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96-219 C:"; (:J. U.~.;F:':'':'..;. I 8 DEPT. OF PUBUC WORKS i II 70 North First St. \J~.l-... Campbell. CA 95008 <1'~ ') (408) 866-2150 " . \V f'V) Fax (408) 376-0958 ~~' ~\l:t~ o ~\\^\C\ APPLICAnON . Application is hereby IIIIIde for a Public Worts Pamit in ICCOI'daaI:e wiIb Campbell MuaicipaI Code, SecdoIIl1.04. (Applic:aioD apinl in 6 IIIDIW t-' '1 if lbe permit is not issued. Applicllion Fee is IIOO-refundable.) A. Work address OTlnICt' ~q~ \. ""'"S. \)\...{1tJ.-....:)C-\:""'"'~--S~l 2 (for working within the public right-of-way) Issued i / " } ql Permit expires in 12 mos. ) 1':r::,'( \' q~~- ~ \.9 . ----- X-Ref. file l>1'> ~ - \ 9. E.~\Cf,"~,\,~'~:=].i~\:~\':' .FE~~:._ Application Date ~-,- \~ ~ Application expires in 6 mos. Utility treIICb IocItion B. NIIIIre of wort -::; -rr-z..-E~ t (}--\;t:::>~~vt.. ~ ~ C. Au.:h four (4) copies of III qineered pWJs lbowiDa lbe IocaDoa and emal of die wort, and four (4) copies of die pnIlminary ED,iDeer', IiIIimMe 01 wort. Tbe pWJs IbaI1Ibow lbe relation of lbe propoIed work to eUtiua 1IIIf_ and UIIIIapowad ~. WbellIIppI'CMId by lbc City ED,inecr, aid plan IIecameI a part of lhis permit. D. All work shall conform to the City of CampbeU Slandard Specificalioas and Delai1s for Public Worts CoosIruction; lbc Genera1 PamIt C'......iQca lilted on lbc reverie ,ide; and the Special Provisions for this permit, lisled below. Failure to Ibide by lbcIe c:oaditions and provisions may reauIt in job lbut-dowu lIIIdIor forfciIIIre of Faithful Pllrform&lll:e Sureties and cash deposits. (See Genera1 PamIt Cooditions 1 and 2.) E. THE CONTRACTOR MUST HAVE TlDS PERM1T AND APPROVED PLANS AT THE SITE AND MUST N011FY THE PUBUC WORKS DEPARTMENT AT ~ TWO DAYS BEFORE STARnNG WORK. NOnCE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Name of Applicant <"5: c:::: W-\..A..JJ"-~J.- ~~W l ~ U-.:::>c.:: T~ (print name) C\ c u cL-L0 2411>UR EMEItCiEI'CY Address ~~ \..~ 1--1.-) ~'-.{ET ~ .1.9-=-1.' '"'l- TELEPHONE NO. 4lC:f~---Z~4-~L:~4- ~~-~~~-~-n- Is this work beiDa done by the property owner Iltheir own relidence? Yes ~No Tbe ApplicantlPennittee hereby agrees by atr11iDa their 'ipalure to this permit to bold lbc City of Campbell, ill ofticcn, .... and ~I~ free, life IIld barmIeu from any c1Iim or demand for damages relultin& from the work covered by this permit. Tbe Appl' information. :- .. (\~.... ..'\~ ~ "'...... ... ............. "'" wi! -- _ _l .. '" '-J ~ Vl-- ce..-\. ~ -, ,,-.,. (Applic:autlPamittee) (sian) Dare Ac:c:epted cr~ ';., ,:::.. (f:..~\:~ .L :.__ E:',G.,)f.ClL\;'::';!\T r:L.;:l (for working within the public right-of-way) l.';..; :~ ~ i ~ !',-. ~f17jl-- DEPT. OF PUBLIC WORKS 70 North First St. Campbell. CA 95008 (408) 866-2150 Fax (408) 376-0958 X-Ref. file Issued Permit expires in 12 mos, Application Date E/l3 Ii r; Application expires in 6 mos. APPLICAnON - Application is hereby IIIIIde for a Public Worts Pamit in KCOCMoc wiIb CIqJbeII MuaicipaI Code, SecdoIIll.04. (App1ic:aioD apinl in 6111D1W if the permit is not ilsued. Appliclrlon Fee is IIOO-refundable.) A.Wortllldress orlnlCtl -??,~/ 5, ~~/7c~~/A/ Utility treIICb Ioc:lItion B. Nllllreofwork sh~d <y.~~-W~~ c. AlIIIdI four (4) copiell of III qineered pWJs IbowiD& lbc IocaDoa and emal oIlbc wort, and four (4) copiel of lbc pnIlminary ED,iDeer', I!ItimIIr: of wort. Tbe pWJs IbaI1Ibow lbe relation of the propoIed wort to eUtiua IlII'fa:e and UIIIIapowad iIIIpnn.eadll. WbellIIppI'CMId by lbc City ED,iDeer. aid plan lIecameIa p.n of lhis permit. D. All wort ,hall conform to the City of ~ Slandard SpecificItioos and Delai1s for Public Worb Comtruction; lbc Genera1 PamIt r......itioaIliIted on lbc reverie ,ide; and lbe Special Provisions for this permit. Iisled below. Failure to Ibide by lbcIe c:oaditions and provisions may reauIt in job Ibut~ lIIIdIor forfeiture of Faithful Pllrform&lll:e Sureties and cash deposits. (See Genera1 PamIt Coadilioos 1 and 2.) E. THE CONTRACTOR MUST HAVE TlDS PERM1T AND APPROVED PLANS AT THE SITE AND MUST N011FY THE PUBUC WORKS DEPARTMENT AT ~ TWO DAYS. B~ORE STARnNG WO~. NOTICE MUST BE GIVEN TO PUBUC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Name of Applicant L), { I { II M r lU1~ ~ l q S-' T~ L(o~ J~I)'1 ~ ~ , I 0 (print twDe) 24 II>UR EMEItCiEI'CY Address-WLr Ai "\ AlJE#'; <l ~ ~..... J;;~.-A- rA- fs;t '0 TELEPHONE NO. C{O~ -J.P.); 74 yJ ~~a l-~ 11 this work beina done by the property owner at their own reaidence? Yea No . L>'\~ - \-l~+ \ - CCl:,,1.?~ ._~'t-~-~~~~/L The ApplicantlPenniaee hereby aarees by atrWna their 'ipature to this permit to bold lbc City of CaqJbe1I, ill ofticcn, .... and employeea free. life and bannIeu from - -r any claim or demand for dama&ea relullin& from lbe wort covered by this permit. The ApplicantlPennittee hereby actDowledpl tba lbey bave read and lItIdentand both lbc froal and bal:t of this permit. and lbey will inform their CODa'ICtOr(s) of tile information. Accepted WORKER'S COMPENSATION INSURANCE INFORMATION The following worker's compensation insurance information is required for all Applicants and Contractors. One of the following items for each Applicant and Contractor must be submitted prior to working under a Public Works permit or contract. WORKERS ' COMPENSATION INFORMATION: Name of Contractor/Applicant ,rc It to C2qQi ./)a I' (..f v It! C , o A Certificate of Consent to Self-Insure issued by the Director of Industrial Relations; OR o A Certificate of Workers' Compensation Insurance Insurance Co. Policy No. Expiration Date ; OR IS' A signed Certificate of Exemption from the Workers' Compensation laws as printed below. CERTIFICATE OF EXEMPTION I certify that in the performance of the work for this contract, I shall not employ any person in a manner so as to become subject to the Workers' Compensation Laws of California. Signed kd/ QQ.. ~ Title -f~+ Date I) -.f D-56 NOTICE TO APPLICANT/CONTRACTOR: If after signing this Certificate of Exemption, you should become subject to the Workers' Compensation pr.ovision of the Labor Code, you must forthwith comply with such provisions or the Permit or Contract will be cancelled or revoked. j: \fonns\ wor kcomp(rev6/96) ENe' lACHMENT PERMIT ISSUANCE Cl ~K LIST '- City of Campbell Department of Public Works Encroachment Permit No. avo - -z.. \ ~ ITEMS REOUIRED FOR PERMIT APPLICATION: ~ -\ ~ ....el <C:. ~- ~'"S; -<=ic.. ~ -\~-.qb Applicant section complete Applicant signature and date (front and back) Permit Application Fee $225.00 paid - Receipt Number qs4-=!.-, Engineer's Estimate submitted ~- ~~ Plan Check Deposit paid (2% of Engineer's Estimate, $500 min) Receipt Number 9.~~ ~--~-'::'..~ c.. Five sets of improvement plans submitted ITEMS REOUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS ~-lq-9<- ~-l~ ~ ~.:o- -l ~-'-( "'" Plan Check & Inspection Fee: If Engineer's Estimate < $250,000, then 12 % of Engineer's Estimate. If Engineer's Estimate > $250,000, then Actual Cost + 20 % . (Deposit of 8 % of Engineer's Estimate required; $30,000 minimum deposit). ~\~.~~ ~~ 1t.~~-~~~ StcurUY-forFaithful Performance and Labor and Matenals, 100% each of Engineer's Estimate, supplied or paid. ~t~ Amount $\-"2.... C::c:>o. €C:> Form C,r::::.<"~ LD. #.1a;: 9.~~'S Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 maximum) Amount $ 4~. (>e;> Receipt No. q~:;:-::;; ~Ca. 'L.-'~-q,= Worker's Compensation Insurance Information Sheet received for Applicant. \""2--:2~ _ci'-,=- All other Public Works requirements listed in the Conditions of Approval of the development. ITEMS REOUIRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: ~- \~-=t~... Contractor's signature added to the permit application (front and back) ~""""c.o--9c.. Worker's Compensation Insurance Information Sheet received from Contractor. e - GC:>- 9<.... Certificate of Insurance with Additional Insured's Endorsement received from Applicant or Contractor. \-"l-c.:rz /-7-47 One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped APPROVED FOR CONSTRUCTION. Permit signed by City Engineer.{ ;,~ hi. ) WHEN ALL OF THE3' ITEMS ARE COMPLETE, PERMIT MAY BE ISSUED. Issuer: Initial ~ and date y~? 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 Department: Payable to: Van CleefEnterprises Address - Line I: Line 2: 411 Park Avenue #203 City: San Jose State: CA 95110 Finance Use Onlv Description: Refundable Deposit Amount Payable: $3,000.00 (Exact Amount) Interest Earned Account Number: 101.2203 10 1.540. 7448 Purpose: Refund maintenance surety deposit Voucher #: Permit #: 96-216 Receipt #:/] 95585 Date: 8/19/96 Requested by: C~ ~ Title: PW Inspector Date: 02/18/99 Approved by: dtt-Hom Title: City Engineer Date: 02/18/99 Michelle Quinney Verified by: Title: Account Clerk II Date: Approved by: Title: Date: Special Instructions For Handling Check Mail As Is: X Mail in Attached Envelope: - - Other: fin: S:/excellchkreq - Revised 1198 To: Accounts Receivable Please Issue Check Payable to: Address - Line 1: Van C1eef Enterprises];)'-" ,-:i:' . ~"" .. ." ",".... '- . ," .... ;., "'",... ',;-;'",>,' '.-':.',.';' , , . Line 2: 411 Park Avenue #203 City: San Jose '.' , ~,;- :;'~""~' State: CA Zip: 95110 ,;"".". . , ~j:. .:' <,,;'. REFUNDABLE 'DEPOSIT . ," ':, .. ..,.. Finance Onty.; ';,',I":"l,INTEREST 'EARNED ,; (t'.: " "':..', ".<.;~; ',;.'- -'-;'-";'-'-'., $ 9 , 5 8 0; 0 ()"j;.,,' i':,", "'::',',,';',:'<.; . Account Number: 101.2203 ~",'f".".," .~.~ . 101.540.7448 ate and Receipt No: Permit No: 8/13/96 #95438, 8/19/96 #95585 $9,000 og $12,000, #95586 '96-219 Pwpose: Refund Plan Check Deposit, 75% of FPS, and all of Cash De osit after withho1din $400 (move to account . Requested by: Title: PW Inspector. Date: 5/8/9 I ~~ Approved by: Title: City Enqineer Quinney FINANCE ONLY~ Verified by: Title: Date: Date: I Approved by: Title: Refund $500 + $9,000 + $80 = $9,58 Mail As Is: Special Instructions For Handling Check xx Mail in Attached Envelope: Return To: (NAME) (Department) Other: 'Cv: 3/25/95 TO: City Clerk .. 4722 2203 4722 .. 2203 4760 4760 4760 4722 4920 4965 TRAFnC 4728 4728 4728 4728 4728 4271 4728 OTHER NAME OF APPLICANT FOR CITY CLERK ONLY 'ForPIari Cbeclcand CUh h:lrec:&m4. wk3(mp )rev7/l/96 PUBLtC WORKS DEPARTMENT RECEIPT Effective July I, 1996 2203 2203 2203 2203 2203 2203 4721 Porklond Dedication Fee POSlalle Intenection Turn Counts ITwo-Hour Countl Intersection Turn Counts (am. or p.m, Dellksl Traffic Flow MID lDailv Traffic Volumes) Campbell Traffic Model (Full Scope "-t ClU1lobell Traffic ModellReduced Scope A........entl Truck Permits No PorkinQ SillDs '.. D8Ie I Pi.... collect cI: receipt for the following monies: ACCT. ........ItEM ................. ............................. 435.535.49211 Proiec1 Revenue 'ect) ENCROACHMENT PERMIT 4722 Application Fee Non-Utility Encro.c1unent Permit ($225) R-I FintPennit(No Fee), Subleouent PennitlYr($]OO) Utility Encro8cIunent Permit ArteriollCollector Street Residentill StreetIOther Areu Plan Check Denosit - 2% ofENGR. EST, Faithful Performance Securitv (FPS) Labor ond Moterills Securitv Monumentation Security Cub Deposit Labor ond Moterill Security Pion Check cI: inspection Fee (Non-Utility) Engr,Est, < 5250,000 Enl!l',Est.>$250 000 Utilitv < $] 00,000 Minimum Clwxe Per Location ConduitslPipelines up to 500 Feet Above 500 Feet ManholesIV aultsIEtc. Pole SetlRemoval Street Tree PlontinlliRemoval Utility> SIOO 000 Proiect Plans cI: Snecifications Standard Specifications cI: Details Cooies of EnQin~nll Malls cI: Plans Penllties: Failure to restore public improvements (Mun; Code Section 11.34,010) 4722 Penalties: Failure to COrTect unsafe conditions LAND DEVELOPMENT 4722 Lot Lin. Ad'ustment 4722 Parcel MID (4 Lots or Less 4722 Finll TI1ICt Map (5 or More Lots) 4722 Certificate ofComnliance 4722 Certificate of Conection 4722 VlIC8Iion of Public Streets cI: Euements 4722 Assessment Segregation or R_portjonment First Split Each Additional Lot StonnDrainag. Area Fee Per Acr. 4e/UiJ.d..44' A~tL'::J JXC:' (J ~ NAME OF PAYOR 1)12 /) (!Ltt;(1 ~-yJ 7; ~ 1... /I '<:~---a.../ -' / //.. t'/, /;; #' '- ADDRESS y// r-H".hAt' V/L,..,-" 7J/' .;)/)3 "Actual Cost Plus 20'-4 Overhead (Non-Interest bIllrillll depositl .. ~ A...~,,-,f2..e.