 I'~ '2ny
:11:~!,~,!.,!,~JIIII:II:i.il;lllllilll'IIIIII:III:11111:.I.lllllllllllllllllllllllllllllllllllillllllllll1IIIillllllilllllil:llllllllllllllllllllllllilllilil:i:1~1~lii:nDA:~:~~~)
." ........."""........, .., ..... .. .. , , , '" t'(;~FERS NO RI~H+~ I~~~~ T~~ ~ERTiFICAT~'HOLDER. THIS cE~~~Tc~~f
Arthur J Gallagher-P luunton DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
4301 Hacienda Drive :1300 POLICIES BELOW,
PO, 80 x 9 1 0 1
PlelSlnton, CA 94566-9101
510-460-9900
COMPANIES AFFORDING COVERAGE
fSfE~NV A
ReDubl ic Ind Co of America
COloPANV B
INSURED LETTER
dba: The Dieden Company COloPANV C
22938 Atherton Street LETTER
Haywa rd COloPANV 0
LETTER
Essex Insurance Co R ~ r I: .,..._
- " ... iii LI
...~
c, () ~,
",
CA 94541 COloPANY -~""'- VVUR/(S
LETTER E ADMINISTRA TlON
(;;~:~~j~l:<,]i!Im:'@:::m:i:in:MnttiiHm:::::m:ttttHtW:';:':::::M:tt::::@Wtt@t:mdm&lff@l:Wt:@:::@m;@MinmiMmiMHW@W@:t#l:M:W:M@:;t;mm@:mmmw:::tW_:
THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA TED, NOTWITHST ANDING ANY REOUIREMENT, TERIIA OR CONDITION OF ANY CONTRACT OR OTHER DOCUvlENT WITH RESPECT TO WHICH THIS
CERTlFICA TE MAY 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. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS,
co
LT
TYP!: Of INSUAANOI!!
POLICY NU_ POLICY EffEOTIVI! POLICY I!XPRATIOIl LIMIT'
DATI! (1oI101100IYV) DATI! (1oI1011001YY)
GENERAL AGGREGA TE . 2000000
3CB3291 8/17/97 8/17/98 PROOUCTS-ClJo1P/OP AGG, . 1000000
PERSONAL & AllY. INJURY . 1000000
EACH OCCURRENCE . 1000000
FIRE OAMAGE (Any one firel . 50000
MEO, EXPENSE (Any one person . 1000
ClJo1BINEO SINGLE .
LIMIT
GENERAL LlABLITY
I--
8 X ClMoAERCIAL GENERAL LIABILITY
I CLAIMS MAOE ~ OCCUR.
I-- OWNER'S & CONTRACTOR'S PROf.
I--
AUTOIolOSLI! LlABLIT Y
I--
I--
Am AUTO
ALL OWNED AUTOS
SCHEOULEO AUTOS
HIREO AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
BODILY INJURY .
(Per person!
BODILY INJURY .
(Per accident!
PROPERTy OAMAGE .
EACH OCCURRENCE .
AGGREGA TE .
I--
I--
I--
I--
I--
I!XOe:SS LlABLITY
RlMBRELLA FORM
OTHER THAN 1MBRELLA FORM
:::;:::::::::::::::::::.::::::::::::::::::::;::::;.::::::::::::::::::::;.::::::::
::::::::::::::::::::::::::::::::;:::::::;:;::::::::::::::::::::::::::::::::::::::
A
WORKI!A" COMPI!NSATION
AND
I!MP\.OYI!AI'LlABLITY
03524287
9/28/96
X I STATUTORY LIMITS
9/28/97 EACH ACCIDENT
DISEASE-POLICY LIMIT
OISEASE-EACH EMPLOYEE
1000000
1000000
1000000
OTHI!A
D1!SCRPTION Of OPERATIONSILOOATIONSIVl!HIOLEIlIPEOIAL ITI!hlI
See attached M/E-009(03/95) as respects GL. coverage is primary
Re: al I work in publ ic right-of-way 1830 S Bascom Ave Encrochment Permit
#96-216 waiver of subrOGation applies to workers' comDensation
II EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL [~lg[ \'lOR ..,0
:,::.:::.i::.:::. MAIL 30 DAYSWRITTENNOTlCETO THECERTlFICA TE HOLDERNAMEDTOTHE
City of Campbell + LEFT,'8IJTj;'Ib.I.IRi!Tg~"'I.C:II(,I--lNOTlCESHAII MPnc:t:",nniill.'~ATln"'nD
Attn: Dept of Publ ic Works f\ ~IABlITYOrAtf:I(ltIDlJPmJTII[OOMPMl'f,lTi.~t:"'Tc:nQQ~PQ~C:I""'TATI\I~.
70 Nor th First Street ::::I AUTHORIZED .. A~U ~ lid a.. _
Camp be II. CA 95008 :::::::: t1l4.o117, "" ~ 500062000
llil~:~I::~g::~'~Jtgmmli:i:::::::::::rWm:;;Ii::':::::':':':':::::'::uwm:m;;m:m;:r:::::::::;::i:::;i:::i:::::::::mmm;:'::::::::;;:::::=m:;i::::::I:=ff@mWfmmWmf:t1mrrltt:."f.~Ml1qj::"J.rm:
"
II " ~
. E~SEX INSURANCE CuMP ANY
MARm
~.,~
ADDITIONAL INSURED ENDORSEMENT
-....
:
0.:.19.... , ItII
.~OA-n
~~
08/17/97
tA~. *r. -' 1M ......._" t.".. _.. r/I#~. . -'
o,S3UUl TO
"ATTA04EDTO AND FCfIlMNQ
PAm' Of JlCUCY NO,
3CB3291
THE DIEDEN COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. READ IT CAREFULLY. ~/
SECTION II . WHO IS AN INSURED of the Commercial General Liability Form is amended to include:
Person or Entity:
CITY OF CAMPBELL
';'-
as an additional insured under this policy. but only as respects negligent acts or omissions of the
Named Insured and only for occurrences, claims or coverage not otherwise excluded in the policy.
It is further agreed that where no coverage shall apply herein for the Named Insured, no coverage nor
defense shall be afforded to the above identified additional insured.
Moreover, It is agreed that no coverage shall be afforded to the above identified addltlonallnlured for
any bodily injury, personal injury, or property damage to any employee of the Named Insured or to any
obligation of the additional insured to indemnify another because of damages arising out of such injury.
Additional Premium:
E0RM M/E-009 (3/95)
~A.M~ &Lv, 8/25/97
AUTHORIZED REPRESENT A fIVE DATE
-.i
6/t'~loa rOrrON
s ~ 3 NVJIH3WV
N)'90:8 L66I'L 'JoV
<&,
DECLARATIONS PAGE
.
6400 STATE FARM DRIVE ROHNERT PARK, CA 94926
STATE fARM
INSURANCE
12
_"
_10
Noon
POLICY NUMBER G 17 0032-D 26-05C
05-2980-3 S ~~_~
* * * C I T Y 0 F C AMP BEL L I! C I! '~I(,VfW)D J AN - 2 1- 9 7 TO
*C* CITY OF CAMPBELL, RE D ~ ~
*0* DEVELOP AGCY_ OFFICERS & EMPS. J_
*P* "TTM DEPT OF PUBLIC WORKS J"~29_"
*V* 70 NORTH FIRST ST"" ~_
~~~E~ A~:~5~~D C A 95008-1436 vuBLIC wona~ PAY PREMIUMS SHeWN ON THIS PAGE,
D I EDEN, ED ~DM'N'sTSllflAtRA"IE STATEMENT ENCLOSED IF AMOUNT DUE.--
DESCRIBED YEAR MAKE MODEL
VEHICLE 1990 FORD F250
COVERAGES (AS DEFINED IN POLICY)
SYMBOL-PREMIUM-COVERAGE NAME-LIMITS OF LIABILITY
BODY STYLE
PICKUP
VEHICLE IDENTIFICATION NUMBER CLASS
2FTHF25HOLCB21331 1WOHOZ1
SEE REVERSE SIDE FOR IMPORTANT MESSAGE
A $440.48 BODILY INJURY/PROPERTY DAMAGE LIABILITY
LIMIT OF LIABILITY-COVERAGE A 1,000,000 EACH ACCIDENT
C $63.52 MEDICAL PAYMENTS
LIMIT OF LIABILITY-COVERAGE C
EACH PERSON
10,000
0500 $44.57 $500 DEDUCTIBLE COMPREHENSIVE
G500 $127.78 $500 DEDUCTIBLE COLLISION
U $88.50 UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
EACH PERSON, EACH ACCIDENT
100,000 300,000
U1 $6.36 UNINSURED MOTOR VEHICLE PROPERTY DAMAGE
$771.21 TOTAL PREMIUM FOR POLICY PERIOD JAN-21-97 TO OCT-26-97
$1009.43 CURRENT 12 MONTH PREMIUM FOR OCT-26-96 TO OCT-26-97
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
01 6028E.5 ADDITIONAL INSURED-CITY OF CAMPBELL CITY OF CAMPBELL, RE,
DEVELOP AGCY~ OFFICERS & EMPS AT TN DEPT OF PUBLIC WORKS 70 NORTH FIRST ST,
CAMPBELL CA y5008-1436.
