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96-264 CITY OF CMtPBELL DEPT. OF PUBLIC WORKS 70 North First St. Campbell. CA 95008 (408) 866-2150 Fax (408) 376-0958 <- 'ot ENCROACHMENT PERMIT (for working within the public right-of-way) .~ Permit No.---2. t~- .z.IJ t/ ~ X-Ref. file Issued q '/<5 cJl , Permit expires in 12 montm~~~ Application Date lIt 91' Application expires in months APPLICATION - Application is hereby made for a Public Works Permit in accordance with Campbell Municipal Code. Section 11.04. if the permit is DOl issued. Application Fee is non-refundable.) ;-s-, Me:- &-1 } NVY h,0 NIt:\. . B. Nwreofwork V\Llb-- DlL\d~JJJ\Y / (\A~ ~ (Application expires in 6 monlhs A . Wort address or tract 1/ Utility crcnch location C. Attach four (4) copies of an engineered plans showing lhe location and extent of lhe work. and four (4) copies of lhe preliminary Engineer's Estimate of work. The plans shall show Ute relation of lhe proposed work to existing surface and underground improvements. When approved by lhe City Engineer. said plan becomes a pan of lhis permit. ('W~J ~1()c.A.Vh.'-cL IJQee.-I,~~ ' , I D. All work shall conform to lhe City of Campbell Standard Specifications and DClaiIs for Public Works Construction; lhe General Permit Conditions listed on lhe reverse side; and lhe Special Provisions for lhis permit. listed below. Failure to abide by lhese conditions and provisions may result in job shut-down and/or forfeilUre of Failhful Performance Sureties and cash deposits. (See General Permit Conditions I and 2.) E. THE CONTRACTOR MUST HAVE THIS PERMIT AND APPROVED PLANS AT THE SITE AND MUST NOTIFY THE PUBLIC WORKS DEPARTMENT AT LEAST TWO DAYS BEFORE STARTING WORK. NOTICE MUST BE GIVEN TO PUBLIC WORKS AT LEAST 24 HOURS BEFORE RESTARTING ANY WORK. Name of Applicant Address ''1,J( t R fY\fr ~e-- P t<.J:. (J ~\e...-\ I . I' (print name) W. V I~~ fD.~ f\i\.s...Jle....!e.<.&1O-24 HOUR EMERGENCY .. / '1 Sb 3.;:] Telephone(~Qf) 3t) /-"iaJ3 TELEPHONE No{ '-fl>~) 3q~ 5Lt () '? , Is lhis work being done by lhe property owner at lheir own residence? Yes )C. No The ApplicanrJPermiaee hereby agrees by affixing lheir signalUre 10 lhis permit to hold lhe City of Campbell, its officers. agents and employees free, safe and harmless from any claim or demand for damages resulting from the work covered by this permit. (ApplicantlPermitICC) Date Accepted SPECIAL PROVISIONS .+1. SltCCl shall not be open cut for underground inswlations. Minimum cuts .!!l!!Y be allowed for collllCCtions or exploration holes. Such CUts may be specifically approved bv the Inspcctor prior to cuniOl!. Pavement may be CUI for underground inswlations and must be restored in accordance wilh lhe Utility Trench Restoration Standatd Details, Method' A' Badcfin, unless Olberwise approved by Inspeaor. Work 10 be staked by a licensed Land Surveyor or Civil Engineer and two (2) copies or !he cut sheets Scllt to the Public Works Department before starting work.. Per Section 4215 of !he Government Code this permit is not valid for excavations until UndcrgroW1d Service Alen (USA) has been notified and lhe inquiry identifICation number has been elllCrcd hereon. USA Phone 1-800-227-2600. USA TICKET NO. Itftnriu..,t I,OJt.,,,, /lrlll!- h.- A {"Ue,t1 ~Lu" .IJ,'s/ /J1/1Jl~"'ll'n,,.nl .1rti'7>t?l 'It:' j"h//.'tx:ed. . ,- ~, _2. _3. ~4. ...a:. 5 . SEE PUBLIC WORKS FEE SCHEDULE FOR CURRENT FEES ~ lJi'A./-t"i}i-/fl-/ AMOUNT s .1.2:'-~...!. s ,,-ce' .-. . S II '1t.,c' "',,: S i,'{'<" S J 3 "1:.1 .:" - RECEIPT NO. PERMIT APPUCA TION FEE PLAN CHECK DEPOSIT SECURITY FOR FAITHFUL PERFORMANCElLABOR & MATERlALS CONSTRUCTION CASH DEPOSIT ~ "Tt+e:;:: V-t. e;:t2..l PLAN CHECK & INSPECTION ~ ~ t~ , \.Al~~~\,~~ C1 r,~ll rx~ Ct<>t 4a; APPROVED FOR rssu "--/ GENERAL PERMIT CONDITIOI'4_ 1. A CONSTRUCTION CASH DEPOSIT is required. Charges will be made against this deposit if there is an emergency call-out, overtime inspection or when City ordered barricading is required. Any such costs in excess of the deposit will be billed 10 the Penninee. 