-. .y.llowcopy.toFillllllCti.... PUBLIC WORKS FILE NO, (/ tfJ " ~ / 9 PROPERTY ADDRESS (;( f 3/ /..;1 it1: ild/u" ;/C[/ AMolJN't . . S $325) S225) S500 minI 100% ofENGR,EST.) 100% ofENGR, EST. ]00% ofENOR.EST.) 4% ofENGR.EST.XS500 minlS]O 000 maxI 100'-4 ofENOR. EST,) · /.'1 r/ /,// ~/(') 't ~L'. O'll (12% ofENGR, EST.) IDenosit 8% ofENGR. EST.1$30 000 min.)" (8% (SI20) (SI.6O/ft) ($ 1.1 0Ift. ) (SI05/08) (S]05/08) (SI051tree) Actual Coli + 20'-4 .. Proiect No. (SIIPQ Sl2lBook (S.50/sa.ft.) $ 1 OOICaIendar Day) /ij't/c, &C (S]OOICllendar Dav) S5(0) SI 060 + S251Lot) SI 380 + S251Lotl S5001 S3(0) S550) (S550) (SI70) (R-l, S2,OOO) (Multi-Res, $2,250) (All Other, S2 5(0) $60) SI25 S27) $2 250) S74O) S351trip) $ I/each or 525fl (0) TOTAL $ Ig ~.,(// ~-- / PHONE ZIP 9'5//~--; . . . . -, ,(t.... r-~ ~ V to .' .......~ ~ -, >'I~"'i1l__ AUG 1 :1 t~,;~;6 (''cT\f CI r';)III,'<: OFFICE ,:11 L,..\ v ~ u '-C. 0:. ~J 0-. c. eo eo c;::. ..... c;::. en ..... a: '-0 Q:: '.0 0-. wo_....... s: ti~ 2:; LLJ,~ A:ol::::;r.:bc;::. ex; L.U 10 .. ~d':':'~ -' ...-'<%; .. ~ ~ -'=I >-:::> = A:o cnLI.I S!Q:>.E; c...:1~~- ~!~~~ ~ -' c;j = 0- x: <C U ~ >- ...- ..... u co c;::. -. C!'. ...., .. -..a ..... ~ - I-- I-- ~ = x: ~ c. c. . c;::. Cl:I .::I" - .:=) = . g <4" - c::> Co c:.... c::> 00 c:=- 0""; 0:) 0:' -.:1" ....,. ..... - '4) ,...,) .. ~ = ...... .... .. <C C) 0::::0 Q- ::z:: Li.1 ..'" """ f:5 ~ c...) 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L..\.J = <t: ::::' ::x: l..U ::x: (...,1 u...... c...:. c;-.. 00 <::> ~ <::> <::> .., 0:::> . 0:) .. g 8: I}S ~ <::> c::> a- u ~ .. 0 '.0 C'..J ('o..J C> .... .... .... C> ..,.. - 0:::> ~I:=:- 0 W ..... fC) .:=:. 'G: .... <::> <::> =-= :z:: . . C,..) .... =- c:::- o::::>- .. en ..... e o:::~ 0::::> ..... :;E:: c:.:: ~ -' ff ...:3 <t: u:I ~"'J C'.J I:t: -...c' 0' ~ ..... - ,:lQ I..LJ 0-....... - ..... - a;)... 0 :c.: 1--......0'0 - <C =0-.- C,..) L.I.J-.......... = .... ...... 0::0 :z: <C La.. u... exl -:O.a ::J ...... 1(':' Q ~l..LJc. La.. CI <C. L.IJ . . ...... t-":1 >- en -' .. ....., en .. ~ ...... -C,..)I..LJ!:C:i: :z::: I- .::=0 - ....:z::~= c::. - ~ .. .. C,..) ..... en <J:: c::. 0:::::. .. <t: ~, ......e ~ :::> c.r:. ffi "- Q.. Q... ::z: ~ ~I ...... ....... ~~ :ac::::O<:LL.I= ~IX>-(f) 1:.-) c..;s = :z:: :> c:o <r. ..... e.,;. u.J u.1 ;z:: 4. ~::;:@:ffi en La.. Ei5~5 L.LJ LL.I c:: a;)... ...... 0:: c::. a::: ............... ....... ....... ................ VAN CLEEF ENTERPRISES, INC. 411 PARK AVE., NO. 203 SAN JOSE, CA 95110 3536 90,78/1211 l!~ ;~\HE f) iL f) 1l0RDEROE l~- i (';.~ i::!~~~ P~l~c;efR.(!~ i.:m.. San Jose Main Office , 50 WEST SAN FERNANDO STREET ,11 . SAN JOSE, CALIFORNIA 95113 ii BANKHf.WEST (408) 947-5030 v-- n 19~ I $ L/va~ -z:r~ .,/ (i'" I!l.... ~LLARS m=~_leatures DetaIls on back 'I FOR~AP~~ C~lLrA~ :i 11100 ~ 5 ~blll I: ~ 2 ~ ~oo?B 21: ~J ) -0 J 00 ~ooL,q 5 2~11 '-" M' ......... ........ ...... ....... .......,..... ................ ................. ............... ................ ................ VAN CLEEF ENTERPRISES, INC. 411 PARK AVE., NO. 203 SAN JOSE, CA 95110 3535 90-78/1211 '9- 19~ PAY ,~~~~OE (Hi/-r~~QO .,il ~/I~ ~,n.r..,. ~D ~A--" r 0.0 ({.'"> ...... j,.:m.. San Jose Main Office 1\:.u 50 WEST SAN FERNANDO STREET I . SAN JOSE, CALIFORNIA 95113 I:: BANKHf.WEST (408) 947-5030 I FORg",~ ~ ~b-C-~ ::! IIloo~S~SIlI 1:~2~~00?B21: "1' '. .................... - -............... - .................. - .................. _................ - ................ - .....::.~.,:.~;... _ DOLLARS m =~'.a,"," Details on back C,t~ 00 ~ooL,q 52111 M'l ... .. ....... ........ ........ ................ ....... ....... ....-.... ....... ....... ....... ................ ................ .................~ ................... VAN CLEEF ENTERPRISES, INC. 411 PARK AVE., NO. 203 SAN JOSE, CA 95110 3962 90.78/1211 V""'-- 1CL $ Itfl(o e:-- DOLLARS m~~;e~teatures Details onbacll M' tUBLIC WORKS DEPARTMENT RECEIYJ' Eft'ective July I, 1996 TO: City Clerk PUBUCWORKSFlLENOE~q~ -l,/f ~t7(/ /. /- L k_ PROPERTY ADDRESS -....r PI_ collect & .-ipt for the followi"l monies: ACCT, ", rt.EM........... ........................................ <AMOIJNt:<<.. 435,535,4921 Proioct Revenue S ENCROACHMENT PERMIT 4722 Application Fee ~~/J' Non-Utility Encroochment Permit (S225) R-I First Permit (No Fee ,Su~uent PermitlYr ISIOO\ Utility Encroachment Permit ArteriaJlCollector Street sn5 Residentilll StreetIOther Alas S22S\ 2203 Plan Check Deoosit - 2% ofENOR. EST. S500 minI . 'J/D 2203 Faithful Perfonnance Security IFPS) 100% ofENOR,EST.\ . 2203 Labor IIId Malerillls Security 100'~ ofENOR. EST.\ 2203 Monumentation Securitv 100% ofENOR,EST.\ . 2203 Cuh Deoosit 4% ofENOR.EST,\lS500 minl$lO 000 maxI . 2203 Labor and MaIeriaI Securitv 1000~ofENOR, EST.\ . Plan Check & Inspection Fee (Non-Utility) 4722 EnIll'.Est. < $250,000 (12% ofENOR, EST,) .. 2203 EnIll',Est.>$250 000 ~1 SO~ ofENOR. EST.1S30 000 min. .. . 4722 Utilitv < SIOO 000 lSO/,\ Minimum Charge Per Locadion (SI20) ConduitslPipelines up to SOO Feet (SI.60Ift) Above 500 Feet (SI.101ft,) ManholesIV ault&IEtc. (S I OSteal Pole SetlRemoval (S I OSteal Street Tree PlantiDl./Removal iSI05!tree) .. 2203 Utilitv > S 1 00 000 Actual Cost + 20% .. . 4760 Pro' oct Plans & S_ifications Pro'oct No. 4760 Standord Soecific:ations & Details ISIIPR S12IBook\ 4760 Cooies of EnRineerin.. Maos & Plans IS,5O/oo,l\. ) 4722 Penlllties: Failure to restore public improvements (S 1 OOlCalendor Dov \ IMuni Code Section 11.34,010) 4722 Penlllties: Failure to correct unsafe conditions is I OOlClllendor Dav\ LAND DEVELOPMENT 4722 Lot Line Adiustment $SOO\ 4722 Parcel MIlO 14 Lots or Less) SI 060 + $25ILot) 4722 Final TIlICI Man 15 or More Lots) $1,380 + $2SlLot\ 4722 Certificate of Comoliance S500\ 4722 Certificate of Correction S300\ 4722 Vacation of Public Streets & Easements S55m 4722 Assessment Segregation or Reapportionment First Split (S550) Each Additionlll Lot 1$]70\ 4721 Storm Drainage Area Fee Per Acre (R-I , $2,000) (Multi-Res, S2,250) (All Other, $2,5(0) 4920 Parkland Dedication Fee 4965 P_e TRAmC 4728 ln1eneCtion Turn Counts n wn-Hour Countl $60\ 4728 Intersection Turn Counts (a.m, or p,m, -u) SI2S\ 4728 Traffic Flow Man IDailv Traffic Volumes\ S27\ 4728 Cllmobell Traffic Model (Full Scone AlIIeIIIIIenO S2 250\ 4728 Cllmobell Traffic ModellReduced Scone Auessmentl S740\' 4271 Trock Pennits S351trin\ 4728 No Parkin.. Silllls SlIeach or S25/100\ OTHER TOTAL S ?d~ L,/_A ~ /~.. ~/- _ L- NAME OF APPUCANT /.'./17/ ~ j/ /':',.~ "/ NAMEOFPAYOR~- ;?k~~2~_A 1J~;~ ~~, . PHONE Y/J,f.. 295- F/';" - '::] ADDRESS P// P- -/ ~I' Y7T'/ /)~ ,- ZIP 4~//d c:;:"At' '2;, . f7L1 . "Actual COli Plus 20% Overhead (Non-Intcn harin.. cleoosit\ v FOR .. ,..... ...L>lf OTY O-ERK RECEIVE ONLY ............. ..... w""' .. ..,. <I (I, t"' "For P.... Check and Cub Deposits, send yeHow copy to .Finance.' b:Irec:fnn.4. wk3(mp )rev7/1196 <<r~~~ o AlIG 1 3 1~9o C\TY CLERK'S OFFICE "'f !~ .' j" j t , " ".~.!'~~I ,t.'; ., I ',~', " , '.' ,,' " .'" ."i. ." .'l } : ;':?, ';~ ~~~..J.~~'" "~,").~ ~(~ ,I i , ;~ , " '" ~' l' .....{'\'~ l '4 '.ll''',.)'. .~,f" It .1-...'.., \ '1~.""". -t, . 1\ .-" " ,.'\J.j~ '- ;,"lr"","~ 1.,,~1..1 )...',},...."-~\'/.1.1-~'."",,:rl.\....:...~~.~'\~""1......r:'. ~~, . :"'<,")o'",~,;;" ,';-""',;':<',\,',: .:.'".',~~"..,::\~~\ t.:'~I;}i..'~,).i:~"\:,'/" \ 1 \ ", t \,'" x '~ 'l\'~ '\' ~,' ,!," ..~.' "6, ,..':~'\' ~..r/~'~j ": ::...,'.;..:.;~..~;,:,":;'~{.:,,~>'; " t.>.:~.'><.,{~.,,; ~:>:.:~'" ,:,,:,;,,\.~~:/\;~'.:~.<~\.'" :' .:.;' :.:.~I.., ,.....1:. ')~'~~" ,\\":.,.",'" ..' :;~.. ". ',; . :" ":""~"'''~:I'!':' , ' j ~ . ~," \,'~,,~~,. '/' ~?,f; .'~.'i'.J.:: (..,. H,"I." ~ t\~"" ill~J:' )': ..' ~ ~ ,;~) J >.- l~ ' 1 ., ',. ",., ',\! '. '.:1 I)t,t~~))~.".~ . j' ",\ . ',...... ..", ~\\ , " ,,,.f,, l, ~ .,'- _I, " ';."'i" ..4 ~Jf)" \ ,I I,', "~ l~ \~. ,(~ '.',1.. ,(! J ,_' .' 1'1'- \ J\~~'~:,\,~::l~. ~~: ,'- " . :<" . :,' ,.'. ",.,'.. ..~':':...'..?y/::~~:.I> . . i " ,; '.\,'. CITY OF CAHPBELL, CA ,II' " ". , . ','j.~, : , '" ".\ ~ .". ~ , 'I" 'I,' t':. '",'. \;;",', ~ . ,~; , .' geP.~~ ~ oJ' 'I :1 CITY OF' CMPBaL, CA RECUlI BY: .MHH ' PAYOR: , IJM ClEEF EHTERPRIS 01000095438 TODt\y'S MTE: 08/13/96 . RE6ISTERJlATE: 08113/96 TIlE: 11:06:28 ,/~);t':a;'lr;(:',<~,," ' ECR!PTImf" : REF JEPOSIlS FUHD 101 AHOOHT , \.. " . 11 $500.00 '},~;(1 TOTAL DUE: ---- 'j'.;,~.; $500.00 ClEf PAID: DECK III: 3947 TEHDEREDr aw&: ,RECUD BY: JANH .01000095437 PAYOR: VAN eLEEF ENTERPRIS TODAY'S DAlE: 08/13/96 REGISTER DATE: 08/13/96 TItlE: 11:05:49 'IESCRIPTIOH AHOUHT ENGR & SUBDIV FILING F $2Z5 .00 --- TOTAL DUE: $225 .00 CHECK PAID: t225.00 QECK NO: 3947 TENDERED: S225.oo CHAHtI : $.00 i '. , j ; .' I , '. ! I , : 1 <' . , , i , i I ; " \ 11; " . t. .. S5oo.oo , $500.00 $.00 .. ',I ,;.t "', " ~ ,I '. ! . , 1 -, ., , '. , , \ , , .'i ""':::\<[.'.: I " ,,:,.,;'I;'r,' i ' ",r'.,'", . I' ) " ':), Jl, \ . ,i;" ;' , . , J J f.; ...." ..t \ ,~' :'\ l1li',,\-;.;.. ,'\ ,.tf,~. .. ': : '. c..' ~~J' ?',"~I, '1"" .p 1,.' ," "f.,' ~.~" ' .o' (,'" .. . /', ,'~!1 ,,) f\)- . i JI .... ,)~,t. ~....,.. )~..~ ;.,;j~1 f'" "~- > ,.': I,. t, If,. 7'~..l'.:t'I':~'.f'~.') 'f,t , ;.t.Mi."'~:\I":JS1~.p\~t\;\:.t ,.'~" " 'r" ~il.,,1' '~'''1."t''.J{(l(t't''''I.~)~ ) f "l' '.' .~~, .., \, ..,... I "......)... ."~" ~'t-A.t:l.."!\ t 1 I,' :;," I I'" l'~ i ~, :. . ) ~ " l" \~ '.. ,... :.,~ ;"'1 l.~t-'l , 'C ' ".,.,. ' " '):\{';f':~~;;Y? ,." t'r ,.1. c ' ,;:, ,,:':'~. ..: 'f~ ~ ' . ! '! ,"f' I' .: t :. .'i;:';;~> }, f '" ;, . ,j ,',:" ~~< J' .~ ,~,~: ',~~ '.: j . , ,. , , ' :",1, " r~ " I'. ,\.,,1 <, \:' l.\l ., INSURANCE REQUIREMENTS CHECKLIST Permit # Cfe:,..- d1 If 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: ff $1,000,000 per occurrence, and ~ $1,000,000 general aggregate limit applying separately to the project, and W $2,000,000 general aggregate limit. /' . . "~ o Policy expiration date 5-11?- f7 l f2 ~ ,l <- ('>,OlJ <2)Cf'''~/J<6!i''~ Automotive Liability - "any auto" g- $1 ,?OO,~ p~r accident for bodily inj~ and property damag: ~('v~ 6) I ~ 1C1 ~j o Pohcy expIratIon date 5---/! - f7 l~U~ -- (YOW '-I-p 9 Wq,rker's Compensation and Employer's Liability Ej' $1,000,000 per accident for bodily injury or disease ~l~.':) r;,/ZB/16 o Policy expiration date (; - 2..1 - 97l(LJ.!JV"J.}-(~J-- - no\..~ Course of Construction (i quired in Special Provisions) o Complete alue of the project o xpiration date Reauired Endorsement to General Liability and Automobile Liability Policies Add.!!ional Insured Endorsement ~ The City, the City of Campbell Redevelopment Agency, its officers, ~ employees and volunteers are named as additional insured. B' The insurance coverage afforded to the Additional Insured is primary insurance. ~/ Workers' Compensation Insurance Sheet Submitted o For General Contractor o Subrogation Clause Insurance Certificate Reviewed ~tialS f~ ZCJ- 7'6 Date o Copy of Insurance Certificate placed in tickler file one month prior to expiration. j:\forms\inscklst 4/96 (rev 6/96) ............................................................ ................................................................................................... ........~~~...~lltoo ...........III_'EIIII~..... ............11.............'11111111................................ . PRoDucER .................................. . .............................. ........................... .....................,.. .................... ................... ................... .........,......., .............,.,.., ................... ................". ................. ........................."..... DATE(MMiDOtVy) Schwager Davis, Inc, 500 Phelan Avenue San Jose, CA 95112 2100 ~..C.' """. f' , \ f eo . L_. \ 'II JUN 0 2 \998 5/29/98 THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Aon Risk Svcs Inc of No. One Market Spear Street Tower Ste. San Francisco, CA 94105 415-543-9360 INSURED Ca I. COMPANY A Re ublic Indemnity Co of Amer COMPANY B Continental Casualt Co, ."lie WOR,KO~ I<.OM\iilSTRAT " COMPANY C Ge r I in America Insurance Co. COMPANY THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACT OROTHER DOCUMENTWITHRESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, co LTR TYPE OF INSURANCE POL.ICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) L.IMITS GENERAL LIABILITY AUTOMOBIL.E L.IABIL.ITY B X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON,OWNED AUTOS B169018445 5/18/98 GENERAL AGGREGATE $ 2000000 5/18/99 PRODUCTS.COMP/OP AGG $ 1000000 PERSONAL & ADV INJURY $ 1000000 EACH OCCURRENCE $ 1000000 FIRE DAMAGE (Anyone fire) $ 50000 MED EXP (Anyone person) $ 5000 COMBINED SINGLE LIMIT 5/18/99 1000000 BODIL Y INJURY (Per person) BODIL Y INJURY $ (Per accident) --""."-..