~2 6028E.5 ADDITIONAL INSURED-OAKRIDGE ASSOCIATES OAKRIDGE MALL, ATTN THE
,'AHN COMPANY 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6037F.11 CERTIFICATE OF INSUP.ANCE-OAKRIDGE ASSOCIATES OAKRIDGE MALL, ATTN
THE HAHN COMPANY 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6031.30 POLICY PERIOD CHANGE-12 MONTHS.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEH,
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMENDMENT OF PHYSICAL DAMAGE COVERAGES. .
6082AG AMENDATORY. ENDORSEMENT: CHANGES-DEFINED WORDS; INSURED'S DUTIES;
COVERAGES; CONDITIONS.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6289MM SINGLE LIMIT OF LIABILITY.
NAMED INSURED- DIEDEN, ED DBA DIEDEN COMPANY 22938 ATHERTON ST HAYWARD CA
94541-6614
------------------------------------------------------------------------------
THIS IS YOUR DECLARATIONS PAGE. AGENT: JOE WEATHERS
PLEASE ATTACH ITTO YOUR AUTO POLICY BOOKLET. PH 0 N E: ( 415) 345 - 3 5 71 2980 -15 1
YOUR POLICY CONSISTS OF THIS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5 PLEASE KEEP TOGETHER
REPLACED POLICY G170032-05B
&
DECLARATIONS PAGE
STATE FARM
6400 STATE FARM DRIVE ROHNERT PARK, CA 94926
INSURANCE
12
-"
10
~MOOXf'*W*~
POLICY NUMBER D61 1623-C09-05D
05-2980-3 S
*** THE CITY OF CAMPBELL & THE
*C* CITY OF CAMPBELL REDEVELOPMENT
*0* AGENCY, ITS Off!~fR~ &
*P* EMPLOYEES, ATTN DEPT OF PUBLIC
*Y* WORKS 70 NORTH FIRST ST
*** CAMPBELL CA 95008
NAMED INSURED
DIEDEN, ED
POLICY PERIOD J AN - 2 1- 97 TO
..
....
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE. -.
DESCRIBED
VEHICLE
YEAR
MODEL
BODY STYLE
AUTO
VEHICLE IDENTIFICATION NUMBER CLASS
6700000
SEE REVERSE SIDE FOR IMPORTANT MESSAGE
MAKE
NONOWNED
COVERAGES (AS DEFINED IN POLICY)
SYMBOL.PREMIUM-COVERAGE NAME-LIMITS OF LIABILITY
A
n
$79.81 BODILY INJURY/PROPERTY DAMAGE LIABILITY
LIMIT OF LIABILITY-COVERAGE A 1,000,000 EACH ACCIDENT
$66.64 $250 DEDUCTIBLE PHYSICAL DAMAGE
$21.03 UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
L250
U
EACH PERSON, EACH ACCIDENT
100,000 300,000
$167.48 TOTAL PREMIUM FOR POLICY PERIOD JAN-21-97 TO SEP-09-97
$133.80 CURRENT 6 MONTH PREMIUM FOR MAR-09-97 TO SEP-09-97
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
01 6028E.5 ADDITIONAL INSURED-THE CITY OF CAMPBELL & THE CITY OF CAMPBELL
REDEVELOPMENT, AGENCY, ITS OFFICERS & EMPLOYEES, ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST ST, CAMPBELL CA 95008.
02 6028E.5 ADDITIONAL INSURED-OAKRIDGE ASSOCIATES OAKRIDGE MALL, ATTN THE
HAHN COMPANY 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6037F.11 CERTIFICATE OF INSURANCE-OAKRIDGE ASSOCIATES OAKRIDGE MALL, AT TN
THE HAHN COMPANY 925 A BLOSSOM HILL RD, SAN JOSE CA 95123-1203.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEH,
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6164RR HIRED CARS.
6165AA EMPLOYERS NON-OWNERSHIP COVERAGE.
6166 USE OF NON-OWNED CARS BY BUSINESSES--PHYSICAL DAMAGE COVERAGE
(LIMIT OF LIABILITY $25,000).
6289MM SINGLE LIMIT OF LIABILITY.
------------------------------------------------------------------------------
NAMED INSURED- DIEDEN, ED DBA DIEDEN COMPANY 22938 ATHERTON ST HAYWARD CA
94541-6614
RECEIVED
FEe -11997
PUtill( 'vv V~;~~
ADMINISTRA TION
THIS IS YOUR DECLARATIONS PAGE. AGENT: JOE WEATHERS
PLEASE ATTACH ITTOYOURAUTO POLICY BOOKLET. PHONE: (415) 345-3571 2980-151
YOUR POLICY CONSISTS OF THIS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5 PLEASE KEEP TOGETHER
REPLACED POLICY D611623-05C
155-4976 CA,3
.A..
..
ST..dE FARM
INSURANCE
6400 STATE FARM DRIVE ROHNERT PARK, CA 94926
. _11
~~iW)(tW)(~R
POLICY NUMBER D61 1623-C09-05C
---
8
12
10
POLICY PERIOD DEC-26-96 TO ~..:
05-2980-3 S
*** THE CITY OF CAMPBELL & THE
*C* CITY OF CAMPBELL REDEVELOPMENT
*0* AGENCY, ITS OFFICERS &
*p* EMPLOYEES, AT TN DEPT OF PUBLIC
*Y* WORKS 70 NORTH FIRST ST
*** CAMPBELL CA 95008
NAMED INSURED
DIEDEN, ED
2.__
2
~--
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE. - - -
DESCRiBED YEAR MODEL
VEHICLE
COVERAGES (AS DEFINED IN
SYMBOL-PREMiUM-COVERAGE NAME-LIMITS OF LIABILITY
BODY STYLE
AUTO
VEHICLE IDENTIFICATION NUMBER CLASS
6700000
SEE REVERSE SIDE FOR IMPORTANT MESSAGE
A
L250
U
$23.15
$21.36
$6.74
BO~ILY INJURY/PROPERTY DAMAGE LIABILITY
LIMIT OF LIABILITY-COVERAGE A 1,000,000
$250 DEDUCTIBLE PHYSICAL DAMAGE
UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
EACH ACCIDENT
EACH PERSON, EACH ACCIDENT
100,000 300,000
$51.25 TOTAL PREMIUM FOR POLICY PERIOD DEC-26-96 TO MAR-09-97
$126.20 CURRENT 6 MONTH PREMIUM FOR SEP-09-96 TO MAR-09-97
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
6028E.5 ADDITIONAL INSURED-THE CITY OF CAMPBELL & THE CITY OF CAMPBELL
REDEVELOPMENT, AGENCY, ITS OFFICERS & EMPLOYEES, ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST ST, CAMPBELL CA 95008.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEH,
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6164RR HIRED CARS.
6165AA EMPLOYERS NON-OWNERSHIP COVERAGE.
6166 USE OF NON-OWNED CARS BY BUSINESSES--PHYSICAL DAMAGE COVERAGE
(LIMIT OF LIABILITY $25,000).
6289MM SINGLE LIMIT OF LIABILITY.
--------------------------------------------------------------------~---------
NAMED INSURED- DIEDEN, ED DBA DIEDEN COMPANY 22938 ATHERTON ST HAYWARD CA
94541-6614
~U)
dJ Q~
~7\111
0":) 1 \" \ J
II,
....