2. A ONE-YEAR MAINTENANCE PERIOD AND SURETY are required. Such period will begin on date ofwrinen acceptance by the City. 3. REFUND of the cash deposit balance and refund or cancellation of the Faithful Performance Surety will be initiated by the wrinen acceptance of the work by the City. 4. The Pennittee MUST REQUEST IN WRITING a ftnai inspection and acceptance of the work upon completion. Acceptance by the City will be made in writing to die Penninee. 5. MAINTAIN safe pedestrian and vehicular crossings and free access 10 privale driveways, bus stops, fire hydrants and water valves. 6. A CONSTRUCTION TRAFFIC CONTROL PLAN and a CONSTRUCTION SCHEDULE is required for all lane closures. detours and street closures. This plan must be REVIEWED and APPROVED prior to any lane closures. 7. The CONSTRUCTION TRAFFIC CONTROL PLAN shall conform with the CallranS Manual of Traffic Controls for Construction and Maintenance Work Zones. daled 1990. available at Callrans. Traffic control equipment shall include Type II flashing arrow signs if required. 8. REPLACE IN KIND any damaged or removed existing improvements, including planting. 9. Sawcut for all PCC or AC removals. All PCC removals shaU be 10 nearesl scoremark and shall be doweled to existing improvements. 10. OVERTIME INSPECTION PREMIUM will be charged against the cash deposit for inspection required outside the hours of 8:00 a.m. 10 4:00 p.m. at the currem overtime rale, minimum one hour charge. I I. SA TURDA Y INSPECTIONS musl be arranged in advance. Saturday inspection lime is charged at the current overtime rate with a three hour minimum. Advance payment for the eSlimated lime is required. 12. Adequale signing and lighled BARRICADING is required on the job site. Failure to provide such signing and barricading may result in the City's renting such signing and barricades and charging the cost (including all labor and materials) against the cash deposit. 13. Compaction lesting of subgrade, base rock, and asphalt concrele by Pennittee is REQUIRED unless otherwise stated by the City Engineer. 14. The Contractor or Pennittee will have a SUPERVISORY REPRESENTATIVE available for contact on the project at all limes during conslIUction. Contractor or Pennittee shall provide a phone number at which they can be contacted outside the hours of 8:00 a.m. 10 4:00 p.m. 15. No STORAGE of materials or equipmenl will be allowed near the edge of pavement, the traveled way, or within the shoulderline which would create a hazardous condition [0 the public. 16. This pennil shall nOI be conslrued as authorization for excavation and grading on privale property ADJACENT 10 the work or any other work for which a separate permil may be required, nor docs it relieve the Pennittee of any obligation to obtain any other pennit required by law. 17. This pennit docs NOT RELEASE the Pennittee from any liabilities contained in other agreements or contracts with the City and any other public agency. 18. This permit is NOT TRANSFERRABLE. Work musl be performed by the Penninee or his designated agent or contractor as specified thereon. 19. CALL BACK (call out) due 10 emergencies regarding this pennit, shall be at the current overtime rate with a three (3) hour minimum charge per occurrence. 20. Pursuant to Chapter 14.02 of the Campbell Municipal Code, applicant shall not cause 10 be discharged any material inlO the municipal storm drain system other than storm waler. Applicanl shall adhere to the BEST MANAGEMENT PRACTICES established by the ~anta Clara Valley Nonpoinl Source Pollution Control Program. . Applicant shall be responsible for ensuring thai all those providing services und , . ;/7 /J",- J J 7 "/'" ) /:i Y ') C il '/IC/7z...f-/-, j:\formslpwpcrm2 6/96 PUBLIC WORKS DEPARTMENT RECEIFT Eft'ecliveJuly I, 1996 E r.. TO: City Clerk PUBUC WORKS FILE No.7:?: - ::Ph 4 PROPERTY ADDRESS -??'7 ~/c;?~4/'/'1/ Pleue collect '" ..