--- PROPERTY DAMAGE C X COMMERCIAL GENERAL LIABILITY 4003463GLP CLAIMS MADE [1<] OCCUR OWNER'S & CONTRACTOR'S PROT 5/18/98 GARAGE L.IABIL.ITV ANY AUTO AUTO ONLY, EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGA TE $ EACH OCCURRENCE $ AGGREGA TE $ $ EXCESS L.IABIL.ITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPL.OYERS'L.IABIL.ITY THE PROPRIETOR/ P ARTNERS/EXECUT I VE OFF I CERS ARE: OTHER X STATUTORY LIMITS 0007441 08 6 / 28 / 97 6 / 28 / 98 EACH ACCIDENT Waiver of Subrogatio DISEASE, POLICY LIMIT Included where requi ed by writ en contrac DISEASE, EACH EMPLOYEE $ 1000000 1000000 1000000 A INCL EXCL DESCRIPTION OF OPERATIONSIl.OCATIONSIVEHICL.ESISPECIAL.ITEMS Re: Permit #: 96-219 located at: 2931 Winchester Blvd" Campbell, CA. All work in pub Ii C right-of-way, City of Campbe II, City of Campbe II Redeve lopment em 10 ees and volunteers. City of Campbe I I 2 Attn: Dept, of Public Works 70 North First Street Campbe I I, CA 95008 SHOUL.D ANY OF THE ABOVE DESCRIBED POL.ICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANV WILL ENDEAVOR TO MAIL. 30 OAYS WRITTEN NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT, 000762000 ~ACQP6cb.RPQR!itioNi9~~) POLICY NUMBER: 4003463 GLP THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: THE CITY OF CAMPBELL, THE CITY OF CAMPBELL REDEVELOPMENTAGENCY /TS OFFICERS, EMPLOYEES AND VOLUNTEERS (if no entry appears above, information required to complete this endorsement will be shown in Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an Insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that Insured by or for you. If required by your agreement with such Insured, this insurance shall be primary insurance for such Insured. If anyone also provides similar insurance for such Insured, then that insurance will be primary, and this insurance will be excess over, or secondary to that insurance. The inclusion of one or more Insured under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. RE: PERMIT 96-219 THE VAN CLEEF BUILDING LOCA TED AT 2931 WINCHESTER BL VD., CAMPBELL CA. THE INSURANCE IS PRIMARY EXCEPT WHEN EXCESS INSURANCE APPLIES. IF THIS INSURANCE IS PRIMARY, OUR OBLlGA TlONS ARE NOT AFFECTED UNLESS ANY OF THE OTHER INSURANCE IS ALSO PRIMARY, THEN, WE WILL SHARE THE OTHER INSURANCE WITHIN THE TERMS DESCRIBED IN THE POLICY. GCD-0004 (05/96) GERLING AMERICA INSURANCE COMPANY Page 1 of 1 POLICY NUMBER: B169018445 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZA TION This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE LIABILITY SCHEDULE Name of Person or Organization: THE CITY OF CAMPBELL, THE CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICER, EMPLOYEES, AND VOLUNTEER A. The person or organization shown in the Schedule is included as an insured but only if liability for the conduct of an "insured" and only to the extent of that liability. B. CANCELLATION 1. If we cancel the policy, we will mail or deliver notice to such person or organization in accordance with Common Policy Conditions. 2. If you cancel the policy, we will mail or deliver notice to such person or organization. 3. cancellation ends this agreement. RE: PERMIT #96-219. THE VAN CLEEF BUILDING LOCATED AT: 2931 WINCHESTER BLVD., CAMPBELL, CA. City of Campbell 70 North First Street, Campbell, CA 95008 & q(,,-,).,jCJ FAX Date: OS/29/98 Number of pages including cover sheet: 2 To: Cheryl Abbott From: Aon Risk Services of Joanne D'Ambrosia Northern California One Market Spear Street Tower, Suite 2100 San Francisco, CA 94105 Phone: (408)866-2150 Phone: (415)543-9360 Fax phone: (408)376-0958 Fax phone: (415)512-2153 CC: REMARKS: o Urgent o For your review [8J Reply ASAP o Please comment The certificate of insurance for general liability and automobile liability covering Schwager Davis, Inc. which we have in file has expired. We require that we receive proof of insurance throughout the course of construction and during the one-year maintenance period. Please provide us with an updated copy of their certificate for general liability and auto liability insurance. A copy of the expired certificate follows for your reference. Please be sure to show all the same specical wording and edits that were shown on the original certificate. Thanks for your help in this matter and feel free to call me at the above number should you have any questions. . "':4.~4~lli~J._~ti!~...~<:;;2i:\;Y:_ '.;;,':7::"'; PRODUCERqq,qqqqq..qqq. q 'qq,q....qqq..q THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA TrON ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMP ANIES AFFORDING COVERAGE THIS IS TO CERTIFY THA TTHEPOLlCIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED ,NOTWITHS T ANDING ANY REQUIREMENT, TERMOR CONDITIONOF ANY CONTRACT OR OTHER DOCUMENTWITHRESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED OR MA Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. co i TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATIONI L TR I DATE (MM/DD/YY) DATE (MM/DD/YY) I , I GENERAL AGGREGATE 'JL~W Aon Risk Svcs Inc of No. Cal. One Market Spear Street Tower Ste. 2100 San Francisco, CA 94105 415-543-9360 INSURED I \VEOI ~AR , 7 '998 I ...,.,Of'KS PU6\..\C''Tf'AT\ON ...0 Mlt-US COMPANY A Re ub lie Indemnit Co of Amer COMPANY Schwager Davis, Inc. 500 Phelan Avenue San Jose, CA 95112 B Continental Casualt Co. COMPANY C Ge r I in Ame r i c a Insurance Co. COMPANY LIMITS : GENERAL LIABILITY C i-xl COMMERCIAL GENERAL LIABILITY ! i i CLAIMS MADE GJ OCCUR ~ OWNER'S & CONTRACTOR'S PROT I ! I I n I ' i I 4002537GLP 5/18/98 1$ PRODUCTS.COMP lOP AGG I $ 1$ i$ 5/18/97 PERSONAL & ADV INJURY EACH OCCURRENCE i FIRE DAMAGE (Anyone fire) : $ MED EXP (Anyone person) : $ ~OMOBILE LIABILITY B I X: ANY AUTO f------, , i ALL OWNED AUTOS ~ SCHEDULED AUTOS :')(1 HIRED AUTOS :'-X1 NON.OWNED AUTOS i : II , GARAGE LIABILITY 5/18/98 COMBINED SINGLE LIMIT BUA1069018445 5/18/97 ! BODIL Y INJURY I (Per person) I ! BODIL Y INJURY i (Per accident) , 1$ I !PROPERTY DAMAGE 1$ I AUTO ONL Y . EA ACCIDENT [ $ i OTHER THAN AUTO ONLY: EACH ACCIDENT '$ ANY AUTO A i EXCESS LIABILITY ~ UMBRELLA FORM r--l OTHER THAN UMBRELLA FORM WORKERS COMPENSATION ANO EMPLOYERS' LIABILITY AGGREGATE 1$ i EACH OCCURRENCE $ AGGREGATE $ $ THE PROPRIETORI PARTNERS/EXECUTIVE OFFICERS ARE: INCL EXCL X STATUTORY LIMITS 0007441 08 6 / 28 / 97 6 / 28 / 98 EACH ACCIDENT $ WA I VER OF SUBROGA T ION , DISEASE, POLICY LIMIT $ INCLUDED WHERE REQUIRED BY WRIT EN CONTRAC IDISEASE'EACHEMPLOYEE $ OTHER OESCllIPTION OF OPERATIONSI1..0CATIONSIVEHICLES/SPECIAL ITEMS Re: Permit #: 96-219 located at: 2931 Winchester Blvd., Campbell, CA. All work in pub lie right-of-way. City of Campbe II, City of Campbe II Redeite I opment em 10 ees and volunteers. 6 ~ 2000000 1000000 1000000 1000000 50000 5000 1000000 1$ i 1000000 1000000 1000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will. !""CA""" .0 MAil. 3 0 DA YS WRmEN NOTICE TO THE CERTIFICATE HaUlER NAMED TO THE LEFT, City of Campbe I I 2 Attn: Dept, of Public Works 70 North First Street Campbe II, CA 95008 !u:r"~.l~I~.T~ T'-YES~ ......................... . .......,.................................... . . . . . . . . . . . . . . . . - . . ................. ..................... . ...................... ...................... ...................... ...................... :3QXCQflPcim#oiiAfioNf9'g3.. 000762000 FAX City of Campbell 70 North First Street Campbell, CA 95008 Date 03/13/98 Number of pages including cover sheet 2 REMARKS: o Urgent o For your review ~ Reply ASAP o Please comment The certificate of insurance for general liability covering Schwager Davis, Inc. which we have in file has expired. We require that we receive proof of insurance throughout the court of construction and during the one-year maintenance period. Please provide us with an updated copy of their certificate for for general liability insurance. A copy of the expired certificate follows for your reference. Please be sure to show all the same special wording and edits that werer shown on the original certificate. Thanks for your help in this matter and feel free to call me at the above number should you have any questions. ........ .... ................. ... .................. ::::: ... AI1~AI1~I.I~:::::::ii,i.I!II:.fl:I!Iii,i.:A]if i.~~Il'."... "..:Sl.tpg,Lri*W\ ....PRoDucER.. . Aon Risk Svcs Inc of No, One Market Spear Street Tower Ste. San Francisco, CA 94105 415-543-9360 INSURED Ca I. .... .. ................... .......................... ...... .... ....... ........ 'i:: ':"lIlj.....III,lllIllIl:':'::":'" .. . . ...:::::>::::::::::::::::}:::<<:::::::.:..:....::::.....:::.......:::::.......<: ...::..:.. .:::::.... '::::'" .::.... ....::......... ::::::::::::::::.:.:. 8 / 1 2 /97 THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORMATION ONl Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Al TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE ......................... ... ..... ...................................... ................................... ................................. .............................. ...............,......... , ...................... .................... . ... ...... ... . ...................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . DATE (MM/DD/YY) Schwager Davis, Inc. 500 Phelan Avenue San Jose, CA 95112 2~OC t ,,,t" ~U6 1. , , . . V'l..Y'o,'" ,J.j ~,'..LL "ntA.l\ON ~O,,^\N\5 COMPANY A Investors Ins Co Of America COMPANY B Re ubi ic Indemnit Co of Amer COMPANY C Continental Casualt Co. COMPANY THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITIONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA TE MA Y BE ISSUED OR MA Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,C:'.. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ~.n I !)~,TE (MMItI"'Y'!') !)AT!' (MMIDD/YY' ' LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY GL P 1 002382 CLAIMS MADE [2U OCCUR OWNER'S &. CONTRACTOR'S PROT 12/16/96 GENERAL AGGREGATE $ 2/16 /98 PRODUCTS-COMP lOP AGG $ PERSONAL &. ADV INJURY $ EACH OCCURRENCE $ FIRE DAMAGE (Anyone fire) $ MED EXP (Anyone person) $ 2000000 1000000 1000000 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS BUA1069018445 5/18/97 5/18/98 1000000 BODILY INJURY (Per person) GARAGE LIABILITY ANY AUTO lEVIS CERTIFICATE OF I This Certificate S All Others Dated BODIL Y INJURY (Per accident) $ SURANC percedes reviously PROPERTY DAMAGE EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AUTO ONLY. EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ B 000744108 ** 6/28/97 6/28/98 X STATUTORY LIMITS EACH ACCIDENT $ DISEASE - POLICY LIMIT $ DISEASE, EACH EMPLOYEE $ 1000000 1000000 1000000 THE PROPRIETORI P ARTNERS/EXECUTI VE OFFICERS ARE: INCL EXCL OTHER ** THE INSURANCE CO PANY, HEREBY WAIVES IT RIGHT OF UBROGATION, BUT ONLY WITH RESPECT TO NEGLIGENCE ARISI G FROM THE INSURED'S 0 ERATION CO DUCTED BY HE NAMED INSURED ON BEHALF OF THE CE TIFICATE HOLDER.** DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS Re: Permit #: 96-219 located at: 2931 Winchester Blvd., Campbell, CA. All work in pub Ii c right-of-way, City of Campbe II, City of Campbe II Redeve lopment em 10 ees and volunteers. City of Campbe I I 2 Attn: Dept. of Publ ic Works 70 North First Street Campbe II, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL E~f'O'K""HI MAIL 3 0 DA YS WRmEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Stly fAILl:I"! TO MM...11I911 Nalla!:: ~IIALL IMr8SE ue OILISATlau 8ft LIADlhRV . :~""'7i'II!I';- 000762000 ..:~AcQijijCQijpaRAiloiji9~# Att.tlllt@ CERTIFICI --'E OF INSURANCE PRODUCER Commercial Lines Unit ALBURGER BASSO de GROSZ INS. 301 Island Parkway, Suite 300 Belmont, CA 94002-4110 INSURED --.--------..------------"-------.--- DRT Grading & Paving Inc. Drt Paving And Sealing Inc. 1580 Old Oakland Rd.,Ste C-211 San Jose, CA 95131 DATE (MM/DD/YY) 04/2,8/97 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE I ! COMPANY --1__~.Gerling Amer}..c~~nsllr~nce I COMPANY ! BUnigard C()mpany COMPANY CFremont Compensation Ins Co COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERTiHCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE: AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~T~ I TYPE OF INSURANCE A GENERAL LIABILITY ,X OMMERCIAL GENERAL L1ABILlT CLAIMS MADE [KJ OCCUR WNER'S & CONTRACTOR'S PRO POLICY NUMBER 4002496 B ~ AUToMOBILE LIABILITY ! X : ANY AUTO [~i ALL OWNED AUTOS U SCHEDULED AUTOS ! X HIRED AUTOS X NON-OWNED AUTOS BA612473 GARAGE LIABILITY ANY AUTO A EXCESS LIABILITY I 4002497 ~ UMBRELLA FORM i I ! CTHERTHANUMSRELLAFCRMi C WORKERS COMPENSATION AND i EMPLOYERS' LIABILITY I THE PROPRIETOR/ II PARTNERS/EXECUTIVE OFFICERS ARE: ; OTHER WN9656425504 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS 90 ~~/1...' d93/ 0 , LA) { 1'1 C.Af:J l" CITY OF CAMPBELL PUBLIC WORKS 70 N. FIRST STREET CAMPBELL, CA 95008 I ACORP2$.S(~$311ofl POLICY EFFECTIVE OLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) 04/27/97 05/01/98 LIMITS GENERAL AGGREGATE Q 0 Q~O 0 0 PRODUCTS-COMP'OP AGG $1 000 000 PERSONAL & ADV INJURY $1, 000 , 000 EACH OCCURRENCE $h~O 0 0 ~RE DAMAGE (Anyone fire)' $___~ O_L 0 QO I ME D EXP (Anyone person) $ 5 0 0 0 04/27/97105/01/98 ' i i COMBINED SINGLE LIMIT in, 000, 000 ! i +---- I E ~ E ,,, !