VEO
""Jr 'i 819
PUBLIc. ,'97
4DMINIS) "
THIS IS YOUR DECLARATIONS PAGE. AGE NT: JOE WE A THE R S
PLEASE ATTACH ITTO YOUR AUTO POLICY BOOKLET. PHONE: (415) 345-3571 2980-151
YOUR POLICY CONSISTS OF THIS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5 PLEASE KEEP TOGETHER
REPLACED POLICY D611623-05B
155-4976 CA.3
---
~
STI'JE FARM
INSURANCE
6400 STATE FARM DRIVE ROHNERT PARK_ CA 94926
12
11
10
XJJ(~R )tJ)(l)(1XD
POLICY NUMBER G 17 0032-D 26-05B
----
8
05-2980-3 S
POLICY PERIOD OC T - 31- 96 TO OC T - 26-97
*** CITY OF CAMPBELL
*C* CITY OF CAMPBELL_ RE
*0* DEVELOP AGCY_ OFFICERS & EMPS
*P* ATTN DEPT or PUBLIC WORKS
*Y* 70 NORTH FIRST ST
*** CAMPBELL CA 95008-1436
NAMED INSURED
DIEDEN_ ED
3
___"
2
_1__.
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE,
SEPARATE STATEMENT ENCLOSED IF AMOUNT DUE..--.
DESCRIBED YEAR MAKE MODEL
VEHiCLE 1990 FORD F250
COVERAGES (AS DEFINED IN POLICY)
SYMBOL.PREMiUM.COVERAGE NAME.LlMITS OF LIABILITY
BODY STYLE
PICKUP
VEHICLE IDENTIFICATION NUMBER CLASS
2FTHF25HOLCB21331 1WOHOZ1
SEE REVERSE SIDE FOR IMPORTANT MESSAGE
D500
G500
U
$57.52
$164.91
$114.22
BODILY INJURY/PROPERTY DAMAGE LIABILITY
LIMIT OF LIABILITY-COVERAGE A 1_000_000
MEDICAL PAYMENTS
LIMIT OF LIABILITY-COVERAGE C
EACH PERSON
10_000
$500 DEDUCTIBLE COMPREHENSIVE
$500 DEDUCTIBLE COLLISION
UNINSURED MOTOR VEHICLE
LIMITS OF LIABILITY-U
EACH ACCIDENT
C
$568.47
$81.98
A
U1
EACH PERSON, EACH ACCIDENT
100,000 300,000
$8.20 UNINSURED MOTOR VEHICLE PROPERTY DAMAGE
$995.30 TOTAL PREMIUM FOR POLICY PERIOD OCT-31-96 TO OCT-26-97
$1009.43 CURRENT 12 MONTH PREMIUM FOR OCT-26-96 TO OCT-26-97
------------------------------------------------------------------------------
EXCEPTIONS AND ENDORSEMENTS
6028E.5 ADDITIONAL INSURED-CITY OF CAMPBELL CITY OF CAMPBELL_ RE_ DEVELOP
AGCY_ OFFICERS & EMPS ATTN DEPT OF PUBLIC WORKS 70 NORTH FIRST ST_ CAMPBELL
CA 95008-1436.
6031.3D POLICY PERIOD CHANGE-12 MONTHS.
6038N AMENDMENT OF DEFINED WORDS, LIABILITY, UNINSURED MOTOR VEH,
PHYSICAL DAMAGE COVERAGES AND CONDITIONS.
6078AU AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6082AG AMENDATORY ENDORSEMENT: CHANGES-DEFINED WORDS; INSURED'S DUTIES;
COVERAGES; CONDITIONS.
6090AT AMENDMENT OF PHYSICAL DAMAGE COVERAGES.
6289MM SINGLE LIMIT OF LIABILITY.
------------------------------------------------------------------------------
NAMED INSURED- DIEDEN, ED 22938 ATHERTON ST HAYWARD CA 94541-6614
" L"!
.. ~E~'!;: D
r.
4DMi/~IS j J~ .
""'4 ,tv'_
THIS IS YOUR DECLARATiONS PAGE. AGENT: JOE WEATHERS
PLEASE ATTACH ITTO YOUR AUTO POLICY BOOKLET. PHONE: (415) 345-3571 2980-151
YOUR POLICY CONSISTS OF THIS PAGE, ANY ENDORSEMENTS, AND THE POLICY BOOKLET, FORM 9805 . 5 PLEASE KEEP TOGETHER
REPLACED POLICY G170032-05A
155-4976 CA.3
_D'~;;~~';;
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BV THE
POLICIES BELOW.
Arthur J. Gllllgher-PlelSlnton
4301 Hlciendl Drive #300
P,O. Box 9101
PlelSlnton, CA 94566-9101
510-460-9900
CA
9454 1
COt.t:tANIES AFFORDING COVERAGE
COliPANY A
LETTER SCOTTSDALE
COliPANY B
LETTER Re ub lie Ind, Co, of Ame r i c a
COliPANY C
LETTER
COliPANY 0
LETTER
COliPANY E
LETTER
.....................................................................
..............,........ ............
................. .
Dieden Complny
22938 Atherton Street
Hlyward
... ........... . .... . ...... .... . . .....
};::.:;:::::\:::::.:,:,::::::,:::::::::.:.:.:jfff~:::::ffffft}:~:::fffff::::::f::ffffft:::ff:}m:}}::#}r}}~tfftfff:;lt}~ffff1t~f:~~m~:::t}:t%}},:}}::::}:t}}:\'::)))::;::\\:;::\"':'::1):;,:,::",,:,,:
THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA TED. NOTWITHST ANDING ANY REOUIREMENT. TEnM OR CONDITION OF ANY CONTRACT OR OTHER DOCLMENT WITH RESPECT TO WHICH THIS
CERTIFICA TE MAYBE 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. LMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS.
co
L
Type 01' INIURANOl!
POLICY NUt8R
POLICY II!I'I'I!OTIV! POLICY I!XPIRAT
DATE (MMIOO/VY) DATE (MM/OO/VV)
L1hlITS
Ql!Nl!RAL L1ABLITY
A X CCMvlERCIAL GENERAL lIABllI TV CLS277798
-:':':'. CLAIMS MADE [KJ OCCUR,
OWNER'S & CONTRACTOR'S PROf.
AUTOhlCl8L1! L1ABLITY
ANY AUTO
All OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE lIABllI TV
I!xce:n L1ABLITY
1MB REllA FORM
OTHER THAN IMBREllA FORM
WORKI!R'S OOhlPl!NlATION
B IHJ 03524287
I!hlPLOYI!RI'LIABLITY
OTHI!R
8/17/96
GENERAL AGGREGATE $
8/17/97 PRODUCTS-COMP/OP AGG. $
PERSONAL & ADV. INJURV $
$
$
2000000
2000000
1000000
1000000
100000
1000
R
STATUTORY LIMITS
9/28/97 EACH ACCIDENT
DISEASE-POLICY LIMIT
DISEASE-EACH EMPlOVEE
$
$
$
1000000
1000000
1000000
9/28/96
DeSORPTION 01' OPI!RATIONSII.OOATIONIIWHIClLDISPRIAL ITI!'"
See Ittlched CG2010 for Idd" ins'ds IS respects GL, Coverlge is Primary,
Re: III work in public right-of-wlY. 1830 S. Blscom Ave. Encrochment Permit
lies to Work. Com,
............................................................................................
. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .' . .
:,:::..:::.:-:.:,:.:,:.:.:::.:::.:::::,:,:.:::,:.:;,::.:.:::.:.:::,::,:,:::.:.:.:-:.::",\:;,:::,;;;;;;:::;;;::'::";'::'::;':':;;';;;;;;;:';::':""':':"::':':'":,::::,;:;:;:;:::::;::;:;;:;;;:,::;,,;;:;,;;;,;,;;,,:,;"';':";;';::;\\i\\\:[;;;;'~'~:b:ct'D:'~;~:~;:b'~:'~':~:~:,:t'~:g:0:~"ciksCRiB'ED ~.~ LICIE ~~k~~~~~L~.~.~"~.~'~'~ ~~..~..~.~ ......
::::I EXPIRA liON DATE THEREOF. THE ISSUING COMPANY WILL ..... T
II MAIL 30 DAYSWRITTENNOTICETOTHECERTIFICATEHOLDERNAMEDTOTHE
Ci ty of Clmpbe II ?? LEFT, - --
At tn: Dept. of Pub lie Wo rks \I:\: 1..:..,__" .~. . .--
10 ND,th F; rot St,ut $.........~
~~
POLICY NUMBER: CLS2" 798
COMMt...,<CIAL 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
The City of Campbell and the City of Campbell Redevelopment Agency, its officers, employees
and volunteers
RE: All work in public right-of-way
(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 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.
This insurance is PRIMARY with respect to the additional insured, Any other insurance
available to that person or organization is excess and noncontributing.
CG 20 10 11 85
Copyright, Insurance Services Office, Inc" 1984
o
CG 20 10 11 85
0" . C A A.