-ip< for the following monies: / ACCT. I ITEM ... . .. ..... ...... .... . .AldO .35.535.4921 Proiect Revenue i 'ect\ S ENCROACHMENT PERMIT .722 Application Fee Non-Utility Encroadunent Permit (S225) R.I First Permil(No Feel Su"";;uent PermitIY~SIOO\ Utilitv ElICI'OKiunent Permit ArterillllCollector S1Ret $325\ Residential StreeIIOther Areu S22S\ 2203 Plan Check o;,;;;;-sit- 2% ofENGR. EST. S500 mi;;l . 2203 Faithful Performance Security IFPS\ 100% of ENGR.EST. \ . 2203 Labor and Materials SecuriIV lOO'~ofENGR. EST.\ 2203 Monumenl8lion SecurilV 100'~ ofENGR.EST.) . 2203 Cash o;;;;;sit 4% ofENGR.EST.\lS500 minlSlO 000 mI- . 2203 Labor and Material SecurilV 100'~ ofENGR. EST.\ . Plan Check '" Inspection Fee (Non-Utility) / -!? tJ: ~O 4722 Engr.Est. < S250.000 (I2"~ ofENGR. EST.) .. 2203 EnllT.Est.>S250,OOO IDenosit8"/. ofENGR. EST.1S30,OOO min. \.. . 4722 UtililV < SIOO.OOO 18"~\ Minimum Charge Per LoceIion (SI20) ConduitslPipelines up to 500 Feel (SI.6O/ft) Above 500 Feel (SI.10/ft.) ManholesNaulWEtc. (SI05/ea) Pole Sel/Removal (SI05/ea) Street Tree Planti~oval ISI05i1ree\ .. 2203 Utilitv> SIOO,OOO Actual Cost + 20*~ .. . 4760 Proiect Plans & Snecifications Proiect No 4760 Standard Snecifications & Details ISllPa SI2/Bookl 4760 Cooies of Enaineerina Mans & Plans IS.50/sa.ft. \ 4722 Penalties: Failure to restore oublic imorovemenlS IS I OO/Calendar Dav\ IMuni Code Section 11.34.01 m 4722 PenaJties: Failure to correct unsafe conditions IS I OO/Calendar Dav \ LAND DEVELOPMENT 4722 Lot Line Adiustment S500\ 4722 Parcel Man (4 LoIS or Less) SI,06O + S25ILot\ .722 Final Tract M..;;{5 or More LoIS SI.380 + S251Lotl 4722 Certificate of Comoliance S5001 4722 Certificate of Correction S300l 4722 Vacation of Public Streets & EasemenIS S550\ 4722 Assessment S~on or Reapportionment First Split (S550) Each Additional Lot ISI701 4721 Storm Drainage Area Fee Per Acre (R-I, S2.000) (Multi-Res. S2,250) IAII Other, S2,500\' / -,~2.~.I:Z. Or:, 4920 Parkland Dedication Fee 4965 po".oe TRAFFIC 4728 Intersection Turn Counts ITwo-Hour Count) S601 4728 Inlersec:tion Turn CounlS lam. or;;:-m.~ S1251- 4728 Tnsffic Flow Mon (Dailv Tnsffic Volumesl S27) 4728 Campbell Tnsffic Model (Full Scooe Assessment) S2,2501 4728 CamDbell Tnsffic Model (Reduced ~Assessmenl\ S7401 4271 TNCk PermilS S35!tJi-;;\ 4728 No Parkino Sions SI/-" or S25/100\ OTHER TOTAL S ~/A"" ,,0 NAME OF APPUCANT ~/4//50'--~ ~.r~e~ . A4_ -me' 7fY"/J5~ M~. PHONE4t1~~3~/-d~) :3 NAME OF PA YOR / / ADDRESS ~Oz? E //C~~>>~/'}: /.? ..-./) . 11ft ZIP 9Qc-V"J .. Actual Cost Plus 20*1. Overhead !Non-Interest belrina denositl / FOR CITY CLERK ONLY RECEIVED BY R~Cf!.,"ED \ t, t.\ 3 , \~~? , " !'~ Off\CE DlIIe Date! Initials h:\rec:frm4. wlc3(mp )rev7/1196 PiTV fit' j'6MPUi:j i .. ;'u ~.&: I \.I: ',..-:na ................. :.a: P-ICVD BY: JANH 01000099407 PAYuR: MARRONE BROS. TrinAv,ro "ATr". At n4 In" IUVHI ~ VHI~' V!!~!!71 DC~TCTLD n^TC. Aii7i iury TTMC. ii.h?ryi i\I...UJ.\oiiL.1\ J,;ni.... ,,~;..;J.;;J 1~liI... ...I.."Ti....U DESCRIPTION AMOUNT ENGR & SUBDIV FILING F $1,368.00 STORM DRAIN FEES FN 2 $1,232.00 TilT AI ill it'. JUlnl... 1.tUL.,' try ~tirl 1111 "",'UVV.V\i CHECK PAID: $2~600:(hj CHECK NO: 'j~1'j . .,~-:: ':"w... ' ...\J\oi CHANGE : $.00 ~ TENDERED: :tj ..::. rVi {Iii T.. ..10:........ 11 .....,: Refundable Deposit Check Request To: Finance Director Check Payable To: MARRONE BROS., INC. Address - Line 1: 17818 W. VINELAND AVE. Line 2: City: MONTE SERENO State: CA Zip: 95030 Description: Refund Deposit Account Number: Amount: $500.00 Account Number: Amount: Account Number: 101.540.7448 Amount: (Finance Dept only) Interest Earned (Finance Dept only) Total Payable: (Exact Amount) Purpose: Project complete. Refund construction cash deposit. Voucher #: Permit #: 96-264 Receipt #: 98812 Date: 01/07/1997 Requested by: Alan Horn Title: Sr. PW Inspector ~ ~ 08/13/2001 Approved by: Michelle Quinney ~ Title: City Engineer Date: 08/13/2001 Finance Dept Only: Verified by: Title: Accounting Clerk II Date: Approved by: Title: Accountant Date: ~ecial Instructions For Handling Check Mail As Is: X Mail in Attached Envelope: Interim Check: - Needed By: Return To: (Name) (Department) Other: h:\permits\86-264 ck req(mp) Please collect & ~~~;.