96-221
'1
1-\' \\~)~'EPT.u~FC;~~~-WORKS ~
VV V) 70 North First St.
r. t/ Campbell, CA 95008
~\I) (408) 866-2150
\ '? ~ Fax (408) 376-0958
(for working within the
public right-of-way)
Issued .2.);9 ) CJ 7
Permit expires in 12 mos.
, 'r-- . . - q i_ --rz..i
} 1 ~.._ ,:. '\!. 'C;;JII
X-Ref. file
El\C "".I~)j\Cll~\~::'l\~j' fER.?~~:-~'
Application Date ./ .J) r " 1/1
Application exp~
APPUCATION . Application is bcn:by mB for. Pub1il; Worb Permit ill ~ willi c..-u Muaicipal Coclc, Scaioo tl.04.~ 'llire\m 6 moMbs
if !be permit is DOt issued. Applicalion Fee is _refimdable.) /' f / / _ ;~ -.~ \" t: , V E 0
A. Wort IlIdIas or lnICt' ~ ~ r~ ~~~ # v-e . 4tfG-1
~~~ 5~
I. NaluRofwork . >;L~;J /n1/r~w;.n-/~~2r '\/"\';1-'~~1.. 'J"J -'''..
I:HKAf/OI,
C. Aaxh four (4) copies of an cqiDeered plans abowiD& !be locaioa 11III atCIIl of 1bc WOJtt. 11III four (4) copies of 1bc pnIiminIry EaP-r'. I!ItimIIe fA wort. The
plans aha1l show lbc relation of 1bc propoIed work to aiIliD& IUrfxe 11III 1IIIIIaJrouIId improvemcI8. WbcIIIppI'OYed by lbc City EDP-r, uid pim...... · JIlIIl of
dIis permit.
D. All work shill conform to lbc City of Campbe11 SlandInl Spccificllionllllll DcW1s for Public Works CoaslnIaion: 1bc Gcacnl Permit CoacIilionJ 1iIted 0II1bc reverse
.ide; and the Special Provisions for this permit, listed below. Failure to Ibidc by lbcIe aJDdilioaIlIId provisions may rcsu1t ill job 1but4lwD fIJIIJIor forfeilurc of Failhful
PafonJllllCC Sumics and cash deposits. (See Ococral Permit CoacIiliom 111III 2.)
j
(?:
t
~
E. THE CONTRACTOR. MUST HA VB nns PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBUC WORKS DEPARTMENT AT ~\
~ TWO DA YS BEFO~TING ",:ORK. NOTICE MUST BE GIYEN TO PUBUC WO~AT LEAST 24 HOURS BEFORE RESTAR'!l!'G ANY WORK. ~
- ev\ ~ L-1\I\tf\ ~ur~~l' (d - ~ l<g~ ~d1;, ~-
N_ of Applicant X '-- fA ~ ~"...J)Clt/!- ~I..-t' /'.J(:.,4C- I T ~ T~ X sg 3 ~ '3 '37 J--
Q4~ ~~ ~ (printnamc) v..>e::J: SAc, CIA q c:::~ I ~~\(P) 372_1~H>URIlME'JtGIK'Y
Address X 5 Z 5' W 77h ~ s r. /-J A /V/~ c:r:::> ''2 3;;{ ~- 'I1iLIlPHONE NO. ~ '13 -1-'1 U/(;
l ~. L...r--^ ~ Fe' IW
15 Ibis work bcin& done by the property owner It their own rcsidcnl:c? Yes No "7 r 5~ib we.)t- .s()CYl\{"r<U\'P
~~\ I a c
The ApplicanllPcrmiacc hereby agrees by IffIXin& their liplIIure to this permit to bold the City of CIqlbc11. ill off'JCCn. IICIIIS and Cllll'loyccs free. ute and IIIImIcII from ,,5 ~ 1 \
any c1aim or demand for dama&es resultina from !be wort covered by this permit.
The Appl'
iDfonnation.
actnowJcdp lbal tbcy bavc rad IIId IIIIdc:r1lIIId both the froat 11III bIck of lhis pcrmit. 11III 1bcy will IDform Ibcir ClOIIII'IClOI1:I) of 1bc
Dale
To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line I:
Line 2:
City:
Description:
Amount Payable:
Account Number:
ate and Receipt No:
Permit No:
Purpose:
Requested by:
Approved by:
FINANCE ONLY:
Verified by:
Ci~. 1f Campbell - Chec - " Reil-uest
Ultrarnar Inc.
III West Ocean Boulevard, 9th Floor
Long Beach
REFUNDABLE DEPOSIT
$?t:;hn nn
101.2203
12/11/96 #98033
96-221
Refund of Cash Deposit
State: CA Zip: 9 0 8 0 2
Finance On(y:
INTEREST EARNED -
101.540.7448
Robe t Phillips
-U-'~
Michelle Quinney
Approved by:
Date: 9 19 9 7
.~~
Date: _
I
TItle:Proiect Inspector
Title:Citv Enqineer
TItle:
TItle:
Date:
Special Instructions For Handling Check
Mail As Is:
Return To:
(NAME)
Other:
rev: 3/25/95
xx
Mail in Attached Envelope:
(Department)
PUBLIC WORKS DEPARTMENT RECEIPT
EfFective July l~ 1996 \
-
TO: City Cleric PUBUC WORKS FILE NO, C\ to - -Z- 't.. \
q "2. \ W. \...\-1--... \--i\ l C-, -, )
PROPERTY ADDRESS C;" "--'
ACCT: Please collect &; receipt for the following monies:
I ITEM . ....-:.:::.1\MOUNr:::::::::::::::-:.
435.535.4921 Proiect Revenue (s_ifv Droiect) S
ENCROACHME1'IT PERMIT
47221 ApplicatiDn Fee
Non-Utility Encroachment Permit (S225)
R-I First Permit (No Fee), Sub5eOuent Permu/Yr (SIOO)
I Utilitv Encroachment Permit
I Anerial/Collector StrccI S325)
1 Residential Street/Other Areas $225)
::031 Plan Check D..,.,sit- 2~. ofENGR. EST. S500 min) .
::031 F:uthful Pertonnance Security (FPS) !OOO!. ofENGR.EST.\ .
:2031 Labor and Materials Securitv (JOOO!. ofENGR. EST.)
:2031 \-1onumenwion Security ((OOOj, ofENGR.EST.) .
12031 Cash Deaosit (4% ofENGR.EST.\lS500 miniS I 0.000 max) --:L""":. f..--",,~ . ..:a{'
22031 Labor and Material Securitv ((OOO!. ofENGR. EST.) .
Plan Check &; Inspection Fee (Non-Utility) . '"\.G,.~,c . ~
4722 Engr.Esl < S250,OOO (l2%ofENGR. EST,)
.. 1203 Enllt.Est.>S250.000 (DODOsit 8~, ofENGR. ESTJDO,OOO min.)" .
47':21 Ulilitv < 5 I 00.000 (8%)
Minimum Charge Per Location (S120)
Conduil5lPipelines up to 500 Feet (SL60/ft)
Above 500 Feet (Sl.l 0I1t)
ManholCSl V aultsIEtc. (SI05/ea)
Pole SetiRemoval (S105/ea)
Street Tree PlantinlllRemoval (S105/tree)
.. :203 Utilitv > 5100.000 Ac:tual COS! ... 20'Yo .. .
47601 ProJect Plans & Snecifications Pro.ect No,
47601 Standard Soecifications &; Details (SIIP~ SI2IBook)
47601 Cooies of En~ineerin~ Macs &; Plans (S.501sa.lt)
47221 Penalties: Failure to restOre oublic improvements (SlOO/Calendar Dav\
I (Muni Code Section 11.34.010)
47221 Penalties: Failure to correct unsafe conditions (Sloo/Calendar Dav)
LA..'1D DEVELOPMENT
4722 Lot Line Adiu.anent (S500)
472:1 Parcel Mac (4 Lots or Less) S1.060'" S2SlLoll
47221 Final Tract Mac (5 or More Lots) S1.380'" S25ILot)
47::1 Cenitlcate of Comoliance $500)
..71if CMificate of Correction S3(0)
47221 Vacation of Public Streets & EaxmenlS (S550)
47221 Assessment SOl!fegation or Reapportionment
I First Split (S550)
Each Additional Lot (SI70)
4721 ~~o,:" DraJn~e Are~.:ee Per Acre . (R-I, S2.000)
(Muili-Res. S2.:50)
c..;;~\ '"'-r = e:J~ <:;::, \--:2-, """c:.. (All Other. 52,500) l": C<>_-"', &7- r'\
49101 Parkland Dedication Fee
49651 PostalZe -
TRAFFIC
47281 Intersection Tum Counts tTwo--Hour Count) ($60)
47281 Intersection Turn Counts ta.m. or p,m. oeaks) (SI25)
47281 Traffic Flow Mao (Dailv Traffic Volumes) (S27)
47:81 Camobell TraIlic Model (Full Scone Assessment) ($2,250)
47281 Camobell Traffic Model (Reduced Scone Assessment) ($740)
42711 Truck Permits (S35/triD)
47281 :-.so Parkin,,- Siws (Sl/each or S25/1(0)
OTHER I
TOTAL 5 t\ e-..; LC. , e:..c
NAME OF APPLlC,\NT
t '\ ~~ ~ih... \? \ t--...l C_
NAME OF PA YOR ..J '---- , PHONE
H\ \.kJ C)C.~...r -,~~,-H-~ t1.~. ,~7...c (1"
ADDRESS ZIP
L-e> ~ '~~<:.-blr- \. lZ-.;b. O"D~67-
.. ActuaJ Cost Plus :0'/1t Overhead rNon.lnterest bearing deposit)
FOR
CITY CLERK
ONLY
RECEIVED B
RECEIVED
DEe \ , 1996
CITY CLERK'S OFFICE
Date
'For Plan Check:md Cash Deposits, send yellow copy to. Finance.
h:\recfnn4. wkJ(mp)rev711196
;J-j, /0 lLJ
CITY OF CAHFBE~L: .:::
DC'j"\iiT! '::IV. i i C/,~
i..~\"''i..' ..:; Jr ......".;;.,:';
PA YQ~~~ ULTRAMAF~
TODA~~S DA1E: 12/1
EEGlSTEE D~TE i
......""'........................,....1
li!:.ji.:r~l !,"'11 Uf~
~. -.
-'.' - - .-
REF DEPDSITS -:J:.~~v~
. ..J....;,..'~
i.:;i1iiliN i
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CITY OF C:AM~:BtLL:: 'oJq
REC!~D t:~: LISAB
PAYQf~: UL Tf;Ai~AE:
TODA~'S D~~E~ 12.,'11;
F~EGISTEF :;A TE:
l._. __
nt"~r-~T ;:TTfiN
;"':'-";J :.:; ~..;.: ,,;.......:..
ENGR & SUBjIV FILING ~
STORM DRAI\ ~~:~
: ;-'; ~'-
CHEC~. PAID ~
CHECK NG; 100919
'T:i..f7;'::: :-:,"
; 4.,.;.,.'....,\i.......::.
i ... ....,... .~.. ~
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"'----~.
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'.,... "",' ......
+- i ~ ~::..r I'''''''
'$8:
;,1
. -.j ~j
l{t
Requested by: (.,
ert P
Approved by: IJ,~
Michelle Quinney
FINANCE ONLY:
Verified by:
. -,'-' --
To: Accounts Receivable
Please Issue Check
Payable to:
Address - Line 1:
Line 2:
City:
Description:
Amount Payable:
Account Number:
ate and Receipt No:
Pennit No:
purpose:
Approved by:
Mail As Is:
Return To:
Other:
\
rev: 3/25/95
Cit., of Campbell - Chet - Request
Robert H. Lee and Assoc, Inc.
1137 North McDowell Blvd.
State: CA Zip: 9 4 9 5 4
petaluma
Finance Only:
INTEREST EARNED
REFUNDABLE DEPOSIT
$500.00
101.2203 101.540.7448
8/15/96 #95514
I
I
\
I
\
\
Date9/19/97 I
Date9/19/97 \
Da~:1
\
\
96-221
Refund of Plan Check Deposit
Title: Project Inspector
Title: City Engineer
Title:
Title:
Date:
Special Instructions For Handling Check
xx
Mail in Attached Envelope:
..
(NAME)
(Department)
.
PUBLIC WORKS DEPARTMENT HCEIPI'
Effectiv. July I, 1996
0: City Cleric PUBUC WORKS FILE NO. ~ -"'"2'-\
PROPERTY ADDRESS ~l \AL Uk.. ..,~...,
Pi.... collect '" receipt for the followina monies:
Atct: ITEM ...... .................. ....................... .. ... ><AMOUNt<
43S.S3S.4921 T Proiect Revenue ...,;, S
ENCROACHMENT PERMIT
4722 Application Fee ~'2.-:s. nD
Non-Utility EncroCunenl Pennit ($22S)
R-I Fint Permit (No Feel. Su"-uent PennitlYr (SI00)
Utility EncrollChmenl Pennit
Arteria1lCollector Street S32S)
Residential Street/Olher Areas $22S)
2203 PIIII Check~t - 2% ofENGR. EST, SSOO mill\ ' '"E;c.:.-~ L~~
2203 Faithful Peri'onnance 100% ofENOR-EST,) ,
2203 Lobor ond M8leriall Securitv lOO%ofENGR. EST.)
2203 Monumentation Security 100% ofENGR.EST.) ,
2203 Cash Deoosit 4% ofENOR.EST.ltSSOO minlSlO 000 maxI ,
2203 Labor and M8leriaI Security 10Cl"~ ofENGR. EST) .
Plan Check '" 1nspection Fee (Non-Utility)
4722 Enw.Est. < 52S0,OOO (12% ofENGR. EST.)
.. 2203 EnIU.Est.>S2SO 000 -lDeoosit 8% ofENGR- EST.1S30 000 min.)" ,
4722 Utility < S I 00 000 (8%)
Minimum Charae Per LocBtion (SI20)
ConduitsIPipelines up to SOO Feet (SL601ft)
Abov. SOO Feet (SLlOIfl)
ManholesIV ault&lEtc, (SIOS/08)
Pol. Set/Removal (SIOS/08)
Street Tree PlantinolRemoval (SIOS/tree)
.. 2203 Utilitv> SIOO 000 Actual Cost + 20'~ .. ,
4760 Proiect Plans /k. Specifications Proiect No.
4760 Standard Snecifications '" Details (SI/Pu SI2/Book)
4760 Copies of Enllineerino Mans'" Plans (S.SO/sa.IU
4722 Penalties: Failure to restore nublic imtll'Ovements (SIOO/CaIendar Day)
eMuni Code Section 11.34.010)
4722 Penalties: Failure to correct unsafe conditions (SIOO/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Lin. Adiustment SSOO)
4722 Parcel MOD (4 Lots or Less) S 1,060 + S2SlLot)
4722 Final Tract ~IS or More Lob) S1,380 + 52SILot)
4722 Certificate of Comoliance SSOO)
4722 Certificate of Correction S300)
4722 Vocation of Public Streets '" Easements SSSO'
4722 Assessment Segregation or Reapportionment
First Split (SSSO)
Each Additional Lot (S170)
4721 Storm DraiI18l!. Area Fee Per Acr. (R-I, S2,OOO)
(Multi-Res, 52,2S0)
(All Other 52 SOO)
4920 Parkland Dedication Fee
496S P.;.......
TRAFFIC
4728 Intenec:tion Turn Counts ITwo-Hour Count' $60
4728 Intersection Turn Counts (Lm. or o.m. oeaks) SI2S)
4728 Treftic Flow MOD (Dailv Treftic Volumes' 527
4728 CIII10bell Treftic Mod.1 !Full Sc:ooe A........enll 52 2Sm
4728 Camnbell Treftic Mod.llReduced Senne Assessment) S740
4271 Trock Permits S3SlIrio)
4728 No Parkinu Sians SlIach or S2S/100)
OTHER
TOTAL SI.'2~.~
NAME OF APPUCANT
t2-e:.>~ L~~h::.~~. lJ-..:, c- ,
NAME OF PAYOR PHONE
\ \ ""'--",-J ~q;;,~ ~c. ..~ \""S 1..-,,"':::' 9:4-~4-
ADDRESS 'r'. ~:....: L .. -~".. f"> -~. ZIP
"Actual Cost Plus 20'~ Overheod /Non-Interest bearinu deoo.;t)
'For PlanCbeckand Cllsh.Deposits,:leridy.llowcop)'lI>FilUll1l>lO.
:~ ~,' r',"," ~
_.., >:."..~ i-. '-.>/, H ......- :..,_;_~ ~:.J
FOR
CITY CLERK
ONLY
4 5 F''''''
AUG ,I~~O
initials
:..' Ii CLERK'S OFFICE
h:\recfnn4. wk3(mp )rev7/1196
Lie WORKS DEPARTMENT RECEIYf
Effective July I, 1996
"'P' C~ /1A /1
TO: City Clerk PUBLIC WORKS FILE NO. / ..Y.'" - .:<:';<
PROPERTY ADDRESS }7/' I ,/'/U, . ~1/ /#),1
Please collect & receipt for the following monies: d -1'7 't:
ACCT: ITEM .......---.".". .._-"..... .. . .<<?f</;tr:AMOuNt::::.:
435.535.4921 I Proiect Revenue (specifv proiect) S
ENCROACHMENT PERMIT
4722 Application Fee ~.e
Non-Utility Encroachment Permit (S22S)
R-I First Permit (No Fee), Subseouent PermitlYr (SIOO)
Utiiitv Encroachment Permit
Arterial/Collector Street S32S)
Residential Street/Other Areas S22S)
2203 Plan Check Deoosil - 2% of ENGR. EST SSOO min) . ~D
2203 Faithful Performance Security (FPS) 100% ofENGR.EST.) . AC.A A/V) ~.
2203 Labor and Materials Security 100% ofENGR. EST) ./J', /1An
2203 Monumentation Securitv 1000100fENGR.ESTT . """7
2203 Cash Denosit 4% ofENGR.EST)(SSOO min/SIO.OOO maxI . ~ 7;'/:..-/,
2203 Labor and Material Security 100% ofENGR. EST.) .
Plan Check & Inspection Fee (Non-Utility) /~ )'p
4722 Engr.Est. < S2S0,OOO (12%ofENGR. EST.)
.. 2203 EnlU.Est.>S2S0,000 (Deoosit 8% ofENGR. EST./S30,OOO min,).. . -/
4722 Utilitv < SIOO,OOO (8%)
Minimum CharRc Per Location (S120)
ConduitslPipelines up to 500 Feet (S1.60/ft)
Above 500 Feet (SUO/ft.)
ManholesIV aultslEtc. (SIOS/ea)
Pole SetlRemoval (SIOS/ea)
Street Tree PlantinWRemoval -(SIOS/tree)
.. 2203 Ulilitv> SIOO,OOO Actual Cost + 20"10 .. .
4760 Proiect Plans & Soecifications Pro'ect No.
4760 Standard Specifications & Details (SIIP~ SI2IBook)
4760 Cooies of En~ineerin~ Mans & Plans (S.SO/sq.ft.)
4722 Penalties: Failure to restore oublic improvements (SIOO/Calendar Dav)
(Muni Code Section 11.34.010)
4722 Penalties: Failure to correct unsafe conditions (SIOO/Calendar Dav)
LAND DEVELOPMENT
4722 Lot Line Adiustment SSOO)
4722 Parcel Map (4 Lots or Less) SI,06O + S2SlLot)
4722 Final Tract Man (5 or More Lots) SI,380 + S2SlLot)
4722 Certificate of Compliance SSOO)
4722 Certificate of Correction $300)
4722 Vacalion of Public Streets & Easements SSSO)
4722 Assessment Sewegation or Reapportionment
First Splil (SSSO)
Each Additional Lot (SI70)
4721 Storm Drainage Area Fee Per Acre (R-t, S2,000)
,,:t/', ~~/ S t: - '" -:P'l:L ~ (Multi-Res, S2,2S0)
(All Other, $2.500) / ..zA/J
4920 Parkland Dedication Fee
4%5 POslalle
TRAFFIC
4728 Inlersection Turn Counts (Two-Hour Count) ($60)
4728 Intersection Turn Counts (am, or p.m~ peaks) $125)
4728 Traffic Flow Man (Dailv Traffic Volumes) (S27)
4728 Camobell Traffic ModellFull Scope Assessmenl) ($2,250)
4728 Camobell Traffic Model (Reduced Scnne Assessment) (S74O)
427t Truck Permits ($3S/trio)
4728 No Parkin~ SilU1s (S1Ieach or $25/1001
OTHER
TOTAL $ //, .!"11 &
NAME OF APPLICANT
NAME OF PAYOR PHONE
ADDRESS ZIP
.. Actual Cost Plus 20"1. Overhead (Non-Interest bearin~ deposil)
FOR
CITY CLERK
ONLY
rm"D~
Date
Receipt fi.