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OileH A IlQ'
CITY OF CAMPBELL
Public Works Department
November 19, 1998
Mr. Kenneth Sarachan
Rasputin Records
2401 Telegraph Avenue
Berkeley, CA 94704
SUBJECT: PERMIT NO, 96-216
LOCATION: 1830 South Bascom Avenue - Rasputin Records
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Sarachan:
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 cash deposits totaling $21,300,00, plus any interest due, will be sent directly to you from
our Finance Department.
~lY'
Rznd1;!j.tfall
Public Works I
MQt~
cc: Permit 96-216
H:\ WORD\LANDDEV\96216AC2JD)
70 North First Street. Campbell, California 95008,1423 ' TEL 408,866.2150 ' FAX 408,376,0958 ' TOD 408.866,2790
Of.CAAt
t~'~ y .' ,b~~
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O~CH~\l\l'
CITY OF CAMPBELL
Public Works Department
November 16, 1998
Edward Dieden
The Dieden Company
22938 Atherton Street
Hayward, CA 94541
SUBJECT: PERMIT NO, 96-216
LOCATION: 1830 South Bascom Avenue - Rasputin Records
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr, Dieden:
The City of Campbell has made the final one year maintenance inspection of subject Public
Works improvements and find that no remedial work is required.
Your warranty requirements, therefore, are hereby released. Enclosed is your original
Maintenance Bond, which we are returning to you.
Rasputin Records posted the surety deposits for the subject permit, therefore, final
arrangements for release of the sureties will be coordinated with them.
If you have any questions, please call me at (408)866-2165,
~~Lt1
MQfM-l
cc: Permit 96-216
Public Works/Maintenance Division
H:\ WORD\PERMITS\98216ACC(JD)
70 North First Street' Campbell, California 95008.1423 ' TEL 408.866.2150 ' FAX 408.376,0958 . TOD 408.866,2790
MAINTENANCE BOND
Bond RED-1019927
KNOW ALL BY THESE PRESENTS, That we, The Dieden Comoany
as Principal, and Redland Insurance Comoany
a corporation organized under the laws of the State of Iowa
and duly authorized to do business in
the State of California
, as Surety, are held and firmly bound unto City of Camobell
as Obligee, in the penal sum of Five Thousand and 00/100 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - - - - - - ($ 5,000,00 )
to which payment well and truly to be made we do bind ourselves, our and each of our heirs, executors, administrators, successors
and assigns jointly and severally, firmly by these presents.
WHEREAS, the said Principal entered into a Contract with the
City of Camobell
for Street Improvements, 1830 S, Bascom
'dated 09/02/1997
WHEREAS, said Contract has been completed, and was approved on 17th
day of Seotember , 1997 .
NOW, THEREfORE, THE CONDmON OF THIS OBLIGATION IS SUCH, That if the Principal shall guarantee that the work
will be free of any defective materials or workmanship which became apparent during the period of
One ( 1) year(s) following completion of the Contract then this obligation shall be void, otherwise to remain in
full force and effect, provided however, any additional warranty or guarantee whether expressed or implied is extended by the
Principal or Manufacturer only, and the Surety assumes no liability for such a guarantee.
Signed and sealed this
29th
day of
October
1997
~
~~ t->r~en
(Seal)
(Seal)
6?'WJY~ .
(Seal)
Redland Insurance Comoany
S-0843/GEEF 7/96
. .
~.
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RED 1 0 19927 (':"}l
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REDLAND INSURANCE COMPANY
POWER OF ATIORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT REOLANO INSURANCE COMPANY does hereby make, constitute and appoint . /,.-
Barbara L. Shine*John W. Bowen*Kathleen Earle* Andrew H. Kammerer ".
its true and lawful Attorney-in-Fact, to make, execute and deliver on its behalf Surety bonds, undertakings and other instruments of )
similar nature as follows':'11 ,.' d $1 000 000
cUl wntten Instruments In an amount not to excee , ,
This Power of Attorney is granted and sealed under and by the authority of the following Resolution adopted by the Board of
Directors of the Company on the 18th day of October, 1993.
NRESOl VIO, that the Chainnan of the Board, the President, an Executive Vice President or a Vice President be, and that each
of them is, authorized to execute Powers of Attorney qualifying the Attorney-in-Fact named in the given Power of Attorney to
execute in behalf of the Company, bonds, undertakings and other instruments of similar nature, and said officers may rename any
such Attorney-in-Fact or agent and revoke any Power of Attorney previously granted to such person,
FURTHER RESOl VIO, that an Assistant Secretary be, and that each or any of them hereby is, authorized to attest the
execution of any such Power of Attorney, and to attach thereto the seal of the Company,
FURTHER RESOl VIO, that the signatures of such officers and the seal of the Company may be affixed to any such Power of
Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile
signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with respect to any bond,
undertaking or instruments of similar nature to which it is attacht:d."
IN WITNESS WHEREOF, REOlANO INSURANCE COMPANY has caused its official seal to be hereunto affixed, and these
presents to be signed by its President this 18th day of October, 1993,
Attest:
REDLAND INSURANCE COMPANY
By
JOSEPH G. SMITH
Assistant Secretary
JOHN P. NELSON
President
STATE OF IOWA
s.s.: Council Bluffs
COUNTY OF POTIAWATIAMIE
On this 18th day of October, 1993 before me personally came John p, Nelson, to me known, who being by me duly sworn, did
depose and say that he is President of REDLAND INSURANCE COMPANY the corporation described in and which executed the
above instrument; that he knows the seal of the said corporation, that the seal affixed to the said instrument is such corporate seal;
that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.
~ .
JEANETTE ALDREDGE dr--
NOTARY PUBLIC
My Commission Expires March 15, 1996
:11\
/h)
JEANETTE ALDREDGE
MY COMMISSION EXPIRES
3-15-96
1.
I, the undersigned, Vice President of RED LAND INSURANCE COMPANY an Iowa corporation, 00 HEREBY CERTIFY that
the foregoing and attached Power of Attorney remains in full force and has not been revoked; and furthermore that the Resolution
of the Board of Directors, set forth in the said Power of Attorney, is now in force.
Signed and sealed at the City of Council Bluffs, in the State of Iowa, dated the day of , 19
4.CJ.~
ROGER D, STORDAHL
Vice President
../
THIS DOCUMENT IS NOT VALID UNLESS PRINTED ON A GREY SHADED BACKGROUND WITH A RED SERIAL NUMBER IN
THE UPPER RIGHT HAND CORNER, IF YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY OF THIS
DOCUMENT YOU ARE URGED TO CONTACT REDLAND INSURANCE COMPANY AT C/O 80 OLD STATE HOUSE SQUARE, P.O,
BOX 231496, HARTFORD, CONNECTICUT 06123-1496 OR CALL OUR POWER OF ATTORNEY CUSTODIAN AT (203) 527-7806,
301/POA/IO/93
''''" "....," =-
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--~ CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT
'lo 5907
State of Caliform.a
County of
,-Uameda
On
October 29. 1997
OATE
before me,
Lisa M. Lucas
NAME, TITLE OF OFFICER, E G., 'JANE OOE, NOTARY PUBUC'
personally appeared
R~rh~r::l L. Shine
NAMElSI OF SIGNERISI
o personally known to me - OR - 0 proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies). and that by his/her/their
signature(s) on the instrument the person(s),
or the entity upon behalf of which the
person(s} acted, executed the instrument,
J 't 'till Jl~.....;"...~.o>__~~
~.~.~.
.' , ' ;;.... '., Us.\ M, LUCAS l
:;( l. " CCMM. ,~ lC4S:9S z
~ ~ -. : Notcry Pwb!ic - Cc::ifcmia S
.1 ". . SANTA CLARA COUNTY -
,"'"'",. My Ccmm, E:q:::res DEe 29, 1998 J
~)IIlt'~~~~_,_,"'~h .
WITNESS my hand and official seal.
~TI- ~
SIGNATURE OF NOTARY
OPTIONAL
Thougn the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattacnment of this form.