~~~'ii>:.......... :'n~:." .....:.:......ii:: ENCROACHMEN I PERMIT 4722 Appucahon t'ee Non-Utility Encroachmen. emu. ((.22)} } R.I first Pemut (No fee). Subsequent Pemu~) Ubhty Encroachment Pemut Anenal/Collec:tor Street Resldenttal Street/Other Areas Plan -cneck DepoSIt - 2 Y. a. eN(jR EST fallhful Pertonnance Secunty (fPS) Labor and Materials Secunty Monumentabon Secunty ash DepoSIt P an Check & Inspeenon fee (Non-Utility) Engr.l:St. < H50,000 Engr.Est.>S250.ooo Utility <$100.000 Mimmum Charge Per Location CondultslPlpehnes up to 500 Feet Above 500 Feel ManholesIV aultsIEtc. Pole SetlRemoval Streel Tree Planttng/Removal Un Ity > S 1 00.000 treet Tree PlanttnglKemovall'emu. Project Plans & Specificanons tandard Specificanons & Uetal s "Oples ot I:nglOeenng Maps & Plans PenaJhes: Failure to restore pUblic Improvements (Mum Code seenon 11.34.010) 4722 Penalttes: faliure to correct unsafe condinons LArw VLVELUPMLN I 4722 Lot Line Adjustment 4722 Parcel Map (4 Lots or Less) 4 22 flOaI Tract Map (5 or More LOts 4722 enilicate 01 Comp lance 4722 ert! lcale of Correcbon 4722 Vacanon of Public Streets & Easements 4722 Assessment Segreganon or Reapporbonment first Sp " Each AddinonaJ Lot Stann Drainage Area Fee Per Acre /.J H 4.f/" t:> 1\.L ~ /1B/13 VJ/la~ &/ ft'n,k .. Actual Cost Plus 20'10 Overhead (Non-Interest bearing deposit) 0.eAD I '" ,,,, RECEIVED BY "--rr'l r JlA ~ ,II A . \I ReceiPt#C '09> l\ I Cl0e II). , TO: City Clerk 4 22 2203 4722 ,.. 2203 4760 4760 4760 4760 4 22 4920 4965 TRAFFIC 4728 4 28 4728 4728 4728 42 I 4728 OTHER NAME Of APPLICANT NAME Of PAYOR ADDRESS fOR CITY CLERK ONLY PUBLIC 2203 2203 2203 2203 2203 4721 Parkland Dedicanon fee Postage Intersechon Turn Count; (Two-Hour Count) Intersechon Turn Counts am. or p.m. pealc.s) Trame ow Map (u.. Y Tratllc Vo urnes) ampbell Traffic Model ( ull Scope Assessment) ampbell Traffic Moael (Ke<lUCe<I ~cope Assessment ruck Pemuts No Parking SIgnS J1 L1fr~ ~ <:... ~-" Date Effective July I, 1996 PUBLIC WORKS FILE NO. r~ -2IPY H c..6/'nr~ I PROPERTY ADDRESS S5S IS ?.:2~ . 00 (S325) (S225) ('500 Olln (I UIr/. o. ~NuREST. (IUO'lool eN(jRl::lir. (100'10 of ENGRBST. (4% of EN snn.nb 00 Ollnl. I 0.000 maxi 12'Y.o (Deposit SO;. of ENGR EST.lS30,OOO nun.).... (.120) (SI.60/ft) (SUO/ft.) (S 105/ea) (.105/03) (SI05/tree) Actuat Cost + 2ll"/. .. (.105) I'roJectNO. (S1Wg 'llIliook) (S.50/sq.ft.) (.looICalei1diCDay) (Sloo/Calendar Day) .500) 1.060 + .2)/LO.) .380 + ")/Lot) '500) S3OO) .550) (S550) (SI70) (R-I, S2.OOO) (Muln.Res;12,250) (All Other, S2.5OO) (>W) (.125) (.27) (.2.250) (S740) \.35/tnp (.lIeach or '25/100 TOTAL 7? I_ Do /L '~ PHONE 37/-'/003 95"0.30 ZIP .'''''- ....i( ;.:. eEl V E D' 2.20~ JAN 0 7 1997 CiTY CLERK'S OFFICE! CITY OF CAMPBELL, CA CITY OF CAMPBELL, CA Rr:r"D BY' 'II"A" ._"v . L ~H!I 0100009881. PAYOR: HARRONE BROS., INC. . - 1 raDAY'S DATE: 01107197 n",,,.,,.TrR '" nCUlJIC DATE: 01/07/97 TIME: 15:15:56 RECVD BY: LISAB 01000098812 PAYOR: KARRaNE Brt~S., INC. TODAY'S DATE: 01/07/97 REGISTER DATE: 01/07/97 TI~E: 15=16:29 DESCRIPTIUN AMOIINT ENGR & SUBDIV FILING F "" $225 . 00 DESCRIPTION AMOUNT REF DEPOSITS -1Q1.2203 $500.00 ---------------- TOTAL [lUE: $225 .00 TOTAL DUE: $500.00 CHECK PAID: CHECK NO: 215 TENDERED: CHANGE : $225.00 CHECK PAID: CHECK NO: 215 $500.00 $.00 TENDERED: CHANGE : $500.00 1.00 ~ $225.00 Premium - Included with t: Performance Bon! It' -c:j" j /L. I. <, / II Cj'/ ) We. the undersiined Robert A. Bothman, I~Ebereinafu:r "Principal") and The American Insurance Co. -' I corporation organized UIIdsr the Jaws of the SUte of l\T.f' braska , and authorized to transact business ill the State of California, u Surety, are Obligated to !be City of Campbell (hereinatccr -City-). a municipal corporarion under me Ia'1lS of the State ofCalJfonUa, in the sum of Eleven Thousand Four Hundered &.No CE: Dollars ($ 1 1 I 4 no - 00 ) for the paymcm of which sum we obUgare ourselve$ and our successors and assigns, jointly and severally by the following provisions: BOND FOR LABOR AND MATERIA.L ; :' [-"i ~"... { I The condition of this obligation is thlJ: the Ptinc;ipal emerc:d, or is aboUI to enter. iDlo a certain written Coatract with tbe City dated . 