.For Plan Check and CllshDeposits; send yellow copy to Finance.
Date! Initials
h:\recfrm4. wk3(mp )rev7/1196
IJd~N~1 '~Hh
vj
CITY OF CAMPBElL, CA
~ITy' ijf CAMPBELL, CA
RECVD BY: peAr.
PAY .4..Jnll ;llr\I\I\OQ~i
OR: ROBERT H LEE & ASSO \I V\l\l hl..J.44
rODAY'S D~Tf: 03/15/96
REGISTER DATE: ~O!f~/Q4
V~ 4W! IU TIME: f~"~.~D
"'W.""'.",u
RECVD BY: lISAF. 01000095513
PAYOR: ROBERT H LEE & ASSO
TODAY'S DATE: OB/15/96
REGISTER DATE: 08/15/96 TIME: 15:23:07
DESCRIPTION A I
REF DEPDSITS FUND 101 MOUNT
$500.00
DESCRIPTION AMOUNT
ENGR & SUBDIV FILING F $225.00
TOTAL DUE:
-------------
$500.00
TOTAL DUE:
$225.00
CHECK PAID:
CHECK NO: 18328
TENDERED:
CHANGE:
$500.00
CHECK PAID:
CHELf NO: 18328
TENDERED:
CHANGE:
$225.00
t500.00
$.00
~
$225.00
$.00
4
1!1
ROBJ.. ...RT H. LEE & AS~
1137 NORTH MC DOWELL BOULEVARD
(707) 765-1660
'CIATES~ INC.
PET ALUMA, CA 94954
FAX (707) 765-9908
John W. Johnson, Architect. James H. Ray, Civil Engineer
TRANSMITTAL
DATE: August 13, 1996
TO: Harold Housley
Land Development Engineer
FROM: Patrick Musser
RECEIVED
lUG 1 51996
ruJLi( \i"';\.",;j':,~'\.~
ADMINISTRA TIOl'<
JOB #: 9943.20
REGARDING: Beacon Service Station
921 W. Hamilton Avenue
Campbell, CA
TRANSMITTED:
[X) AS REQUESTED
[) FOR YOUR USE
[) FOR YOUR APPROVAL
[) FOR REVIEW & COMMENT
QTY.
1
1
NO.
DESCRIPTION
18328
Encroachment Permit application
Check for the sum of $725.00
Mr. Housley,
Enclosed, please find a completed Encroachment Permit application and check #18328 for the sum of
$725.00 ($225.00 [permit application fee); $500.00 [plan check deposit]). This is sent per our meeting
on 8/8/96 regarding the above mentioned project. I will contact you soon to set up a meeting to discuss
this project with the civil engineer. If you have any questions, or if additional material is needed, please
give me a call at (707) 765-1660.
Thank you,
~~
Patrick Musser
Job Captain
F:\WP\9999IFORMS\TRANSMIT .WP
EXPLANATION
~1Ii '1'1 ROBERT H. LEE & ASSOCIATES. INC.
~ 1137 NORTH McDOWEll BLVD.
PETAlUMA, CA 94954
707-765-1660
:JaUNT JJ).[fJ &ndrvd ~'))rrrfl~ 0?/j( i CDfrffS
F m rf1Rh V Co;ybLi I
THE ORDER
OF
AMOUNT
90-4021/1211
192fg
Dollars I
CHECK
AMOUNT
$1 7d0.tJ) I
fYU;j1l1fto,d.~~tydr~
" WASHINGTON SQUARE OFFICE
~WESTAMERIC'A MNK 203 MC DOWEll BLVD.
~" PETALUMA, CA 94953
1110 .8 ~ 28111 1:.2. .1.0 2 .81: 0 SOq 2 :l80 .0111
onCl Lro1 -p IlC'ud~
(() - '-iJ~ rct It=f J~ 7
~ BOND FOR FAITHFUlJ PERFORl\'fANCE OF MAINTENAi~€E PEiIOD q b ~ 2- 2~
i Bond Number P2686330
I Premium Included in Performance Bond
W<:, tba:] UndersliJ3Cd Walton Engineering (bmwfter "PrirJC:ipaI~)
and Reliance, National Indemnity Company _ ' a corporatiOtl Ql"&anized Wldcr the Jaws of tbe ~we Of
· .' I and authQrized tu tlzuuact husiness in ~ Sra.~ of California, 3S
~urety, a.re obli~atild to the City of Campbell (hereinafter "City"), a mWlicipat t;oIporation under the laWs of the: Stite of California.
Jrl the sum of ' *~ixteen Thousand Dollars and No/100* · Dollars
($ 16. 000 .00 < . ) fcr the payment of whi<:h sum we obligate ourselves llnd our SucCessors and a..:;:,-i,gIU,
jQintry and sevl:nllj' by the followU1& pwvisioQ3; .
The cundi~lon: of this obligation is :that tbe Principal entered, or is about to Cflter. into Ii certain written Contract with tM
City dated November lL. 19. 96 and ~nddc:d Construction/Remodeling of Service Station.
I .
· :; . . . a one year
maint~nancc: periodjof the wark described 10 said Contract. a true and correct copy of which is presentJy 00 fiJe in the ()ffice of the
City Clerk of th, aty ~f Campbell. wl1ic:h said asreemcnt i::s bureby refcm:d LV and made 3 part hereaf'. And, the Cicy requiresi
guarantee from tb~ J>rin;:ipal against ,jefective materials and wo~kmansltip in connection with that m.:Unrerunce.
New, th;refo~. the Principal agrees that it shall make ~l repairs or replacc:mems nec~s.ary during thepeood'of one-year
from the date of accep~cc: of the contract work, by re3.'ion or defective mareriills or worl<'.manship in COMection with the COlUrier.
Ii ~Os.': c1ekctivci materlaJ~ or workmansh!-p occur within that period, the Cit"1 sha.ll give tile Principal and Surety written notice of
I . .
that defect within 6'0 days l1fter discovery. When each replac::emenr is ma.de to ~ .:l.uillfactioD of me City, lbe obUgatloll of the
Prindpal and SUr~ty shai-l be discharged as to that n~laccme1lt, otherwise to remain in fun fore! llnd effect,
, . .
Any rep';..irs ortcplkcmcnts Tnade under this bond shall in Iike manner be subjeet to the tc:nn5 IUl.C1 cOllctl~om or it.
No prep~)'mend Of' deb)' in payment and no chaoge$, t;lltensions I addition or llIl'Jlr~tioll of any provision ot'saia Contract Qf
in any plans and ~pcc:itic~tions reftmd to heroin, and ~ forb~arance on tbe ~t of the City shall Qperate. TO r~l;lI.SC ~ Su:c~. from
liability on this ~D.d, ~ COJisem to make SU~ alterations without further noace to or consent by the Surety IS h.ereby glven~ and
the Surety hereby waiveS: the prQvisions of Se~t10tl ZS19 of the Civil CQdo or tile Stato Of Califorma.
hl witne~$, the parties have aeeuted this agreement as or July 28
, 19-21..
(principal) Walton Engineering
By
Title
By
I!Iati~nfJ '1;demnity C_any
fiUiJal-_
Ci:OUl",y':"L1-'.lac1:
Par.~...av __....__
19101...__ __
i:>nirley Paiva,
Address o'f Surety; Thre
Philadelphia. PA
(Attach Mlwlwledge:rcnlS)
(Itoth Principal' 5 3.l1d i
SUm)" s Attarne)' in ~act)!
(j;\forms\fpmbonc:l~ i
Suret'\" S );ond Number
(Acc~mp~' this bond with .'\ttorneoj.in.Cact's
I
&uth<:lri:;." trOln Surety t\) exeeup: the bond
ceniried to incluc1e me date ofthe bone!.)
I.
STATE OF California
} 55.
COUNn' OF Sacramento
On
~/~t1r
, before me,
PERSONALLY APPEARED
Shirley Paiva
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/ are subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her i ":.leir ,,-,itt.irized. capiicity(izs), Zl~d- fr,::~, byl'-:.s,lher,l
their signature(s) ort the instrument the person(s), or the
entity upon behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal.
Signature ~
OPTIONAL
JoBeth Swalley. Notary Public
. . ". ~
./':)-./'>.................~.........../"o.---~--"-""'.-....-..~
~ ~ :;,:. t' lO BETH SWALLEY ~
o ,<, Comm,IH042809 G)
(j ..~ NOTARY DUBUC . CALlFORN~ ()
II: ~ S~rAll\lIftlO Collnly .
-' MJ C:mm tll~m <let 211998 ...
This area for Official Notarial Seal
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
o INDIVIDUAL
o CORPORATE OFFICER
T1TlE(S)
o -PARTNER(S)
o LIMITED
o GENERAL
[iI ATTORNEY-iN-FACT
o TRUSTEE(S)
o GUARDIAN/CONSERV A TOR
o OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
Reliance National Indemnitv Company
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OM TYPE OF DO\;UMENT
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNER(S) OTHER THAN NAMED ABOVE
ALL-PURPOSE ACKNOWLEDGEMENT
RE:..IANCE INSURANCE CO...' ~Y
UNITED PACIFIC INSURANCl .JMPANY
RELIANCE NATIONAL INDEMNITY COMPANY
01384
ADMINISTRATIVE OFFICE, PHILADELPHIA, PENNSYLVANIA
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENlI, that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, ere oorpored.
dulV orgenlzed under the lewe of the Convnonweelth of Pennaylvanla and that RELIANCE NATIONAL INDEMNITY COMPANY I. a corporation d
orgenized under the law. of the Stat. of Wlacon.ln Ch.r.ln col'.ctlveIV call.d -the Companl..-) end that the Companies bV virtu. of "gnatur. I
..al. do h.r.by mak., con.titut. and appoint
ahlrley Paiva of aaOfamente. CaUfomla
th.lr tNe end lewful AnorneYC.t-In-Fect. to mak.. execut., ..al end d.liver for and on th.lr behelf, end e. th.lr ect and de.d:
VALID ONLY IF NUMBER fa IN I
Contract Bonde . Maximum Penahy
All Other Bond. . Maximum Pen.'ty
.760.000
.16.000
- ANY BOND OR INDEMNITY PROVIDED THAT WRITTEN AUTHORITY FROM AN OFFICER OF THE COMPANIES
SPECIFICALLY AUTHORIZING ITS EXECUTION ACCOMPANIES THIS POWER OF ATTORNEY. _
end to bind the Compenle. t"er.by e. fuB e~ to the ...... extent e. If .uch bond. end und.rtekJng. end oth.r writing. obUgatory In the naIL
thereof w.r. "gned by en Exeou1iw Officer of the Compen/.. end .....d and ett..t.d bV on. oth.r of .uch ofllo.r., and h.r.bv ratifl.. and conflm
I!!I.!~!!! ftJ.lr said A~om.vf--! 'h.F-l!!!'~ ~!I'r' tI. l!"l~!~!!!J!':MlIl ~~~~~f,
ThI. Power of Attorney I. grented und.r end by the euthority of Article VII of the 8y-laiw. of RELIANCE INSURANCE COMPANY. UNITE
P~CIFlC INSURANCE COMPANY,and RELIANCE NATIONAL INDEMNITY COMPANY which provlalon. ar. now In full 'arc. and ettect, reading I
followa:
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKING
1. The Boerd of OIrecto,., the Pre.,dent, the Chairmen of the Boerd, eny S.nlor Vlc. Pr..'d.nt. env Vice Pr..ldent or A..I.t.nt Vie
Prealdent or other offic.r d.s/gneted by the Board of DirectOR .hall have power and authority to Ca) appoint AttorneYC.)-ln-Fact and to authorlz. ,her
10 .xecut. on b.half of the Company. bond. and und.rtaklng., r.eognlzanc.., contract. of Indemnitv and oth.r writing. obligatory in the natur
ther.of, and Cb) to remove anv .uch Attorn.yC.)-ln-Fact at any tlma and revoke the powar and authority giv.n to tham.
2. Attom.yf.Hn-Faot .h.., hlMt pow.r end euthorl~ .ubject to the t.rm. and Ilmltadon. of the Power of Attorney I..u.d to th.m, II
lIlC8CUte deliver on bahalf of the COfl'1Ja"'14 bond. and und.rtaking., recognizance a, contract. of indemnity and othar writing. obligatory In the naturl
thereof. The corporate aeall. not neceaaaIV for tho validity of any bond. and und.rteking., recognizance., contrect. of indemnity and other writingl
Obligatory In the nature thereof.
3. Attom.yC.)-In-Feot .hell hlMt pow.r and euthorlty to .x.cut. affldevlt8 r.qulr.d to b. ett.ch.d to bond., r.cognlzanc.., contract.
of Indemnity or oth.r conditional or obligatory undertaking. and thay .hall al.o have pow.r and authority to c.rtify the financial .tatement of the
Companvend 10 copl.. of the By-laiw. of the Company or anv article or ..ctlon ther.of.
ThI. Power of Attorney I. algned end ....ed by feo.,mlI. und.r end by euthorlty of the following r..olutlon. adopt.d by the Ex.cutlve .nd Ananc.
Commine.. of the Board. 0' Oir.oto"- 0' United Pacifio Insurence Company end Reliance National Indemnity Company by Unanimous ConlOnt. deted
a. of FebN.ry 28, 1894, ~V the Ex.cutlve and Finano. Committee 0' Relianoe Inaurance Company at e meeting held on March 10, 1994.
-Ra.oIved that Ih. "gnatur.. of auch dlr.ctor. end ottio.r. and tha .... of the Company Mey ba afflx.d to eny .uch Pow.r 0'
Attorney or any c.rtificat.. relating th.r.to bV fec.,mil.. end eny .uch Power 0' Attorn.y or c.rtificat. b.arlng .uch fac.lmil.
.ign.tur.. or fac.imll. .... .han b. valid and binding upon the Company and any .uch Pow.r .0 ex.cut.d and certified bV
f.c.lmlle "gnetura. and fac.lmile ..e' .hall b. valid and binding upon the Company, In the future with re.p.ot to any bond o~
und.rtaklng to which It I. attaohed.. ,
IN WITNESS WHEREOF, the Companl.. have oau.ed th... pr...nt. to b. .'gn.d and their oorporat. ..al. to b. h.r.to afflx.d, thl. lth day of
Nowmb.r, 1996.
l~;;/T5~"~:~\
. ..'-. ~. .~ :~~~~';~
. .....................- ',,""" .'
STATE O~ Pennlly/yt!fli.......... )
COUNTY OF i'l'lllcdlllp:-.I. ) ...
On thI., the 7th day of NOIlII..... 1816 before me, Valencia Worthem. app..r.d David T. Ak.,., who aOknowledg.d hlm../f to b. the Vloa Pr..'d.",
of Rellanc. In.uranc. Company, United Pacific In.uranc. Company and R.llanc. Natlonallnd.mnlty Company, and that a. .uch, b.lng authorized
to do '0, .xeout.d the 'or.golng In.tNment for the purpo... th.reln contaln.d by .ignlng the name of the corporation by hlm.elf a. It. dulV
euthorlzed off/cer.
RELIANCE INSURANCE COMPANY
UNITED PACIFIC INSURANCe COMPANY
RELIANCE NATIONAL INDEMNITY COt.!lPANY
()~ 7~
In wltne.. Wher.of, I have ....raunto ..t my hand a~ ottiolal ..a'.
NOTARIAL SEAL
VALENCIA WORTHAM, Notary Public
City 01 Phl/adelphla, PhI/a. County
My Commlaalon expires Nov. 18, 1996
~o1m~~~
NotaIV Publlo in and for State of Penll.ylvanllt
Re.iding at Philadelphia
j
'j
THtI POWIR 0' ATTOflNIY EFRClIVI ONLY. ATTACHED TO IOND NO.
.J I. ,. .~. "
~ AnIta Zlppert S.or.tery 0; RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY
COMPANY do' h.reby c.rtify thet the above and for. going I. e tNe and corr.ct oopy 0' a Pow.r of Attorn.y execut.d by .aid Companle.,. wh/c~
I. .till In full forol and ett.ct.
IN WITNESS WHEREOF, I have h.raunto ..t my hend and efflxed the ..~. of .al~r.OAlp~f!IJ~hl. 28th dey of --:luly _
/"~~~~::~~~~~"'~~~:'~>~"
....~.......$ii!l;~....-:::..:. ~
,~~'At:'I~ -~9. '., \-; ~~ .
.",';;ll. ~~~ . : ~-:. ~
~.~, \;' ...'-" ~ .
~ . -.:, . "'". ........::';. .:&1C;lItery
'(:!:.~ ,~<;:. ~.: ,.;-::.,~ ~-."
P2686~1D /~.'-""'-" .:.......:.'.;"
......~.... .......:. ~ .....
19-91.
~
~
;,~. .
".~
.j',
. .,
, :;~
Bond # P2686330
~.. ... mR P"AlTI:fFUL PERFORMAJ_ Premium: $1~280_00
70 Ucu...c( I'
.2//7/ '11
We. the under~i!';n~d Wa~ton Enginee~ing, Inc_ , \he:,:l:.1~t
.Conl!'ac~o:-) ~d Re11ance J!fat1ona1 Indemn1ty Co,_a c:orpor2.oon Ot..~ec u:sdcr ~c: Ia.", of th; StJt: of
Wiscon~in _' aJ:ld authorized to c:aC.nct bu.s~ess iQ~: S~~ o(~ifon:.b. u Sur::y. ue
~blig~[cd to \be C:t'f ofCi<Sp~ll. (h:reio.afic::- .Cir)'") a ltlumc::p31 cQCl'oration uoccr:.l:1: law,s oftb.= StaLe 8fC.ili.~r:il,
10 the ~um or Sutv Four Thousand and 00/100* DolL.1t!. (5 .64,000~---=:J
for the payment of .....n::h sum ~.~ obligate cursel',,~s md c'W" succ~ss;:>rs Uld usigr.l5. joU:.u>' :uld~vcr;u11' ~y ~=
follov,:ing provisions:
Th'~ condition of ~~ ~Ii!~~on !~:
Scc~use tr.~ ob!iga1.:d C~::=J.~mr ha;;. on November 12 _, 19 96 . entered iorc ;..:~:n
CcnC":3'::c -wiib t11:: City fer :~: ?oj::ct cntitld Construction/Remodeling of Se~. a::opy of whic~ is
aruchcc! d.lJd made a p:u-r of ~ ::-Oed. for ccn::cruc::io:m of Project. Station
N'J\V, ~:re{or;, if l.b: Cot:craccor shall r3ill:fu!ly perfOn:1 tl:.~ ,:"'-crk i...1 accorcia.lJC: '::lith t.h~ plans. spccif..:.:J.:ii:i:J.i
u:d coocr~C{: docum~nl.S duri;:;.s t:J: original (e~. Uld aL4.;, c.n.:os:cns of the co:l'z...:. wwcb. ::wy be gra.:!ed b~' tt: Ci,!"