~~rD~~~s~~)URY$ I B LYINJURY I nf>R (Per accident) f. Ii 80 ffttft- .~ 1-" ,,, . 'v::t/ I PROPERTY DAMAGE $ VuL ~, 4DM NISTRAr/;~ AUTOONLY-EAACCIDENT $ OTHERTHANAUTOONL~ EACH ACCIDENT AGGREGATE 04/27/97 105/01/98I'EACHOCCURRENCE I . AGGREGATE $ $ . $1 0 _OJlJQQQ WLQO 0 LQQ_O I ~ 07/01/96 07/01/97; X STATUTORYlIMITS EACH ACCIDENT___J1l..,_Q()QI QO 0 DISEASE-POLICYlIMIT $1, 0 QiLLQO Q DISEASE-EACH EMPLOYEE $1, 000 , 000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANYWILL~!:llMIitMAIL ...:lL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~~}(O{IJ(t~IJ/IRCG~~~ JlJKJW!~~Bt:XOlllJe )qJ6~~l)BC~n.>>l1€X AU.........T......H.O..R......I..Z....E.....D. R......E............p....~.............. WE .l?e..... '.(_\~..... '..._,~....~~'J/..~.... ... . ...... _ ... .. ... .. .PDO-,+A~DCORPORArION1993 g~~ V AND CO~F~~~.lii.r8U R~~rS "'UPON" fH'E "CERTlFIC~~~ ARS of Northern CII ifornil HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Mu ket ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spur Street Tower Ste 2100 COMPANIES AFFORDING COVERAGE Sin Frlncisco. CA 94105 COlPANY 415-543-9360 A Continentll CUUlltv Co ~ COlPANY Schwlger & Divis. Inc R. E C E ..,,:c rS'O':'-'ANYReDubl ic Indemnitv Co of Amer 500 Phelln Avenue ~ Sin Jose. CA 95112 C VII lev Forae In~urlnce Co I AUG 2 a 1996 CO'DANY . . . . . THis IS TOCERTIFY THA T THE POLlCIESOFINSURA~hftitij~WliINE BEEN ISSUED TO THEINSURED NAMED ABOVEFORTHE POLICY PERIOD INDICA TED, NOTWITHST ANDINGANYREOUIREMENl':'TCRMTIR'ccmrnrrt:lNOF ANY CONTRACT OROTHERDOCLMENT WITHRESPECT TOWHICHTHIS CERTIFICA TE MA Y BE ISSUED ORMA 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 POLIOY !l'Pl!OTIVI!: POLIOY!XPIIATION L TR T'IIIt! 0# INIUItANOl! POLIOY NU/lRR DATe (h1N1DD1YY) DATil! (h1hl1DD1YY) L1NITS lIDI!RAL L1ABLITY - C X COMlERCIAlClEIERALLlABILlTY A-b [X] .<,: ClAIMS MAa: X OCCLfl "'-"'- OWIER'S 8. CONTRACTOR'S PROT - - C207833364 5/18/96 ClE!ERAL AOOREOATE . 2000000 5/18/97 PROOUCTS,COlP/QP AOO $ 2000000 PERSONAL 8. ADV ItURY . 1000000 EAa-t OCCLmENCE $ 1000000 FIRE DAMAGE (Any one fire) $ 50000 lED EXP (Any one person) . ~nnn COMBIIED SINOLE LIMIT $ 5/18/97 1000000 BOOIL Y INJJlY . (Per person) BOOIL Y INJJlY $ (per accident) PROPERTY DAMAClE . AUTOMOtlLl! L1ABLITY - A ~ ANY AUTO ALL OWIED AUTOS SOEDU.ED AUTOS I-- Jt HIRED AUTOS ~ NON.OWIED AUTOS BUA07833365 5/18/96 I-- I-- ClMAGI! L1ABLITY I-- ANY AUTO B I!XOUSLlABLITY R UflElRELLA FORM on'ER THAN UMBRELLA FORM WORKI!RS OOhl'll!NSATION AND II!IoIILOY2RS'L1ABLITY n-E PROPRIETORI RI PARTIERS/EXECUTlVE NCL CHICERS ARE: EXCl OTHI!A AUTO Oft. Y EA ACCIDENT $ OTI-ER THAN AUTO Oft.Y: ///////,)) EACH ACCIDENT $ AGGREOATE . EAa-t OCCLmENCE $ AOOREOATE $ . I-- I-- 3521973 6/28/96 6/28/97 x I STATUTORY LIMITS EACH ACCIDENT $ DISEASE POLICY LIMIT $ DISEASE, EACH EIoPLOYEE $ .... . .. . . ...... ....... .... . .. . .................. .... ......... ::::-:::;::;:;:::::::::::::::;:;::::: 1000000 1000000 1000000 ***THE INSU~CE COMPANY, HEREBY WAIVES ITS ***ONLY WIT RESPECTS TO NEGLIGE~CE ARISING ***CONDUCTE BY THE NAMED INSUREr ON BEHALF ,IT~_ Re: Permit #: 96-219 loclted It: 2931 Winchester Blvd. Clmpbel I. CA AI I work in publ ic right-of-wIY City of Clmpbel I. City of Clmpbell Redevelopment AlIencv ih officer~ emDlovee~ Ind volunteer" Ire nlmed I" Additionll Insured RIGHT OF FROM THE OF THE CE UBROGATION, BUT*** NSURED'S OPERATION*** TIFICATE HOLDER.*** i~ -}~ : ':":::::':':::::':::::::::':'::::::':'::::::::::;;:;;;;;;;;;;;;;;:;;;;;;;;;;;';;;;:';;';:;;;;';';;:;;;';;;;;:;:::;';:;';';';'::::;:;';':;::;::';:::;;::"'::':':::;:.:::.::::::::::::::.:::: . :.:.:.:.;.:.:.:.;.;.:.:.:.:.:.:::.;.:.;,;.;.:.:.;.;.;.;':':':';';':';':';'::'::.:.:.:.:.:.::::::;.:.;.;-:.;::.:.;.:.:.;.;.;,;.;.:.;.:.:.:.:.'.:.:.:.:.:-:.:.:::.:.:::.:.:.:.:.:.;.::;.;.::;.;:;.:.;.:.:.:............ ...........:.:::.:.;.:.::::::;::.;.:::.::;:;:;:;.;.;:;;;.;:;.;:;.;:::;.;:;.;:::;.;.;.;:;:::::;:::::::::::::::::~:::::::::;:::::::::::::;:::::::::::::::::;:::::;;;;;;:;:;:;:;:;:;:;:;:;:;:;:::::;:;:;:;:;:;:;:;:;:;:::;:;:;:::;:::;:::;::::::::::::::;:;;:;;~:;:~:;:~:~:~:~:~:~:~::::::.:;::;::.:.::;;:;;.;:;.;.;;;.;.;.:.:.:::.:::.:;:::::.:;:.:::.::~:~:~:t~:~:~:~:~:~:~:~:~:~:~;~;~;}~:~;~:~:~:1:1:1:;:;:~:~;:~:;:~:~:~~~:~:~:~:;:;:~:~:~:~:~:~:~:~:~:~:~:~:~;~:~:i;;:~:;;~:~:;:~:;:~:~~~:~:;:~:~:;:;;;;~:i:~:;;;:i:~:i:j;j:j:;:j:i:~:1:;:i:i:~:;:;:;~;~;~~!j~;~ SHOULD ANY 0# THI! ABOVI! DnOR.u POLIOII!S III! OANOl!Ul!D 1II!l'0RI! THI! I!XPIRATION DATe THI!Al!O#, THI! IlSUINClI OOhPANY WLL ...A.OIl '0 MAL City 0 f Clmpbe I I 2 ~ DAYS WRITTI!N NOT_TO THI!Ol!ATPIOATI! HOLDI!A NAMl!DTO THI!LI!I'T, At t n : De p t 0 f Pub I i c Wo r k s 1M' 1'11"_ T4I ItA..1UIH ..,.... IHMoI. II Fe.. NIl .....AT_ OR ..IAII..R'Y 70 North Fi rst Street ... AN'( ... lINN 'AI. ....AHY. R'I A....- OR ItUlMIDA'AlAIU ~UjjMIiMIiIiIi!~'~ POLICY NUMBER: C207833364 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, the City of Campbell Redevelopment Agency, its officers, employees, and volunteers. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: Permit #: 96-219. The Van Cleef Building located at: 2931 Winchester Blvd., Campbell, CA **THIS INSURANCE IS PRIMARY EXCEPT WHEN EXCESS INSURANCE APPLIES. IF THIS INSURANCE IS PRIMARY, OUR OBLIGATIONS ARE NOT AFFECTED UNLESS ANY OF THE OTHER INSURANCE IS ALSO PRIMARY. THEN, WE WILL SHARE THAT OTHER INSURANCE WITHIN THE TERMS DESCRIBED IN THE POLICY. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 o POLICY NUMBER BUA07833365 AUTO COMMERCIAL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Additional Insured Designated Person or Organization This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name and Address of Person or Organization: The City of Campbell, the City of Campbell Redevelopment Agency, its officers, employees, and volunteers A. The person or organization shown in the Schedule is included as an insured but only if liability for the conduct of an "insured" and only to the extent of that liability. B, CANCELLATION 1. If we cancel the policy, we will mail or deliver notice to such person or organization in accordance with the Common Policy Conditions. 2. If you cancel the policy, we will mail or deliver notice to such person or organization. 3. Cancellation ends this agreement. RE: Permit #: 96-219. The Van Cleef Building located at: 2931 Winchester Blvd" Campbell, CA. AON January 3, 1997 Aon Risk Services "to I.tct\ . ,,~~ ~6 ,~1 tV';"\\" S;~;~1'\~~ A.ot-^\~v Ms. Marlene Pomeroy CITY OF CAMPBELL Department of Public Works 70 North 1 st Street Campbell, CA 95008 Re: Schwager Davis, Inc. Certificate of Insurance Dear Ms. Pomeroy: We are in receipt of your fax regarding the captioned insured's Certificate of Insurance issued on 12/27/96. Please disregard this certificate as it was issued in error. The certificate issued on 8/19/96 is the correct one. We apologize for any inconvenience this may have caused you. Please call our office if you have any questions; my direct line is (415) 512-6176. '<?tu<.~ Geri Navarro Senior Account Administrator ---- /gna enclosure Aon Risk Services, Inc. of Northern California Insurance Services. License #0363334 Formerly Rollins Hudig Hall of Northern California, Inc. Insurance Services One Market, Spear Tower, Suite 2100 . San Francisco, California 94105 . tel: (4] 5) 541-9360 . fax: (4] 5) 543- 562R 1 -1dl2-1 997 4: 1 7PM FROM C^~PBELL PUBLIC WKS 408 3760958 P,4 ,~~".IID. . . ;li'i~' ..... ONLY AND CONFERS NO RIGHTS UPON THE CERTlFleA TE HOLDER.. THIS CERTIACATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELow. CO....AJUEI AFFORDlNC: COVERA ARS ot Northern Californi. One Mu ket Spear Street Tower Ste. 2100 San francisco. CA 94105 415-543-9380 COMPANY A tinental C. ualt Co c:or.>ANV Schwager III Davis. Inc. SOD Phelan Avenue San Jose, CA 95112 ubllc Indemnit Co of Ame .ru:e Co. ClQ L'I1l TWIt! Of' lMURlIIIIle: -'10'1 Nll...:R LIW.,.. _~LtA8LlT't C X COMN;At;IAl..Of~lI~lLlT'Y C207833364 ii;l; Cl.AIW$ WADE [i] oca.R (lwlER"S L CONTRACTOR"S PROT 5/18/96 a:~ ~QAIE I 5/18/97 PRCO.CTS.COw>'CP ACIO I f'fFlSONAL II. II/)v I~V I EAO-I ~1'Ct: I FIRE OAI,lo.OC (Any _ rw.) I lED f)O? (~ -~) S aura"'LI! UMlCJ1" A X ANY AUTO All. OWIED AUTOS SC>EOU.ED AUTOS X HIRED AUTOS X 1OI.Q\IItEQ AUTOS COIiEI{~D SIIC1f LIMIT . 8UA07833365 5/18/11& 5/18197 0000 EICDt. V I~V (P- ,.,.....) . RECEIVE BCOlLV 1tU.JW (P... lIacidn) I Ill_MZ LIMLITV ANY AUTO PRCPERTV OANACE a i-''';'''l..i( 'II! i... 40M1NISTRATIOt" .lUTO OM.V . EA ACClCl1:llr . OTI'ER TIiAN AUTO QIIl.V, ,~j;j~j!~i~fi~H~HiW~j{ii~iiijH EAO'l ACClOEIlT I AOOREOATE I EACH Cll;CUlRE1CE I AClClRE(lA re: * B n_LIMlLrrv IJJiIEI<e'LU.FORI4 OTtGl THaN UIofR:LLA FORN W_PIlI CIO_n_ .. ~-.oft!l1S'LIMLTrV TI'f: PIlCPIlIETORI PARrlERS/EXfCUTl\If a:F1CERS ARt;: ***THE INSU ***ONLY \lIT ""*"'CONDUCTE 3521973 6/28/98 6/28/17 X STATUTORY LIMITS Yii!i~;!;!;!!~!i!~!i!i!iW?i;ii EAOf AC:CICENT I 1 00000 Dr5EASE . Pa..1CV L1141T a 10 000 DtSEASE.EACHElI"l.oYU I 10DOOOO UBROGATION. BUT*** NSURED'S OPERATION*** TIFICATE HOLDER.*** CE COMPANY. HEREBY RESPECTS TO NEGLIGE BY THE NAMED INSURE RIGHT OF FROM THE . OF THE CE work Ci tV of Campbell Attn: Dep'L of Pu"'ic Works 10 North First Straat "...,~.~~,P::k~~,~~:"':%!It't\.~~"'";r.;;tr,.~,l/;.~ll'jfW'"."'_."""'~,'<~:;r.:':f:<;,*~,~*:{fI<'I<'''~.\l"........";\!'!:\t";Mlt. . ", ,;..~;(.;~. ~~~~~,~~~-!~~~j;~:;.~ .::':"NC~~:~~~~1~~~~l~!~~li~~Mf~!~~~~1~~.~~~~~!,!e@;8~~.~~~;' .i*:~~ .~mBl;$~..'4(:W~ 2 ~ frl".'" T. IN........ t&.--. PI d.L JW .MII!" .....,... ~. ......"y -;..~ DDo76Z00D 1-02-19974:18PM FROM CAMPBELL PUBLIC WKS 408 3760958 P.5 POLICY NUMBER: C207833364 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 L1ABILllY COVERAGE PART. SCHEDULE Name of Person or Organization: The City of Campbell, the City of Campbell Redevelopment Agency, its officers, employees, and volunteers. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amefJded to inctude as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE~ Pennit #: 96-219. The Van Creef Building located at: 29,31 Winchester Blvd., Campbell, CA "'-HIS INSURANCE IS PRIMARY EXCEPT WHEN EXCESS INSURANCE APPLIES. IF THIS , ,,1./ INSURANCE IS PRIMARY. OUR OBLIGATIONS ARE NOT AFFECTED UNLESS ANY OF THE ~ ~ OTHER INSURANCE IS ALSO PRIMARY, THEN, WE WILL SHARE THAT OTHER INSU~NCE '--f\: ' WITHIN THE TERMS DESCRIBED IN THE POLICY. . CG 20 10 11 85 Copyright, Insurance SelVices Office, Inc_. 1984 o CITY OF CAMPBEll I {, , / Date: / l//~I '/ f FACSIMILE COVER SHEET TO: i ( J;J I f _, Iii '- ,- d'} / /' J. ,- .,1-" ^ 'e/If' J!' _;: i . :;: ,(/1 :./'CJJ ,,-,,-<_ I ~ j ~ " '4' ( /'-/1':7\.-' 1:"(, (L. /:..:;--' /v-. (' t., /~ f'-/~ /")f (i ; Fax Telephone No. I /-//-:.:. , ~:::/.~) _", _, I..... ?, <"? , r, "', /--' , " FROM: '-;/.\1''- '"-~ ; If j /, / ./.' .' ,'J j/V. }/I" ..,'_'17, / , l-'....-,_/ ,,/ ,,....,<_.- .11_..( I r:._~_ . _, /.../,\) //1. 'II fi ~ // .. I ,j jv.:.L./,-I._ .' " C:z- :,/'-;.,/ ' I /1 ~ 1",-')1'" ,/) ,'.J . 71- I MESSAGE: Number of Pages Transmitted (including this page) 1 " j '- 0',- tL (, ),!/y_, /,,1 ,--., . h/(,I -c I tJ I uY_ ' s A / i./-'~ ('{.'~/ ,:;(_, I /;.:', - IPJ :J .' .' ". 'i-' Vi j~.;,U ktl./.--. / !.. /j/j,{; d... (F/j14 / j.- ~..-f-/ Lit>':. J a.d~!. i " 4Lz ( . 't) /.ll" 1 &'- .J If ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE ARS of Northern Cal i forni a One Market Spear Street Tower Ste. 2100 San Francisco, CA 94105 415-543-9360 COMPANV A Continental Casualt COMPANV Co. B Re ubi ic Indemnit Co of Amer COlAPANV C Investors Ins Co Of America COMPANV D . CO VERAGES' ,.. "...., "..,... ... .. ..,'....'.'.'..,','..'.'... ............ , .. ....,' ,'........,.....,........... """:':""':':':':':"':':':':':':':':':': ":::::'::::::::':::::::'::::::'::::::::':::::::::::::'::::::::::::::::::::::::::::::::::'::::::::::::::::::::::::::::':::':::.' ....:.......,:'~.:~IS.I:~':T. o.6~.~.~. iF ~:'~'H.~:T\ ,~'~:~C;Lg~~:6:~::~~J~:f~B:~';~li:+.~:6..~E~'8:v/m; \iE:.~:~:~.