19 . and entitled Marrone 0 ffi c e Bld,g. a true and correct copy of which is presently 011 file In the office of the City Clerk of the CIty of CampbeU, ..bid1 said Contraet is hereby referred to and made a part hereof. Because Principal is rIlquired to furn.iJb a bond in connection with the contract. providing that if Principal, or any Or its subconrncto1'3, shall fail to pay for any materials. or other supplies., or Cor my work or labor OD tbe eoDtr3C~d work of any kind, or for amounts due under: the un~Joymem insurance acx: with respect to any work or labor OD this projeCt, the Surety otI this bond will pay for the debt., in an anwUIll not uceeding the mm specified in this bond, and alllO, in case suit is brought upon die bond. a reasonable attomey'a fee ID be fixed by tile court. Now, therefore. ",e, Robert A. Bothman, Ir:u Principal. ANI)The American Insurance Co. -' as Surety. ~ obligated 10 the City ofCampbeU, in lhellWD of$Eleven Thousand Four Hundred.& No cents 1a.'lVfulmoney of tb.t: United Stares. for the payment of which sums will ana trUly to be made, we the said Principal and Surety bind oursclvell, SUCCClI30rs and assigll3. joimJy and ~verally, by these provisioIlS. The conditIon of this Obligation is mat if Principal. its SUCCCSS01'3 or assigns. or its subconttactor, or SUbC011lrIlGUln. shaJI fail to pay for any labor, 11taterials. or other supplies. used in the performance of the work eona-acted to be done. or for amounts due under the unemployment insurance act with respect to r.his work or labor. then the Surety OD this bond wilJ pay for them, in '!,[I ~nt not exceeding the sum 2pCCified in this IxmG, aDd in l:ase suit is brought upon tb.i.s bond will wo PilY a reasonable atrorney's fee, to be fu.cd by the COUrt. No prepayment or delay iD payment md DO changes. eXT.emlorul, addlrlOD or alteration of any provision of said Contract or in any plam lIIld specificatioIlll referred to hereIn, and no forbearance 011 the pan of the City shall operate to release the Surety t'ro01liabiIity on this bond. and COlUent to make such alterarioD4 without further notice to or eonsent by the Surety is hereby given, and tile Surety hereby waives the provlslol15 of SeedoD 2819 of the Civil Code of the Sare at California. In witness, the parties bave executed thi. agreement as of Sept .~;' / <1921-.. , . // {prlm:raL)Ro beJ;'tl /. "Sl1t~a:n,_-1~, t. _/,' (' ._ _ By I, /1 //1- '<~~_.. I -. \,., '. Tide Robert A. Bothman, President By (Ameh AclcDowledgemc:nts) (Both Principal's and Surety'" Attorney in Fact) (h;\(orI!U\bonds. frm)(mp) Surety's Bond Numbcrll1333 01736 (Accompany tb.ls bond witb AttOrney-in-fact', authority from Surety to ex:ecute the bond, certified to includ~ !be date of the bond.) 8 GENERAL JlOWER OF ATIORNEY Tlit: AMERICAN INSURANCE COMP.AI'Il 1. KNOW ALL MEN BY THESE PRESENTS: That THE AMERICAN INSURANCE COMPANY, a Corporation incorporated under the laws of the Stale of New Jersey on February 20,1846, and redomeslicaled 10 the State of Nebraska on June 1,1990, and having its principal office in the City of Omaha, Slate of Nebraska, has made. constituted and appointed. and does by these presents make, constitute and appoinl DAVID Me GARRY, KENNETH K. PETERSON and CHARLES J. WILSON, jointly or severally PALO ALTO CA its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name, place and stead, to execute, seal, acknowledge and deliver any and all bonds, undertaking, recognizances or other written obligations in the nature tbereof ____________________________________ and to bind tbe Corporation tbereby