~;Lh or '\l.;thout node: to tl:i: sur::,!, ~d l( II shUl satisfj aoil cl3lm.s a.nd dcrn.a.ncis bCWTCd l.I.Uul:r <he c.onC:~Ct. ~j slllJ!
fu1Jy indemnUy and s.ve h1..-::;U':ss the C:ry from J.JI COsts 6..!ld ~ages ~;h.ieh :t m:a.y ~ar by ~~:UO(\ DE (;.ilur: :0 do
so. and shall reichurs! 3..C.C: ,~p~y th= e!ry all out.l.ay and crpense ~...tict: the Ci:y ma:. iIlC1.:.( :.a mAAW~ a=!y d:t'.1uj.. r.b::'\
t1Jis obligation $ha.il OC \'Oi,~: o~::"'ou.:: to r~:J:U.in in ftlll for.::: aad eff::t.
rr a.ny legal ar::ioo 0.: ;"J;d iJ~OC llili be,od, it sbalI !:;e ~Jed w1r..b..ll: coe y~u a.fter ~-r~l p:aymcnt h.15 bc::~ o~c<:
\;.;'liJer rbe: Cor-ene! e1:cludici~: -:"arrul':Y period. if ;u:.y, ~ro'''r(kd for in the: Ccc:.rrJct, .m:i "i;;:F.1~ sh..1U Ii::n t.t: ":~u.:~:y
c( SUlU Clua., SULU: of C.LifQr-~~. 6..'JC th.lt ru:cry, for value received stipulates a.od iJ.gre~s tb..ax 0.0 c~u.g:, e:t"..::.s:C:l
of time. a1!~ration or a.ddiaon to ~~ ~r=..s of :be Coor::-ac, Qr 10.1 ili:: work t.o b<: pc:rformc:d J.:.::!d.:~ it or tl1= roccif.':.Idon.s
a::o:r:p:u)yic.l it sh.1.l1 ill Ul)' 0:.'3.1' :arrc:~: if.S obligati.JU oa r.1lj::; roed. ud it dGCS :y l.h.:s means ';\,'ajvc ooti~: ci Ul)' .::...cp.
e~:~:'l..Sion of tir:n:, :u(!:,:nior, ;:J:' ;;.jdic;::n t.? we t:mu of m: C;:;1tnCt or to t.:lc OIiO,j;; or to u= ~ci:ic::uio;lS. md D:::::Y
....;liye~ tbe pro\'isioC,S of S=e':h~o :!1S' o( tile Civil Code of ~e s~ of Cilifcmi..a.
In 9iltnl:s'). COQl!'lc~r Uld surery luve uec~ted ells .'I.S1'ec:%lc:Jt as of November 12
,1~~.
By
0: form.s \bond.oi. frm( mp)
TItle
Pn..lS~\ bE M.,-
By
, hirley Paiva,
Address of Surety:
.onar 1. ndemnity Company
~---
ttorney-:in-Yact
6 0 Freedom.~~~e3s C~~ter~/204
King of Prusgia~PA 194Q6
(Attach. Acknowledgements)
SuretY's Bond Number P2686~30
(Accompany this bond wlt14 ^tu:lfucy-iaotact'S
.al,lmoricy From Sure!'"; to. c:%Cc:~~tbe bonc1,
certified tQ i~ude the date of tbe bond.)
(Both Principal's wd
Surety's AnDrney in F:lct)
COUNTY OF Sacramento
} 55.
STATE OF California
On
1- ~ -'17
, before me,
JoBeth Swalley, Notary Public
PERSON ALL Y APPEARED
Shirley Paiva
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/her/
their signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal.
l"'- ~~~~~--"'-~--""""'-- -"'-.-.. ...J"'"'................
U .' ,. JO BETH SWALLEY 1
. 'f Comm. t 1042809 f'\
C) NOTMY PUB. Lie . CALIFORNIA 0111
~IlIM\lnlo 04~nl'r
MJ COmm. rx~m \'leI. 23. 1998 ...
Signature -~~..b lJa~
This area for Official Notarial Seal
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
D INDIVIDUAL
D CORPORATE OFFICER
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OR TYPE OF DOCUMENT
TITLE(S)
D PARTNER(S)
D LIMITED
D GENERAL
[i] ATTORNEY-IN-FACT
D TRUSTEE(S)
D GUARDIAN/CONSERVATOR
D OTHER:
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF F'ERSON(S) OR ENTITY(IE5)
Reliance National Indemnitv Company
SIGNER(S) OTHER THAN NAMED ABOVE
ALL-PURPOSE ACKNOWLEDGEMENT
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
State of
California
County of
Yolo
On
1/31/97
DATE
before me,
}
Lawrence G. Schleiger, Notary Public,
NAME, TITLE OF OFFICER. E.G,. 'JANE DOE. NOTARY PUBLIC'
personally appeared
Michael E. Walton
NAME(S) OF SIGNER(S)
I!l personally known to me . OR . 0 proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s),
or the entity upon behalf of which the
person(s) acted, executed the instrument.
, -^-.......... -"-~<'.~..;.~ ....... --"'- J"Io....J'Ilo... ~ ~1
,. .,,~.;". L.a~"r0nce G. Schleiger~
(,) . . ,. Comm #1022297 1'\
~ - . : NOTt.R\ PUSLlC CALlFORNIA\IIO
~ / '(OlO COUNTY
~ FO~ Mv COMm E%plres April 3. 1998"
-.,---...,.- ___ ___ ...,,---....,-~~--...r""'"~..(.
THIS CERTIFICATE MUST BE ATTACHED TO
THE DOCUMENT DESCRIBED AT RIGHT:
OPTIONAL SECTION
TITLE OR TYPE OF DOCUMENT
NUMBER OF PAGES
No. 5193
- OPTIONAL SECTION -
CAPACITY CLAIMED BY SIGNER
Though statute does not require the Notary to
fill in the data below. doing so may prove
invaluable to persons relying on the document.
o INDIVIDUAL
o CORPORATE OFFICER(S)
TITLE(S)
o PARTNER(S) 0 LIMITED
o GENERAL
o ATTORNEY-IN-FACT
o TRUSTEE(S)
o GUARDIAN/CONSERVATOR
o OTHER:
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
DATE OF DOCUMENT
Bond for Faithfull Performance
11112 /96
Though the data requested here is not required by law.
it could prevent fraudulent reattachment of this form. SIGNER(S) OTHER THAN NAMED ABOVE
@1993NATIONALNOTARY ASSOCIATION. 8236 Remmet Ave.. P.O. Box 7184' Canoga Park, CA 91309-7184
'u l:'\..JK l_J,-\l:H..H< A._~U !\-1."\l1:.K.J.~ Bond # P2686330 7b(/tV/h:Y;'I"1jr?7
Premium included in Perf. Bond
We. the !.lr.der::g:l...-d Wal Engineering, Inc.. (hc:rei}uft=r 'FL -lp~') and Reliance National Indemni
CompanL-. a ~ol'For:1tiol\ org:u~l.Z...'-d w:>.:kr the IJws of the SW.c of W1sconS1n . u:d JU~ri.t~ct
:0 tta.n:~Ct business ill r..,~ Sea:.; or CaIirorrJa. ~ Surery, ;u-e otli,gat:d to the Cit)'. of Ca.:nrbcll (hcl:cin.1ftcr 'Ci~"). a
~unjC:lp:ll COrpoClt;on U:loc:r the l..~.s of the StJt,! of C2.1iforni3. iI1 tbe sum of S1Xty Four Thousand DO.Llars and OO/IC
DQllus ($ 64.000. OO----j-fcr the pJYr.l~n~ '~f ;"h.ic:h sue ;"e OOlig3~ ourselves ~~ 'Ju.r$ucr:e~sors a.1)~ :.s.si,n:.
jointl)' AA<i- ~e"'~r~lly by t.'i: fOllo1lligg provisioos:
The concitbn of this [)bli,gation is t::)l[ the ?~i.D.cipaJ cQtered. or is ~bout to ente:', [mo J cerUiu wrinen C,r:CrJC:
....ith the Ciry date'~ November 12 . 19 96 . 1.Od eetirle.:1 ,
J. truc :md COrrect COp)' 0;" ..ttkl1 lS pre!cnuy 00 tile L:l ~t office 0: ~e Cic.... C:erl.: of r.he Ciry of Carnl'b<:!1. ';I.'hi.::;; SJ.id
r.:onl.nr;~ i~ hp.rel:y ref:rrc:: ..) ~j !I:lde a p~"i. h~rccf.
BeC,"ll$~ Prin:i;:~j ~ r~s:rJircd TO furujs~ .1 bond i= eOMectiorl "'-!th the eontUl:t, prr;o'd4ing th.3t if F:-:J:I;:;?:.l. or
~r.i' 1;( ir.s subcona-aC:lors. ,obll rtil.(o :n:: fo; my materials. ,:)rC.Wer ,ljppli~$. ,,( f,,~ Wi' o:r,Il)r1c: yr ~wor on the ce:::u.:::J
wo.k o{ wy ....ind, or ror l.Q,';J:l::' d\,;c -.n(!cr dJ~ :J!lemployme=t iLlS\.ir;~.;c ac: v:th respect to c1.Oy \\Iork or lltxJr .;\0 this
r'~OjC;:l, (be Surecy on r.ll:s ~Qj ~ill poly for !.be de~t, il1 U1 amOunt not ~.'tCt~~h:.g the :;um sp:dficd i.o tl).,is IN::':. ~d
.liso. i" case suit is b(oug~t t.:poJ. the bcud, ~ re3$oablc l:wme.y's fee (0 ee fueci by ~e COUrt.
No\l.'. t.'Jerefore. 1\:. Walton Engineering, Inc:.u Prin;;pai. AND Reliance National Indemnity Compan=
-' as Sllrcry, ue coli;:!.::::: to ~: Ci:y of Cm1pbeJI. 1O the $U.DJ. of S.l?~..!y Four Thousand Dollars and ,00/100-----.
Ja wful ~(lne;r of t..'le Uni\:::~ 5~,-=s. (or ~c pa)'!:nect of which ruCj -:r.1I and :ruly to be ~c~. we: the solid Prin.::;:1.l .1lld
Surctj' bi~d 1)ursdyes, $Ue:~s.s~~$ ~d :l.Ssi~ns. jointly a.cd Kverally, by ~.f:S~ provisions.
ir,:; condition c-f :..':1is ooli.sal.ion :~ UlJ.t if Frincip3..L its roec~ssors 01" assl;c.s. oJr itS S'.lb<;()ocrz.:~'r. or
,UO::;Q:lC"3CtOr!s.. SCt3H fd :0 ~.:ly for Uly labor. ali~ria.lJ, or other s\lppli~s, used i..o. tile y<::rf'JrT}la.J:lCe ,~f r."~: ;.-ork
':('(ltra';Ced to be de,ne. Ot f~r 2.C'lC'UllU due under the u.'~t!lploym:nt In.)Unl~c~ act ...itb rcsp:::r Ul Uti.. work: or J.1b.:-r. ~~n
U'le' Surety on this bond "'1j ::;;;y fo:r thc:r.. i: .1n aInQ'.l!.Jt :lot c~c!!dU::i t.'1e ru=l specified i:'1 :,kJs beed, ar,d 1:3 C.l~ 5uil
is l-rougl1t upor. LlJjS bond -:.ill ~ i'ay I rU..loOnal1Ie aao~C)"s (ee. l\J be :=:~:d 0;1 t1l~ ccun.
No pre~3.Yr.lem 0: c~!.1:-' iD payment ar-d no chan~!s, cmn.s:oc.s. additioQ or 3Jt.et~tivn of d.r1y provi.siG:l C'f ~jd
CC:1tracr Of iu .1:1)" plans .u;,j gecitteilJoo.s (cr"c;-r:c1 to herein. a..nd no forbe:uuce on the ;>a..-t of the City slu.\J "p-er:.te
!o releaJe toi: Sure~ (rom Ij2hm~' on thi:s bond. J..:Id coaseD! to make :-.:cb altual:ions ':!without fu.nb~r tlotice tv or cocs~or
by t.'1~ Sur::)' is hereby ~iv~:::. :<nd tl':e Surety be.reby waiv~s t.!:e ilfQvision.s of Section 1819 of the Civil Code of L':~ Sute
(J( C.ili iorni.:l.
in Wi!1less. the prti:s b.1ve e~cc1;~d t,'Jjs agre~:r.c::lt as of
January 30,
97
,19_
By
Title--P n... ~ vb E-- ~
1 Indemnity Compan~
Ad~c~ofS~,ry; 620 Freedom.Busin~ss Center,
1204
Kin2 of Prussia, PA 19406
-
(Aeuch Ackno w{c;dgeml;rnJ)
(Both !'rineipa.!'$ and
Surety's Anotncy in Fae~)
(h: \fomu\bonds. frm)(mp)
SW-Cl)"s Bond Num~. . P2686330
(Accomp.141Y this bond wiUl Attorney-in.faefs
authority from Surety to exeCute we bond,
certified to ~lude the eLau: of the b(lnd.)
COUNn' OF Sacramento
}ss
STATE OF California
On
l-~-Cf7
, before me,
JoBeth Swalley, Notary Public
PERSONALLY APPEARED
Shirley Paiva
personally known to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowl-
edged to me that he/she/they executed the same in his/
her/their authorized capacity(ies), and that by his/her/
their signature(s) on the instrument the person(s), or the
entity upon behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal.
".......... ""'--"""'-~--"---'^'--~......................... -"- ~ --:- -"'- f
o " to'. JO BETH SWALLEY s:
. " Comm, , 1042809 f'\
~ .. NOTAA'1 PUBlIO. CALI'ORNlA ~
SlOril'l'llnlll Ooun~ \ I
~ Gomm. Illllire~ OCt ~3. 1998 ...
Signature -~~~ ~
This area for Official Notarial Seal
OPTIONAL
Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent
fraudulent reattachment of this form.
CAPACITY CLAIMED BY SIGNER
o INDIVIDUAL
o CORPORATE OFFICER
DESCRIPTION OF ATTACHED DOCUMENT
TITLE OR TYPE OF DOCUMENT
TITLE(S)
o PARTNER(S)
o LIMITED
o GENERAL
[i] AlTORNEY.IN.FACT
o TRUSTEE(S)
o GUARDIAN/CONSERVATOR
o OTHER:
NUMBER OF PAGES
DATE OF DOCUMENT
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IESl
Reliance National Indemnitv Company
SIGNER(S) OTHER THAN NAMED ABOVE
ALL-PURPOSE ACKNOWLEDGEMENT
RELIANCE INSURANCE COMPANY
UNITED PACIFIC INSURANCE COMPANY
RELIANCE NATIONAL INDEMNITY COMPANY
01384
VALID ONLY IF NUMBER IS IN RED
ADMINISTRATIVE OFFICE, PHILADELPHIA, PENNSYLVANIA
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that RELIANCE INSURANCE COMPANY and UNITED PACIFIC INSURANCE COMPANY, are corporatif.'ns
duly organized under the laws of the Commonwealth of Pennsylvania and that RELIANCE NATIONAL INDEMNITY COMPANY is a corporation duly
organized under the laws of the State of Wisconsin (herein collectively called ~the Companies") and that the Companies by virtue of signature and
seals do hereby make, constitute and appoint ' .
Shirley Paiva of Sacramento, California
their true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver for and on their behalf, and as their act and deed:
Contract Bond. - Maximum Penalty
All Other Bond. - Maximum Penalty
$750.000
$15,000
"ANY BOND OR INDEMNITY PROVIDED THAT WRITTEN AUTHORITY FROM AN OFFICER OF THE COMPANIES
SPECIFICALLY AUTHORIZING ITS EXECUTION ACCOMPANIES THIS POWER OF ATTORNEY."
and to bind the Companies thereby as full and to the same extent as if such bonds and undertakings and other writings obligatory in the nature
thereof were signed by an Executive Officer of the Companies and sealed and attested by one other of such officers, and hereby ratifies and confirms
all that their said Attorney(s)-in-Fact may do in pursuance hereof.
This Power of Attorney is granted under and by the authority of Article VII of the By-Laws of RELIANCE INSURANCE COMPANY, UNITED
PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY COMPANY which provisions are now in full force and effect, reading as
follows:
ARTICLE VII - EXECUTION OF BONDS AND UNDERTAKING
1 . The Board of Directors, the President, the Chairman of the Board, any Senior Vice President, any Vice President or Assistant Vice
President or other officer designated by the Board of Directors shall have power and authority to (a) appoint Attorney(s)-in-Fact and to authorize them
to execute on behalf of tha Company, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature
thereof, and (b) to remove any such Attorney(s)-in-Fact at any time and revoke the power and authority given to them.
2. Attorney(s)-in-Fact shall have power and authority, subject to the terms and limitations of the Power of Attorney issued to them, to
execute deliver on behalf of the Company, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature
thereof. The corporate seal is not necessary for the validity of any bonds and undertakings, recognizances, contracts of indemnity and other writings
obligatory in the nature thereof.
3. Attorney(s)-in-Fact shall have power and authority to execute affidavits required to be attached to bonds, recognizances, contracts
of indemnity or other conditional or obligatory undertakings and they shall also have power and authority to certify the financial statement of the
Company and to copies of the By-Laws of the Company or any article or section thereof.
This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolutions adopted by the Executive and Finance
Committees of the Boards of Directors of United Pacific Insurance Company and Reliance National Indemnity Company by Unanimous Consents dated
as of February 28, 1994, by the Executive and Finance Committee of Reliance Insurance Company at a meeting held on March 10, 1994.
"Resolved that the signatures of such directors and officers and the seal of the Company may be affixed to any such Power of
Attorney or any certificates relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile
signaturas or facsimile seal shall be valid and binding upon the Company and any such Power so executad and certified by
facsimile signatures and facsimile seal shall be valid and binding upon the Company, in the future with respect to any bond or
undertaking to which it is attached."
IN WITNESS WHEREOF, the Companies have caused these presents to be signed and their corporate seals to be hereto affixed, this 7th day of
November, 1995.
RELIANCE INSURANCE COMPANY
UNITED PACIFIC INSURANCE COMPANY
RELIANCE NATIONAL INDEMNITY COMPANY
{)cvd7~
STATE OF Pennsylvania
COUNTY OF Philadelphia
}
} ss.
On this, the 7th day of Nowmber, 1995 before me, Valencia Wortham, appeared David T. Aker., who acknowledged himself to be the Vice President
of Reliance Insurance Company, United Pacific Insurance Company and Reliance National Indemnity Company, and that as such, being authorized
to do so, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himself as its duly
authorized officer.
In witness whereof. I have hereunto set my hand and official seal.
NOTARIAL SEAL
VALENCIA WORTHAM, Notary Public
City of Philadelphia, Phila. County
My Commission Expires Nov. 18, 1996
\( o1m~ ~0Jf'f'-)
Notary Public in and for State of Pennsylvania
Residing at Philadelphia
I, Anita Zippert, Secretary of RELIANCE INSURANCE COMPANY, UNITED PACIFIC INSURANCE COMPANY, and RELIANCE NATIONAL INDEMNITY
COMPANY do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by said Companies, which
is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this ~ day of January
1 L!fl..
s.o'''.'y ~
THIS POWER OF ATTORNEY EFFECTIVE ONLY IF ATTACHED TO BOND NO.
P2686330
CALIFORNIA ALL.PURPOSE ACKNOWLEDGMENT
State of
California
County of
Yolo
On
1/31/97
DATE
before me,
}
Lawrence G. Schleiger, Notary Public
NAME, TITLE OF OFFICER - E.G., "JANE DOE, NOTARY PUBLIC'
personally appeared
Michael E. Walton
NAME(S) OF SIGNER(S)
[] personally known to me - OR - 0 proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) is/are
subscribed to the within instrument and ac-
knowledged to me that he/she/they executed
the same in his/her/their authorized
capacity(ies), and that by his/her/their
signature(s) on the instrument the person(s),
or the entity upon behalf of which the
person(s) acted, executed the instrument.