. CAPACITY CLAIMED BY SIGNER
o INDIVIDUAL
o CORPORATE OFACER
DESCRIPTION OF ATTACHED DOCUMENT
TT11.EISl
TITtE OR TYPE OF DOCUMENT
o PARTNER(S)
o UMITEQ
o GENERAL
[X] A rrORNEY-IN-FACT
o -mUSTEE(S)
o GUARDIAN/CONSERVATOR
o Ol1-fER:
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNER IS REPRESENTlNG:
NAME OF PERSONlSI OR EHT1TY(IESl
SIGNER(S) OTHER THAN NAMED ABOVE
C1993 NATIONAL NOTARY ASSOCIATION .82:38 R_Ave.. P,O. BOll 7184 0 Canoga ParK. CA 91309-7184
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MEMORANDUM
CITY OF CAMPBELL PUBLIC WORKS DEPARlMENT
TO:
Anne Bybee, City Clerk
DATE: October 28,1998
FROM'
SUBJECT: Document for Recording
Attached is an Offer of Dedication for Rasputin Records at 1830 S, Bascom Avenue, This Offer of
Dedication was part of the original Conditions of Approval for the Rasputin project, Please forward
this Offer of Dedication for recording,
Attachment
"
Recording Requested By and When
Recorded Mail To:
City of Campbell
Community Development Department
70 North First Street
Campbell, CA 95008-1423
OFFER OF DEDICATION
The undersigned, being the present title owner of record of the herein described parcel of
land, does hereby make an irrevocable offer of dedication to the public use to the CITY OF
CAMPBELL for the future boulevard treatment as required by the City's Standard Streetscape
Policy, of the real property situated in the City of Campbell, County of Santa Clara, State of
California, described in Exhibit A (written description) and shown on Exhibit B (plat map)
attached hereto,
It is understood and agreed that the CITY OF CAMPBELL and its successors and assigns
shall incur no liability with respect to such offer of dedication, and shall not assume any
responsibility for the offered parcel of land or any improvements thereon and therein, until such
offer has been accepted by appropriate action by the City Council, Planning Commission, or such
other appropriate agency of the City or its successors or assigns, provided that upon such
acceptance the City (or its successors or assigns, as appropriate) shall assume full responsibility
and liability for the offered parcel and any improvements thereon and therein, including, without
limitation, liability for any person injured on the property as a result of a dangerous or defective
condition on the property.
In the event that the CITY OF CAMPBELL, or its successors and assigns, on behalf of
the public, should determine that the use of said property or any portion thereof is no longer
needed, the rights herein given shall terminate as to those portions not needed and revert to the
undersigned owner or his successors or assigns.
The provisions hereof shall inure to the benefits of and be binding upon t.lJ.e heirs,
successors, assigns, and personal representatives of the respective parties hereto.
IN WITNESS WHEREOF, the undersigned has executed this instrument this 2j day of
September, 1998,
~J~-
[Notary Acknowledgement Attached]
State of
County of
On Saf.23. /tf?Ebefore me, ~fJ#tQ, - ad-Ire
- , IDATEf (NAME/TITLE OF OFFICER-i,e,"JANE DOE. NOTARY P
personally appeared Kr:n flefh I )q17lf'J1alJ MJkr'f
(NAMEIS) OF SIGNERISlI
o personally known to me -OR-~
proved to me on the
basis of satisfactory
evidence to be the .
personls1Whose name(s-V
IS/EU=e-- subscribed to tne
within instrument and
acknowledged to me that
he/she/they executed the
same in his/hcr/thoir
authorized capacity(ies),
and that by. his/her/their
signature(j1 on the
instrument the person(,s1',
or the entity upon behalf
of which the personL8"f
acted, executed the
instrument,
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COMM. # 10596!D ~
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Witness my hand and official seal.
(SEAL)
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' (SIGNATURE F OTARY)
ATTENTION NOTARY
The information requested below and in the column to the right is OPTIONAL.
Recording of this document is not required by law and is also optional.
It could, however, prevent fraudulent attachment of this certificate to any
unauthorized document,
THIS CERTIFICATE Title or Type of Document 6~r d l:J?ji~ 'en
MUST BE ATTACHED "1- ~ 'I')
TO THE DOCUMENT Number of Pages I Date of Document .:< R /q'( a .
DESCRIBED AT RIGHT:
Signer(s) Other Than Named Above
WOLCOTTS FORM 63240 Rev. 3.94 (p,ice clas. 8-2A) <tl1994 WOLCOTTS FORMS, INC,
ALL PURPOSE ACKNOWLEDGMENT WITH SIGNER CAPACITY/REPRESENTATlONITWO FINGERPRINTS
RIGHT THUMBPRINT 10ptional)
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CAPACITY CLAIMED BY SIGNER(S)
DINDIVIDUAL(S)
DCORPORA TE
OFFICER(S)
(TITUS)
--
DPARTNER(S) DlIMITED
DGENERAL
DATTORNEY IN FACT
DTAUSTEE(S)
DGUARDIAN/CONSERV A TOR
DOTHER:
SIGNER IS REPRESENTING:
(Name of Personls' or Entity(iesl
RIGHT THUMBPRINT (Optionall
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CAPACITY CLAIMED BY SIGNERIS)
DINDIVIDUAL(SI
DCORPORA TE
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(TITUS)
DPARTNER{S) DlIMITED
DGENERAL
DATTORNEY IN FACT
DTAUSTEE(SI
DGUARDIAN/CONSERV A TOR
DOTHER:
SIGNER IS REPRESENTING:
(Name of Person(s) or Entity(ies)
7 1I~~~~llll~~I!lm 8
EXHIBIT A
That land situate in the City of Campbell. County of Santa Clara. State of
California being a portion of Parcel A as said parcel is shown on that certain Map
entitled Parcel Map which Map was filed for record in the Office of the Recorder
of the County of Santa Clara. State of California. on March 26. 1981 in Book 481
of Maps at page 42. described as follows:
Beginning at the northwest corner of said parcel being in the east line of
Bascom Avenue; thence along the north line of said parcel S 890 42' 27" E 7,00
feet; thence leaving last said line S 00 41' 58" W 199.56 feet parallel to said
Avenue; thence along a tangent curve to the left having a radius of 20,00 feet.
through a central angle of 900 24' 25" an arc length Of 31.56 feet to the north line
of Ridgeley Drive as said drive is shown on said map; thence along last said line
and along said east line of Bascom Ave, N 890 42' 27" W 7,00 feet to a tangent
curve to the right having a radius of 20,00 feet; thence along last said curve,
through a central angle of 900 24' 25". an arc length of 31,56 feet and N 00 41'
58" E 199.56 feet to the point of beginning,
Containing 1538 S. F, more or less,
END OF DESCRIPTION
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MEMORANDUM
CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT
TO:
Bill Seligmann, City Attorney
DATE: August 10, 1998
^
FROM: Michelle Quinney, City Engineer '-OJ.
SUBJECT: 1830 S. Bascom Avenue - Rasputin Records
On September 2, 1997, Encroachment Permit 96-216 was issued to The Dieden Company for
installation of street improvements at 1830 S. Bascom Avenue, Rasputin Records, The improvements
were completed and the final inspection was performed. The permit is now in the maintenance period
(until November 1998); however, there is approximately $21,300 in refundable fees that are eligible
for release to Rasputin Records,
On January 21, 1998, I sent you a memo with copies of correspondence to Ken Sarachan of Rasputin
Records regarding his failure to dedicate right-of-way as required in the Conditions of Approval. As
of this date, Mr. Sarachan has not followed through to dedicate the right-of-way.
By this memo, I am asking you whether or not the City should refund any of the fees on deposit in
light of the fact that the dedication has not occurred,
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CITY OF CAMPBELL
Public Works Department
January 8, 1998
Edward Dieden
The Dieden Co,
22938 Atherton Street
Hayward, CA 94541
SUBJECT: PERMIT NO, 96-216
LOOCATION: 1830 South Bascom Avenue
FINAL INSPECTION AND ACCEPTANCE
Dear Mr, Dieden:
The City of Campbell has made a final 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 began as of November 11, 1997. 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,
Rasputin Records posted the various deposits and sureties for this permit, therefore, final
arrangements will be coordinated directly with them.
If you have any questions, please call me at (408) 866-2165,
-f;Sincer~y, ,
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Randy Jstfall /;; .
Public Works InSpector
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cc: Suspense - 11 months
Permit #96-216
Inspector File
H: \ WORD\PERMITS\96216FIN(JD)
70 North First Street. Campbell, California 95008,1423 ' TEL 408,866,2150 ' FAX 408.376,0958 ' TOD 408,866,2790
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Public Works Department
City of Campbell
70 North First St,
Campbell. CA 95008-1423
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Re: Permit No, 96-216
1830 So. Bascom Ave.
Dear Randy:
Enclosed please find the maintenance bond for the subject
project. If you need anything further. please give me a call.
Very truly yours.