as fully and to tbe same extent as if sucb bonds were signed by the President, sealed with the corporate seal of the Corporation and duly attested by its Secretary, hereby ratifying and confirming all tbat the said Attorney(s)-in-Fact may do in the premises. This power of attorney is granted pursuant to Anicle VII, Sections 45 and 46 of By-laws of THE AMERICAN INSURANCE COMPANY now in full force and effect. .. Article VII. AppoJDtlIJeDt aDd Autborlty of ResideDt S<<ntMies, AttorneJ'$-iD-Fact aDd Ageau to .ccept Leglll Process aDd Mue Ap~. sictlOD 45. AppOJDtDleDt. The Chairmaa of the Board of Dir'ccton, the President, aay VIce-President or any other penoa authorized by the Board of Directon, the Chairman of the Board of Directon, the President or any Vice-President may, from time to time, appolat Resident Assistant Sec:n:taries aad Attorneys-In-Fact to represent and act for aDd on bebalf of tbe CorpoJ'lltiOD aDd Ageuts to accept lqal process aDd make appeaJ'llDces for and OD bebalf of tbe Corpontioa. Section 46. Autborit,. The autbority of sucb Resident AssIstaDt Secretaries, Attorneys-iD-Fact aDd AgeDts sball be as prescribed iD tbe instnuDent eTidendag their appointmeat. Any such appolatmeat aad all authority gnated thereby may be revoked at aay time by the Board of Directon or by any person empowered to make such appointment:' This power of attorney is signed and sealed under and by the authority of the following Resolution adopted by the Board of Directors of THE AMERICAN INSURANCE COMPANY at a meeting duly called and beld on the 31st day of July, 1984, and said Resolution has not been amended or repealed: "RESOLVED, tbat the signature of any Vice-President, Assistant Secretary, and Resident Assistant Secretary of this Corporation, and the seal of tbis Corporation may be affIXed or printed on any power of attorney, on any revocation of any power of attorney, or on any certificate relating thereto, by facsimile, and any power of attorney, any revocation of any power of attorney, or certificate bearing sucb facsimile signature or facsimile seal sball be valid and binding upon the Corporation:' IN WITNESS WHEREOF, THE AMERICAN INSURANCE COMPANY has caused these presents to be signed by its Vice-President, and its corporate seal to bebereunto affIXed tbis 1st day of February ,19~. _.I"~Y""[~"'\. I-'+\.......,~-f+ " :~. . \ ,1.._ . ~ l .. .. f ~ ... ~"" "..1'1>..0/ :.t''''C'c CO r THE AMERICAN INSURANCE COMPANY BYr~~) - STATE OF CALIFORNIA COUNTY OF MARIN } a. On this 1st day of Februarv ,19~,beforemepersonallycameR- n_ F;:!rnc::tJnrr-n . to me known, who, being by me duly sworn, did depose and say: that he is Vice-President of THE AMERICAN INSURANCE COMPANY, the Corporation described in and whicb executed the above instrument; that he knows the seal of said Corporation; that the seal affIXed to the said instrument is such corporate seal; that it was so affIXed by order of the Board of Directors of said Corporation and tbat he signed his name thereto by like order. IN WITNESS WHEREOF, I have hereunto set my hand and affIXed my official seal, the day and year herein first above written. @ OFFICIAl. SEAl. N.H.CARROLL -.,; NOTARY PUBUC.cA1.1FORNIA . ~ MARIN COUNTY My Comm. Expires Apr. 25. 199~ 1;. jJ.~ Notary Public CERTIFICATE STATE OF CALIFORNIA COUNTY OF MARIN } a. I, the undersigned, Resident Assistant Secretary of THE AMERICAN INSURANCE COMPANY, a NEBRASKA Corporation, DO HEREBY CERTIFY that the foregoing and attached POWER OF ATTORNEY remains in full force and has not been revoked; and furthermore that Article VII, Sections 45 and 46 of the By-laws of the Corporation. and the Resolution of the Board of Dircctors; set forth in the Power of Altorney, arc now in force. Signed and sealed al the County of Marin. Dated the 4 th day of September 97' .19-:_. ......-.....,.. /~.....~~.~~!.~'f,:>""~ .. .. . . . ~ :. : : . . ....~.r. :,.t .;! ..-.~~"c.rtO~~--: "'"'.......