~_..;;,__~_~~....... ..A..~~
"" ,~~~', ;_~:.\':"r.mce G, Schlelger~
o '.,~::mr #1022297 "
CJ " - ~:01 AR\ PU~UC CALlFORNIAIlI
~ ~ , YOLO COUNTY 0
.J. ~ ' Mv Comm Expires April 3, 1998~
-.r ."".. ___ __ ___ -V ~-.r --""-'-"'-'" "" ""
THIS CERTIFICATE MUST BE ATTACHED TO
THE DOCUMENT DESCRIBED AT RIGHT:
....~
OPTIONAL SECTION
TITLE OR TYPE OF DOCUMENT
NUMBER OF PAGES
No. 5193
_ OPTIONAL SECTION -
CAPACITY CLAIMED BY SIGNER
Though statute does not require the Notary to
fill in the data below, doing so may prove
invaluable to persons relying on the doaJlnent.
o INDIVIDUAL
o CORPORATE OFFICER(S)
,
~
j
~
~
TITLE(S)
o PARTNER(S) 0 LIMITED
o GENERAL
o ATTORNEY-iN-FACT
o TRUSTEE(S)
o GUARDIAN/CONSERV ATOR
o OTHER:
(,
~
'.
~.
"
I
~
i
~
~-
~.
~.
SIGNER IS REPRESENTING:
NAME OF PERSON(S) OR ENTITY(IES)
DATE OF DOCUMENT
Bond for Labor and Materials
1130/97
Though the data requested here is not required by law,
it could prevent fraudulent reattachment of this form. SIGNER(S) OTHER THAN NAMED ABOVE
@1993 NATIONAL NOTARY ASSOCIATION. 8236 Remmet Ave., P.O, Box 7184' Canoga Park, CA 91309-7184
INSURANCE REQUIREMENTS CHECKLIST
Permit # 9 (~ ~ 2 Z I 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:
a $1,000,000 per occurrence, and
'KL $1,000,000 general aggregate limit apf~ing separately to the project, and
..1)i $2,000,000 general ag~~ .*,'1,.:2, . . r
"R. Policy expiration date 'Ii) . r2JY1-CA..J-r-/ if! TL~.
U-s~
h. .. C h., ,. c/ V\-lo../\,
. . I. I-..JJ. r, f,)C c. f' .. ~..-
,Automotive Liability - "any auto"~ ci:?UJd1 r h~ cg'U'.Q"c 0\'-;-' ill ~~4-'
1& $1,000,000 per accident for bodily injury and proper:t}' damage ~.."
~ Policy expiration date ~II Jq~ ~ //1 Ie; 7 /Ze4LL~/t<..L LCl h (c
Worker's Compensation and Employer's Liability
m $1,000,000 per accident for bodily injury or disease! '., t,
'S Policy expiration date \Z-) 5 l } 1/ ~ No niL( I '.' 1 0 j Coon, 1 Ii. :., .'
FrDV, L-\J\, W C, l,.- i..- I"ij ("0' 1 ".
Course of Construction (if required in Special Provisions) P"('\ l<',,..{'''k \/.\ \lci t)- t i till
o Completed value of the project -i , 14 S
o Policy expiration date
Required Endorsement to General Liability and Automobile Liability Policies
Additional Insured Endorsement
? The City, the City of Campbell Redevelopment Agency, its officers,
employees and volunteers are named as additional insured.
IS The insurance coverage afforded to the Additional Insured is primary
insurance.
o Workers' Compensation Insurance Sheet Submitted
o For General Contractor
-m. Subrogation Clause
~
;
Inmrance Certificate ReViewe~
( Initir.ls
d-/~ CjJ~'7
.
Date
)( Copy of Insurance Certificate placed in tickler file OIie month prior to expiration.
j:\forms\inscklst 4/96 (rev 6/96)
. .. ....
ACORQw........II':_:IIII~....,:.li:lll:ili:iil~\.\\.\:\'\.II~':IIII'I.I:liililii:il:IJ.I~4Iilll-:'..,:.::.li.iIII,...:.:.:,:,,:,:.:,::.:,:,: .......DA::~:::Diyy)........
:':':'''R:(;j'bt;=~~,.':': ..... .. THIS CERTIFICATE"is ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Plckett-Rothholz . Murphy
7801 Folsom Blvd., Ste, 300
P.O. Box 13190
Sacramento CA 95813
COMPANY
A
General Security Ins, Co.
(916) 383-2222
INSURED
RE;~j;;-n -
-, "-,:::u
I:r:D ., /!O ~_
-... ,:lYU
COMPANY P ~-...
I D i&~.BI.IC ~-
.. ................. ....... ............ .......... ........... .................. ........................ .... . ..... ...... ...
..CO'V~RAGE:S..., .. ..... .. .... ::::."".,.......... . .....::?::::::/...,..'.."....::)!"':':~..tt:r:.
THIS IS TO CERTIFY THA T THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P6tlCY PERIOD
INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICA TE MA Y BE ISSUED OR MA Y PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POl.ICY EFFECTIVE POl.ICY EXPIRATION
LTR DATE (MMIDDIYY) DATE (MMIDD!YY)
COMPANY
Walton Engineering, Inc.
843 Riske Lane
West Sacramento, CA 95691
B
COMPANY
c
l.IMITS
A ~OMOBIl.E LIABIl.ITY
CA4010122
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
2/11/99 2/11/00 COMBINED SINGLE LIMIT $
1,000,000
BODILY INJURY $
(Per person)
BODIL Y INJURY $
(Per accident)
PROPERTY DAMAGE $
AUTO ONLY EA ACCIDENT $
OTHER THAN AUTO ONLY: >>>...
EACH ACCIDENT $
AGGREGATE $
EACH OCCURRENCE $
AGGREGA TE $
GENERAL LIABILITY
-
COMMERCIAL GENERAL LIABILITY
27 l CLAIMS MADE D OCCUR
OWNER'S & CONTRACTOR'S PROT
-
I---
ANY AUTO
-
L ALL OWNED AUTOS
SCHEDULED AUTOS
-
.!.... HIRED AUTOS
L NON.OWNED AUTOS
~
CARAGE l.IABIl.ITY
I---
ANY AUTO
I---
-
EXCESS LIABIl.ITY
I UMBRELLA FORM
~ OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
_..--- -.
$
I f~Q~T f i9~:rl~k7 > ......... .......
EL EACH ACCIDENT $
EL DISEASE.POLlCY LIMIT $
EL DISEASE-EA EMPLOYEE $
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
RINCL
EXCL
DESCRIPTION OF OPERATIONS/L.OCATIONSIVEHICl.ESISPECIAl.ITEMS
RE: PERMIT #96-221, 921 W. HAMILTON AVENUE - ALL WORK IN PUBLIC
RIGHT-OF-WAY
..............................................................
::~g~n.tlt:4rgHp.p~gg))i/
.............................
..........................
. . . . . . . . . . . . . . . . . . .. .
. . . . . . . . . . . . . . . . . .
...................................::<,:)\:qtiRQ.g~tfsl~N:lJp.ii$)~Qt'J.ift.itNQNJ!fAYM.~ijtQr::~ijtiiQM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELl.ED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY Will. ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOl.DER NAMED TO THE l.EFT,
-
BUT FALURE TO MAil. SUCH NOTICE SHAll. IMPOSE NO OBl.IGATION OR l.IABIl.ITY
OF ANY KIND UPON THE COMPANY, ITS ACENTS OR REPRESENTATIVES.
......M,-WW@W,~~~~,mR_.iila.W!lbm
CERTIFICATE: 002/001/ 00014
CITY OF CAMPBELL
ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CA 95008
A6bijdi5~saHi5i:.:"...>................
i.......~ ~9fla".. .......lllIlllljlll...~.......I.I....II.I.............g11.ljlllll.I.III.III.IIIIIIL.~..~lfllll..:.I....I..III.1.1...:.1...1.:...:::...:.:.... .......DATE..(MMlOO/Vy)............
PRoDuceif...
Pickett-Rothholz & Murphy
7801 Folsom Blvd., Ste. 300
P.O. Box 13190
Sacramento CA 95813
(916) 383-2222
INSURED
3/26/99
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
Walton Engineering, Inc.
843 Riske Lane
West Sacramento, CA 95691
......._,'~
COMPANY
~ United Ca itol Ins. CO.
COMPANY
B General Securit Ins. Co.
COMPANY
c
. #5179
s
THIS IS TO CERTIFY THA T THE POLICIES OF BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICA TED,NOTWITHST ANDING ANY REQUIREMENT, TERMOR CONDITION OF ANY CONTRACT OROTHER DOCUMENTWITHRESPECTTO WHICH THIS
CERTIFICA TE MA Y BE ISSUED OR MAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS
A GENERAL LIABILITY GLA1003484 3/06/99 3/06/00 GENERAL AGGREGATE $ 2,000,000
X COMMERCIAL GENERAL LIABILITY PRODUCTS.COMP/OP AGG $ 1,000,000
CLAIMS MADE [i] OCCUR PERSONAL & ADV INJURY $ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $ 50,000
MED EXP (Anyone person) $
B AUTOMOBILE LIABILITY CA4010122 2/11/99 2/11/00
COMBINED SINGLE LIMIT
ANY AUTO 1,000,000
X ALL OWNED AUTOS BODIL Y INJURY $
, SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODIL Y INJURY $
X NON.OWNED AUTOS (Per ace i dent)
PROPERTY DAMAGE
GARAGE LIABILITY AUTO ONLY. EA ACCIDENT
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCiDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGA TE
OTHER THAN UMBRELLA FORM
C WORKERS COMPENSATION AND NWC482730-01 12/31/98 12/31/99
EMPLOYERS' LIABILITY $
1,000.000
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXECUTIVE
OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SPECIAL ITEMS
RE: PERMIT #96-221, 921 W. HAMILTON AVENUE - ALL WORK IN PUBLIC
THE CITY OF CAMPBELL, CITY OF CAMPBELL REDEVELOPMENT AGENCY, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE
INSURED AS RESPECTS LIABILITY PER ATTACHED CG2010 ** WAIVER OF SUBROGATION CLAUSE INCLUDED FOR WORKERS
RIGHT-OF-WAV
NAMED AS ADDITIONAL
COMP
egijnRje.AtgH94Piij.)<<
CITY OF CAMPBELL
ATTN OEPT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CA 95008
HeANqi4ijAtij,?iiiljijQAV$.NQT:jt.lfQijNQii(ijAXMlijiQijHj~QM
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN HOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
ORIZED REPRESENTATIVE a
~......'~;.......~~AC.QijbCQijPiRiilhOU.]9i&
CERTIFICATE: 004/001/ 00014
.........1.. .............................................
Ac(>>tb~lmr Msij)>>>.. .
COMMERCIAL GENERAL UABILITY
CG20101093
THIS ENDORSEMENT CHANGES THE POllCY. PLEASf: lttAD If CAREFULLY.
ADDITIONAL INSURED - OWNERS. LESSEES OR
CONTRACTORS - FORM B
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABlllTY COVERAGE PART
SCHEDULE
Name of Person or OrganiDtion:
Any person or organizarion thaI is an owner of Real Property or P~nal Propmy on which you arc
performing opet'3tio[d, or a contractor on whose behalf you are performing operations, and only at the
specific written request of such person or organization to you, wherein such request is made prior to
~ of op::r.oioos, and for which a certificate of insUflIIIcc naming such person or org,mi7.ation
as an additioml insured is on :file with United Capitol lrumnmcc Company.
WHO IS AN INSURED (Scaion m is amtIlckd to include as an inJured the penon or Of!,iUlization
shown in Ihe Schedule, but only with respect to liability arising out of your ongoirlg operations performed
for that insured.
CG20101093
Copyright. Inaumoce Services Qj]ice. Inc.. 1992
o
...... A CtJR/J ".'.".,J.l.a;R;';'~~'I;iI!IJ.I..:~ .;.; ...Z;.."'.~~"".'I.",.\I'.:.I~~.,..lifiji;.. ..ii).:A"ifi.~:.",.".'.'
:.'-:. Till :::::::::::~Ii....:;...../'~~~~;..<C~....:~..;.~-::Ii:.;.;.::::::::,.,[L:.;.;.:-:-:::!M.. ..ftJ;.... .-::-...:~.. ?'t~~~I~~~L:::::::-:-:.. ..:_j':iI:~:.~:ell'~:I~t:::-:-:-:-....... .
.....................................
DATEIMMiDDlYv) ....
Pickett-Rothholz & Murphy
7801 Folsom Blvd., Ste. 300
P.O. Box 13190
Sacramento CA 95813
(916) 383-2222
INSURED
4/21/98
THIS CERTIFICATE IS ISSUED AS A MAHER OF INFORM A TION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
............................
PRoDucEif...
COMPANY
A
Royal Surplus Lines Ins. Co.
COMPANY
C
RECEIVED
APR 2 3 1998
Walton Engineering, Inc.
843 Riske Lane
West Sacramento, CA 95691
COMPANY
B
THIS IS TO CERTIFY THAT 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 OR OTHER DOCUMENTWITHRESPECTTO WHICH THIS
CERTIFICA TE MA Y BE ISSUED OR MAY PERT AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EXPIRATION
DATE !MMIDDIYY! DATE (MMIDDIYY!
TYPE OF INSURANCE
POLICY NUMBER
LIMITS
CO
LTR
A
GENERAL LIABILITY
KIW100168
4/14/98 4/14/99 GENERAL AGGREGATE $ 2,000,000
PRODUCTS.COMP/OP AGG $ 1,000,000
PERSONAL & ADV INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Anyone fire) $
MED EXP (Anyone person) $
COMBINED SINGLE LIMIT
BODILY INJURY
(Per person)
BODIL Y INJURY $
(Per accident)
PROPERTY DAMAGE
AUTO ONLY. EA ACCIDENT
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGA TE $
EACH OCCURRENCE $
AGGREGA TE $
$
$
EL DISEASE-POLICY LIMIT $
EL DISEASE.EA EMPLOYEE $
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE W OCCUR
OWNER'S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPR I ETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
EXCL
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS
RE: PERMIT #96-221, 921 W. HAMILTON AVENUE - ALL WORK IN PUBLIC
ADOITIONAL INSURED/PRIMARY PER ATTACHEO FORM WAIVER OF SUBROGATION CLAUSE INCLUDED FOR WORKERS COMP
RIGHT-OF-WAY
CITY OF CAMPBELL
ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL, CA 95008
..... ..........................................~....~.<U~....(M;Ne~M;l~jjQN.jOO~it$NQtiijgFQi.NQN#AMM~Nt.PF~i.PMQ.M
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
J:J;;ZlEN22E fJ1 '
.... ........................................................................(..?'m...?~.Qijb.OQijp.aRA'l':lQNj9aij?
CERTIFICATE: 002/001/ 00014
.......................................................................................
C~R'fiji!ltA:t~Ho.ijb~l't).................. .
.....................................................
......J ...............................................
AC.()JtP~~mf JHj~f.. .
ROYAL SURPLUS LINES mSURANct COMPANY
l(ameclllllured: W1\LTON ENGINEERING, INC.
ItKZW100168
No:
ral~~
. Effedivl!.>>.te: 4 / 14 / 9 8
a>>tMEllCIAL GElURAL LJABILITY
THIS ENDORSEMENT CHANGES THE POLICY. }'U.ASE READ IT CAll'EFULLY.
ADDITIONAI4 INSURED
(BLANKET)
Thls enclonement Ir$ldifies illJurance pr~vidod \.Inlier the following:
COMMEN.:IAL GENEllAL UABnJTY COVB&AGB PAllT
OWNE1\S iA.ND CONtRACIOB.S paOTBCTIVE LIABIUTY ~O'tEllAGE PART
PR.Ol)U~COMPLE'IED OPl1MTIONS UABLlTY COVEllAGB PAllT
I
WHO IS AN XNS~ (ScctiQQ fi) is araenclod to include as IlQ inSl.U'ed: at,y penoD, ClLpniZ.JtiO". tN~> es\lIZe or
Gc)Yt'.IlIment&l entllJ to ~hom or to which you arc obliple4, by virtue of& MiueCl COIJD'a.ct or by the. iSSI.lJDCe or
existeoee of a perru.iJ. to provide in&uraoce NlOb IS is alrorded. by this polic.J, but Cltlly with respect fD oper.uons
pcrf'ortned by yo\!. 0( an your hchalf Dr to facilitie.. UStld by you and then or:t>' far the limits of liability apcdficd in
S\Ich eontnet. but ill JICI event for limltJl ofliablUty huxuss Dfrhupp1i~e limiu of Ji..bility 01 EllIs pollcy~ pro..;ded
that JI1th penoll. or~~n. In.I$Cee, estate or Govemml:Dlal elrtity shall 'e an Insured 0C11y with respect to
ocamvnC4..-ttn", 1I~'U'511c.h wOtt8ll. g)nlract hu been exa;utcd or S1kck pcnDit ba6 baen Issued.
I{ fIN are requi~ by . written CODtraC.t t:b provide prltna.,. in&ur..Qi Ihea tb& POIict IbaD be prhury and
Condition 4. OthelllnllmUlce doe. not apply. but only ~tb rapcct to ~v...... provided by ~Q poIiq.
THE CITY OF CAMPBELL,
CITY OF CAMPBELL REDEVELOPMENT AGENCY
ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE NAMED
AS ADDITIONAL INSURED AS RESPECTS LIABILITY
c/o 70 NORTH FIRST STREET
CAMPBELL, CA 95008
SOLELY RESPECTS: PERMIT #96-221, 921 W. HAMILTON AVENUE
ALL WORK IN PUBLIC RIGHT-OF-WAY
r---(
I A.~.jlll..
I
I
I PRODUCER
C ERTI FICA Tr-rJF I NSU R~~~_~_.__.___.__ _~_!i~_~ ~~L_._ DA;E)~;;~~J
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I
I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ,
-------~----- ---._---------~_.._--------_._------------j
COMPANIES AFFORDING COVERAGE '
I
Pickett-Rothholz & Murphy
7801 FoLsom BLvd., Ste. 300
P . () . B () x 1.:3:1. 90
Sacramento, CA 95813
I 916-383-2222
I INSURED COMPANY
I W...~ L ton E ng i nC:?(.?\" i ng, I nc . B t!t
I 843 Risk f? La nf? COMPANY'" 1: C ~I
l,Je~,t Sacr'<:JOH,?nto, CA 9:':j69:1. C &;; "EO
I COM~ANY ~E8 2 0 19i I
I COVERAGES 11"lJ81.10 8 ~;l
! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMM~'~_~L1CY PERIOD
I INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ~Nri:olUD WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COMPANY
A
Ge TH~~r' <~ l
S<-::c ur. i t.y' I 1\5. Co.
i
I ~T~ TYPE OF INSURANCE POLICY NUMBER
, ~--"-~-_._~-~---_'_----~'_'~------._,-._--_.__._-~_._-.~-------
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMIDD/YY) DATE (MM/DD/YY)
LIMITS
I
I
!
-i
~
!
! t~
GENERAL AGGREGATE $
PRODUCTS. COMP/OP AGG $
PERSONAL & ADV INJURY $
EACH OCCURRENCE $
FIRE DAMAGE (Anyone fire) $ I
__~_____~_______M..E~EXP (Any one personL~________---i
I
lQQQooi
I
2/11/98
COMBINED SINGLE LIMIT
2/:1.:1./99
$
CLAIMS MADE
OCCUR
OWNER.S & CONTRACTOR'S PROT
AUTOMOBILE LIABILITY
ANY AUTO
X ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON.OWNED AUTOS
CA40:1.O:J.22
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL
I
PROPERTY DAMAGE $ I
i
- --- ------------ -----------------j
AUTO ONLY. EA ACCIDENT $ ,
OTHER THAN AUTO ONLY J
_ ___ __u _E~~:G:~~::~;~_______
EACH OCCURRENCE $ I
I
$ i
$ I
I
I
.----- -.----_!
AGGREGATE
I
i
r-
I
I
I
I
I
r
I
i
f-
i WORKERS COMPENSATION AND
I EMPLOYERS' LIABILITY
I
I
I
I
I DES~~'I~:ON ~F.:~~.ER~T~ONS:~OCA~~~~::~~~HICLE~S;')E.CIAL ITEMS. .
I "E.. I f.J\MJr 696 M...I.t ?..1 W. HAl-iIL10N
I
,
i
I CERTIFICATE HOLD~R
I
i
I
I
!