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Edward Oieden
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October 24. 1997
Randy Westfall
Public Works Department
City of Campbell
70 North First St.
Campbell. CA 95008-1423
Re: Permit No. 96-216
1830 So, Bascom Ave.
Dear Randy:
I would like to arrange for a final inspection on the subject
project, I can meet you at the site at your convenience. The best
way to reach me is to page me at (510) 515-1180,
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Edward Dieden
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CITY OF CAMPBELL
Public Works Department
September 17, 1997
The Dieden Company
22938 Atherton Street
Hayward, CA 94541
Subject:
Permit No. 96-216
Location: 1830 South Bascom Avenue
Preliminary Inspection Report - Deficiencies
Gentlemen:
This letter is in response to your request for a fmal inspection on subject Public Works improvements,
There are deficiencies in the work which are indicated on the enclosed preliminary inspection report.
These deficiencies must be corrected in accordance with City standards before we can make a final
inspection or accept the work,
Upon completion of the corrective work, please submit a written request for a final inspection and
acceptance, Prior to final acceptance of the work, you will also need to make the necessary
arrangements to provide the one-year maintenance surety which will be used to replace the
performance surety currently held by the City,
Please contact me at (408)866-2165 to coordinate the correction and inspection of these deficiencies, or
if you have any questions,
;p:1I'/_ M
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Public Works Inspector
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Attachment: Deficiency List
cc: Building Division
Permit 96-216
Inspector File
h: \ word\permits\96216isp(mp)
70 North First Street' Campbell, California 95008,1423 ' TEL 408,866.2150 ' FAX 408,376.0958 . TOD 408,866,2790
PRELIMINARY INSPECTION DEFICIENCIES
1830 SOUTH BASCOM AVENUE
RASPUTIN RECORDS
September 17, 1997
1. Repair broken curb at curb drain outlet onto Ridgeley Drive.
2. Install parking stalls and signs on Ridgeley Drive. Move the existing 25 mph sign to
the new sign post at the south side of Ridgeley Drive.
3, Reset the on-site stop sign so that it is secure with a proper 24" deep foundation and the
bottom of the sign is no less than 74" above finish grade.
4, Sweep and clean entire work site, Remove all construction related debris.
5, Remove graffiti from new concrete,
6, Patch the AC at the back of driveway onto Bascom Avenue.
7. Replant all street trees per the standard detail, including root barrier, deep watering
tubes, etc, Tree stakes must be 18" apart as a minimum and shall be supported by a 1"
x ~" board at the mid-point.
8. Install correct bubbler irrigation in each of the two deep watering tubes for each tree,
9. Submit mylar as-built drawings stamped "RECORD DRAWINGS" and signed by the
ep.gineer of record.
10. Replace dead sod.
CITY OF CAMPBELL
CONTRACTOR: tJo iU...."
PROJECT NO. 9(,/21 {.;
REPORT NO: 2--
DATE: q/7/7
WEATHER: PAIR.
INSPECTOR: K. .v~51fALL
FIELD ENGINEER'S DAILY REPORT
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ITEM
DESCRIPTION
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CITY OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
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CONTRACTOR: (~d D)~)
PROJECT NO. 7b---J/0
REPORT NO: I
DATE: 9$ ~ lit 97
WEATHER: F/1/ R.
INSPECTOR: K, klG:-51fALL
ITEM DESCRIPTION
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________________________: Metroscan/Santa Clara :-------------------------*
ier : SARACHAN KENNETH
Owner: ~
ite :1047 RIDGELEY DR CAMPBELL 95008 /Jff~~~~
fail :1000 RISPIN DR BERKELEY CA 94705
Xfered :06/06/96 Doc #:13321224
Price Deed :INTERSPOUSAL
LoanAmt:$1,430,000 Loan :CONVENTIONAL
Lender :BANK OF AMERICA
VestTyp:SOLE AND SEPAR IntTy:FIXED
LandUse:58 COM,RETAIL NOT IN SHOPPING CENTER
Zoning :C1 COMMERCIAL NEIGHBORHOOD
SubPlat:KUEHNIS ESTATES UN NO 2
Legal :KUEHNIS ESTATES UN NO 2 PARCEL A
Census :Tract 5026.02 Block 2
MapGrid:853 G5
..........
Total Rms:
Bedrooms :
Bathrooms:
stories :1
Dining Rm:
Family Rm:
Rec Room :
Bldg SF :11,620
Lot SF :44,866
Lot Acres:1.03
Lot Dimen:
CntIHt/AC:YES
Pool
Fireplace:
units :3
Patio
Porch
Elevator :NO
Lease SF :11,620
Office SF:
sprinkler:NO
Parcel :288 10 073
Bldg Id:1
Land :$1,134,454
Struct :$1,292,185
Other
Total :$2,426,639
%Imprvd:53
% Owned:100
Exempt :
Type
TaxArea:10041
96-97Tx:$28,775.94
-- Phone --
Owner :510-548-7193
Tenant :
...........
Year Built:1976
EffYearBlt:1977
Garage Sp :
Garage SF :
Bldg Cond :AVG
Bldg Class:6.5
Bldg Shape:L-SHAPE
The Information Provided Is Deemed Reliable, But Is Not
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CITY OF CAMPBELL
Public Works Department
February 28, 1997
Ken Sarachan, Rasputin Music
2401 Telegraph Avenue
Berkeley, CA 94704
Subject:
1800 - 1840 South Bascom Avenue
UP 96-05, Encroachment Permit and Offer of Dedication
Dear Mr, Sarachan:
The Public Works Department has reviewed the plans for offsite improvements and the plans are
ready for approval by the City and for the issuance of the encroachment permit. We will not
issue the permit until you submit the offer of dedication which you are required to submit.
Please call me at your convenience if you have any questions or comments.
Very truly yours,
tf:::s~'
Assistant Engineer
cc: Harold Housley, Land Development Section
Stevan H. Nakashima, 4800 El Camino Real, Los Altos, CA 94022
Michelle Quinney, City Engineer
Gloria Sciara, Planning Division
H:\ WORD\LANDDEV\RASPL TR(JD)
70 North First Street' Campbell, California 95008.1423 ' TEL 408,866,2150 . FAX 408,379.2572 ' TOD 408,866.2790
NEW PW FAX #
408.376.0958
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
ENGINEER'S ESTIMATE
Address: 1830 S, Bascom Date: 8/8/96
Encroachment Permit No, ~ -~ \,c..-. Application No, UP 96-05
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO. DESCRIPTION UNIT QUANTITIES < $30 K $30 K to $150 K > $150 K $ AMOUNT
I. SURFACE CONSTRUCTION
MOBILIZATION I LS $1,500,00 $1,500.00
CONSTRUCTION TRAFFIC