~:I~,~:j~:gVg::f~;~:i:~:ge~iig~:i~~6~i~~gJ~:~g~V~~:Jg~:i2'~::~~:~igg:~::::::,:::,: INDICA T ED, NO T WITHST ANDINGANVREQUIREMENT, T EI'lM ORCONDITIONOF ANVCONTRACT OROTHERDOCI.Jv1ENT WITHRESPECT TO WHICH THIS CERTIFICA TE MA v BE ISSUED ORMA v PER f A Ii\!, THE INsunANC~ AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LMITS SHOWNMAV HAVE BEEN REDUCED BV PAD CLAMS. Schwager Davis, Inc. 500 Phelan Avenue San Jose, CA 95112 CO TYPE 01' INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE (MM'DD'YY) DATE (MM'OO'YY) LIMITS GENERAL LIABILITY GENERAL AGCREGATE $ C X COMMERCIAL GE NERAL L1ABILI TV GLP1002382 12/ 16/96 2/16/98 PRoo..cTS,COMP/OP AOO $ CLAIMS MADE ~ OCCUR PERSOOAL &. AnV I~Y $ OWNER'S &. CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A X ANV AUTO BUA07833365 5/18/96 5/18/97 ALL OWNED AUTOS BODILV I~V SCI-EOULED AUTOS (per person) X HIRED AUTOS BODILY I~V X NON,OWNED AUTOS (Per aooident) PROPERTV DAMAGE GARAGE LIABILITY AUTO Ol'i. Y , EA ACCIDENT ANY AUTO OTt-f:R THAN AUTO Of'{. Y: EACH ACCIDENT $ AOClREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AOClREGA TE $ OTHER THAN UMBRELLA FORhI $ WORKERS COMPEI~S;,ml~1 ANti X STATUTORV LIMITS EMPLOYERS' LIABILITY B 3521973 6/28/96 6/28/97 EACH ACCIDENT THE PROPRIETOR/ INCL DISEASE, POLICV LIMIT PARTNERS/EXECUTIVE OFFICERS ARE: EXCL DISEASE. EACH EMPLOYEE OTHER 2000000 1000000 1000000 1000000 1000000 1000000 1000000 1000000 RE: Van Cleef Bui Iding at 2931 S. Winchester in Campbell, CA 95008 Job #6040 (SEE ATTACHED ENDORSEMENT) RECEIVE, DEe 3 '" 1996 DESCRIPTION 01' OP RA ION LOC TlONS VEHICLES SPECIAL ITEM Ol1ilHIF .o.Arl1;HP~p~~/?:( ... ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................................... .. ................................... ;::::::::}~~:::::::::::::::::::::::::::)tt~t~r{f~ttt~~{;;;;; ::::::I::::::::::::::::::::J:::m:t8~:,:,8g,:,/t~m{"j:::::::::::::::::::m::r::r::::r:t:::::::::::::lt::::::t::::t:::;::::r:l&biimttiiiUi:WMMrr:J} SHOULD ANY 01' THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE tHE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL Krill!: "'IlR TO MAL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAhIEl) TO THE LEfT, City of Campbell 70 North 1st Street Camp be II, CA 95008 ATTN: DEPARTMENT OF PUBLIC ....................L....,~9.R'5,~, A99~P~~f.J!"!t: . .. .... .............. Bid,. r AIL""E TI 1.1"'1.. IWIII u.na! BII.thl 1:.tI"le_ u. IBLla.lTleU e.. LlMlI.ITY :.:.:-:.:. . . . . . . . . . . . . .. ......... . ... POLICY NUMBER GLP1002382 COMMERCIAL GENERAL LIABILIlY 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 LIABILIlY COVERAGE PART. SCHEDULE Name of Person or Organization: CITY OF CAMPBELL AND CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES & VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: VAN CLEEF BUILDING AT 2931 S. WINCHESTER IN CAMPBELL, CA 95008 JOB #6040 CG 20 10 11 85 Copyright Insurance. Services Office Inc., 1984 ONL V AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BV THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE ARS of Northern Car ifornia One Mar ket Spear Street Tower Ste. 2100 San Francisco, CA 94105 415-543-9360 COliPANY A Continental Ca ualt COliPANY Co. Re ubi ic Indemnit Co of Ame cQliPANY C Valle COliPANY D CERT IFICA TE MA Y BE ISSUED ORMA 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 POLIOY I!I'ROTM POLIOY!XPIlAT L TR TYPE Off INSUIlANOE POLIOY NIl..... DATI! (MMIIlDIYY) DATI! (MhlIDOIYV) Schwager & Davis, Inc. 500 Phelan Avenue San Jose, CA 95112 RECEIV AUG 2 G 1996 anee Co. LIMITS GDEtAL LIABLITY GE'€RAL AOClREOATE S 2000000 C X COMMERCIAL GE'€RAL LIABILITY C207833364 5/18/96 5/18/97 PROOUCTS,COliP/CP AClO S 2000000 ClAIMS MADE [i] OCClR PERSONAL I!. AnV IN..UlY S 1000000 OW'€R'S I!. CONTRACTOR'S PROT EACH OCCUlRENCE S 1000000 FIRE DAMAGE (Arf1 one fire) S 50000 MED EX? (Arf1 one person) $ AUTOMOllLl! L1ABLITY COlEll'€D SINCllE LIMIT A X ANY AUTO BUA07833365 5/18/96 5/18/97 1000000 ALL OW'€D AUTOS BOOIL Y IN..UlY SCl-EDU.ED AUTOS (Per person) X HIRED AUTOS BOOIL Y IN..UlY S X NON.OW'€D AUTOS (per accidenl) PROPERTY DAMAGE GARAGI! L1ABLITY AUTO Ot>L Y , EA ACCICl:NT S ...,.... ........... ANY AUTO OTIoER THAN AUTO Ot>L Y: ............ ...... ...... ...... .... ... ... .... ........... :::::;:;:::::::::::::;:;:::::::::;:;: ...,..... ....... .,- ......... ......... EACH ACCICl:NT S AOClREQA TE $ !XODS L1ABLITY EACH OCCUlRENCE S UlElREllA FORM AOClREQA TE S OTIoER THAN UlElRElLA FORM S WOAK!RS COhlPeNSATION AND X STATUTORY LIMITS !hllt.OYDll'LIABLITY B 3521973 6/28/96 6/28/97 EACH ACCICl:NT S 1000000 TIoE PRa>RIETORI DISEASE, PQICY LIMIT S 1000000 PART,€RS/EXECUTlYE CHICERS ARE: DISEASE, EACH EIFLOYEE S 1000000 ***THE INSU CE COMPANY, HEREBY RIGHT OF UBROGATION, BUT*** -!-:-}:;;":' * ***ONLY WIT RESPECTS TO NEGLIGE FROM THE NSURED1S OPERATION*** ***CONDUCTE BY THE NAMED INSURE OF THE CE TIFICATE HOLDER. *** work "OULD ANY Off TH! AIIOVt!: ~II!D POLIOI!S B! OANOELL!D __ TH! !XPIlATION DATI! TH!RI!Off, TH! ISSUING COhl'ANY WLL ...'VOlt TO MAL C i t Y 0 f C ampb e I I 2 30 DAYS WAITTI!N NOTIO! TO TH! Cl!RTPICATI! HOLD!R NAN!II TO TH! L.!I'T. A t t n : De pt. 0 f Pub lie Wo r k s 1M' , AllUM At ..All. IUOH ...TIR lit AU. II File... ......"ION OR UAIIIl.R'Y 70 No r t h Fir s t 5t r e e t ... ANY 11_ w... IN. MIPANY, R'I A_ OR -...rATIlIU Clmpbel I, CA 95008 ~ 000762000 :A{;)~~P;~$.?l,=~g[U:r:U:rrimrrr:::::::::::::::Umrrimrrr:Uumr:u:r::rr::::::::r:::,:::::::uUUU?rri?mi?:::::=U=:U=:::?=r::rr:uUU??mrr===..:;:.'..~:,l~=i POLICY NUMBER: C207833364 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, the City of Campbell Redevelopment Agency, its officers, employees, and volunteers, (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. RE: Permit #: 96-219. The Van Cleef Building located at: 2931 Winchester Blvd., Campbell, CA , **THIS INSURANCE IS PRIMARY EXCEPT WHEN EXCESS INSURANCE APPLIES. IF THIS _ 'y/ / INSURANCE IS PRIMARY, OUR OBLIGATIONS ARE NOT AFFECTED UNLESS ANY OF THE _ / "" OTHER INSURANCE IS ALSO PRIMARY. THEN, WE WILL SHARE THAT OTHER INSURANCE WITHIN THE TERMS DESCRIBED IN THE POLICY. ~\'!.' '.' '/' ....".- \ CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 D ~ Y19/96 MON 09:53 FAX 415 51? 2153 AonRiskServices ~-#-(cc LIe V C'L il C' (c:-c f' IaJ 001 ,] I/~lc-t~j AOII Aon Risk Services VIA FACSJMlLE DATE: 08/19/96 10:03 AM TO: Joanne Fax#: Company: 408-294..8072 Schwager & Davis, IDe. FROM: Fax#: Phone: Robert Fitzgerald 415-512-2153 415-512-5834 Pages: 4 RE: CERTIFICATE OF INSURANCE FOR THE CITY OF CAMPBELL '~'W'~.W,~,W.~~~.~~~.~.~~~,T.~,~+~,~,~,~,~+~.T.W.~,T.~.~ Joanne: According to your request. here is the Certificate of Insurance) along with the related endorsements) which name the City of Campbell as an Additional Insured to your auto & general liability policies. I will send you a hard copy of these to you in the mail. with the originals to the City of~~ if you should have any questiollll. Thauksl 1?~ ..- Robert Fitzgeral Account Manager Ao" 1U~k Services, [nc, o{Northern CalifarnllJ Insurafl(;e Sern~'o Llcens' #0363334 F'or7llerly RoUin' Hwdig Hall a{North,rn California, lnG, [nsurafl(;f! SerVices Ono MIU'k.et, SpcarTower. Suite 2100. San Ftanc~, Cnlifomi.94105 o tel: (415) 543-9360 0 fax: (415) 54:M628 r~/19/96 MON 09;53 FAX 415 51? 2153 AonR1skServ1ces III 002 COWPANY A C coaPAM\' B RD U COW"NY C V.II (:OlIP"NV D . .~ ' ~., ", . ;!;~." .b';"." '.i~t.m :.;,~ T His IS T 0 CERY IPY T HA T T HE POLICIES OF INSUFlAN~ LIST EO aELOWHA VE BEENISSUEO T 0 THE1NSUREO' NAMED ABOvEFoliTHE POLICY PEIOClO INDICA TED. NOTWITHST ANOlNGANYREOU1REMENT, TE~ORCONDITIONOF ANYCONTRACT OROTI-EROOCl.I'JIENT WITHRESPECT TOWi'tCHTHIS CERTlFICA TE MA Y BE ISS~D OR MA Y PERT AIN. THE INSURANCE AFFORDED BY THE POLICIES DESCJWEO HEREIN IS SUBJECT TO ALl.. THE TERMS, El<CLUSIONS AND CONDITIONS OF SUCH POLICES. LI\IIITS SHOWNMAY HAVE BEEN REDUCED BY PAlO CLAMS. 00 POLIO' IIft'HlIft POLIO' I!-'II I- TIt T_OP' .-!AAN8I!l POLIOV NU..- PATIl (MMIDDIV'I) PATIl (.......'1'1) l_ ARS of Northern California On. M.rkot Sp..r StrDet Tow.r StD. 2100 Sin Franci$GD, CA 94105 415- 43- 380 .~ AtM."." . i~.H~.t.W~~ Schwager a Dlvi s. Inc. 500 Phelln Avenue S.n Jos., CA 95112 _~UAIILIT' ANY AUlO AU. OWtED AUlOS SCHfJlU.ED AUlOS HIRED AUlOS NON-OWIED AUf OS 8UA018US85 5/18/1. (ENiRAL ACDlEOAlE . 5/18/97 PRCDJClS-COIiI'/17 AQQ . PERSONAL. e. AnV llUAY . EACH oc:c;I..flRIEtCE . FIFE ~MACIE (Any _ lire) . lED EXP (Artf - 1*''''") . COIIIIIIED SIID..E \.I..T . 5/18/11 BODILY llUJW . ,.., ~) BODIlY IIUJW . ~., aooiranl) ~TV DAlAAOE . A _lILUIBL"' COMIliERCIAL oelERAll.IAB,LHY CLAIMS MAIl!! [i] ocClJ'l OWlER'S" CONTRAClCR'9 PROT C2.D1833364 5/18/98 c B II!X_UADut'l ulltlREl.I-A 1'000ll Oll-ER lHAN UIIIlFIElLA FCIW WORICI!ftS IlO......ATION ". .1lI'I.O_LI...." ll1t PIO='RlElORJ PART Nl!:A$/EXECUf IVI:. OFFICERS AI'O, cmtp AUTO ON.. V . EA AcclcENl . OT161 ll-lAN AU'lO Ott.V, i!i!H!iiH~j!i!~imni~ll;lH!~1!il EACH ACCIDENt $ A(l[R:QAfE . l!AOi OCCI..MEIICE . AIXJ'lEQAlE . , _All'" L1AIILITV AIH AUlO 352.1913 1/28/88 X StAlUlORY l.llftTS 8/28/87 !ACH ACCI~Nl . 10 DISEASe; . PO..ICV l.IMll, '0 DISEASE. EACH EIoP\..OVl!~ . 1 RIGHT OF UBROGATION. BUT*** +.** FROM THE NSUREDIS OPERATION*** OF THE CE TIFICATE HOLDER.*** ***THE, INSU ***ONLY 'WI ***CONDUCTE work Re: Ci ty of Campb-II " A11n: o.pt..f Public Warks 70 North First Str..t C..pb.1 I, CA 95000 ..." ,.. .' 1",. r..:,. '. '.:. ,:,..~ .!L M r..~ ,. w...... ,...IM.... "Fl." ._anON.. wlIlLIr' .. ...., lit.. ,.lI ~ ...IJU1_ DOD76Z000 r~/19/96 MON 09:54 FAX 415 51? 2153 AonRlskServlces 1aI 003 POLlCY NUMBER: C207833364 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, the City of Campbell Redevelopment Agency, its officers, employees, and volunteers. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an Insured the person or organization shown in the Schedule, but only with respect to liability a~sing out of .your work" for that insured by or for you. RE: Permit #: 96-219. The Van Cleef Building located at: 2931 Winchester Blvd., Campbell, CA **THIS INSURANCE IS PRIMARY EXCEPT WHEN EXCESS INSURANCE APPLIES. IF THIS INSURANCE IS PRIMARY, OUR OBLIGATIONS ARE NOT AFFECTED UNLESS ANY OF THE OTHER INSURANCE IS ALSO PRIMARY. THEN, WE WILL SHARE THAT OTHER INSURANCE WITHIN THE TERMS DESCRIBED IN THE POLICY. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 o 1':8/19/96 MON 09; 55 FAX 415 51? 2153 AonRlskServlces ~004 poLICY NUMBER BUA07833365 AUTO COMMERCIAL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Additional Insured Designated Person or Organization This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE Name and Address of Person or Organization: The City of Campbell. the City of Campbell Redevelopment Agency. ib officers, employees. and volunteers A. The person or organization shown in the Schedule is included as an insured but only if liability for the conduct of an '1nsured" and only to the extent of that liability. B, CANCELLATION 1. If we concel the policy, we will moil or deliver notice to such person or organization in accordance with the Common Policy Conditions. 2. If you cancel the policy, we will mail or deliver notice to such person or organization. 3. Cancellation ends this agreement. RE: Permit #: 96-219. The VClIn Cleef Building located at: 2931 Winchester Blvd., Campbell. CA. .Of.C.-t<4,o (..~: $Yf, .< , ()~rHAR\) (, CITY OF CAMPBELL Public Works Department February 18, 1999 Schwager Davis, Inc. A TTN: Claudio Hunger 500 Phelan A venue San Jose, CA 95112 SUBJECT: PERMIT NO. 96-219 LOCATION: 2931 South Winchester Boulevard ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE Dear Mr. Hunger: 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 and any surety, therefore, are hereby released. The warranty deposit of $3,000.00, plus any interest due, will be sent directly to Van Cleef Enterprises from our Finance Department. SinCerelYji.~ v/ [/&:L ~~ Alan Horn Public Works Inspector MQvI cc: Permit 96-219 Public Works/Maintenance Division Van Cleef Enterprises, 411 Park Avenue, #203, San Jose, CA 95110 H:\ WORD\PERMITS\96219ACC(JD) 70 North First Street, Campbell, California 95008,1423 . TEL 408.866,2150 . FAX 408,376.0958 . TOO 408.866.2790 of'CA-it 4,' .o~ (0.., ~ U ~ -" $ .<- I)RCHA.\l.Q CITY OF CAMPBELL Public Works Department March 11, 1998 Mr. Claudio Hunger Schwager Davis Inc. 500 Phelan Avenue San Jose, CA 95112 SUBJECT: PERMIT NO. 96-219 LOOCA TION: 2931 South Winchester Boulevard FINAL INSPECTION AND ACCEPTANCE Dear Mr. Hunger: The City of Campbell has made a final inspection of subject Public Works improvements and finds the work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts the improvements. The one year maintenance period stated in the permit begins as of the date of this acceptance letter. The permittee is responsible for the repair and/or replacement of any defective work or failures that occur within one year. The City will inspect the improvements within one year and notify you, in writing, whether or not any repairs are required. The City will continue to hold your $3,000.00 Maintenance Surety for the duration of the one year maintenance period. All other monies have been refunded. If you have any questions, please call me at (408) 866-2165. s~'~ )/ .... .1 'i (?