~.. ~L~ J607t2-TA-6-90 (REV) CALIFORNIA ALL.PURPC ! ACKNOWLEDGMENT State of ~~ County of On personally appeared , /' Name(s) of Signer(s) ~rsonally 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 acknowledged 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. 1.111111111111111111111111.1111111 IInunn. ~lIllIlIliI =, ...;. '. JILL A. WEA. VER = ~ .....1 COMM. #: 1142671 i ~ ~ NOTARY PUBLIC _ CALliORNIA :u : """, COUNTY OF SANTA CLARA f:!l = . Comm. Exp. June 20 2001 = · .1111.111111.11.11.11..11..... ."1111111 i< .;(UII rn ~ WITNESS my han and official seal. OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: o Individual o Corporate Officer Title(s): o Partner - 0 Limited 0 General o Attorney-in-Fact o Trustee o Guardian or Conservator o Other: Top of thumb here o Individual o Corporate Officer Title(s): o Partner - 0 Limited 0 General o Attorney-in-Fact o Trustee o Guardian or Conservator o Other: Top of thumb here RIGHT THUMBPRINT OF SIGNER Signer Is Representing: Signer Is Representing: C 1994 National Notary Associalion' 8236 Remmel Ave., P.O. Box 7184' Canoga Park. CA 91309,7184 Prod. No. 5907 Reorder: Call Toll,Free 1-800-876-6827 r<:l Bond #11133301736 Premium - $239.00 I r BOND FQR FAITHFUL PERFORMANCE - .' . 1:-1 " c/ ,.-, :"j.. 1/16> We. Ihe underS'igned Robert A. Bothman. Inc. . ~ft.cr .CouU'ar.:tor") and. TT The American Insurance ~i ~ration organized UDder the laws at die Srue of ~ebraska J mc1authorized to transact bwi.aea in tho Sta12 afCaIifonUa. IS SuretY. IU'C obligated 10 the City at CampbeU. (hereinafter .CIty") alDlWcipal corpoatiOJl under the laws otEbe SI3IC ofCalJ1brnja. in the sum of.. El pvpn 'T'hollsand Four Hundred & Noents DoUars ($ 11.400.00 ) for lhe p~me!U of which sum We obU,ate ourselves and. OUf,.mcCllSSOl'3 and assigns. Jai:ntly and severally by rbc folIo wing provisions: 'the concfuioQ of this oblipriou is: Because the obligated CoaIr2C~ has, on . 19_. entered into 'NritIen Contract with the Ciry for me Project cMftled Marrone Office Buidllng , a copy ot which js attached and audc a pan of this boDd. (Or CODltl'Ucd.on of Projcct. Now, therefore. if the COntractor shaD (ai~lly pQfor:m.lhc 'lIIOrk in acco~ Wirh me pJ3m. specificatioDl and comrae! documentll durinl tho onsi.n.al teon, md any e=usioJ15 of the contract whlcJ1 may be gt2DIed b)" Ibc City,' with or without notice to tile surety, ami I! it !ball n~ aU claims and dmnand5 incIlmd ~r tile caDtract. and shall fully indllm.oify and save harmlCSII !he Ciry from all c.oBtB and damages wIrlch 11 ma)" suffer by reason of faiJUR Ul do so. and shall reimburse and repay tbc CIly tll OlJlIay and expense which the CIty may ixlcur ill making ;my default. then this obligation shall be void; cnber'lli3e to remain iD fun fon::e and effect. If any le~al action be tiled upon this bond. itlhall be ftJed within one year ~ fuW paYtMlJI: bas been made under tile Contract ext:ludini the wur;Qlty period, if 1lDY. provided for in 1hc Coru:ra.ct. aDd Vel:JUe shall Iie in tbr County of Santa Clara. State of California, lI21d that surety, for VlUue received stipul.1b:S and agree. rhu DO chanlc. eXtenSIon of lime. alteration or a.ddition to the terms of the Contract or CO the work to be pcrfu~ under It or the specltic.ations accompanymg it shall in any 'llaY at'lecl itS obIlg2tloQ on this boad, and 11 dou by this m~ans waive notice of any change. extension of time. alteration or additioZl to mil am:n.s of the Contract or to the work or to the specifications. md thereby waives th~ l'rovisiOllS of SectloQ.2819 of the Civil Code of the StAtll of Califomla. In wlmess. contractOr and surety have execuIDd this aJI'ec:.meDt 1921-. '. Inc. h:farms\boncb.frm(mp) = Tltl~5_ Robert A. Bothman, President (Surety)Th~fAferica.p sur c<::(; By 0~ 1/1,/ David McGarry, Attorney~ n- Address of Surety: 777 San Marin Dr'. Navato: CA 94998 . (Attacb Acknowledgements) Surety's Bond Nl1:a1bcT 111'13301736 (Both Principal's and Surety's Attorney in Fact) (Accompany this boed with Aaomey";l1-fl1ct's authority itom Surety to UUUu: the bond, certified to include the data of the bODel) 7 CALIFORNIA ALL.PURPC ! ACKNOWLEDGMENT State of C9-. ~\J(\ ~ County of ~~ Clo.