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
EACH ACCIDENT
DISEASE - POLICY LIMIT
EXCL
DISEASE - EACH EMPLOYEE
I
j
I
!
i
AVE. - ALL W(~~K IN PUBLIC RIGHT-OF-WAY
CITY OF CAMPBELL
ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST STR8~T
CAMPBELL CA 95008
I
I ACORD 25-S (3/93)
CANCELLATION
I
I
I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
I :30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
I BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
t OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
~.OORRIIZZEED R;PRESENTATIVE IJJ. ~. --
l.LL1u~ jC t~ 2<,~979()OOO
@ RD CORPORATION 1993
10 DAYS NOTICE FOR NON PAYMENT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
~.:.-- --::-~-_._------------_.__. -----.--------------.--.--- ---..--...-------.-..-.-..--------.-.-.--------, ,"
,. At:..lllt. CERTIFICAT"OF INSUR~~CE_________~ _________________._~::;(;~~~;~~~? ~
i PRODUCER i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I
i ; ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
I F' i c k (~~ t t --R 0 t h h 0 I. z & M u ,- p h y I HOLDER THIS CERTIFICATE DOES NOT AMEND EXTEND OR
I. 7801 F 0 I.~,; 0 m B I. vd . t f:) t e . 300 I AL TER.ili~_~OV~~~Lt\!fORDED BY THE 1~9!:igE_~ELOW'__J
j::'. O. Bo X 13190 COMPANIES AFFORDING COVERAGE
, Sacramento t CA 9::5813 COMPANY
" 916-383-'2222 A
INSURED COMPANY
I General Security Ins. Co.
: COM:ANY
i 9~:;6("; 1. C
I
I
I COVERAGES
I THIS is TO CERTiFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~CTOR TYPE OF INSURANCE POLICY NUMBER POLIcY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/VY) DATE (MM/DD/YY)
- ~--------_._--_.._-----~._----_.__..._._.._--~----_...,.----- _._-~~-------
I ~-~EN:~~~::~:YGE~:R~L L~A:~TY--~ I 0006~~;-:- 8/19/97 8/19 /98 ::~::~~;G~:::~:: AGG: i~~~~gg
, CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1000000
i OWNERS & CONTRACTOR'S PROT EACH OCCURRENCE $ 1000000
i FIRE DAMAGE (Anyone lire) $
~ _~________~E!J:' (Any one pers"I1L___~___.___J
I AUTOMOBILE LIABILITY I
I COMBINED SINGLE LIMIT $ I
,B ANY AUTO CA40 1 0 122 2/11/97 2/1:1./98 :I. 000000,
X ALL OWNED AUTOS BODILY INJURY
R E eEl V E D person) I
BODILY INJURY i
2 (Per accident) i
SEP Q 1991. I
PROPERTY DAMAGE $ I
~~:~f~~:~:~;~~~:~--;-- ----- -------1
!
__.__.______.____~~GRE~..:r_~_.J_..___..____________J
EACH OCCURRENCE $
AGGREGATE $
.---------------- -------~---- -----
Fremont Compensation Ins
WaLton Engineering
843 Riske La nt:~
West Sacramento9 CA
Pacific
I YiSU1- a nce Co.
Ltd.
COMPANY
D
i
I
I
LIMITS
SCHEDULED AUTOS
X HIRED AUTOS
I
,
I
I
r
i
I
X NON-OWNED AUTOS
[.il'"!;.,, WORKS
ADMINISTRATION
GARAGE LIABILITY
ANY AUTO
EACH ACCIDENT
1----------------___
i EXCESS LIABILITY
i
I
r--------
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
A EMPLOYERS- LIABILITY
STATUTORY LIMITS
WN9665173602
12/31/96 12/31/97 EACH ACCIDENT $ 1000000
DISEASE - POLICY LIMIT $ 1000000
__ ._ _______. ____.________._____._____ n_ ___ __ __. __~2IOA~_.E.!I(;I1_E~.F'.LgY...E~__L_ _ _.1.0 )
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE EXCL
--------_._._,----~_._~_._-_._----
OTHER
INCL
CITY OF CAMPBELL
ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL CA 95008
I
I
!
----------~
I
I
I
I
--.3.Q.. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, I
i
! BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR L1ABILlTYj
L..9!~NY KIND ~ON TH~__c:()M!!~~_ !T~__~~E~!S_~R _!lEPR~~NTATIVES.
i AUTHORIZED RE~ESENTATIVE
i ~ K 269790000 I
RD CORPORATION 1993
~ -------------.--------.
! DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
RE: PERMIT ~96-221t 921 W. HAMILTON AVE - ALL WORK IN F~BLIC RIGHT-OF-WAY.
ADDITIONAL INSURED/PRIMARY WORDING PER ATTACHED CG2010
: WAIVER OF SUBROGATION CL.AUSE INCLUDED ON WORKERS COMPENSATION
I CERTIFICATE HOLDER CANCELLATION 10 DAYS NOTICE FOR NON PAYMENT
I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
I ACORD 25-S (3/93)
POLICY NUMBER ZI0006491
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.
Name of Person or Organization:
THE CITY OF CAMPBELL,
CITY OF CAMPBELL REDEVELOPMENT AGENCY
ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE
NAMED AS ADDITIONAL INSURED AS RESPECTS LIABILITY
PER CG2010
70 NORTH FIRST STREET
CAMPBELL, CA 95008
Solely as respects
PERMIT #96-221, 921 W. HAMILTON AVENUE
ALL WORK IN PUBLIC RIGHT-OF-WAY
(If no entry appears above, information requireed 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.
"SUBJECT TO ALL OTHER TERMS AND PROVISIONS OF THE POLICY, SUCH INSURANCE AS
PROVIDED BY THIS ENDORSEMENT SHALL BE DEEMED PRIMARY, BUT ONLY WITH RESPECT
TO WORK PERFORMED BY OR FOR THE NAMED INSURED IN CONNECTION WITH THE ABOVE
CONTRACT."
CG 20 10 11 85
Copyright, Insurance Services Office, Inc., 1984
FEB-13-1997 11:12
FROM PICKETT-ROTHHOLZ
TO
14083750958
P.02
Pi chtt-RathhlJliil: 8c Murphy
7801 Folsom Blvd., St.. 300
P . O. Bu 13 1 '0 ,
Slcrlmento, CA'I581'
~383-
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NoT AMEND.. EXTEND OR
AL TER THE COVERAGE AFFORDED BY TH' POLICI&S BELOW.
COMPANIES AF ORD G C A
COIolPA~
A
CQIFANV
B F
COIFAl'l'/
C Gene
COMPA~
D
. . .. .!~ :':' '\. .:,' l;~: . 1 '..:1lJi&l:V ~l.. . nr : ~ ), '. \ ,. , ,,~.;. j' ,
THlSrS ToCERTFy 1M. T TIotEPOllciESOFINSUR~NCE LrslEOBELOWHAVE BEEN IS NAMED'S' VEFORT HE POLICY PERIOD
IND1CA T EO. NO T WITHST ANDlNG,NYREQUiREPo'EIIIT . T ERM ORCONOlTIONOF ANYCONT R ACT ORO T HERDOCl.'IAENT WIT HREsPECT TO WHICH t HIS
CERTFICATE MAY. BEISSVEOOflMAYPERT AIN.:fHEINSuRANCE A~FORO~OBY THE POUCIESOESCRIBEO HEREIN IS SueJECT TO ALL THE TEf:t.IS.
!; xc\'USIONS AN) CONDIT IONS OF SUCH POLICiES. l,.MIT S SHQWNM A V HAVE BEEN IlEOUCEO By PAID Cl AMS,
00 fW'&CIP lNIURlINK 1'<<..,..... -.IOY ~ -,IOY.....'
L'III Djn (MMIDD'VY) D..... (M.....,'\?
ce Co, ltd.
Waltvn Engin.erlng
843 Riske lan. ,
West S.cr.me~t.. CA 95&91
Co.
LIMITS
MNPAL LlllltLlTt
COMlERClALat~LI~lrv Z I OD049~~
CtAIr.tS ~ [i] OCCUR
~& CO~TOR'S PROf
8/19/98
CZN!RAl AOt;RGA Tf .
8/ 19/97 llROCU::1$-cQloP'oP AOO .
~NAL L:ADV IIUAY .
EACH oc:o.R'ElCf .
fl~ DoUIIoClf: lelny _ fir.) f
IIlEO EXP (llnJi _ ---l .
AlIJOMOlU LIAlLITY
C ANV AIJ1tl
., All OwtEO ~ros
SOEOIA.ED AVTOS
HlFED AUTOS
I<<)N-OWJED AUIOS
CA4010122
2/11/17
COlo1ElllED Sll'o.E LIMit t
2/11/11
800ll Y 1tu.RY .
"... Ptt->
IlOOIL V I~ t
"'''~l
~TY DIlMACE t
100 0
IoUlO ON.. V . 8 ACCIIENT .
Ofl'Sl l)4jN WlO Oft. Y
~ ACCUIIJT
:~,~
ElICH ~JCE
~~IE
B
WNue517360Z
stAM~ LI""tS 'i:~:::::i<':::::::HYi~"."
12/31191 11131/97 EAOl ACClCENt '1000000
DI$EAS1;. PQ.tCv llwT t 1000000
DI~SE.E~EtoIPl.ove;; t 1000000
INCl
EXt:l
"REVISSDH-REPLACES
CERTS (SSUED 1 l~Zl
113/17 I 2/4/'7
C I TV OF CAM~8ELL
ATlN DEPT OF PUBLIC WORKS
70 NORTH FI~STL STREET
CAMPBELL CA 95008
, I
: .~;~";:; ~.~,.. ~. Ii. ';.'.. '; ~a~-; .
IMOUU lilY or nil: UOVC ___ "'-lOa lit: OllNll!!1UD IIP1lIlE ltl&
EXPIIATlON DjTl! TMIMor. tllli __ eo.."" ~ MAL
.!L ItAVI WlIITTEH NIIT_ TO rHe cnwICITI! KOUIIJI N"NI!D TO THe IDT.
. ~~
FEB-13-1997 11:13 FROM PICKETT-ROTHHOLZ
TO
14083760958 P.03
."-../
'--../
POLICY NUMBER COMMERCIAL GENERAl!.. LIABILITY
. ZIOOO4944 . I
; I ;
THIS !eNDORSEMENT CHANGES THE POLICY. PLEASE READ IT eAREFULL Y.
,
: ADDITIONALl INSURED - OWNERS, LESSEES OR
.. ,
OONTRACTORS (FORM B)
This endDf~ modifies insurance provided under the following:
Name of PerSon << Organization:
. I '
COMMERCiAl GENERAL LIABILITY COVERAGE PART.
SCHEDULE
THE CITY OF CAMPBELL. ,I
CITY OF CAMPBELL REDEVELOPMENT AGENCY
ITS OFFICERS, EMPLOYEES AND VOlUNTEE~ ARE NAMeD AS
AOOmONAL INSURED AS RESPECTS UABILrW PER CG 2010
70 NORTH FIRST STREET
CAMPBELL, CA 95008
Solely as ~pects:
PERMIT ##96-221, 921 W. HAMILTON AVENUE -
ALL WORK IN PUBLIC RIGHT-OF-WAY
I
(If no entry sq,pears above, information required to complete this endorsement will be sOOVVn in the oeclarations
as applicable to this endorsement.)
, : 'I
WHO IS. ANIINSURED(Section 11.) ia amended to include as an insured the person or orgQnization shown in the
'. ' I
Schedule, ~ only with respect to liability arising out of "your work" for that insured by 01' for you.
'. . I
.SUBJ~T iTa ALL OTHER TERMS AND PROVISIONS OF THE POLICY, SUCH INSURANCE AS PROVIDED
BY THIS E..DORSEMENT SHALL BE DEEMED PRIMARY, BUT ONLY WITH RESPEC~ TO WORK
PERFoRMED BY OR FOR THE NAMED INSURED IN CONNECTION WITH THE ABOVE CONTRACT/'
I
, I
CG20 1011185
. 1
I
Copyright, Insurance Services Office, Inc., 1"984
I I
TOTRL P.03
GOLDEN EAGLE INSURANCE COMPANY
P.O. Box R5R26 . San Diego. California 921R6-5R26 · (619) 463-5800
Fax: (619) 460-8860
To:
FEBRUARY 5, 1997
CCP 39 98 82-01
CITY OF CAMPBELL
ATTN: DEPT OF PUBLIC WORKS
70 N FIRST ST
CAMPBELL CA 95008
RECEJV!~
FEe.. 71991
PUBLIC W U",
ADM'N'STRA 1-ION
Date:
9'Ll '~, ~\"4\s._::rc::)~
Regarding:
Policy Number: CCP 39 98 82-01
Named Insured: WALTON ENGINEERING
Cancellation Date: JANUARY 16, 1997
The above referenced policy in which you hold an interest as a loss payee or additional insured,
was cancelled due to the following reason(s):
Non-Payment of Premium
Non-Report of Payroll/Audit
Company Election
Insured's Request
x
Non-Payment - Finance
In order to comply with the terms and conditions of the insurance policy or your certificate of
Insurance, we will provide coverage "For your interest Only" for a period of 15 days from
the date of this letter.
We would suggest that you contact your client for replacement insurance coverage.
P. LOMIBAO/ECF
CC: PICKETT-ROTHOLZ & MURPHY INSURANCE (5179)
GE UNO 0034 (01'93)
A.~..III..
CERTIFICAT~F INSURANCE
DATE (MM/DD/YY)
':> <.
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.
. .C()MPAt.lIES_AFEQRDINQ~OYI;RAGE
..
I
PRODUCER
Pickett-RothhoLz & Murphy
7801 Folsom Blvd.t Stet 300
P.O. Box 13:1.90
SacramentOt CA 95813
91~r-~383--2~~22
COMPANY
A
_ _.Pa.cificI ns.ur.dru::e Co. Lid..
WaLton Engineering
843 Riske Lane
West SacramentOt CA
i
r-
i COMPANY
l B
-------------
_.G!Lld_e.n Eaq le Ins~_Cj)~.
:::5i72
- ---
INSURED
9!;j6<1l1
I
~---_.- --..---
I
! COM~ANY
COMPANY
C
ELe.m~Dt CQmpeD'SdtLQn._Ins
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRiBED HEREIN is SUBJECT TO ALL THE TERMS,
EXCLUSIONS AN[) CONDITI()NS.QET~LJ(~H POllCIES_~I~ll~~f:lQlo"JN. M,A.Y HA VEI3E.~.BE:.DU<::_EDBY PAID CL..AIfv1S
TYPE OF INSURANCE I POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATION
I DATE (MM/DD/YY) DATE (MM/DD/YY)
CO
LTR
LIMITS
: EACH OCCURRENCE
200000
100000
100000
.100000
, GENERAL LIABILITY
i ._-,
A i~q CgMMERCIAL GENERA.LLlABILITY I Z I0004944
1.-+1 CLAIMS MADE [~] OCCUR:
I , OWNER'S & CONTRACTOR'S PROT !
-I
! GENERAL AGGREC;ATE ~$
8/19/96 8/19/97 If>.ROi)UCTSCOMP/OPAC;Gj $ _
PERSONAL &ADVINJUF\Y. ~$
;
.FIRE .DAMAGE (Anyone fire) $
$
$
B
AUTOMOBILE LIABILITY
ANY AUTO
X ALL OWNED AUTOS
CCP329882--0 1
9/15/96 9/15/97
SCHEDULED AUTOS
,X HIRED AUTOS
: .j{l NON.OWNED AUTOS
--1
.1
RE
BODILY INJURY
i (Per person)
E I V tptti~~~~RY
PROPERTY DAMAGE
j
PUBLIC WORK:JAUTQ-O.r-J-L\,- EAi\.c.Ql.DENTj $
AD~INISTRA TIO~IH..EB.Tf1.11r--J...i\.lJI..O.9JiLY.+ ....
, . I EACH ACCIDENT i $
, ,_. _n.__.__..._ ___ _m __ -+.
, , AGGREGATE $
EACH OCCURRENCE $
AGGREGATE _ .$
$
~ GARAGE LIABILITY
Ii
L_.. _~ ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
C EMPLOYERS' LIABILITY
,STATUTORY L1MLTS
: WN966517~3602
12/31/96 12/31/97 ,EACH ACCIDENT $
DISEASE. POLICY LIMIT $
_n____ _______.-.-__.___
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
OTHER
INCL i
EXCL'
DISEASE. EACH EMPLOYEE $
I
I
DESCRIPTION OF OPERA TIONS/LOCA TIONS/VEHICLES/SPECIAL ITEMS
II REV I SED 1,.- REPLACES
CERTIFICATES ISSUED
11/22/96 ./ ~
RE: PERMIT *96-221t 921 W. HAMILTON AVE - ALL WORK IN PUBLIC RIGK-OF-WAY.
ADDITIONAL INSUF<ED/PRIMARY WORDING PER ATTACHED CG20:LO
WAIVER OF SUBROGATION CLAUSE INCLUDED
CERTIFICATE HOLDER CANCELLATION 10 DAYS NOTICE FOR NON PAYMENT
CITY OF CAMPBELL
ATTN DEPT OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL CA 95008
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL E~AIL
:50 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
I
ACORD 25-S (3/93)
RIZED REPF!fSENTATIV~ /h~
~ ~ //~ ,~~ 269790000
@ ~RD CORPORATION 1993
COMMERCIAL GENERAL LIABILITY
POLICY NUMBER
Z10004944
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:
Name of Person or Organization:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
THE CITY OF CAMPBELL,
CITY OF CAMPBELL REDEVELOPMENT AGENCY
ITS OFFICERS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS
ADDITIONAL INSURED AS RESPECTS LIABILITY PER CG 2010
70 NORTH FIRST STREET
CAMPBELL, CA 95008
Solely as respects:
PERMIT #96-221, 921 W. HAMILTON AVENUE -
ALL WORK IN PUBLIC RIGHT-OF-WAY
(K no entry eppea", 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.
'"SUBJECT TO ALL OTHER TERMS AND PROVISIONS OF THE POLICY. SUCH INSURANCE AS PROVIDED
BY THIS ENDORSEMENT SHALL BE DEEMED PRIMARY. BUT ONLY WITH RESPECT TO WORK
PERFORMED BY OR FOR THE NAMED INSURED IN CONNECTION WITH THE ABOVE CONTRACT.'"
CG 20 10 11 85
Copyright, Insurance Services Office, Inc., 1984
SENT BY:
1-31-97
1 : 54PM
M&M SAN ANTON I O~
408 3760958;# 2/ 2
, ". .... <'''"''';':<:~''''''\'t'''!;".>:,r' 'R"".;.,,:".;~"'''\\; ;v"",~.."".<-("~..~t.~. 'l:~:':~.'.'.'.' ...'i!!:...'.' ~:~."'~'.....~.""". ..t. ::\i~!.l~i\i"li:;;ii2!ili~,"it~~ax.i.!.lS~~.~'}:,'"i!!M~,'t;t,'~"..'".".'t'~.~,..:'~".~~.n~~ '
.. A-~.:;:..__,-..,..'~. ,_ _)~{~:=.~~t~~~\:~~;~;~;>l~~~fi~J;~t;~e~=~~~ii~:~::;.~~~l~f:;~i;;;~:;~~;;~;~f.~~~:R~~... ~~~;~J.(~~~~~~;-<::~~~,~~~~~;~~~~~~~~~~;I~f>fJ~~~~~~O=f~~:~~i!~~i~~~!~~~!!~ft~fi*i~~~;i;;J~~~;~~~~~~:t!~~
THIS IS TO CIIlTlFY THAT PClICIES OF INSUMNCE USTED H9IEIN HAVE BEEN ISSUED TO THe INSUIlED NMlED HElWN FOR THE POUCY ~IOO INDlCAlHl.