~~ t~ .;;j/ Randy westfall Public Works Inspector MQ./ cc: Suspense - 11 months Permit #96-219 Inspector File William Van Cleef, Van Cleef Enterprises, 411 Park Avenue, #203, San Jose, CA 95110 Building Division Traffic and Lighting H: \ WORD\PERMITS\96219FIN(JD) 70 North First Street. Campbell, California 95008.1423 ' TEL 408,866.2150 ' FAX 408.376.0958 . TOD 408.866,2790 o \' . C A A. J..~~' '''l.o~~ .... r" U ~ . . "" ... <$- '" ~. ,-,' OI?CH A \l'O' ." May 8, 1997 CITY OF CAMPBELL Public Works Department Mr. Claudio Hunger Schwager Davis Inc. 500 Phelan Avenue San Jose, CA 95112 SUBJECT: PERMIT NO: 96-219 LOCATION: 2931 South Winchester Boulevard PRELIMINARY INSPECTION REPORT - DEFICIENCIES Dear Mr. Hunger: This letter is in response to your request for a final inspection on subject Public Works improvements. There are deficiencies in the work which are indicated on the enclosed preliminary inspection report dated 517/97. These deficiencies must be corrected in accordance with City standards before we can make a final inspection or accept the work. Please contact me at (408) 866-2165 to coordinate the correction and inspection of these deficiencies, or if you have any questions. Upon completion of the corrective work, please submit a written request for a final inspection and acceptance. 75% of your Faithful Performance Surety cash deposit of $12,000, plus any interest due, is now being processed, and will be returned directly to Mr. Van Cleef. We will continue to hold $3,000 for the duration of the one year maintenance period as a maintenance surety. Additionally, the refund of the $500 plan check deposit and $80 of the $480 cash deposit are being processed. As discussed in our letter dated 4/2/97, the City is withholding $400 of your $480 cash deposit in penalties for failing to correct an unsafe condition. If you have any questions, please call me at (408) 866-2165. iaY' iJ#J?j ~b~~:~ctor MQ 1!0. Attachment: Deficiency List cc: William Van Cleef, Van Cleef Enterprises, 411 Park Avenue, #203, San Jose, CA 95110 Building Division Traffic and Lighting Permit #96-219 H:\ WORD\PERMITS\96219DEF(JD) 70 North First Street. Campbell, California 95008.1423 ' TEL 408.866,2150 ' FAX 408.376.0958 . TDD 408.866.2790 DEFICIENCY LIST PERMIT NO. 96-219 2931 SOUTH WINCHESTER BOULEVARD 5/7/97 1. Remove sign post, drive down, and grout hole in concrete, then strap No Stopping sign to electrolier. 2. Backfill at all new concrete to finish grade. 3. Sweep gutter. 4. Install a second set of tree ties at the top oftree stakes to straighten tree. 5. Remove form board from southwest flag at PG&E pole guy anchor at south end. Backfill with topsoil. 6. Electrical A. At pole location: 1) Label pole with reflective Brady #5890 series per City of San Jose detail #E-22. Clean area where labels are to be affixed with an alcohol swab then place labels plumb and vertically at 45 degrees toward direction of vehicle travel, bottom label located 10ft. above sidewalk. EXAMPLE: On face of clock, arm is at 6, labels should be placed between 4 & 5. Pole number is B-50758. 2) Pull box lid should read "CAMPBELL STREET LIGHTING". 3) Clean loose debris from bottom of box. B. Pull box on street side of wood PG&E pole: 1) Pull box lid should read "CAMPBELL STREET LIGHTING". 2) Remove excess bond wire (2 foot coil is sufficient), coil and dress it on bottom of box under insulated conductors. C. Pull box on back side of wood PG&E pole: 1) Pull box lid should read "CAMPBELL SERVICE". 2) Remove excess bond wire (2 foot coil is sufficient), coil and dress it on bottom of box under insulated conductors. DEFICIENCY LIST/PERMIT NO. 96-219 2931 SOUTH WINCHESTER BOULEVARD 5/7/97 Page 2 3) Grout in box is VERY rough, has many valleys and is cracked. Re-do with sand mix this time (sand mix more porous, doesn't set up as hard and is less likely to crack from shrinkage as mortar or thin set mixes). Apply (l" min-2" max), smooth out, air dry some, smooth again with paint brush dipped in water before it sets up. H:\ WORD\PERMITS\96219DEF(JD) CITY OF CAMPBELL FIELD ENGINEER'S DAILY REPORT ITEM cc: )/7'"3/ '5. w;/) ksV PROJECT NO. 9&-..L11 REPORT NO: CONTRAf:rOR:tf!J; EJ,..SC , DATE: v(~9/7l WEATHER: rAJ R.. INSPECTOR: K. ~G:-5"TfALL PAGE: / OF I CITY OF CAMPBELL 70 NO. FIRST STREET CAMPBELL, CA 95008 (408) 866-2150 FIELD MEMO DATE PERMIT OR PROJECT NO, ADDRESS/LOCATION TO: RE: [;d- . " INSPECTOR/ENGINEER RECEIVED BY ENGINEER Author: TonyR at Service Ce:ucer Date: 5/7/97 2:30 PM Priority: Normal Receipt Requested TO: RandyW at City Hall CC: TonyR CC: CharlieG Subject: 2931 Winchester street light punch list ------------------------------------ Message Contents ------------------------------------ &,. Randy, } found the following items 6I.uJr.fJ'~ ~t pole location: 1) Label pole with reflective Brady #5890 series label per City of San Jose detail #E-22. Clean area where labels are to be affixed with an alcohol swab then place labels plumb and vertically at 45 degrees toward direction of vehicle travel, bottom label located 10 ft. above sidewalk. deserve attention: EXAMPLE: ON FACE OF CLOCK, ARM IS AT 6, LABELS SHOULD BE PLACED BETWEEN 4 & 5. Pole number is B-50758 2) Pull box lid should read "CAMPBELL STREET LIGHTING" 3) Clean loose debris from bottom of box. B) Pull box on street side of wood PG & E pole: 1) Pull box lid should read "CAMPBELL STREET LIGHTING" (NO .;.-( ~~-( 1../1G-1-H~ ') 2) Remove excess bond wire (2 foot coil is sufficient), coil and dress it on bottom of box under insulated conductors. C) Pull box on back side of wood PG & E pole: 1) Pull box lid should read " CAMPBELL SERVICE" 2) Remove excess bond wire (2 foot coil is sufficient), coil and dress it on bottom of box under insulated conductors. 3) Grout in box is VERY rough, has many valleys and is cracked. Re-do with sand mix this time (sand mix more porous, doesn't set up as hard and is less likely to crack from shrinkage as mortar or thin set mixes). Apply (1" min-2" max) smooth out, air dry some, smooth again with paint brushed dipped in water before it sets up. Ci1) of Campbell - ChecK Request To: Accounts Receivable Please Issue Check 1(0-11\ c/eef bfu)r/rL~ Payable to: . Address - Line 1: A:lJ ?aI~ k . Line 2: -it .10 ~ City: 5~ l)~~ State:~ Zip: 7 c; / /0 Finance Only: Description: REFUNDABLE DEPOSIT INTEREST EARNED Amount Payable: 9tJR6,- Account Number: 101.2203 101.540.7448 Date and Receipt No: f"j)...9b:li'1,/ftg , !~n.~ ittt'J'i't5' 1(90dO "(~l,()()O I It 15-i,! b I Permit No: crt, - J-J9 Purpose: ~.{J N/Lc.t.r:k.J ~cfH / 1~ Z ,( f'/J~, ~ ad tJ( (tAf~ ~~1b tJJ~a/ vJ :.;. h Ita / J I ~ "',fd 0 ~G f'L If. Ci cd it Jj. 7 ~.)..) r: ( "..,.,..al}; J.., ~ . I jdfUM/2 '506 + 90 <.l() oJ. fa ::: 9~cfo- Requested by: RtJesf~lI Title: I w. ~ I JU~ r Date: f /%/97 I Approved by: Title: Date: FINANCE ONLY: Verified by: Title: Date: Approved by: Title: Date: Special Instructions For Handling Check Mail As Is: Mail in Attached Envelope: .,- Return To: ... (NAME) (Department) Other: - . .... rev: 3/25/95 TO: City Clerk .. 4722 2203 4722 .. 2203 4760 4760 4760 4722 4920 4965 TRAFFIC '4728 4728 4728 4728 4728 4271 4728 OTHER NAME OF APPLICANT ADDRESS FOR CITY CLERK ONLY PUBUC WORKS DEPARTMENT RECEIPT Effeclive July I. 1996 2203 2203 2203 2203 2203 2203 4721 Parkland Dedication Fee Postaae PUBUC WORKS FILE NO. ~ r 6 ~ X / 9 PROPERTY ADDRESS c:< 513/ 4- [('/I iZtJA/<. ticV' ':::::AM()tJNt::.::::..: S $325) $225\ S500 minI 100% o{ENGR,EST. \ 100% o{ENGR, EST.) 100".4 o{ENGR,EST. 4% ofENGR.EST,\lS500 minlSlO,OOO lIWt\ 100".4 ofENGR. EST.\ "S''l,r 7' . /.''/ '~I'f.} L/~ 7"0" - Please collect &; receipt {or the (ollowing monies: :3~~S.49211 = Revenue .......d.~\ ..... ENCROACHMENT PERMIT 4722 Application Fee Non-Utility Encroachment Permit (S225) R-I First PermitlNo Fee Sublequent PermitlYr(SIOO) Utilitv Encroac/unent Permit AneriallCollector Street Residential StreelIOlher Areas Plan Check Deoosit - 2".4 o{ENGR. EST. Faithful Perlonnance Securitv IFPS) Labor and Materials Securitv Monumentation Security Cash Denasit Labor and Material Securitv Plan Check &: Inspection Fee (Non-Utility) Engr.Est. < $250,000 Enor.Est.>S250,000 Utilitv < SI 00,000 Minimum Charge Per Loc:otion ConduitslPipelines up to 500 Feet Above 500 Feet ManholesN aultsIEtc. Pole SetlRemoval Street Tree Plantinlll1lemoval Utilitv > SIOO,OOO Proiect Plans &: Soecifications Standard Soecificalions &: Details Cooies of Enaineerina MIDs &: Plans Penalties: Failure to restore oublic imorovements Muni Code Section 11.34.010\ 4722 Penalties: Failoreto correct unsafe conditions LAND DEVELOPMENT 4722 Lot Line Ad'ustment 4722 Parcel MID (4 Lots or Less \ 4722 Final Tract MID (5 or More Lots\ 4722 Certificate of Comoliance 4722 Certificate of Correction 4722 Vacation of Public SIreelS &: Easements 4722 Assessment Segregation or Reapportionment First Split Each Additional Lot Stonn Drainage Area Fee Per Acre fa - 'f<,;t, Dr} 4fo -'It>, t 7 )~~ h A.{~,f ~fj ~ 0+ J-Ifr 0 ~,j ( ,,+ ~ fI1(('N., ~ ~ () ,'A. r" <>\cc-f ~ 171J.- ~ /' r---oJ:;f;'L-5 tV (12% o{ENGR, EST.) 9) i ~ II- (Deposit 8% ofENGR. ESTJS30 000 min.\" 8".4\ (SI20) (S1.601ft) (S1.1 O/ft.) (S lO5/ea) (S I 05/ea) (S I 05/tree \ Actual Cost + 20'.4 .. Project No. (SllPa SI2IBook) (S.501so,ft, \ (SIOOICaIendar Dav\ / ~~ If'c (S I OO/Calendar Day) S500\ SI,06O + $251Lot) SI ,380 + S251Lot S500\ S3(0) S550) (S550) (SI70\ (R-I, S2,(00) (Multi-Res, S2,250) (All Olher, S2,500\ Intenection Turn Counts (Two-Hour Count\ Intenection Turn Counts (Lm, or O.m, oeaks\ Traffic Flow Man (Dailv Traffic Volumes) Camobell Traffic Model {Full Scooe Assessment\ Camobell Traffic Model (Reduced Scooe Assessment) Truck Permits No Patkina Sians r"} >2 E RECEIVED BY'. V\ : fV~ .'.</ ::::::: . ... .. Date T i I / ~ "ForPlan Check and CashDeposi~dyellowcoPYtoFilUlllCl!. l ' ,,-:j c!-/UC:c...a.-"1-{ t. ., Ii:, I ~ ~ NAME OF PAYOR C ({ I) '- ,{tt;/ /.. ':Y17,? /-. .J. c' -CL.",:.--z...../ 't-j., - / i/// />t/~. d) k><-;-? ///. :7/('3 ~/, "Actual Cost Plus 20'/. Overhead 1N0n-lnterest bearing deposit) .::;Jr:; .-(.- h:lrecfrm4. wk3(mp )rev7/1196 $60\ S125) S27) S2,250\ S74O) S35/trip) SI/-" or $25/100 TOTAL S/g) ~-.\y;~- / ~ . /1 .,Lk(.(. ;'-c:J ~tC PHONE t?'5 //~~ ZIP ~..$;'-rL.2:.- ./ .< ''i t'.s-_...:'- ~ --, -.,.... ~. ~ ,r ~ D ~ .:~.,,~;-,. <..\~j '1/....- . '.. '. J I A ~\} ~::; 1 ;j lSgG ~-. v " 'IDaIe! lnitialVF<1 C\T'{ CLt:{r\'S OFFICE . \ TO: City Cleric ,. 4722 2203 4722 2203 4760 4760 4760 4722 4920 4965 TRAFFIC 4728 4728 4728 4728 4728 4271 4728 OTHER ADDRESS lUBLlC WORKS DEPARTMENT RECEIPT E/fective July I. 1996 PUBUCWORKSFILENOC~q~ -~// PROPERTY ADDRESS ~t?t/ /. ~ / L L._ 2203 2203 2203 2203 2203 2203 4721 Parkland Dedication Fee POSlalle ::.::AMoti:Nf:::..... . S ~~/) - $325) S225) S500 min) 100% ofENGR.EST. 100"10 ofENGR. EST.) 100% ofENGR.EST.) 4% ofENGR.EST.VS500 minlSlO,OOO lrIlIX) 100"10 ofENGR. EST.) /' ./ \ · 1"'10.; I ./ / \ ./ .~ Pi.... collect & receipt for the followina monies: :3~~S,4921 . I~Rev""ue(5P<"ify p~ject) ENCROACHMENT PERMIT 4722 Application Fee Non-Utility Enc:roechment Pennit (S225) R.I Fim Permit (No Fee). Subseouent PennitIYrlSIOO) Utilitv Encroachment Permit Ar1crialICollec:lOr SIrecI Residential StreetIOther Areas Plan Check Deoosit. 2% ofENGR. EST. Faithful Perfonnance Security (FPS) Labor and Materials Securitv Monumentation Security Cash Deoosit Labor and Material Security Plan Check & Inspection Fee (Non-Utility) Engr.Est. < $150,000 EnIU'.Est.>$150,OOO Utilitv < SIOO,OOO Minimum Charge Per Loc:otion ConduitslPipelines up to 500 Feet Above 500 Feet ManholesN aultsIEtc. Pole SetlRemoval SIrecI Tree PlantinlllRemoval Utilitv > S I 00 000 Proiect Plans & Soecifications Standard Soecifications & Details Copies of Enaineerina Maps & Plans Penalties: Failure to restore public improvements IMuni Code Section 11.34.010' 4722 Penalties: Failure to colTOCl unsafe conditions LAND DEVELOPMENT 4722 Lot Line Ad' ustment 4722 Parcel Man 14 Lots or Less) 4722 Final Tract Man IS or More Lots) 4722 Certificate of Comoliance 4722 Certificate of Correction 4722 Vacation of Public Streets 8< Easements 4722 Assessment Segregation or Reapportionment FimSplit Each Additional Lot Stonn Drainage Area Fee Per Acre (12% ofENGR. EST.) IDeoosit8% ofENGR, EST./S30,OOO min.)" 18%) (SI20) (SI.601ft) (SUOlft,) (S I 05/08) (S I 05/08) IS I 051tree) Actual Cost + 20% .. Proiect No. -(SItP. SI2IBook) IS.50/so.ft, ) IS I OO/Calendar Dav) IS I OO/Calendar Dav) S500) SI,06O + $151Lot) SI,380 + S25ILot)- S500) S300) S5501 (S550) IS170) (R-I, $1,000) (Multi-Res. $1,250) All Other S2,500) Intersection Turn Counts Cfwo--Hour Count Intersection Tum Counts Ia.m. or p.m, oeaks) Traffic Flow Man {Dailv Traffic Volumes' Campbell Traffic Model {Full Scope Assessment' Campbell Traffic ModeJ (Reduced Scope Assessment) Truck Permits No Parkina Sians FOR CITY CLERK ONLY "Actual Cost Plus 20'10 Overhead 1N0n-lnterest beorina deoosit' I 1\ r RECEIVED BY . : l' Yr1 i I\J TOTAL , .