CONTROLCONTROL/PHASING 1 LS $2,000,00 $2,000.00
CONSTRUCTION STAKING 1 LS $500.00 $500.00
CONSTRUCTION TESTING 1 LS $300.00 $300.00
II, DEMOLITION/CLEARING
1. CLEARING & GRUBBING I LS $2,000.00 $2,000,00
2. SA WCUT P.C.C./A.c.(UP TO 6") 240 LF $4.50 $3.00 $2.00 $1,080,00
3. P,C.C, REMOVAL 60 SY $30.00 $23.00 $10.00 $1,800,00
4, CURB AND GUTTER REMOVAL 50 LF $6.00 $3.00 $2.00 $300,00
5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25
6. DEMOLISH EXISTING INLET/PLUG RCP'S EA
Ill. STORM DRAINAGE
1. 12" R,C.P. (CLASS V) LF $60.00 $40.00 $20,00
2. 15" R,C.P. (CLASS III) LF $65.00 $48,00 $38,00
3. 18" R,C.P. (CLASS III) LF $70.00 $60,00 $52.00
4, 24" RC.P. (CLASS III) LF $80,00 $68,00 $59.00
5, 30" RC,P, (CLASS III) LF $90,00 $75,00 $65,00
6, T.V, INSPECTION (12") LF $1.20 $0,75 $0,60
7, STD, DRAINAGE INLET EA $1,600.00 $1,300,00 $1,000,00
(C.C, DETAIL 9)
8. FLAT GRATE INLET EA $1,400.00 $1,100,00 $900,00
(C.C, DETAIL 6)
9. STANDARD MANHOLE EA $2,000,00 $1,600,00 $1,300.00
(C.SJ, DETAIL D-l1)
(INCLUDES FRAME & LID)
10. BREAK AND ENTER M.H,/DJ. EA $700,00 $550,00 $450,00
~
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO, DESCRIPTiON QUANTiTiES < $30 K $30 K to $150 K > $150 K $ AMOUNT
I. SIDEWALK 475 SF $6,50 $4,50 $2,75 $3,087.50
2. DRIVEWAY APPROACH SF $7,50 $5,50 $3,75
3, CURB AND GUITER 60 LF $22.00 $18,00 $15,00 $1,320,00
4. VALLEY GUITER SF $12.50 $10,00 $8.25
5. HANDICAP RAMP EA $1,200.00 $800.00 $700.00
6. TYPE B-1 CURB LF $12,00 $9.50 $7,50
7, TYPE AI-B3 CURB LF $15,00 $12,00 $10,00
8, COBBLESTONE MEDIAN SURFACE SF $12.00 $8,00 $5,00
9, P,C.C. DRIVEWAY CONFORM SF $7.00 $5,50 $4,50
10. A.C, DRIVEWAY CONFORM SF $4.50 $3.75 $3.00
V. PAVEMENT
I. ASPHALT DIGOUT AND REPLACE CF $5,00 $3,50 $2,50
2. PAVEMENT WEDGE CUT (6') LF $5,00 $2.50 $1.50
3. PAVEMENT GRINDING SF $0.80 $0.50 $0.35
4, PAVEMENT FABRIC (PETRO-MAT) SY $2,00 $1.85 $1.50
5, ASPHALT CONCRETE (TYPE A) T $80,00 $50.00 $35.00
6, AGGREGATE BASE (CLASS 2) T $40,00 $20.00 $12,00
7, SLURRY SEAL (TYPE II) SF $0,07 $0,06 $0,05
8, SLURRY SEAL (TYPE III) SF $0,11 $0.09 $0.Q7
VI. TRAFFIC SIGNALS/LIGHTS
I. DETECTOR LOOP (6' ROUND) EA $450.00 $300,00 $250.00
2, DETECTOR LOOP (6' x 30') EA $650.00 $540.00 $440.00
3. DETECTOR LOOP (6' x 50') EA $900.00 $750,00 $640.00
4. ELECTROLIER EA $2,600,00 $2,200,00 $1,800.00
5. 1 1/2" RIGID CONDUIT LF $9.00 $7.00 $5,00
6, 2" RIGID CONDUIT LF $17.00 $13,00 $10.00
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO, DESCRIPTION QUANTITIES < $30 K $30 K TO $150 K > $150 K $ AMOUNT
7, CONDUCTOR LF $0,70 $0,55 $0.45
8. PULL BOX (NO.3 1/2) EA $300.00 $240.00 $185.00
9, PULL BOX (NO.5) EA $400,00 $350,00 $300,00
VII. STRIPING AND SIGNS
I. REMOVE PVMT, MARKINGS (PAINT) SF $2.50 $1.50 $1.00
2, REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40
3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40
4, STRIPING DETAIL 9 LF $1.35 $0,85 $0,35
5. STRIPING DETAIL 29 LF $2.25 $1.65 $1.20
6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25
7. STRIPING DETAIL 37 (THERMO) LF $1.85 $1.50 $1.00
8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 $1.15
9, STRIPING DETAIL 39 LF $1.50 $0.85 $0.45
10. STRIPING DETAIL 40 LF $2.20 $1.70 $1.00
11. LIMIT LINE LF $1.35 $1.05 $0.90
12, CROSSWALK LF $1.35 $1.05 $0.90
13. PAVEMENT MARKINGS (PAINT) SF $2.50 $1.90 $1.60
14. PA VEMENT MARKINGS (THERMO) SF $5.50 $3.80 $2.60
15. PAVEMENT MARKER (NON-REFL.) EA $4,50 $3.00 $2.20
16, PAVEMENT MARKER (REFLECTIVE) EA $6,00 $4.15 $3,15
17, TYPE K MARKER EA $95,00 $80,00 $70,00
18. TYPE N MARKER EA $95.00 $80,00 $70,00
19. SALVAGE ROAD SIGN EA $85.00 $75,00 $65,00
20, RELOCATE ROAD SIGN EA $100.00 $85,00 $75,00
21. INST. RD. SIGN ON EXIST, POLE EA $200.00 $145,00 $110.00
22, ROAD SIGN WITH POST EA $300,00 $240.00 $195,00
23, SIGNING AND STRIPING I LS $750.00 $195,00 $750.00
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO. DESCRIPTION QUANTITIES < $30 K $30 K TO $150 K > $150 K $ AMOUNT
VIII, LANDSCAPING
1. IRRIGATION, PLANTING WORK 0 LS $7,770.00 $0.00
(7' X 185' X $6,00)
2, PRUNE TREE ROOTS EA $125,00 $100.00 $85,00
3. TREE REMOVAL EA $650.00 $500.00 $400.00
4, ROOT BARRIER (12") LF $20,00 $10.00 $6,00
5, ROOT BARRIER (18") 90 LF $25.00 $15,00 $10.00 $2,250,00
6. STREET TREE (24" BOX) 5 EA $450.00 $325,00 $250,00 $2,250.00
7. STREET TREE (36" BOX) EA $700,00 $550.00 $400.00
8. TOP SOIL BACKFILL 30 CY $15.00 $450.00
IX. MISCELLANEOUS
1. PEDESTRIAN BARRIER LF $75.00 $60,00 $50,00
2, CHAIN LINK FENCE (6') LF $15,00 $11.50 $9,25
3. RAISE MISC, BOX TO GRADE EA $300.00 $200.00 $175.00
4, RAISE MANHOLE TO GRADE EA $400,00 $275,00 $200,00
5. INSTALL MONUMENT BOX EA $450.00 $350,00 $300,00
6, MEDIAN BACKFILL CY $19,00 $17,00 $15,50
c=.~ ~-"'\ -9<- SUBTOTAL $19,587.50
PREPARED BY: Cruz S. Gomez
10% SECURITY ENFORCEMENT FEE $1,958,75
REVIEWED BY:
TOTAL ESTIMATE FOR FAITHFUL $21,546.25
APPROVED BY: PERFORMANCE SECURITY $20,000.00
.See Section 66499,4 oflhe Map Act.
h:1830bas.wk3(mp)
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
ENGINEER'S ESfIMA TE
Addre.. \,. ~~c:>
Encroachment Permit No.
~. ~-,.C.,CJM
DateA..u~~~\ ~b
Application No, U po 9 <.o--o~
ITEM
NO,
DESCRIPTION
/WRFACE CONSTRUcrJON
MOBILIZATION
I,
~ONSTRucrION TRAFFIC
~Om"ROLCOm"ROLIPHASING
CONSTRUcrlON STAKING
CONSTRUcrlON TESTING
I
i i
II. DEMOLITION/CLEARING
!
1. CLEARING'" GRUBBING
i
!
2, ~A WCUT P.C,C./A,C.(UP TO 6')
i
3, P,C,C REMOVAL
i
4. FURB AND GUTTER REMOVAL
S, /-lEDlAN REMOVAL
6, DEMOLISH EXISTING INLETIPLUG RCP'S
i
I
~TORM DRAINAGE
12' R,C,P, (CLASS V)
!
i
i
I
. III.
I.
i
2. IS' R,C.P. (CLASS nn
I
3, 18" R,C.P. (CLASS III)
4, 24' R,C,P. (CLASS nn
I
S. 30" R,CP. (CLASS nn
6, :r-v. INSPEcrlON (12')
I
7. STD, DRAINAGE INLET
I
rc.c, DETAIL 9)
8. FLAT GRATE INLET
fCC' DETAIL 6)
I
9, STANDARD MANHOLE
IC.SJ. DETAIL 0-11)
I
(INCLUDES FRAME'" 1.10)
I
IV.
la, ~REAK AND Em"ER M.H,/D.1.
i
fONCRETE IMPROVEMENTS
flDEWALK
!
I.
2, DRIVEW A Y APPROACH
27-Jun-96
UNIT PRICES FOR PROJEcr AMOUm" I
UAJlITmES < S30 K I S3OKlOSl5OK S AMOUm"
"~~t ~~Oo" ~ I~~
! I
I' I
LS~.~~ L.Cc.~,~~
I ":", c:<:":' ~ u I
LS~. ~
- , I
I ~C::i.c.', Co <.:. I
~,OC.;
LS' ~ . i
I i
I ~l~~' ..- I
I
LS'C.O..:r:>'F
'2..40 LF I ~.OOrl"'U~f~:
S4,SOI ~.001
i~
SY S3O,OO I $23'001 Slo.ool t ~ CC>. C; 0 I
.,+"'-' . '~O .