NOlWITHSTANDlNG ANY NiQUIIliMENT. TERM OR CONDITION OF ANY OONTMCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CEl'TIFICATE MAY
BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POuCIES USTEO HEREIN IS SUBJECT TO AU. THE TEIlMS. CONDITIONS AND EXCLUSIONS
OF 5UCH POliCIES. UMlT1SHOWN MAY HAVE IEEN f1EOUCED IV PAID ClAIMIii.
c;O llft 1IF IllUflllIIaIi IIOUCY ~
"'
MClDIICIR
.arah , KcLeDDan, Incorporated
112 B.at Pecan
Suit. 1400
.an Antonio, ~x 78205-1505
-
ULTRUU, IIIC.
ULTDJIAR DIMOlfD 8J1N1aOCJt
0.. IDter.aatioDal C.ntr.
100 II.B. LOOp 410, Suit. '200
SaD AntoDio, TX 7821'
_&lM&IT\'
COoWiIlCW. o&N&NL Uo\8lJTV
DC\ANlIloW:E~.
OWI'ER'I ~s".gr.
MI'I'ClIIlOIU UMl.1'l
NI(Y AUTO
~ 0WNi0 Al,/fOS
~ AuTOt
H1AEU AUT08
HON-OW~ AUTOS
-~
,.,." AUTO
UM9AE1.IA FOAM
OTHEI'I'TIM UMBRBlA FORM
W1lIlICEN' ~1ICIIt _D
DAOftM UIlaI1'l
_C2177748
01M!R
~lON a: gIIE~11ONII\.OCATION'~~ nEMS
CERl1flCATE HOLDER
CITY or C"f'BBLL, PUBLIC WOUS
Mil. CRUZ GO"E.
70.. S~. .~RB.T
CAMPBELL, CA 95001
;"W'x....'X~~ "":'+:+000 <<~;'O'><' ".:>;+:
, CIR1lACA1E~
. 2758
TRII amtICATllI1IRISD AI".....TI'IJl or u.uuL\nOl'f OlILY AND <.'VI'l....
NO UCWI1I tfllON TlIlI Clla'IVIC4TJ: HOI.Dal 0'1'11" T1IAN THOR noVlDllD iii
TIS IOUCY. 'IWa CMnllCATa DOD IfOI' o\NIM). ~ 0" ALTP TlD
cv"lbCI AlJOU)ID IV,. JIOLICIU LIII'ID 8D11N.
COW'M'I
~
COMPANIES AFFORDING COVERAGE
A DTIODL 0111011 rIU 1118. CO.
~
B
00I't1PMY
IEfTER
c
ClCM'ANY
\EITEA
D
IIA~
Ef'I'WC1M IJClUCV "'.111II
Dl1l
IMTt
~_n: ,
PRCOUCTJ.COMP{QP AGG S
PliR8ClNN. . NJV INJUFlV $
I!ACIi CJCt'AJMEN\2 S
F"" 00I-.e ~ _ "t' S
MEO, ElCI'eN8E "''l' - ..-I $
~~ll",n" $
80IlLY IIUJAY [Per ......, $
IIODI. Y INJURY (Per accIdtnG $
PAQIIIEfl1Y DAMMlE $
AUTO ONLy . fA ACCIlle(T S
OTHER 1lWI AIIl'O OIlLY
fACH ACCIDENT S
~'TE $
EACH~ S
AGGAEGt.TE S
12/03/" 5/01/97 STATUTORY UIlIITI X ..; ?..: ~ ,. , :~ , ,,", A:, ,"
F.AQ4 ACCIllENf $ 1000000
DlEAIIE . POUCV llMrr S 1000000
DIEAIE . EACH EMI'\.O'IE S 1000000
CANtELlAlION
SHOuLtl Nf'( OF THE POUCIE8 U8TED HEREIN IE ~caJ.EO BEFQRE THl: txPlMTlON DI''l'E
THEREOF, THE INSUREIl AFFORDING ~ WIll EN0E4VOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THe!; CEft, IflCATE HOLDER NMED HEREIN. BUT FAlL~ 10 /MIl SUCH NOTICE
SHAU.IMPOSE NO OBU(MTION OR lWIlllTY OF N('( ICIND UPON THE INllUR81 AFFORDING
COYI:MGE. ITS NaENTS OR REJIflESENTATIVES, OR ISSUER OF THIS CERTIFICATE.
MMIH . MCUNrWI, 1NCXlIPtlAI\1C /.
M: r
1M 1 .a/HI
PAGB:
1 01'
1
A4~..III',
CERTIFICATE "'F INSURANCE
DATE (MMiDD/YY)
':>?
THIS CERTIFICATE IS 1~:::iUED 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 P LI IE
COMPANIES AFFORDING COVERAGE
. .f.
I PRODUCER
Pickett-RothhoLz ~ Murphy
7801 Folsom Blvd.. Ste. 300
P.O. Box 13190
Sacramento. CA 95813
I 916-383-??':>?
I INSURED .~---_.
!
COMPANY
A
Fn::tmo nt Compensa t ion Ins
Walton Engineering
843 R i s~'e La ne
West Sacramento. CA
COMPANY
B n __ .Pac if i c .1 nsura nceCa .L td .
95691
COMPANY
___~_.___---.-G o.lde.R..Ea g.le__Ins t._ C 0 t__~5 LZ.2...-
COMPANY
D
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCj;P BY PAID CLALML_________n__
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MMiDD/YY) DATE (MMiDD/YY)
LIMITS
i GENERAL LIABILITY
B _X i CO~MERCIALGENER~IABILlTY ZI0004944
,_.J...j CLAIMS MADE LX OCCUR
i-~ OWNER'S & CONTRACTOR'S PROT 1
; i
GENERAL AGGREGATE S
8/19/96 8/19/97 PRODUCTS. COMPIOP AGG is
PERSONAL & ADV INJURY
EACH OCCURRENCE
AUTOMOBILE LIABILITY
C ANY AUTO
X ALL OWNED AUTOS
CCF'329882-01
9/15/96 9/ 15/97 n~O_MBINED SI~~~~~~~_1
BODILY INJURY I, S
(Per person)
SCHEDULED AUTOS
~ HIRED AUTOS
._~' NON.OWNED AUTOS
------------ -------------
,
BODILY INJURY ,
(Per accident) i S
-~--_._--------------!.-----~._-
PROPERTY DAMAGE
is
GARAGE LIABILITY
ANY AUTO
~~IQQ..NJ.'(..:.E.A..A~CIQ_~"L_l.l_____
OTHER I.H_Ai'J...AUT9.9!-lI",L_._~.__
___.__~A.c:Ii..Ay.C_'~E_NI__ $
AGGREGATE
EXCESS LIABILITY
QCH OCCURRENCE
AGGREGATE
'$
~ UMBRELLA FORM
, I OTHER THAN UMBRELLA FORM
'I WORKERS COMPENSATION AND
A EMPLOYERS' LIABILITY
II THE PROPRIETORl
PARTNERs/EXECUTIVE
OFFICERS ARE:
OTHER
WN9565173601
STATUTORY LIMITS
12/31/95 12/31/96' EACH ACCIDENT
I DISEASE. POLICY LIMIT
I DISEASE. EACH EMPLOYEE
INCL
, EXCL
DESCRIPTION OF OPERATIONSiLOCATIONSlVEHICLEs/SPECIAL ITEMS
RE: ALL WORK IN PUBLIC RIGHT-OF-WAY
ADDITIONAL INSURED PER ATTACHED CG2010
WAIVER OF SUBROGATION CLAUSE INCLUDED
CERllFICATE Ho.~9~R. ~.', ,'. " CANCELLATION:, 10 DAYS NOTICE FOR NON PAYMENT':,.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
CITY OF CAMPBELL
ATTN DEF'T OF PUBLIC WORKS
70 NORTH FIRST STREET
CAMPBELL CA 95006
I
AC'ORD2s.;S (3/93):"/ .;'"(.....1::Y,.'
OF ANY KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
~DREPRE~NTATlVE y- j/h,~ .
J. ~ ~ I~/t 69790000
:"~'~~"'~~'_'''''''?(''''">_''~ ,:,~_","",;},..'_'_. ", '-' ,,"'~.",....- .~...', -:t,,: .
. .,',.' '.' ".' ", . ','. 1iI O~RATiOA .
POLICY NUMBER
ZI0004944
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 L1ABIUTY COVERAGE PART.
Name of Person or Organization:
SCHEDULE
CITY OF CAMPBELL,
CITY OF CAMPBELL REDEVELOPMENT AGENCY
ITS OFFICERS, EMPLOYEES AND VOLUNTEERS
70 NORTH FIRST STREET
CAMPBELL, CA 95008
Solely as respects:
ALL WORK IN PUBLIC RIGHT-OF-WAY
(If no entry appears above, information requireed 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 workn for that insured by or for you.
CG 20 10 11 85
Copyright, Insurance Services Office, Inc., 1984
CA.=... State of california@..
ConIumer CONTRACTORS STATE LICENSE BOARD .
AJtidrs ACTIVE LICENSE ..
l<enseN""", bl1238 Entity CORP
B""nessName WALTON ENGINEERING INe
C~ssfficatilllisJ.~ B H A Z
E.lpi~tiooOate 1)4/30/97
~~L~
w ~
o,,'C"'Af
4,' ..o~
f..." ~
... -r'
U r'"
'" ....
1- "-
" ,,'
'O~CHA\l\)
CITY OF CAMPBELL
Public Works Department
August 12, 1998
Robert H. Lee & Associates
1137 North McDowell Boulevard
Petaluma, CA 94954
SUBJECT: PERMIT NO, 96-221
LOCATION: 921 West Hamilton Avenue
ONE YEAR MAINTENANCE INSPECTION - ACCEPTANCE
Dear Mr. Lee:
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,
Please find attached your original Maintenance Bond which we are returning to you.
Alan Horn
Public Works Inspector
MQ~
Enclosure
cc: Permit 96-221
Public Works/Maintenance Division
Steve Linn, Walton Engineering, PO Box 1025, West Sacramento, CA 95691
Paul Clark, 525 West Third Street, Hanford, CA 93230
Ultramar, Inc. 111 West Ocean Boulevard, 9th Floor, Long Beach, CA 90802
Valley Surety Insurance Agency, 1540 River Park Drive, Suite #105, Sacramento, CA 95814
H:\ WORD\PERMITS\96221ACC(JD)
~
70 North First Street. Campbell, California 95008,1423 . TEL 408.866.2150 . FAX 408,376,0958 . TDD 408.866,2790
.~
"
O\,'CA~
~".' ,b4l~
- r"
U r"
. .
... "-
'So ...
~. ",'
OJi'CHA",Q"
....
Public Works Department
/t-4v. tZV'l(/
) .
Ii > /)) n I r
r:rr a r: l)t.i:~ ~'JI tY fi::~'7 J
/1 /l
+ C\,,{ Q.{/
rh ;'.::
CITY OF CAMPBELL
September 19, 1997
PERMIT NO. 96-221
LOOCATION: 921 West Hamilton Avenue
FINAL INSPECTION AND ACCEPTANCE
vt l~jhr'~'0 1
<oJ -( d__ Y , ." [r
I /.jz / 51 ~ 7
\:0
Robert H. Lee & Associates
1137 North McDowell Boulevard
Petaluma, CA 94954
SUBJECT:
- /\)
(CA.,
Dear Mr. Lee:
The City of Campbell has made a fInal inspection of subject Public Works improvements and fmds the
work to be acceptable and in conformance with City standards. Accordingly, the City Engineer accepts
the improvements.
The one year maintenance period stated in the permit 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.
Your cash deposit of $500.00, plus any interest due, is now being processed and will be sent to you
under separate cover. Additionally, the construction cash deposit of $2,560 will be processed and sent
to Ultramar, Inc.
A Maintenance Bond has now been received in connection with this permit, therefore, we are returning
the Faithful Performance and Labor & Materials Bonds to Walton Engineering.
If you have any questions, please call me at (408) 866-2168.
Sincerely,
o/~
r
.-::: -
Robert Phillips
Project Inspector
MQ~
cc: Suspense - 11 months
Permit #96-221
Inspector File
Steve Linn, Walton Engineering, P.O. Box 1025, West Sacramento, CA 95691
Paul Clark, 525 W. Third Street, Hanford, CA 93230
U1tramar, Inc., III West Ocean Boulevard, 9th Floor, Long Beach, CA 90802
H:\ WORD\PERMITS\96221FIN(ID)
70 North First Street. Campbell, California 95008.1423 . TEL 408,866.2150 . FAX 408.376.0958 . roo 408.866.2790
VALLEY SURETY INSURANCE .916 567 ..0815 12/22/97 08:31 B :03/03 NO:867
VALL_ (SURETY INSURANCE AG~~Y
Surety SpeeI.,I,,.
ls.to River Park Drive, Suite #105
Sacramento, CA 95815
(916) 567-6676
Date. r ~-~-97
To: CITY OF CAMPBELL
DEPARTMENT OF PUBLIC WORKS
70 N. FIRST STREET
CAMPBELL, CA 95008
ATTN. ROBERT PHILLIPS
1t8tue Inquiry
Company:
Bond NOI
Obligee.
principal:
Description.
RELIANCE NATIONAL INDEMNITY COMPANY
p2696330
CITY OF CAMPBELL
WALTON ENGINEERING, INC,
CONSTRUCTION/REMODELING OF SERVICE STATION.
Amount:
$64,000.00
As Surety Representative on the above referenced bond, we would
appreciate your cooperation 1n providing the information requested
below. Please return this form to US 80 that we may have current
status information on the above captioned job. Your immediate
re.ponse would be greatly appreciated,
PLEASE COMPLETE ONE SECTION ONLY:
I. IF THE CONTRACT HAS BEEN COMPLETED:
1. What was the completion date? c~pf . 19 I ) l' 'i 7
Da te of acceptance: J:.'fr (1 I /9 ({(' \ '~
2. What was the final cont act'pr cef 0/
Has the full amount been paid? '; /
3. Was the work satisfactory? It:)
4. Have all labor and material bills been paid? uu):! 1::.-'1J/
II. IF THE CONTRACT HAS NOT BEEN COMPLETED'
1. What percent of work has been completed to date?
2. Total amount paid to Contractor to date?
3. What is amount of retainage?
4. What ia anticipated date of completion?
5. Is the Contractor paying labor and material bills?
6. 18 the work progre88ing 8atisfactory?
f'
Comments a rIVf\nr+ 4' 7& ~) J. )
:i~' C~ftt1f)1
ADDRESS 1/ ;0 I' /. :>51, >/, ,( Wvv!",~dt' ('/'I 9'iuuf
DATE. /JD i/97 PHONEI4."oY-' fLJ(--)J!,c;
I
VALLEY SURETY INSURANCE
a 916 567 0815
12/22/97 08:31 I5l :01/03 NO:867
VALL,"- . · SURETY INSURANCE AGE^ ___ r
surtJly Spec/.II.t.
1540 River Park Drive, Suitt: # IO~
Sacrllmenlo, CA IJ5815
(9Itl) ~11.('l.116
Fax '(916) 567-0815
Licen8e '0799396
FAX TRANSMITTAL
DATE I December 22, 1997
TO. City of Campbell
ATTN. Randy Westfall
FAX ..
408-376-0958
FROM. JoBeth Swalley
Number of Pages. (including this page) ~____________________________
REI Statue tnquiry on Walton Engineering/Permit. 96-221
comments. Please find the following blank status inquiry and
the last one you completed dated 11-7-97. I am faxing you
another one, as the surety requires a status letter signed
90 days past date of acceptance which the indicated date is
----------------------------------------------------------------------
9-19-97. If you could please complete the new status
inquiry indicating the same dates and sign as of today and
fax it back to me at 916-567-0815 I would greatly appreciate
it, Thank you again for your help.
If you did not receive the above number of pages, or have any other
questions regarding recelpt of this material, pleaae call back as 800n
as possible at (916) 567-6676.
Thank you 1 I
VALLEY SURETY INSURANCE 1il916 567 0815 12/22/97 08:31 15l :02/03 NO:867
I I -1 3-1 ~97 I '" : 5:2AM l='ROI.l ~ I\.MPBELL PLeLI C WKS 408 37StJ9F P 1
VALL!Y SURETY INSURANCE 91 567 oa1S 11'
----
VALLn lUll., .,. IN'UlfANCE AGENCY
..., .".11I.....
,~ ,,~ ,.,11 br~ Kunt; .lUJ
.......tn. t"A '~1S
(916) !61_76
:O2l~ NO:Y~
o.~., H(11'rl
'l'O1 CI'l'Y 0' CMP81LL
DIPAlt'nlINT 0' PUaLIC waus
70 II. rxa.'I' IT'IIIIT
CAM"'LL, CA '5001
ATTft. ROIIRT PHl~LJPS
....... ...."
C.,.ny.
land Jo.
Obl1V-'
pZ'!ncU.pel.
De.c~ipt10nl
ItILIMe. .A'1'JOMAL JNDIMNJII'Y COM.AIIY
1'2'113JO
CIn OF CAJlPJILl,
WAL1Uf DCIWIIRtNG, nte.
COR.~UCTJOW/RCMODBLIWG OT SERVICE STATION.
Imunta
l'f,OOO.OO
.. .urety R.p~..ntetlve on ~he above referenced bond, ww would
.ppr.ol.~. your ooo,.r.~ion in provtdin9 th. tn'o~tlon ~qu..~ed
M1aw. '1.... r.turn thi. fom to U. .0 th.t .,. NY h.y. c\ll'~.nt
.t.et.u. l"fo~tlOft on t.he .bove e.ptton~ job. Your J.~l.t..
re.pon.. would be ;r..tly .ppreclated.
Pl.IAlI CQIIPLI'1'I 0111 IIC'l'IO" ONLT,
I , t r THE C:OIITMCT HAl III" COJU'LITID,
1, What ..... t.he C:0Mp1et1on ,d'te~~.I~~:1
o.~. of aoc.ptano., s:...If. 1 ~
Z. Whet ..... th. final cOAt/.ct r ee7 A
.... th. full tUIIOunt ".n rid? _. _ .
,. ... the wert .ettef.etorY~l ---
t. Have.U l.bor and Mterlal-mI. been paid? 4.u.~-uJ'
I I . I r 'l'H1 COI'l'MCT HAl lOT liD COMPLftID.
1. What percent of work h.. be.n completed to date?
2. Tot.l aMOunt pald to Cont~.ctor to dlte?
3. YnI.t. 1. .-oun\ or ~t;.i.n.9.?
4. ".t 1. anticlpat.ed dat.e of completion?
5. I. t~. Contr.~tor paying labor and Mater)al bill..,
,. I. the work pro,re..ln, ..tielactory?
c__nta.jfk"'~-Ji. t:JI:J.-lJ-1
~~' C'~~l
~
eft_ISI, ~o C' j;jl'~. ~ ~~
DATI. JI,/A '7. ___ I. 1-'"
V 1
r
V~ISURETY INSURANCE ._ Jil916 5?! 0815 11[07197. 11 :45 B :01/02 NO:988
~ ~ ..
VALL.... I SURETY INSURANCE AGE,...... Y
SUl'flty SpeclslI.,.
1540 River Park Drive. Suite # H15
Sa\:ramento, CA lJ5H15
(916) ~7-6676
Fax '(916) 567-0815
License #0199396
FAX TRANSMITTAL
DATEs November 7, 1997
----------------------------------------------------------------
TO. CITY OF CAMPBELL
-----------------------.----------------------------------------
ATTN. ROBERT PHILLIPS
----------------------------------------------------------------
FAX ..
408-376-0958
------------------~---------------------------------------------
FROM. ERIN RUSSELL
-------------.~-----------------------~-------------------------
Number of Pages. (including this page) 2
-------------------------------
R!. WALTON ENGtNEERING
---------------------------------------------------------._~~---
Comments. PLEASE FINO FOLLOWING A STATUS LETTER REGARDING
-----.~-----------------------------------------------------
A PROJECT THE ABOVE MENTIONED CONTRACTOR HAS COMPLETED.
----------------------------------------------------------------------
PLEASE COMPLETE THE STATUS LETTER AND RETURN TO ME AS SOON
AS POSSIBLE. YOU MAY FAX IT TO ME @ 916-567-0915.
----------------------------------------------------------------------
----------------------------------------------------------------------
THANIC: YOU.