~ fi7 I~~ A' / _ NAME OF APPLICANT //J/n/ ~ (~. /~/~..-:' 7 NAMEOFPAYOR/k ;?~d ~:lfJr/o~rk;, #'// ~/;; ~ ~ Y'7'1~~ ~"" 7~" . /74 t/ ....... .. .... -- $60 S125) S27 S2.2501 S740) S35/trin' SII-=h or S2511 00) S ?d~ . . PHONE '1/JS~ 295- /'/ "J~ ZIP 4?"//eJ Dale . . 'f - j, , ,..., '-1 ') "'t' '" I , -~--:- ? 'NECZ1VED "For Plan Check and CashOeposits, send yellow COPr to Finaru:e. I ~ ~/lW.z~~ .......... 1\ i ,f" M ,.} iJ 1 3 'iQn"O ..,0.1 h:lrecfnn4. wk3(mp )rev711196 C\TY CLERi('S OFFICE ;.,~.~o f' CA4t~~1:!'> ... r" U r" . . .. ... 10 .. ~. ,,' O"CHA\lO' ~-<M-;r 70, ,~J9 CITY OF CAMPBELL Public Works Department. Maintenance Division April 25, 1997 Pacific Gas & Electric Co. 10900 Blaney Ave. Cupertino, Ca. 95014 Attention: Kathy Donohue SUBJECT: Request for pole number and an addition to Campbell Municipal Lighting District billing Kathy, a contractor for the City of Campbell has installed a new street light in front of 2931 Winchester Boulevard, north ofBedal. New conduit and conductors were installed and it has been tied into the existing street light service for the street light south of it, pole #9442. The new light fixture is a 200 watt, High Pressure Sodium, 240 volt unit. Please add it to the Campbell Municipal Lighting District billing under the LS-2A rate. Please call of fax me with the new pole number as soon as you can do so. The City of Campbell will number the pole. Ifthere are any questions, I can be reached at 408-364-2827 or you can page me at 408- 631-1815. The fax here at Signals & Lighting is 408-374-9738. t:iI?~ Tony Ruc er Senior Signal & Lighting Technician cc: Randy Westfall Charles Gallardo PG& E File 70 North First Street. Campbell, California 95008.1423 ' TEL 408.866.2145 . FAX 408,370,3304 ' TDD 408.866,2790 " .::.Il~~R.~~iO'n~~';~A;~~EN,t 'PLAN . ",~J~~;.,~J:f~~; .,' ,.: . '\&:'" ',. . .... .', '.' j , .j "",,"P',:"',: ..;ty~>",~.:","".: -'~~' ~. _,.,', . ,",'" '__' '__~', "", ;'", _ . ..... ~};1i?f:E~/':fiE~VE' SEcTI'qN OF EXISrtNG Sl D.EWALK. Po'::; ~SHO'~. (SEE LEGEND) ~~..;,.;.; ~.f:!.+'~2\>,tX'Sll NG,CUR8 ,GUTTER~, .AND BASE )\OCl< TO REW.I N. SEE HAND .~.~~~~;.t~\~~'::~;:Y.'.~"'l2"F-oR $1 DEWALK REPLACEMENT: ?ATCH AND REPA; R DAMAGED CURB iJ,:'4H'~'~r;'~}:".. ' SECT (ONS TO' t.t:..JCH, qt Ty Of CAMPBELL STANDARDS, ~. . '~~X,;:;<~:~:!:~;i::'~~'", REMOVE EX Isr; NG,NO STOPPING :)1 GN AND PO S 1'. ~, Ol......-,:=. (:~',;.;.....~ .;"lNSTALL 51 GN:ONNEW STREETL I GHTSTANDARD. :(':t~~<'::';>Q~":E:X1STING PG&fJqlNT UTilITY POlE~itH RISERS, COORD' I NATE ..~,.~;.:.. ",~. ~~,':RELOCA liON OF' EXISrtNG UT 1l '-T t ES TO UNDERGROUr~D i..OCA T IONS '(;;/~:S. ~ '<','^:-.,:)N ITH THE. .RESPE:CT J VEUT! L I'rY COMPAN! ES . '" ' ':7}j~'".,: '~'D"';,NEW $TREET'LlGHT AT 1+ 19,0 iNSTALL STATE TYPE 15, . ,:;',',,,?-' ~GALVANI2ED STANDI;RDWITH 12'-0" MAST .ARM AND 200 WATrHfGH :X;;;/:'" ';PRfSSURE SODIUM' cur OFF' 'TYPE lUM 1 NA IRE, WITH PEe. 120/240'/.. ", "SHOW LABEL CONNECT TO ,EX 1 ST I f'.jG LIGHT! NO C 1 RCU 1 -; ! N PG&E PULL BOX. ATb+18.'J'S. COORDINATE WORK WlTHCITY .or: CAMPBELL. .'" STANDARODETAllS= SEE DETAIL 15 FOR CONDU!T. '~,: ~'EXISTING STREET UGHT.orO REMAIN. . ' . cV . ':'" PRoviDE' 2 "co'NPu i T Wi TH PULL . ROPE TO PRO? liNE FOR FUTURE . ....,.uNDERGROUND CABLE.- tELE\lf S I ON. (SEE SITE PL,AN OFON-SI TE ....." ,WORK,.)'. COORD INA,TE, REQU IREMENTS FOR P\JLL BeXES, JO 1 NT TR.ENCH, . Ere WI TH UT.1L'(TYCOMPANY. . P'ROVI DE: 2". CONDurr W1 TH PULL ROPE TO':PROPERTY LINE FOR NEW :'UNQERGROUND "TELEPHONE (SET Sin: pLAN Of: ON-S! iE WORK.) COORDIN;c.. TE REOV! REMENTS. FOR PULL BOXES,JO I NT TRENCH, ETe .W! TH UT j llTY COMPANY. , REMOVE SECTJONS -Of' (E) SIDEWALK, BASE ROGK, AND. SO 1 L, AS NE~ESSARY F.(*NEW'STREET TREE AND I RRl GA nON. "(.E~' 4," T.. '~'" 'l~ 1"ll .~ '20 . . -..... -. '-"'~':'! 1\ ,. :,..-..,) ~"t - .:;Iex; '1" c,EXl STl NG.tO'. WATER U t'lL EXIST I NG ReF> ';SEWER' LINe: EXIST i NG S kDEWALK. TOREMA IN.. PROV,I DE CONDn!'r WITH PULL ROPE' TO PROPERTY LINE FOR NEW . Vri~.ERGROUND "El..'ECTR I CAL SERV I CE (SEE SITE PLAN' OF ON-S I IE ' 'WDRK. Y >COORO;t'NATEREQU I,REMENTS.FOR PULL BOXES.: JO I NT TRENCH, .~.~, .... .~ 'ETC W1TH UT1LI1Y COMPANY. "c . '. '" ' " -:;";~;Y,'.'~f;;~ STR-EET II (;HT' CQNDU IT:, t l' 1/2. SCHEDUL E .4-0 pva CONDUJ TWITH ',' ':,'\~,:' '. .,.,. .' TWO ,,8 AWG: TW.:CQNDUCTQRS AND & UNINSULAITD 18 AWG STRANDED: ". . .;> ;.,"','~..; : - GROUM) W1RE','PROVIDE30"AMP HEX-,.,AA FUSE HOLDERS. ,.,' ''',', .SHOW ,LABEL. REMOVE,' AND REPLACE, S !DEWALK, AND, DR I VEWAY' AS ~.',':.:-:;,:,.;.,'" """JE"'C'E':S"SAR"y' ~~/J~.,,/~>,,? " :,"-~ ':~ ,"'.' I...),.'".':"~". +:' ;:'~ -"~' ,,--- f"&, " -' -, - - ..,.... r.r-e.tt~:Y.'H.~'''~,~r:-r:-~--)'~.~__.:-r;/{ ~..! ..........,}.....t;.,. .r..J;:...-'~.""", '.,.", @ ""IN$TALL .NO.,J"1'2'PU("L BOX' W1JH 1.1/2" GALVAN,IZED RIGID' .. ':...'~.'>./ ""'~" '. . . STE'EL'CONOUlt",1NTb STREETLIGHT FOUNDAT fON INSTALL GROUND ',,' " '~'}J:~~~,/".,! "" .' ROP:~.',ANOfU,S( H6lpE~ . U-l,PULL. Bbx~ '( 1 +1 9".0) ;' 'i':'/~\:15, 'RELQCAT~W.ATER:METERTO.pLANTING AREA (BEHIND PROP€RT'( LINE) .' <"\~i~,'EX+SriNGPROPERTYU NE (AT ,BACK OF 5J DEWALK) : "':~':r',,:;,:17., 'E:X1SI.f.NG.aA.Ct<.oF,SJ DEWALKLrNE. , . , -:" ';'.~.: 'EX:ISTlNG>RIGHTOf,WAY.LINE. . '., '... .....7f~.EXJST:lNG "~'P~ULl,; BOX' AT. 'BACK OF CURB. PROVIDE NEW,~ROU~D' >:.' . c:~(){): fO~STREET ,:~ I GHJ C1RCU I L (0+1 8'. 75) '20 '.' 'EX ISTfN~ fACEr'Of' 'CURB , " '., " " .' " tr.~'. EXISrlNGpROPERTY'LfNE" " .', , " '22.:, .1'2.,~WIOE:W^RNING<,BAND,.tN,CONCRETE:.PROVIDE .3/4-" DEEP ..' " ; · ROUNb'ED -GROOVES.,.'lN CONCREtE AT 3/4 .. QN. CENTER. ".' - . 23~!i;REMGVEANO RSPLACEEXI ST lNG, GUTTER 'AT ,DRIVEWAY CUT, AS'SHOWN . ';:',,-?::.' ;;,', ", 'SEE'OETA1L)6'/ 'THIS PAGE..t..,- ......... .-....._~.~....~....'~..'...;~. ~.... . .', .IN~..J.;All... '. NO. -:. 3':,.,:.'. /2.;P~L. ,1.;...BbX'~ . ","c,,-,',-2 .,..llP.OF'.GUTTERu. " " ",jj':,'?T",;',:;,2.6..'. .:CONOUA TFOij EXJSTlN~,'.StREErLI GHTiCH~CUj T>'. ,:\~t:.\~tL;~; .:'21,.'~i:.\;.t;^ TCH BASlN . "ANt> '.P'fPINC:' SEE'O~S"I n:' C I V. I L .O~AW I NGS . ?;-:'~'~~:''<,:;28~ · :S tDEWALK UNDER".oRA I N.,.SEE ON S I TEe 1 VILDRAWI NGS. . '~~~:f;,:~~ILhxic~p:ILAN)SHEEI ..NOTES.......... . · 5c~1f11~~~~:x" J.~b~fp5f1 "'I ... .;- ~." , ~''''', "', - . 8. ~~'......'Dr;...~~.f1'kfiY . '-~.:":LJ~.l ^ l'l~' .'.0' ""-(ID '::>,p)i':' . " .. ' EX! fe, \ . . '''It , '~"1 ~,~ >.'~ -,; ~- .,~ l' ~ ~ ~ ~ ~':t~ - I ~ ,~ -$ ~ -- ~::j . \..' . ~,t , '->~ '~J" -.......: 'Y'I .-s"~ ~\.01 "'..... ' . \~ / / ./ '0>4, .' / ,~' ~:t/ . , s:- .~ . /,/ .~.~~,> ' ~ Yl/./ / .,: , 2. 3. 4. , "I '.,.\ .." .. .<8. 'L,utll ''vr ,..'4: .' '.;\-' I- .J. { . I I I L ' '1 . I' . , IF I SCORE LINE r I,: ..'.....,.U,.jl:........'................... . .' .. - ~ '.,' - . ,- ' ~-. - ,-. ' ,. ' ~ - .' ~. . ,...I ... ". . . " :" . 1 .;, .' "", .", . (E:) -: E GUTTtR EB . . / ......1 :', /, 1/ _ \, ,'" _. "I I ,.'. I '{/'~,: ..Ji),"S1REEJ'tlGHT .'. ':':'''l'''':''~~('~..'' <~<, ". ;C. ." :;;,,<......;.,..'"P:;~._il".;':...,~ ~.....-W- -.".. I" . . ..,",' ~. .:.;,;:..~:..::...,~...~:~~:~....:'\,~21 0...-- -....-':o<..t- "";....... ......:,,,:~,-~~;. 'C ~~.'';; .:::... CITY OF CAMPBELL FIELD ENGINEER'S DAILY REPORT PROJECT NO. REPORT NO: CJc-Z! '-2 q]( 56.' (((NC Ilrr s. T/"€ DATE : L/_((_c'? WEATHER: C,C r, (+1(' CONTRACTOR: tJZ L.(j r/2 ((AlC (I INSPECTOR: t:);'1 13 r; N/iL F <"I S' I) 'CK:. l(r,')'; ITEM DESCRIPTION //2 . ~ /2 rC,$ c II C /V ,;, / i' /f -;;::-; D /I v 12. 7('kL c( c ?(- c ,.../" / ~/ c: .::- C < .? [ .' .---' /h:D C:-' ;Zc (r V 0 1~r'Y! ~. E-..:.r- ( S '-/ /t< C- /l c / b u/! /t'cr-... L Clri (/?c) .IV! /'--r~ (iJ 4L/ /I<:C- C' /?" /'u 'Y10 (/ ..-,.-- / /f Ci~\ /' {c " ~l( It 6 c.-..S cc: ~~ PAGE: I OF I Of'C"<f.t ;........~A-&>~ U . ~ . . . ....., ... 1- . "- ~. c...... O~CHA\l$. CITY OF CAMPBELL Public Works Department April 2, 1997 Mr. Claudio Hunger Superintendent Schwager Davis Inc. 500 Phelan Avenue San Jose, CA 95112 RE: 2931 South Winchester Permit #9HiJ5 e:r" - C I cr Dear Mr. Hunger: Pursuant to my phone message today, the City of Campbell is formally notifying you of our intent to utilize section 11.34.010 of the Municipal Code providing the City authority to assess a penalty of$100.00 per day for every day in which you fail to complete the subject project. Moreover, the failure of S.D.I. to properly correct an unsafe condition within the public right-of-way, warrants an additional $100.00 per day penalty for every day the condition persists. The combined daily penalties to be assessed total $200, and will become effective as of Monday the 7th of April 1997. As always, Campbell Public Works Inspection personnel are available to answer any of your questions regarding your responsibility in this matter. Sincerely, {//~ ~ Robert Phillips Const. Inspector cc: Michelle Quinney 70 North First Street. Campbell, California 95008.1423 ' TEL 408.866.2150 . FAX 408.376,0958 . TDD 408.866.2790 FR0i1 : SD I SAN JOSE MAR. 4.1997 9:58AM P 1 PHm'.... NO. : 408 294 8072 500 Phelan Avenue San Jose, CA 95112 FAX COVER SHEET DATE: ..3/ f/ /37 , TIME: TOTAL PAGES: \ TO: (co.) o;C v. v 2- fJ;C nlu/~e/I FAX # . (INCLUDING COVER SHEer) 37( - 08r<p .R~xV 4Jer;L~// REGARDING: t/C;{;f C /e ~_;C 8~....~d,Q v FROM: llcu~e;?~ I/u~ COMMENTS: /l-I-tClC{ f2c/ ;o/~ ;/&-,L re-r~/k r?~Uf Fe ,1<S.r/- ATTENTION: /fh=/ cote.,~qc~# . c9h &&t~y ~ /. -- , It~ I (A,jQ...r ..r~~~(PJ"t?qP ~ ..r~ YlJ)u c?. C O.P~ ~ J{: vVOCJ J? @go{ qot6/,' .;)OHQ / qQ IQr ,/-l/etzJe /e;/:. 4.("'L k,,~c..) PLEASE DELIVER THIS INFORMATION TO THE APPROPRIATE PARTY UPON RECEIPT. IF YOU DO NOT RECEIVE ALL OF THE PAGES LISTED, OR IF ANY OF THEM ARE NOT LEGIBLE, PLEASE CONTACT THE SENDER IMMEDIATELY. OFFICE (408) 294-5224 FAX # (408) 294-8072 FROI" . SD I SAN JOSE MAR. 4.1997 9:59AM P 2 PHOt',r NO. : 408 294 8072 ~ ~ .~', Quality Assurance Services Materials Consulting Since 1954 Testing Engineers, Inc. FEO 1991 1lIoFJ....~e h, '.~d --.... DaI'I~'liic PROJECT NO: 38720 TYPE OF INSPECTION PLACE OF INSPECTI PROJECT NAME: Van Cleef Bldg. Nuclear Density JObsite 2931 s, Winchester Blvd. WORK REQUEST: H5933 ZONE: ~ .- '-------- - "--'~'-' OATE: 2-1-97 HOURS: 4 INSPECTOR: Griffiths Reported to: Claudio H Company: Schwager Davis Feature: Curb & Gutter at Driveway Entrance Field Test Procedure: ASTM D2922 & 03017 Lab Test Procedure: ASTM D1557 MATERIAL DESCRIPTION 1. Recycle CL II AB MOIST. 6.7% MAX_ DENSITY 130.5 pcf LAB REF. , SC334 FIE L D T E S T R E S U L T S Curve Field Field Rel_ Pro: Location Elev. No. Dens_ Moist. Compo Spec pcf % % %- 8. @ C&G north end FGAB 1 125.7 5.2 96 95 9. @ C&G center FGAB 1 12,4.3 7.2 95 95 10. @ C&G south end FGAB 1 123.0 7.3 94* 95 11- Retest of test #10 in the FGAB 1 124,3 6.7 95 95 same vacinity * BELOW PROJECT SPECIFICATIONS * .......... ................ ............... .... ...................".. ......."....." NOTE: Test results constitute the reporting of factual information derived from test(s) made by our laboratory following prescribed procedures. These test results should not be considered as an engineering opinion with respect thereto. lee: Schwager Davis Inc. City of Campbell r- l.~~ Reviewed by Terry R. Chiccino, Soils/Asphalt Field Op rations Manager Corporate Office. 2811 Adeline Street, Oakland. California 94608. (510) 835-03142 _ F=AX (510) 834.3n7 SouthlWllst Say - 2123 Bering Drive, SullO E . San JO$e, Calilorni1l95131 - (408) 451-2420. FAX (408) 451-2425 EalillNorth Bay. 827 Arnold Drive. Bay 4- Maninez, California 94553 - (510) 370-7000. FAX (510) 2<9.2951 FROM : SDI SRN JOSE MRR. 4.1997 9:55RM P 1 PHONF ~O. : 408 294 8072 500 Phelan Avenue San Jose, CA 95112 FAX COVER SHEET DATE: .3/ f/ 137 TIME: . TOTAL PAGES: 2. (INCLUDING COVER SHEET) TO: (Co.) 0 ~ 'V. () ~ ca4</~e/1 FAX # 37' - 0 9 ~ <P v ATTENTION: Ic:?