"5(:) LF $6.00! :::1
I
I
SF S4'SOi SI.151 I
I I
i I
I I
EA
$40,001 I
Lf S60.oo : $20.00 I
I
LF $65.00 i ~.001 $38,00
I
I
LF S70.OO I S60,OO $52,00
LF $80.00 $68,00 $59,00
LF S9O.OO $7S.OO $65,00
LF S 1.20 I $O,7S $0,60
EA S1.6OO.OO I SI.3OO.oo SI,oo.>.oo
EA SI ,400.00, Sl,loo,oo S9OO.oo
!
I
I
I
EA S2,OOO,OO' SI,6OO.00 SI.3OO,OO
EA S700.OO I $550,00 $4SO,oo
i
: 4- .!':: SF $6.50, S4.5O $2,7Sj::lt, ~C) 'C,..,.
I
I
! SF S7.S0 $5,501 ~,7S
Page 1 of 4
ITEM,
NO,
DESCRIPTION
3. FURB AND GUTrER
I
4, ~ ALLEY GUTrER
too LF
5. HANDICAP RAMP
,
6, jrYPE B.I CURB
7. IfYPE AI-B3 CURB
8, FOBBLESTONE MEDIAN SURFACE
!
9. P,C.C, DRIVEWAY CONFORM
!
10, ~,C. DRIVEWAY CONFORM
:
V, PAVEMENT
,
I. ~SPHAL T DIGOUT AND REPLACE
1
2, rA VEMENT WEDGE CUT (6')
i
3, "A VEMENT GRINDING
4, ,PAVEMENT FABRIC (PETRO-MAT)
5. ~SPHAL T CONCRETE (TYPE A)
6. AGGREGATE BASE (CLASS 2)
7. SLURRY SEAL (TYPE II)
VI.
,
,
8, SLURRY SEAL (TYPE Ill)
~mc SIGNALSn..IGHTS
I, jETEcrOR LOOP (6' ROUND)
2, pETEcrOR LOOP (6' x 30')
3. pETEcrOR LOOP (6' x 50')
4. ~LECTROLIER
5, 11/2' RIGID CONDUIT
,
I
6. 2" RIGID CONDUIT
27-Jun-96
UNIT PRICES FOrt ...l/ECT AMOUt(J'
< S30K S30K IOS150K > SI50K
$22,001 SI8,OO
I
1
SF
SI2.50'
,
1
EA
I
LF'
I
LFI
I
SFI
I
SFI
SI,200,OOI
$12.00 i
SI5.001
1
SI2,OOl
,
$7,001
I
!
~'50I
!
55.00!
!
55,OO!
SF'
I
i
I
CFI
I
LFI
I
SF'
!
!
$0,801
I
S2,OOl
I
~,ool
i
1
1
$40,001
I
$0.07 i
i
,
$0,111
I
$4SO,OO i
I
SYI
!
TI
!
1
TI
I
SFI
1
"I
I
EA!
I
1
EAI
I
EAI
EA
i
LFI
I
LF'
S6S0.00 i
i
S900,OO I
I
$2,600,00 I
S9'OOl
SI7,OOI
SIO.OO
$800,00
S9.50
SI2,OO
$8'001
55.50
I
$3.75
$3.50
$2.50
$0.50
S1.85
SSO.OO
$20,00
$0,06
$0.09
S3OO,OO
$S4O,OO
$750,00
$2.200.00
$7.00
SI3,OO
Page 2 of 4
S2S0,OO
S440,OO
S640.00 I
SI'800'OO,
55.00,
Slo,ool
S AMOUt(J'
SI5,OO <%.l,,> 1-0 ~ (:)
$8.251
,
I
~,ool
$7.50 [
SIO'OOI
55,00
~.50
$3,00
$2.50
SI.50
!
$0.35/
SI.50'
$35,00
S:::I
I
$0,07
,
ITEM I
NO. , DESCRIP'I'ION UANTITIES i
! < SJOK S AMOUNT
7, fONDUcrOR lFI $0,701 $O,SSI
,
I I
~Ull BOX (NO, 3 1/2) ,
8, EAi S3lXl.OJ , S24O,OOl
1 I
I i
9, PUll BOX (NO, 5) EAI S4OO.00 ; S35O,OO I
i ,
I
I VII, ~IPING AND SIGNS
I. EMOVE PVMT, MARKINGS (PAINT) SFI $2,50 SI.SO SI.OO
,
I
2, ~EMOVE PVMT. MARKINGS ITHERMO) SFI $3,00 $2,00 SI.4O
1 I
i
3. REMOVE PVMT STRIPING LFi SI.40 $0,80 $0.40
~ ,
I 1
4, FRIPING DETAIL 9 LF! S1.35 $0.85 $0.35
I
5, RIPING DETAIL 29 LFI $2,2S SI.6S SI.20
,
6, RIPING DETAIL 32 LFI $2,40' SI.75 I SI.2S
I 1
I ,
7. RIPING DETAIL 37 (THERMO) LFi SI.8S SI.SO Sl.oo
!
I
8. ~R1PING DETAIL 38 (THERMO) IF $2,SO, SI.85 SUS
9. r~~A" LF SI.SO' $0,85 $0,45
LFI
10. FRIPING DETAIL 40 $2,20; SI.70 SI.OO
I I
i LFI
,
II. liMIT LINE S 1.35 SI.OS $0,901
I I
12, ~R_~ lFI S1.35 SI.OS $0,90
i
i
13, A VEMENT MARKINGS (PAINT) SF S2,50 SI.90 SI.60
I
14, fAV<M',," MAR'''''' IT'''MO, SS.50' $3,80 S2.60
15, AVEMENT MARKER (NON-REFL.) EA $4.50 $3,00 $2,20
i
16, J>AVEMENT MARKER (REFLECTIVE) EA $6.00 $4,15 $3,151
I
17, rYPE K MARKER EA S95,OO i $80,00 $70.00
18, trYPE N MARKER EA S95.00 i $80.00 $70,00
[ALVAGE ROAD SIGN EAI I
,
19. $85.00 , $75.00 S6S .00
I !
i i
20, rELOCATE ROAD SIGN EA SIOO,OO I $85,00 $75,00
I
21. INST, RO, SIGN ON EXIST. POLE EA $200,00 I SI45,OO ,$110,00
I I
!
ROAD SIGN WITH POST EA S300,OO I S240,OO SI95,OO
<:::>l~lIk540..0. ~'-.J r-"" I "1';:0. r~
,
."....~"T\Z-\ (~l~"" t L<' cJ. ""~..c
. ",.
27-Jun-96
Page 3 of 4
rrEM !
I
NO. DESCRIPTION
VIII. ~SCAPING
I
I. ~~RIGATION, PLANTING WORK
~-, ')(.. l~' ,.c:, ~b .Cl~)
2. rRUNE TREE ROOTS
I
3, ~REE REMOVAL
4. ROOT BARRIER (12")
I
5, ~ooT BARRIER (18')
i
I
6, m'REETTREE (24" BOX)
!
I
7, ~REET TREE (36" BOX)
I
8. ~OP SOIL BACKFILL
I
I
IX, ~lSCELLANEOUS
EDESTRIAN BARRIER
I.
I
2, FHAIN LINK FENCE (6')
I
3, rAISE MISC, BOX TO GRADE
4, RAISE MANHOLE TO GRADE
I
5, ~NSTALL MONUMENT BOX
I
6, MEDIAN BACKFILL
PREPARED BY: CSC3a-
REVIEWED BY:
APPROVED BY:
"See Section 66499,4 of the Map Act,
H:\CECOSTEST, WK3(MP)REV6/3/96
27 -Jun-96
UNIT PRICES FOR ,JEcr AMOUNT
UANTmES < S30 K
~ "'''"1
LSi
\
EA SI25,OO
EAI $6SO,OO I
LF' $20.00 I
Cio LF; $25,001
-.; S- EAl $4SO,OO
4
EA S'lOO.OO I
C> ":4L\~+
LF S75,ooi
LF' SI5,OO
EAI $300.00
HI $400,00
E.... $4SO,OO I
Cy SI9,OOl
30 K TO SISO K SISO K
SIOO,OO $8S,OO
SIO.OO
SSOO,OO $400,00
SI5,OO
$325,00
$SSO,OO
Sl1.SO
$60,00 $50.00
S2OO.00
$275.00
S3S0.00
SI7.00
S AMOUNT
;-"l"'a>. "'0
$6,00
SIO.OO
J....~<;;;:<..:::)
S2S0,OO
...."1- ~or-~<='J~ ~"-'
$400,00
<t.4'-~, u.:,
S9,25
SI75.00
S2OO,OO
$300.00
10S SECURrrY ENFORCEMENT FEE
TOTAL ESTIMATE FOR FAITHFUL
PERFORMANCE SECURrry
Page 4 of 4
c,