----------------------------------------------------------------~-----
-~------------------~-------------------------------------------------
~-------------------.---------------------------~M____________________
-------------------------------------------------------------------~--
----------------------------------------------------------------------
--~---------------------._--------------------------------------------
If you did not receive the above number of paqes, or have any other
questions regarding receipt of this material, pleaee call back as Boon
as possible at (916) 567-6616.
Thank you I I
Of'CA.4(
!..4..~A~~
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ORCHAIl".
CITY OF CAMPBELL
Public Works Department
September 19, 1997
Robert H. Lee & Associates
1137 North McDowell Boulevard
Petaluma, CA 94954
SUBJECT:
PERMIT NO. 96-221
LOOCATION: 921 West Hamilton Avenue
FINAL INSPECTION AND ACCEPTANCE
Dear Mr. Lee:
The City of Campbell has made a fmal inspection of subject Public Works improvements and finds the
work to be acceptable and irl conformance with City standards. Accordirlgly, the City Engirleer accepts
the improvements.
The one year mairltenance period stated irl the permit begins as of the date of this acceptance letter,
The pennittee 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, irl
writing, whether or not any repairs are required.
Your cash deposit of $500,00, plus any interest due, is now beirlg processed and will be sent to you
under separate cover. Additionally, the construction cash deposit of $2,560 will be processed and sent
to Ultramar, Inc.
A Mairltenance Bond has now been received irl connection with this pennit, therefore, we are returning
the Faithful Perfonnance and Labor & Materials Bonds to Walton Engirleerirlg.
If you have any questions, please call me at (408) 866-2168.
Sincerely,
.....-/ .-
O/~ --
Robert Phillips
Project Inspector
!"I
MQ~
cc: Suspense - 11 months
Permit #96-221
Inspector File
Steve Linn, Walton Engineering, P.O. Box 1025, West Sacramento, CA 95691
Paul Clark, 525 W. Third Street, Hanford, CA 93230
U1tramar. Inc" 111 West Ocean Boulevard, 91h Floor, Long Beach, CA 90802
H:\ WORD\PERMITS\96221FIN(JD)
70 North First Street. Campbell, California 95008.1423 . TEL 408.866,2150 . FAX 408.376.0958 . TDD 408.866.2790
q b'" k2,
I
Date:
VALl" / SURETY INSURANCE A~CY
Surety Specialists
1540 River Park Drive, Suite #105 PLEASE RESPOND TO THIS REQUEST!!
Sacramento, CA 95815
(916) 567-6676
qllP -5~7-Dgl'5 [~:4-)
To: City of Campbell
Dept. of Public Works
70 North First Street
Campbell, ~A 95QO~ /
-A11n: (lan dt; /))l.6fft:t-~
'ECE
'''E
JlJfao I)
~ !-/e ~ l197
'-"'I1rl/' I Vy"c..IR....
IvIS;R4 r. .,$
IOtv
Status Inquiry
Company:
OUlicl i~v: .
Reliance National Indemnity Company
__""'~n.-"""",,"
r~ooo.:J.:JU
City of Campbell
Walton Engineering, Inc.
Construction/Remodeling of
Service Station.
Obligee:
Principal:
Description:
Amount:
$64,000.00
As Surety Representative on the above referenced bond, we would
appreciate your cooperation in providing the information requested
below. Please return this form to us so that we may have current
status information on the above captioned job. Your immediate
response would be greatly appreciated.
PLEASE COMPLETE ONE SECTION ONLY:
I. IF THE CONTRACT HAS BEEN COMPLETED:
1.
What was the completion date? G -30 ~
Date of acceptance: 7-3~ -q-r
What was the final contract price? K~
Has the full amount been paid? ~}L
Was the wo~k satisfactory? V~~
Have all J..C1.bor and. iT.ater:-iiAl bil.le been paid?
~~~kX'~ ~
2.
3.
4.
UIU. '"t^'.ot. ),.J
II. IF THE CONTRACT HAS NOT BEEN COMPLETED:
1. What percent of work has been completed to date?
2. Total amount paid to Contractor to date?
3. What is amount of retainage?
4. What is anticipated date of completion?
5. Is the Contractor paying labor and material bills?
6. Is the work progressing satisfac~ory?
Comments:
95008
FIRM: City of Campbell/Public Wor~DRESS: 70 N. First St., Campbell, C
BY: r/207',((t"L-T?N-. U:l,~ So. DATE: 7-70 -"7 PHONE:( 408) 866-2168
..
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CITY OF CAMPBELL
Public Works Department
June 11, 1997
c) ,
cf-:>\o
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Mr. Steve Linn 0\ cJ, . U.c .'L':::J,...to
Walton ngineering tL ~ (SJh \ 0 ~f"-'
i'6e-tQ.Ede~anding Road po . v 2:sc? c ~ 0\ c, ~
Haywa~ 45 ~?' It',....
SUBJECT:
PERMIT NO: 96-221
LOCATION: 921 West Hamilton Avenue
PRELIMINARY INSPECTION REPORT - DEFICIENCIES
Dear Mr. Linn:
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 6/9/97. 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. Prior to final acceptance of the work, you will also need to make the necessary
arrangements to provide the one-year maintenance surety in the amount of $16,000.00 which will be
used to replace the the performance surety currently held by the City. We have enclosed a copy of our
required bond form for your use.
If you have any questions, please call me at (408) 866-2165,
jje;,
:I::;J.~4
Public Works Inspector
MQ
Attachments: Deficiency List
Bond Form
cc: Traffic and Lighting Division
Building Division
Permit #96-221
H:\ WORD\PERMITS\9622I DEF(JD)
70 North First Street. Campbell, California 95008,1423 . TEL 408.866,2150 . FAX 408.376.0958 . TDD 408,866.2790
PERMIT 96-221: 921 West Hamilton Avenue
DEFICIENCY LIST
6/9/97
1. Submit mylar record drawings, signed by engineer.
2. Install two benches required by Planning Division.
3. Electrical Items
STREET LIGHT POLE ON MARATHON
Pull Box:
. Replace missing end bells on conduits
. Replace wrong size fuses with 3 amp fuses
. Replace wires that are too short
. Remove excess concrete from inside of pull box
. Install 6" of I W' crushed drain rock
. Install tar paper, grout, and 1" drain hole
. Replace split shrink tubing
. Replace cracked fuse holder
PULL BOX ON NWC
Pull Box:
. Replace wires that are too short
. Replace bond wire that is too short
. Replace missing end bells on conduit
. Lower conduits that are too high into pull box
. Install 6" of 1 W' crushed drain rock
. Install tar paper, grout, and 1" drain hole
. Raise pull box to grade
FIRST POLE NORTH SIDE. WEST OF MARATHON
Pull Box and Street Light Pole
. Replace cracked fuse holder
. Remove and replace wrong size fuses with correct size
. Lower conduits that are too high into pull box
. Replace wires that are too short
. Replace split shrink tubing
. Replace split end bells
. Install 6" of 1 W' crushed drain rock
. Install tar paper, grout, and I" drain hole
. Remove excess concrete from pull box lid
. Remove rust from anchor bolts and cold galvanize
. Install standard labels on pole # Al 066
. Remove and replace wrong type fixture with correct fixture
. Dress all scrapes on the pole where the galvanize was removed and cold galvanize
PERMIT 96-221: 921 West Hamilton Avenue
DEFICIENCY LIST
6/9/97
Page 2
STREET LIGHT POLE IN FRONT OF 923 HAMILTON
Pull Box and Street Light Pole
. Replace wires that are too short
. Lower PVC conduits that are too high in pull box
. Install 6" of I 'li" of crushed drain rock
. Install tar paper, grout, and 1" drain hole
. Remove rust from anchor bolts and cold galvanize
. Remove and replace wrong type of fixture with correct fixture
. Remove alld replace wrong size fuses with correct size
. Replace cracked fuse holder
. Dress all scrapes on the pole where the galvanize was removed and cold galvanize
. Install standard labels on pole # AI068
H:\ WORD\PERMITS\96221DEF(JD)
VALLE SURETY INSURANCE AGE- ~y li~. ~ G - Z 2 J
Surety Specialists
1540 River Park Drive, Suite #105 PLEASE RESPOND TO THIS REQUEST!!
Sacramento, CA 95815
(916) 567-6676
Date: 5-:D -'1/
To: City of Campbell
Dept. of Public Works
70 North First Street
Campbell, CA 95008
~e
Cf',,,
. ''llA . ~"
VI fAI "
f'1 .. 2
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AIIINISr.
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Status Inquiry
Curupdf1y;
Bond No:
Obligee:
Principal:
Description:
Relj.&nca Natic~~l
T_~__"",.: ....,...
..I..I.L'-A.'-,....LI..L~ '-1
"'r"'"",,,~~T"I"r'"
""'_.....1:'-... J.
P2686330
City of Campbell
Walton Engineering, Inc.
Construction/Remodeling of
Service Station.
Amount:
$64,000.00
As Surety Representative on the above referenced bond, we would
appreciate your cooperation in providing the information requested
below. Please return this form to us so that we may have current
status information on the above captioned job. Your immediate
response would be greatly appreciated.
PLEASE COMPLETE ONE SECTION ONLY:
I. IF THE CONTRACT HAS BEEN COMPLETED:
1. What was the completion date? ~010 ~~A~
Date of acceptance:
2. What was the final contract price?
Has the full amount been paid?
3. Was the work satisfactory?
4. Have all labor and material bills been paid?
II. IF THE CONTRACT HAS NOT BEEN COMPLETED:
1.
2 .
3.
4.
5.
6.
What percent of work has been completed to date? ~~~
Total amount paid to Contractor to date? N;?J
What is amount of retainage? Bo^'I'J It ~?=-~C:~CXJCJ il-'l=fotlax; if ~OhO DI vo.
What is anticipated date of completlori? /'1"/ (I) J"v"-'If...
Is the Contractor paying labor and material bills? ~rc:./i_ N t:7,/!.-
Is the work progressing satisfactory? >~~S
Comments: aOIVG-ll.r<.. 7r2... eo"'-it/Z.4C ;-~'-?
( ..' , ,,[ (~I /"j,.....r ",:;;
FIRM: __ I t-::., " '...l,\ I' f....<
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ADDRESS: 1/ A~ (;If~ (~/ /7;i1iLI;Jfi( III j'Y;/:"f
DATE: C:, -0) - 9 7 PHONE: ~C:~ - 2..-16 g
cr.t'Y OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
PROJECT HO.
C]c:'-zz/
REPORT HO:
13'~A L 01'\/ C-tl-s. S Yfl-r'; c-",/
DA'1'E :
5'- Z. 8-97
WEA'l'HER:
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CONTRACTOR: w ICIL TON l.?"'l.-.
INSPECTOR:
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1365 VANDER WAY
392 WEST LARCH RD., SUITE 39
12 THOMAS OWENS WAY
1500 GRAHAM HILL RD., SUITE B
141 SUBURBAN RD., SUITE D1
1016 EAST MAIN ST
3656 RESEARCH WAY, SUITE 34
SAN JOSE, CALIFORNIA 95112
TRACY, CALIFORNIA 95376
MONTEREY, CALIFORNIA 93940
SANTA CRUZ, CALIFORNIA 95060
SAN LUIS OBISPO, CALIFORNIA 93401
SANTA MARIA, CALIFORNIA 93454
CARSON CITY, NEVADA 89706
(408) 297-6969
(209) 832-8743
(408) 372-3716
(408) 458-4383
(805) 543-5493
(805) 922-5983
(702) 885-0144
FAX (408) 297-7716
FAX (209) 832-8749
FAX (408) 372-7481
FAX (408) 458-4388
FAX (805) 543-2748
FAX (805) 925-2490
FAX (702) 885-0786
May 16, 1997
Project 104264
Permit #96-221
Mr. Bob Ph ill ips
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
70 North 1st Street
Cupertino, CA 95008
Subject: Field Density Tests
Beacon Station #786
Sidewalk, Curb, Gutter and Approach
921 West Hamilton Avenue
Campbell, California
Dear Mr. Phillips:
As requested, a representative of TERRATECH, INC. was present at the subject
site on April 23 and May 1, 1997 to perform field density tests within the
aggregate base materials comprising the pavement section at the Beacon
Station, #786, in Campbell, California. Seven (7) field density tests were
performed in accordance with ASTM Test 02922-91 (Nuclear Method) at random
locations within the aggregate base materials for the. sidewalk, curb, gutter
and approach.
RECEIVED
MAY 211997
r '""""i"'" vw ~I\"."'_
I\DMINISTRATIO"'"
The optimum water content and maximum dry density of a selected sample of the
aggregate base utilized in the construction of the pavement section were
measured in Terratech's laboratory using ASTM Test 01557-91, Method C.
The results of the field and laboratory tests are presented on the attached
Table A. These are for record purposes only.
Sincerely,
TERRATECH, INC.
NI11'~r-
Kent M. Screechfield
Construction Department Manager
Attachment
cc: Walton Engineering - Mr. Steve Linn (2)
Field Laboratory
Test Date DepIh Location Appro><. MIximum Oplimmn Relative Remarks
No. of of EIev. DIy Wiler DIy Wiler Compaction
Test FiB Density ~ Density Content (%)
(feet) (feet) (pet) (%) (pet) (%)
WIthIn MI!l'el!ate base Material
Marathon Street
1 04/23/97 0,5 North end of sidcwaIk 119.8 11.4 125.0 9.0 96 Passed
2 04/23/97 0,5 North side ofsidewalk driveway 120.5 14.5 125.0 9.0 96 Passed
3 04/23/97 0.5 South side of sidewalk driveway 119.5 12.5 125.0 9.0 96 Passed
4 04/23/97 0,5 South end of sidewalk 122.8 10.8 125.0 9.0 98 Passed
HamDton Avenue
5 05/01/97 0.5 East west of sidewalk 118.8 12.4 125.0 9.0 95 Passed
6 05/01/97 0.5 Mid point of sidewalk 118.5 13.1 125.0 9.0 95 Passed
7 05/01/97 0,5 Curb and gutter /Wheel Chair Access 119,0 13,3 125.0 9.0 95 Passed
NOTE: Specified minimum relative compaction for pavement aggregate base is 95 percent.
Rev. 2197
CI'l'Y OF CAMPBELL
FIELD ENGINEER'S DAILY REPORT
PROJECT NO.
'1(,-eel
,//4/>1, L -rC~Y
lJf:/4Cc',...../ G-A S S T/-711 C/y
REPORT NO:
DATE :
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WEATHER:
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CONTRACTOR:
INSPECTOR:
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DESCRIPTION
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DATE :
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FIELD ENGINEER' S DAILY REPORT
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PROJECT NO. 96 ~:1~ I
REPORT NO:
FIELD ENGINEER'S DAILY REPORT
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FIELD ENGINEER'S DAILY REPORT
PROJECT NO.
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cr1'Y OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
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PROJECT NO. 96 -' ).,)-!
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FIELD ENGINEER'S DAILY REPORT
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VA. EY SURETY INSURANCE A
Surety Specialists
1540 River Park Drive, Suite #105
Sacramento, CA 95815
(916) 567-6676
ENCY 1(;,22;
92/ vv /:crr,- ,'."!,
~~A- tJVj-
-2-} /rr8
Date:
~ - L::[J -CJ7
To: City of Campbell
Dept. of Public Works
70 North First Street
Campbell, CA 95008
Status Inquiry
Company:
Bond No:
Obligee:
Principal:
Description:
Reliance National Indemnity Company
P2686330
City of Campbell
Walton Engineering, Inc.
Construction/Remodeling of Service Station.
Amount:
$64,000.00
As Surety Representative on the above referenced bond, we would
appreciate your cooperation in providing the information requested
below. Please return this form to us so that we may have current
status information on the above captioned job. Your immediate
response would be greatly appreciated.
PLEASE COMPLETE ONE SECTION ONLY:
I. IF THE CONTRACT HAS BEEN COMPLETED:
1.
What was the completion date?
Da te of acceptance: ~~~-t~~" t'i J 19" l'
What was the final contract price?
Has the full amount been paid?
Was the work satisfactory?
Have all labor and material bills been paid?
2.
3 .
4 .
II. IF THE CONTRACT HAS NOT BEEN COMPLETED:
1. What percent of work has been completed to date?
2. Total am6unt'paid to Contractor to date?
3. What is amount of retainage?
4. What is anticipated date of completion?
5. Is the Contractor paying labor and material bills?
6. Is the work progressing satisfactory?
Comments: u.~cLw l (jAr l/1I'4,':-'+elt\'llr1CA- ~IC:I~
FIRM: ~J c;.~"Ill.J... ADDRESS: 70 ~{t.. "f\-)t 5?,fy....t
BY: _ ~ ~ DATE: 'Feb.z..) l~CfB PHONE=(4oB )8'4""'<"6
CITY OF CAMPBELL
FIELD ENGINEER' S DAILY REPORT
PROJECT NO.
c: - 2 -Z ;
REPORT NO:
or '( i LJIfS-r {-/~YVIIL ,Ot-/
'5 f'i ,:j C 07<..../ C-/J S'
DATE :
WEATHER:
C
INSPECTOR:
.~.
,2 / I U
CONTRACTOR:
ITEM
DESCRIPTION
"/
0.
e:- ^ ( ..s-- I "-' 6.
-r::.
/?-r A'(' c.~.
~.I'\/D~'! 0
~
I:
~
CC:
PAGE:
I
OF I
~;
ENCROACHMENT PERMIT ISSUANCE CHFCK LIST
------,. \
City of Campbell
Department of Public Works
Encroachment Permit No.~.--"Z~
ITEMS REOUlRED FOR PERMIT APPLICATION:
~- ( 2. _=1'<;" Applicant section complete
~ -. n. -9 c... Applicant signature and date (front and back)
f>.~-l~-oq,- Permit Application Fee $225.00 paid - Receipt Number ~3;S\3
~ .'-2.-0:-1-<- Engineer's Estimate submitted
~.-\::s ~ Plan Check Deposit paid (2 % of Engineer's Estimate, $500 min)
Receipt Number~~"S \4
~--rt;...c.ck. Five sets of improvement plans submitted
~ \ - \.<i "9~
ITEMS REQUIRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS
-\.l..=4-1 .,.~e
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).4\. ~c.,~ ,('''0
'l~ ~'P'r .~ .""'t~~__ ~ ""'\<e:..c:>~"'2..
Security for Faithful Performance and Labor and Materials,_ 100% each of Engineer's Estimate,
supplied or paid, 'F-r..::> \ L ~ H P ~Cb ~o
Amount ~l~' 60 Form LD. #
-z-- 7~ -'9.,"'"l
\'L. -\1-"'1-,,- Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000
maximum)
Amount $""'L'S,(...e.. CK:) Receipt No. 9~C.::;i'~
U\..."T'~""""+-t+-. Lt...Jc. ~t:z.A.~~ Di I':::.~o~r-::. c::::; ~\ivl~<'.j.<...
\ -~ I -91 Worker\-s Compensation Insurance InrorInation Sheet received for Applicant.
l-~~-eT' ~~I-->'r \jJ,="e'--~ \;~~ tc...lG::Il.P't" =P- ",,'L"'~'-(
All other Public Works requirements listed in the Conditions of Approval of the development.
~-\\'-9..~ <:\\, \'""2-~D c:::;.'~'-'-'-l l~ ~ ~~ r::. ~ \Z" ~
ITEMS REOUlRED PRIOR TQ ISSUANCE OF ENCROACHMENT PERMIT:
\-~\ -9, Contractor's signature added to the permit application (front and back)
"L-~-q'1 Worker's Compensation Insurance Information Sheet received from Contractor.
~<l;.-.:> -~', Certificate of Insurance with Additional Insured's Endorsement received from Applicant or
Contractor.
One mylar set and four blueline sets of off-site plans signed by licensed engineer, stamped
APPROVED FOR CONSTRUCTION.
Permit signed by City Engineer.
WHEN ALL OF THE ABOVE ITEMS ARE COMPLETE, PERMIT MAYBE ISSUED.
Issuer: Initial
and date
and file with permit.
UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND
j:\mq\ld\pmtcklst rev. 6/96
CITY OF CAMPBELL
PUBLIC WORKS DEPARTMENT
ENGINEER'S ESTIMATE
Address: 921 W. HAMILTON
Encroachment Permit No, 96-221
Date:
Application No.
1lI19/96
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO. DESCRIPTION UNIT QTY < $30K $30 K to $150 K > $150 K $ AMOUNT
I. SURFACE CONSTRUCTION
MOBILIZATION 1 LS $ 1,500.00 $ 1,500.00 $ 1,500,00
CONSTRUCTION TRAFFIC
CONTROLCONTROUPHASING I LS $ 1.000.00 $ 1,000.00 $ 1,000.00
CONSTRUCTION STAKING I LS $ 750.00 $ 750.00 $ 750.00
CONSTRUCTION TESTING I LS $ 750,00 $ 750.00 $ 750.00
II. DEMOLITION/CLEARING
I. CLEARING & GRUBBING LS
2. SAWCUT P.C.C.lA.C,(UP TO 6") 324 LF $4.50 $3,00 $2.00 $ 972.00
3. P.C.C. REMOVAL 333 SY $30.00 $23.00 $10.00 $ 7,659.00
4, CURB AND GUITER REMOVAL 307 LF $6.00 $3.00 $2.00 $ 921.00
5. MEDIAN REMOVAL SF $4.50 $2.25 $1.25
6. DEMOLISH EXISTING INLET/PLUG RCP'S 1 EA $300,00 $ 300.00
Ill. STORM DRAINAGE
1. 12" R.C.P, (CLASS V) 19 LF $60.00 $40.00 $20.00 $ 760.00
2. 15" R.C.P. (CLASS III) LF $65.00 $48.00 $38,00
3. 18" R.C,P. (CLASS III) LF $70.00 $60.00 $52,00
4. 24" R.C.P. (CLASS III) LF $80.00 $68.00 $59.00
5. 30" R.C.P. (CLASS III) LF $90.00 $75.00 $65,00
6, T.V. INSPECTION (12") LF $1.20 $0.75 $0.60 $ -
7. STD. DRAINAGE INLET I EA $1,600.00 $1,300.00 $1,000.00 $ 1,300.00
(C.C. DETAIL 9)
8. FLAT GRATE INLET I EA $1,400.00 $1,100.00 $900,00 $ 1,100,00
(C.C. DETAIL 6)
9, STANDARD MANHOLE EA $2,000,00 $1,600.00 $1,300.00 $ -
(C.S.J. DETAIL D-11)
(INCLUDES FRAME & LID)
10. BREAK AND ENTER M.H.lD.1. EA $700.00 $550.00 $450.00
Page 1
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO. DESCRIPTION UNIT QTY < $30K $30 K to $150 K > $150 K S AMOUNT
IV. CONCRETE IMPROVEMENTS
1. SIDEWALK 2261 SF $6.50 $4.50 $2.75 $10,174.50
2. DRIVEWAY APPROACH 981 SF $7.50 $5,50 $3.75 $ 5,395.50
3, CURB AND GUTIER 307 LF $22,00 $18.00 $15.00 $ 5,526.00
4. V ALLEY GUTIER SF $12.50 $10.00 $8.25
5. HANDICAP RAMP 1 EA $1,200.00 $800.00 $700.00 $800.00
6, TYPE B-1 CURB LF $12,00 $9.50 $7.50
7. TYPE AI-B3 CURB LF $15.00 $12.00 $10.00
8, COBBLESTONE MEDIAN SURFACE SF $12,00 $8.00 $5.00
9. P.C.C. DRIVEWAY CONFORM SF $7.00 $5.50 $4.50
10. A,C. DRIVEWAY CONFORM SF $4.50 $3.75 $3.00
V.
PAVEMENT
1. ASPHALT D1GOUT AND REPLACE 324 CF $2.00 $3.50 $2.50 $ 1,134.00
(lO'XI2'X115' PCC SLURRY)
2. PAVEMENT WEDGE CUT (6') LF $5.00 $2.50 $1.50
3. PAVEMENT GRINDING 307 SF $0.80 $0.50 $0.35 $ 153.50
4. PAVEMENT FABRIC (PETRO-MAT) 68 SY $2.00 $1.85 $1.50 $ 125.80
5. ASPHALT CONCRETE (TYPE A) 8 T $80.00 $50.00 $35.00 $ 400.00
6. AGGREGATE BASE (CLASS 2) T $40.00 $20.00 $12,00
7. SLURRY SEAL (TYPE 11) SF $0,07 $0.06 $0.05
8. SLURRY SEAL (TYPE III) SF $0.11 $0.09 $0,07
VI. TRAFFIC SIGNALS/LIGHTS
1. DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $250.00
2. DETECTOR LOOP (6' x 30') EA $650.00 $540.00 $440.00
3. DETECTOR LOOP (6' x 50') EA $900.00 $750,00 $640.00
4. ELECTROLIER 3 EA $2,600.00 $2,200.00 $1,800.00 $ 6,600,00
5, I 1/2' RIGID CONDUIT 180 LF $9.00 $7.00 $.5.00 $ 1,260.00
6. 2' RIGID CONDUIT LF $17.00 $13.00 $10.00
7 CONDUCTOR 540 LF $0,70 $0.55 $0.45 $297.00
Page 2
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO, DESCRIPTION UNIT QTY < $30K $30 K to $150 K > $150 K $ AMOUNT
8 PULL BOX (NO, 3 1/2) 4 EA $300.00 $240.00 $185.00 $960.00
9 PULL BOX (NO, 5) EA $400.00 $350.00 $300.00
VII. STRIPING AND SIGNS
I. REMOVE PVMT. MARKINGS (PAINT) SF $2.50 $1.50 $1.00
2, REMOVE PVMT. MARKINGS (THERMO) SF $3.00 $2.00 $1.40
3. REMOVE PVMT STRIPING LF $1.40 $0.80 $0.40
4. STRIPING DETAIL 9 LF $1.35 $0.85 $0.35
5, STRIPING DETAIL 29 LF $2,25 $1.65 $ 1.20
6. STRIPING DETAIL 32 LF $2.40 $1.75 $1.25
7. STRIPING DETAIL 37 (THERMO) LF $1.85 $1.50 $1.00
8. STRIPING DETAIL 38 (THERMO) LF $2.50 $1.85 $1.15
9. STRIPING DETAIL 39 LF $1.50 $0.85 $0,45
10. STRIPING DETAIL 40 LF $2.20 $1.70 $1.00
II. LIMIT LINE LF $1.35 $1.05 $0.90
12. CROSSWALK LF $1.35 $1.05 $0.90
13. PAVEMENT MARKINGS (PAINT) SF $2.50 $1.90 $1.60
14, PAVEMENT MARKINGS (THERMO) SF $5.50 $3.80 $2.60
15. PAVEMENT MARKER (NON-REFL.) EA $4.50 $3,00 $2.20
16. PAVEMENT MARKER (REFLECTIVE) EA $6,00 $4.15 $3.15
17. TYPE K MARKER EA $95.00 $80,00 $70.00
18. TYPE N MARKER EA $95.00 $80.00 $70.00
19. SALVAGE ROAD SIGN 1 EA $85,00 $75.00 $65.00 $75.00
20, RELOCATE ROAD SIGN 2 EA $100.00 $85.00 $75,00 $170.00
21. INST, RD. SIGN ON EXIST. POLE 1 EA $200.00 $145.00 $110.00 $145.00
22. ROAD SIGN WITH POST EA $300.00 $240.00 $195.00
23 STANDARD BARRICADE 7 LF $15,00 $105.00
VIII. LANDSCAPING
I. IRRIGATION, PLANTING WORK I LS $3,500.00
Page 3
ITEM UNIT PRICES FOR PROJECT AMOUNT
NO. DESCRIPTION UNIT QTY < S30K S30 K to SI50 K > SI50 K S AMOUNT
2 PRUNE TREE ROOTS EA SI25.00 $100.00 $85.00
3. TREE REMOVAL EA $650,00 $500.00 $400.00
4. ROOT BARRIER (12") LF $20.00 $10.00 $6.00
5. ROOT BARRIER (18") 96 LF $25.00 $15,00 $10,00 $1,440.00
6. STREET TREE (15 GAL) 6 EA $450.00 $325.00 $250,00 $1,950.00
7. STREET TREE (36" BOX) EA $700,00 $550.00 $400.00
8, TOP SOIL BACKFILL 25 CY $15.00 $375.00
(119)(7)(12")/27=
IX, MISCELLANEOUS
I. PEDESTRIAN BARRIER LF $75,00 $60.00 $50.00
2, CHAIN LINK FENCE (6') LF $15.00 $11.50 $9,25
3, RAISE MISC. BOX TO GRADE EA $300.00 $200.00 $175.00 $200.00
4. RAISE MANHOLE TO GRADE EA $400.00 $275.00 $200.00
5. INSTALL MONUMENT BOX EA $450,00 $350.00 $300.00
6. MEDIAN BACKFILL CY $19.00 $17.00 $15.50
SUBTOTAL $57,798.30
PREPARED BY:
10% SECURITY ENFORCEMENT FEE $ 5,779.83
REVIEWED BY:'\.-
TOTAL ESTIMATE FOR FAITHFUL $63,578.13
APPROVED BY, PERFORMANCE SECURITY $64,000.00
'See Section 66499.4 of the Map Act.
H:\92IHAMIL(MP)EXC
Page 4
..J
CITY or CAMPBELL
I'UIlUC WORXS DEPARTMENT
ENG1J'\'EER'S ESTIMATE
w- ~~~'\\O<J
AcIcIrcu
9'd\
Due 10-- d ..~~
Applialiae N4.
I UNIT PRICES FOR PROJECT AMOUHT .
I
. OUM'TTTlES I < S:lOK ! S:lOic iomolC I > SI~K
En::raadun<JIl'tnnil No.
: ITEM I
I NO. I DESCRI~
: L t:;.A.CE CO!\'S'TJttJCTI<r(
i
I OBIUZA nON
I !
I FNm.UcnONTIlAFl'IC
I fOImlOL.COImlOLJl'H~
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I I
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I rONSTltucnONTtSnNG
. U DOl OUTI ON/Cu:J.JUSG
! . I. rUNe: &. e:RUBBINe:
I 2. fAWC\1T P.C.C.lA.C.(VHO n
! I
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3. r-c.c. REMOVAL
I
I
4. CuRB 1."'0 e:l.T'ITIRREMO\'AL.
I
!
,. MEDIAN REMOVAL
I
i
I
6. DEMOUSH EXISTING J"'lEi:l'l..V:; J.C""S
I
hoR.~ DllAINACI:
I
I. 12' R.C,P. (CLASS V)
I
I
2.. i," R.C.P. (Cl..ASS III)
!
i
"
1 L.S.
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,
!i33 SY
;- 3c:c L.F
I
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J. I." R.C.P. (CLASS III)
4, :4' R.C.P. (ClASS III)
I
,. )0' R.C.P, ICl..ASS III)
I
i
I
6. '{-V, INSPECTION (l2')
I
i. ST!). !l'_'.lSAG~ IN~
I
ic.c. DETAIL 9)
,
....
.. .Fl..A T e:1lA TE INLET
I
IC'c. DETAIL. 61
9. ;l'TANDARD MANHOL!
fC.5J. DETAIL. 0.11)
(lNa.UDES FRAME &. UD)
I
I
I
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I
I
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IG. IlREAJC ANt) EHTER M.H.IO.L
lOsCJU:TE ~IPRcivDtn.7S
I
SJDEWAUC
I
I
2. DRIVEWAY APPROACH
.
I
27-Jun-96
I
L.S:
I
;
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L.S!
L.S
L.S:
SF:
EA
Lr
LF
IF
LF
LF
LF
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.
EA.
SI.400.lXh
EA
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S90.00.
SI.:!O!
56-'0.
S7 -'0:
n.oo
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S40.00
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S60.00
$61.001
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Page 1 of 4
SAMOUHT
1
s~.............
s~~ I
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12.00! \I?-- i
SIO.OO .1 G, oSi !
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S:i1.00
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$I 6.001
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$9(0.00
S I.JI"O.OO
kiO.Oll
!:2." . ~~ ~u
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)
.
ITEM I I I QUM'TTTlES UNIT rRICES FO" ,)IECT AMOUIoTT I
I I
~O. , DESOr.' < S:lOK S:lO K AlK > mor: S AJ.4QUlo.,
3. CURB AND Cl1ITU I d~OLf s:2l.lXIl SII.lXI '=1 ~~~
I
I .
I I I J
I .
I .. ~ ALLEY CurrER I SF Sluoi SIO.lXI
I ! I
, I I
"- HANDICAP RAMP I I' EA SI.200.lXI! SIOO.lXI S1lXl.lXI &a:>
I I i I
I j ! I -.
. .
6. jrYPE B.I CURB ! Lf SI2.lXIl S9~ S7~
I ~ I
I SI.5.ool
7. hPE AI.B3 CURB I u: SI2.oo SIO.lXI
I i I
I
L COBBLESTONE MEDI.\.'l SUEF.\CE ! SF SI2.lXIi sa.lXI ~.lXI , i
I , I
!
9. P.C.C, ORIVEwA Y COSl'ClUI ; SFI l7.lXI ~.)O ~.)O
i ;
i
10. rc' DRIVEWAY CONfoo. I SF ~.)O $1.7S $1.lXI
I
, ;
I i !
V. PAVIMo.T .. f I
I I 1\'Ok'
I. f'sPHALT OIGOlTT M:l ~~_~ , ~~~FI ~.lXIl $3.50 S2~ :
,
~.lXIl I
I , / !
I
2. rA VEMEJo."T WEDGE Qrr 10 LF SUO SI.50 I
i !
I. i ,
: i
350 SF so.101 \,S: I
3. PA VEMEJo."T CRINOI~G , $0.50 SO.3.S
I ulXIl ,
I : ! l~P( I
.. ~AVEMEJo."T FABRIC (l'mo-!o'_~n , ,13 SYI S US SI.501 . i
i I S3.S .lXIl i
I . I I I
I
;"SPHALT CONCRETE (")1'[ JJ ! m.lXIi I
s. TI 1SO.lXI 1
I , I I ;
. I i I
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6- ;"GGRECA TE BASE (CLUS :J TI SAa.lXIl r.!I:l.lXI Sl2.lXIi
I so.os!
! I ;
, :;FI
7. SLURRY SEAL (TYPE In I SO.071 $0.06
! i I
I i
I : I
L SLURRY SEAL (TYPE 1Ir) SF ~"I $0.09 $0.07 !
i i i
I -- f
. . ~mc SICNALSIUCHTS ~ i
I. pETECTOR LOOP (6' RCli1'o'O) , Bi ~so.ooj S3CXl.OO SlSO.lXI I
! . I I
I
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2. DETECTOR LOOP 16' I Jon . EAI wo.oo! ~.OO S4A0.00 I
I I
I i
pETECTOR LOOP 16' I ~ i I
3. :1 SlIOO,lXI S7SO.lXI ~.lXI I
I SI.IOO.ooI. I
, I
.. tuCTROLIER . 3 sum.lXI S2,2CO.lXI .~ looo
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! '80'~! f .\ ~o
s. ! 112. RIOlO CONDUIT ~'.'!:'! ... .... i
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6. . RIOlO COND IT LFI S11.ool S13.lXI
I
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27-Jun-96
Page 2 of 4
/
\,
l i UNIT /'RICES FOR PROJEC JtlT
DESCIUPTI(X I UAtlTmES I <noK : nOK TOSI501C > SI501C. SAMOlr.'ooT
I 5~OLF Sll.?01 $0.55 SO,'" ;)'7
,
,
I :-"J ~
L I ~ EA S3OO.OOI $240..00 SIIS.OO
.. !
,. EA $-IlX).OO; S350.OO SDl.OO
!
....:-:. ........ ...." .... I
VII. IN.C AND SI.CNS :.: :
I. OVE pVlo4T. MAIU:ItG (PA%!-o"T) SF $2-'Oi SI.50 :11.00 .
I
I
2- MOVE pVlo4T. MAlU:lNCS (TllSl.IOt SF noo: 12.00 :a..o
3- FOYE PVMT STRIPING LFI SI.40. SO.IO !iO..o
~IPING DFTAIL 9 I
~. LFI SI.35. SO.15 SO.35
I I I
LFI ,
s. F'"' om,,,. ~: SU5 ::1.20
i SI'''I
I
6- IPING OFT AIL 32 LF $2.40' ~1.25
I
LFi i
7. rlPlNO DETAIL" (Tllt1.lo'OI 5 us , SI.50 ::1.00
I
I
L CIPINCi OFT ~IL 31 (THEI\M 01 LF $2-'0 ; SI.15 ~1.15
,. IPING OFT AIL 39 LF SI-'O: SO.tS ~;o.~5
,
I LF/
10. mlPlNG OFT AIL 40 $1~; SI.70 ::1.00
I
II. UMIT UNE LF/ 51.35 SI.l15 :0.901
I
12- CROSSWALK LFI 51.35 SI.l15 $0.90
r' """'" """'"" · ."" i
I
13. SFI $2-'0 SI.9O ".60
I
I~. r "'"'''' "",,'Os """"0' SFj 55.50. S3.lO 12.60
15. AVEMEt.7MARKER (NON.REFL) EAI SUO 13.00 $1.20
~AYEMEt.T MARKER CREFUCi1\'El I
16- [Ai 16.00. SUS S3.15
I
I !
17. r" ""'" EA S95.OO: $10.00 $73.00
IL PE N MAIU:ER EA S95.OO: $10,00 S7).OO
It. k..,L V ACE ROAD SIGN EA $15.001 $75.00 541.00
lEl.OCATE ROAD SICH :
!
20. EA SIOO.OO: $15,00 m.oo
I
21. NST. lD. 5101'1 ON EXIST. POLE EA noo.OOI SI.S.OO .111:1.00
,
I
n. rOAD}lCiN WITH POST EA s300.ooi ~.OO SI95.00
i
,
27-]un-96
Page 3 of 4
rrEM I u"". rRICES J J1ECT AMOUI'lT
NO. D~.. < S)O K k)oKTOSI~K SISOK S AIo4Ol:-'~
VIII. r=.SCAJ'XNG :L..~ ~-" I
I. RRlGATION. PLM1'Ni~ U! ~i,;U::)
I !
1- F'm..~ EA! S 12S.00 SIOO.OO S&5.00
J
i
1. REMOVAL I EAI $6$0.00 SJOO.oo s.&OO,oo
I
'- rOOT 8AIlJUER (IT) I UI moo 110.00 $6.00
I
I o~~
s. f"U~' on , \S U' S2S.oo SI5.OO 110.00
I I
I ,
6- EElTREE~ 1'5~......\ 1 s EA; $.4~.00 132S.00 1~.00 \ c...o ~
I
I I
1. EEl TREE ()6' IlOXI EA: S1CXI.OO Sj~.OO ~.OO
~OP SOIL BACKFlU.
I J3
.. I (Yi \ - ;;:;:0
~lScti.L.v.-tOUS . I
DC. I
L [EDESTRJAN BARRlEX Lf' Sis.ool S60.00 SJO.OO
,
2., HAIN UNK FENCE l.51 I LF' HS.oo S 1I.so S9.2S
I I
3. . ~E MISC. BOX TO~..o; I EAi UXl.oo S2lXl.00 1m.00 . ;)00
I
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.. RAISE MANHOLE TO.;:;A...o; I E.." ~.OO 1m.00 S2OO.oo
I i
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S. ("'STALL MONUME"" s.::x B $.4SO.OO 13SO.oo SJOO.OO
SI~.ool
6. Io4EDIAN BACKFILL O' 117.00 11S.so
SUBTOTAL
PREPARED BV:
10S SECURrTY ENFORCEMENT FEE
REVIEWED BV:
TOTAL ESTIMATE FOR FAITHFUL
APPROVED BV: PERFORMANCE SECURrTY
-sa. Scoioa 66'99.. of &he Map Aa.
H:\CECOSTEST.WK3{MI')REV6f.V96
27-Jun-96
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