~ cUe.r;LlG: // REGARDING: I/Ciu. C /e e,/:' 8Q//bt/t,Q V' FROM: r/Q~~b ~~ COMMENTS: /l-1-hc(Q.c! ~/~ /fh=/ C()U,,::JqcJ1bk . ;/er.,L r~..rt(/k H"<!Jtvr Fe /&'~ rj)J., ~ k"t-roh. y ;::e5 /, ....., r ,C" I .-j) /.- - ~ ~ t.,VCC,J' ..rc,/r:'tA.Ff2'-C /'f) -..( et'f'-'r ;yt!)u ct.. Co,Py . I?' you 11 eGo( qet6/,' .1bHQ I ale( ~( /;(~Je le~ "-t-<L ku(!)c.J PLEASE DELIVER THIS INFORMATION TO THE APPROPRIATE PARTY UPON RECEIPT. IF YOU DO NOT RECEIVE All OF THE PAGES LISTED, OR IF ANY OF THEM ARE NOT LEGIBLE, PLEASE CONTACT THE SENDER IMMEDIATELY. OFFICE (408) 294.5224 FAX # (408) 294-aO?2 FROM SDr S~N JOSE MRR. 4.1997 9:56RM P 2 PHo~r NO. : 408 294 8072 ~ ~ ~j' FEB 1997 ReceilU'\~ IcInriit lJ~1!,.~'ln~. Quality Assurance Services Materials Consulting Since 1954 Testing Engineers, Inc. PROJECT NO: 38720 TYPE OF INSPECTION PLACE OF INSPECT!C PROJECT NAME: Van Cleef Bldg. Nuclear Density Jobsite 2931 s. winchester Blvd. WORK REQUEST: H5933 ZONE: - .-- L..-_____- . - DATE: 2-1-97 HOURS: 4 INSPECTOR: Griffiths Reported to: Claudio H Company: Schwager Davis Feature: Curb & Gutter at Driveway Entrance Field Test Procedure: ASTM D2922 & D3017 Lab Test Procedure: ASTM D1557 MATERIAL DESCRIPTION ~. Recycle CL II AB MOIST. 6.7% MAX. DENSITY 130.5 pcf LAB REF. # SC334 FIEi,f> T L~~4fl~n nl << ~ ~ Cjtr2J 1 Testing Engineers, Inc. RECEI\/ED FEB 141991 Quality Assurance Services Materials Consulting Since 1954 PUtlLIC W'~i'\.'''',- AOMlNISTRA TIOI\i PROJECT NO: 38720 TYPE OF INSPECTION PLACE OF INSPECTION PROJECT NAME: Van Cleff Bldg. 2931 S. Winchester Campbell Nuclear Density Jobsite WORK REQUEST: H5928 ZONE: '"--- ..- -- .....- -l.---.---r--.-l-----L DATE: HOURS: INSPECTOR: 1-31-97 4 Griffiths Reported to: Claudio Company: Schwager Davis Inc. Feature: Driveway Field Test Procedure: ASTM 02922 & 03017 Lab Test Procedure: ASTM 01557 MATERIAL DESCRIPTION 1. CL II (AB) Recycle MOIST. 6.7% MAX. DENSITY 130.5 PCF LAB REF. # SC334 * BELOW PROJECT SPECIFICATIONS * ..... ................................................................................................................................................ NOTE: Test results constitute the reporting of factual information derived from testes) made by our laboratory following prescribed procedllres. These test results should not be considered as an engineering opiniorl with respect thereto. _ ~ Reviewed by --=-~~()~_____ ,__ Terry R. Chiccino, Soils/Asphalt Field Op rations Manager 1cc: Schwager Davis Inc. City of Campbell Corporate Office - 2811 Adeline Street, Oakland, California 94608 - (510) 835-3142 - FAX (510) 834.3777 South/West Bay - 2123 Bering Drive, Suite E - San Jose, California 95131 - (408) 451-2420 - FAX (408) 451-2425 East/North Bay - 827 Arnold Drive, Bay 4 - Martinez, California 94553 - (510) 370-7000 - FAX (510) 229-2951 ~ ~ Quality Assurance Services Materials Consulting Since 1954 Testing Engineers, Inc. PROJECT NO: 38720 TYPE OF INSPECTION PLACE OF INSPECTION PROJECT NAME: Van Cleef Bldg. Nuclear Density Jobsite 2931 S. Winchester Blvd. WORK REQUEST: H5933 ZONE: -, I DATE: 2-1-97 HOURS: 4 INSPECTOR: Griffiths Reported to: Claudio H Company: Schwager Davis Feature: Curb & Gutter at Driveway Entrance Field Test Procedure: ASTM 02922 & D3017 Lab Test Procedure: ASTM 01557 MATERIAL DESCRIPTION 1. Recycle CL II AB MOIST. 6.7% MAX. DENSITY 130.5 pcf LAB REF. # SC334 FIE L D T E S T R E S U L T S Curve Field Field ReI. Proj. Location Elev. No. Dens. Moist. Compo Spec. pcf % % %- 8. @ C&G north end FGAB 1 125.7 5.2 96 95 9. @ C&G center FGAB 1 124.3 7.2 95 95 10. @ C&G south end FGAB 1 123.0 7.3 94* 95 II. Retest of test #10 in the FGAB 1 124.3 6.7 95 95 same vacinity * BELOW PROJECT SPECIFICATIONS * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NOTE: Test results constitute the reporting of factual information derived from testes) made by our laboratory following prescribed procedures. These test results should not be considered as an engineering opinion with respect thereto. lcc: Schwager Davis Inc. City of Campbell l.~ Reviewed by Terry R. Chiccino, Soils/Asphalt Field Op rations Manager Corporate Office - 2811 Adeline Street, Oakland, California 94608 - (510) 835-3142 - FAX (510) 834-3777 South/West Bay - 2123 Bering Drive, Suite E - San Jose, California 95131 - (408) 451-2420 - FAX (408) 451-2425 East/North Bay - 827 Arnold Drive, Bay 4 - Martinez, California 94553 - (510) 370-7000 - FAX (510) 229-2951 ~ ~ IECIEIVED FEB 1), 61991 r'UIH.iL '.V ~n'.,',;:; ~DMINISTRATION Quality Assurance Services Materials Consulting Since 1954 Testing Engineers, Inc. _LABQRATQFL,NQ,~..5.C;;J.J,4_.._..... ......BEPQR'll.QE .TOB DATA: 38720 Van Cleef Bldg 2931 S Winchester Blvd Campbel.L, CA . S.o.JL., 'rES.Ts.__, .........._..J)ATf~;_ 1./J1J,r:lJ. SAMPLE DA'rA:sampled 1/31/9'1 from jobsite stockpile AB2, unknown source Et~.l~:L In~Q~gtQr:H ~~ri,[t.;[j::J}~. VISUAL CLASSIFICATION: _.Gx:,gyi ~b_Q.r,QJtlD.. _~il tY-.~_smgy__g.rgY~.1__...... MAXIMUM DENSITY DETE&~INATION; Method ASTM D1557 Optimum Moisture, % 6.7 Maximum Dry Density 2.09 g/ce _..__JJt:J~._.c;!l. nf;.~t_.J._ . .. _lJQ. ~ Zero Air Voids, Gs=2.50 132,0 131,5 131.0 130,5 130.0 129.5 129,0 128,5 128.0 127.5 127.0 l.L 126,5 0 0... .:q 126,0 (0 '125.5 ~ Cl 125,0 C 124.5 Cl 124.il '123.5 123,0 122.5 122.0 121.5 121,0 120,5 120.0 119,5 ~1 9.0 3.0 35 4.0 4.5 5.0 5.5 .......,........ lee: Schwager Davis Ine lee: c.o. Campbell Rev~~:: · b:Y;:Crrn7~-/fP:;-~~'; ~~n 'll~~~t~-:. i.'(;'~-j ~O-;. 's~il~ - As'phaj t Field 0 erations Manager Corporate Office - 2811 Adeline Street, Oakland, California 94608 - (510) 835-3142 - FAX (510) 834-3777 South/West Bay - 2123 Bering Drive, Suite E - San Jose, California 95131 - (408) 451-2420 - FAX (408) 451-2425 East/North Bay - 827 Arnold Drive, Bay 4 - Martinez, California 94553 - (510) 370-7000 - FAX (510) 229-2951 Sanla OQ(Q Valley WcX8( ~6 ,,150 AlMADEN EXPRESSWAY. SAN JOSE. CA 9511, JS1265.2600 PERMIT Facility: Page Percolation System Date Issued: August 27, 1996 Permit No,: 96932 Permittee: Mr, Bill Van Cleef 411~'. ue,No, 203 San , A-.95110 " Telephone: (408) 295-1734 File: 16431 Page Percolation System Wly South Winchester Boulevard Sly West Sunny.oaks Avenue Applicant: ~r. J. Rick Rechenmacher 1552 Fuchsia Drive San Jose, CA 95125 (408) 266-6329 Re: Lands of Van Cleef Purpose of Permit o Encroachment mI Construction o Temporary 1. Demolition and backfill of swimming pool. 2, Construction of a parking lot and drainage system adjacent to the District's Page Percolation System. Construction Expiration Date: Auaust 27. 1997 Encroachment Expiration Date: REBJmtrnrne.e::iNf.:us:Jili:::f.l.:axlEM::lIN1J::::EUBNlSB::::s:cHEDU:c.e::::(;lJmi:::WQRl<iim:Q: District's Construction Unit, c/o Mr, Dean Arroyo, (408) 265-2607, extension 2801, at least 2 normal working days before starting any work under this permit. Failure to notifv is cause for revocation of Dermit and removal of work. Exercise of this permit shall indicate acceptance of and agreement to comply with all provisions included herein. This permit is subject to the General Provisions listed on the reverse side hereof or as expressly modified in the additional Special Provisions listed below. Violation of any provision shall be cause for immediate revocation of permit, SPECIAL PROVISIONS 1. All backfill within District right of way shall be compacted to at least 90 percent relative compaction in accordance with California Test Method 216 or 231 or ASTM Test Designations 01556,01557, or 02922 except as modified herein. 2. The District's inspector must verify removal of all drainage facilities directed towards the percolation pond and the demolition of the pool. Approval: '&AL ar ~ Sue A. Tippets, P.E. Supervising Engineer (Acting) Community Projects Review Unit cc: Building Department City of Campbell 70 North First Street Campbell, CA 95008 FeE SOb (1218/96) CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 2931 S. Winchester Encroachment Permit No. 96-219 Application No, UP 95-19 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30K $30 K to $150 K > $150 K $ AMOUNT I. URFACE CONSTRUCTION MOBILIZATION 1 LS $750.00 $750.00 ~ONSTRUCTION TRAFFIC ONTROLCONTROUPHASING I LS $750.00 $750.00 ~ONSTRUCTION STAKING LS "'ONSTRUCTION TESTING 1 LS $250.00 $250.00 11, bEMOLlTION/CLEARlNG 1. CLEARING & GRUBBING LS 2. SA WCUT P.C.C.lA.C,(UP TO 6") 164 LF $4.50 $3.00 $2.00 $738.00 3. p.C.C. REMOVAL 37 SY $30,00 $23,00 $10.00 $1,110.00 4. ~URB AND GUITER REMOVAL 22 LF $6.00 $3.00 $2.00 $132.00 5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25 6, DEMOLISH EXISTING INLET/PLUG RCP'S EA 111. STORM DRAINAGE 1. 2" R.C.P. (CLASS V) LF $60,00 $40.00 $20,00 2, 5" R.C.P. (CLASS 111) LF $65.00 $48.00 $38.00 3, 8" R.C.P. (CLASS III) LF $70.00 $60,00 $52.00 I I I I I 4. 4" R.C.P. (CLASS 111) LF $80.00 $68.00 $59.00 I 5. 30" R,C.P. (CLASS III) LF $90.00 $75.00 $65.00 6. ,V. INSPECTION (12") LF $1.20 $0.75 $0.60 7. TO. DRAINAGE INLET EA $1,600.00 $1,300.00 $1,000.00 C.C. DETAIL 9) 8. PLAT GRATE INLET EA $1,400.00 $1,100.00 $900,00 C,C. DETAIL 6) I 9, TANDARD MANHOLE EA $2,000.00 $1,600,00 $1,300,00 C.S.J. DETAIL D-11) INCLUDES FRAME & LID) Date 8/15/96 -1- ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K to $150 K > $150 K 10. BREAK AND ENTER M.H.lD.I. EA $700.00 $550.00 $450.00 IV, ONCRETEIMPROVEMENTS I. IDEW ALK 1S0 SF $6.50 $4.50 $2.75 $1,170.00 2. PRlVEW A Y APPROACH 114 SF $7.50 $5.50 $3.75 $S55.00 3. ~URB AND GUlTER 22 LF $22.00 $18.00 $15.00 $484,00 4. ~ ALLEY GUlTER SF $12.50 $10,00 $S.25 5. HANDICAP RAMP EA $1,200.00 $SOO.OO $700,00 6. !rYPE B-1 CURB LF $12,00 $9.50 $7.50 7, !rYPE AI-B3 CURB LF $15,00 $12,00 $10.00 S. OBBLESTONE MEDIAN SURFACE SF $12,00 $S,OO $5.00 9. p.C.C. DRIVEWAY CONFORM SF $7.00 $5.50 $4,50 10. I\.C. DRIVEWAY CONFORM SF $4.50 $3.75 $3,00 V. A VEMENT I. /\sPHALT DlOOUT AND REPLACE 12 CF $5.00 $3,50 $2.50 $60.00 2, A VEMENT WEDGE CUT (6') LF $5.00 $2.50 $1.50 3. PAVEMENT GRINDING 12 SF $0.80 $0.50 $0,35 $9.60 4. PAVEMENT FABRIC (PETRO-MAl) SY $2,00 $1.85 $1.50 5. ~SPHALT CONCRETE (TYPE A) T $SO,OO $50,00 $35.00 6. ~GGREGATE BASE (CLASS 2) T $40.00 $20.00 $12.00 7. ~LURRY SEAL (TYPE II) SF $0.07 $0,06 $0,05 S. ~LURRY SEAL (TYPE III) SF $0.11 $0,09 $0,07 VI. ~FFIC SIGNALS/LIGHTS I I 1. PETECTOR 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, ELECTROLlER 1 EA $2,600,00 $2,200,00 $l,SOO.OO $2,600.00 5. 1/2" RIGID CONDUIT 95 LF $9,00 $7.00 $5.00 $S55.00 -2- ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K TO $150 K > $150 K 6. . RIGID CONDUIT LF $17.00 $13,00 $10,00 7. CONDUCTOR 285 LF $0,70 $0,55 $0.45 $199.50 8. PULL BOX (NO.3 1/2) I EA $300,00 $240,00 $185.00 $300.00 9. PULL BOX (NO.5) EA $400.00 $350.00 $300,00 VII. ~TRlPING AND SIGNS 1. REMOVE PVMT. MARKINGS (PAIN'!) SF $2.50 $ 1.50 $1.00 2. bEMOVE PVMT. MARKINGS (THERMO) SF $3,00 $2.00 $1.40 3, ~EMOVE 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. 5TR1PING DETAIL 32 LF $2.40 $1.75 $1.25 7. TRlPING 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. TRlPING DETAIL 40 LF $2.20 $1.70 $1.00 11. IMIT LINE LF $1.35 $1.05 $0,90 12. ROSSW ALK I LF $1.35 $1.05 $0,90 13. AVEMENT MARKINGS (PAIN'!) SF $2.50 $1,90 $1.60 1 l>AVEMENT MARKINGS (THERMO) $5.50 $3,80 i $2,60 14. SF I 15. PAVEMENT MARKER (NON.REFL.) EA $4.50 $3,00 $2,20 16, PAVEMENT MARKER (REFLECTIVE) EA $6,00 $4,151 $3,15 17. rrvPE 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 I 20. RELOCATE ROAD SIGN I EA $100.00 $85.00 $75,00 $100.00 21. NST, RD. SIGN ON EXIST, POLE EA $200.00 $145,00 $110,00 -3- ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < $30 K $30 K TO $150 K > $150 K 22. ~OAD SIGN WITH POST EA $300,00 $240.00 $195.00 VIII. ANDSCAPING I. RRIGATlON, PLANTING WORK LS 2. RUNE TREE ROOTS EA $125.00 $100.00 $S5.00 3. rnrnE REMOVAL EA $650.00 $500.00 $400.00 4, ~OOT BARRIER (12") LFI $20.00 $10,00 $6.00 5. ROOT BARRIER (1S") LF $25.00 $15.00 $10,00 6. TREET TREE (24" BOX) 2 EA $450,00 $325.00 $250.00 $900.00 7. TREET TREE (36" BOX) EA $700.00 $550.00 $400.00 S, Irop SOIL BACKFILL CY I IX, ~ISCELLANEOUS I. PEDESTRIAN BARRIER LF $75,00 $60.00 $50.00 2, ~HAIN LINK FENCE (6') LF $15,00 $11.50 $9,25 3. RAISE MISC. BOX TO GRADE EA $300.00 $200.00 $175,00 4, ~AISE MANHOLE TO GRADE EA $400.00 $275,00 $200.00 5, NSTALL MONUMENT BOX EA $450,00 $350.00 $300.00 Cyl i , 6. MEDIAN BACKFILL $19,00 I $17,00 $15.50 l SUBTOTAL $11,263,10 PREPARED BY: ~c-~'::. ,,<,...~:; C'-_~- \\~ .s~ " J;iJ ! 1~(.J/9f} 10% SECURITY ENFORCEMENT FEE $1.126.31 REVIEWED BY: '12,389,,,j ! I TOTAL ESTIMATE FOR FAITHFUL APPROVED BY: PERFORMANCE SECURITY FAITHFUL PERFORMANCE SECURITY $12,000.00 I 'See Section 66499.4 of the Map Act. H :\LOTC:;\293I WIN, WK3(MP) -4-