~\e-- on-3 ~L\,-ctl Date G\lL Zersonall appeared . , ame(s) of Signer(s) ersonally 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 acknowledged 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. .IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII! 5 JIll A. WEAVER 5 ~ .. COMM. "" 1142671 i ~ ~ -6 NOTARY PUBUC _ CALIFORNIA ~ - " . COUNTY OF SANTA CLARA : 5 Comm. Exp. June 20, 2001:: illlllllllllllllllllllllllllllllllllllllllllllllllll.. OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: o Individual o Corporate Officer Title(s): o Partner - 0 Limited 0 General o Attorney-in-Fact o Trustee o Guardian or Conservator o Other: . Top of thumb here o Individual o Corporate Officer Title(s): o Partner - 0 Limited 0 General o Attorney-in-Fact o Trustee o Guardian or Conservator o Other: RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer Is Representing: Signer Is Representing: C 1994 National Notary Association' 8236 Remmet Ave., P.O. Box 7184' Canoga Park, CA 91309-7184 Prod. No. 5907 Reorder. Call Toll-Free 1-800-876-6827 mSURANCEREQ~MENTSCBECKLffiT Qjl - "') I ( j Permit # ~ d- (0 +- CIP Project # The following insurance is required of all contractors working in the City of Campbell public right-of-way. Insurance certificates must be accepted by City staff before work can begin. These insurance requirements apply to work being performed under an Encroachment Permit and work being performed under contract for Capital Improvement Projects. Limits Commercial General Liability for bodily, personal injury and property damage: ff $1,000,000 per occurrence, and ~. $1,000,000 general aggregate limit applying separately to the project, and lIT $2,000,000 general aggregate limit., Dn ~~.', L (, o Policy expiration date ~ .!f 1 ~1Q1 \'--'c:'.-J ~c....A. \..f"'\ ~\ l ~)l /~~~OIJ'-\. '-- Automotive Liability - "any auto" rr $1,000,000 per accident for bodily injury and property damage if Policy expiration date ,j,- i J1:!r ;'Yl. ~ IS'\ 'fv~ CO I l%.~ ~o ..}'\...L W g,rker' s Compensation and Employer's Liability 'l'J, $1,000,000 per accident01~~~lIIt or diseas. e . I _ ~ Policy expiration date 9 I - ~.b'" d2Rru \.A.J(J.. l./\ r LL - 2:VCf' ;lO\.:) '" "'2 Course of Construction (if required in Special Provisions) o Completed value of the project o Policy expiration date Required Endorsement to General Liability and Automobile Liability Policies . A~ional Insured Endorsement \.ej The City, the City of Campbell Redevelopment Agency, its officers, ./' employees and volunteers are named as additional insured. ~, The insurance coverage afforded to the Additional Insured is primary insurance. Workers' Compensation Insurance Sheet Submitted o ~r General Contractor \k:rSubrogation Clause 1. .... Insurance Certificate Rev~i:::~ ,~ q/f2/1) Date o Copy of Insurance Certificate placed in tickler me mi.e month prior to expiration. j:\forms\inscklst 4/96 (rev 6/96) ACORD.M CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNY) 07/31/2001 PRODUCER (65tJ)934-0300 FAX (650)934-0495 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Thoits Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA License # 0243213 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 444 Castro Street. Suite 200 Mountain View, CA 94041-2017 INSURERS AFFORDING COVERAGE INSURED Robert A. Bothman, Inc. INSURER A: Conwnerci a 1 Union DBA:B & B Concrete Construction INSURER B: One Beacon 650 Quinn Avenue INSURER c: State Comp Ins. Fund - - - -.. It:;r-, San Jose, CA 95112 INSURER D: I..r .... V t; I V ......, I INSURER E: . _ i ""It COVERAGES AlJG 1 I l.\lV I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA~_ ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE E MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDM~ "- POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER P6'k+~~~~~ggmr- Pg~!fl,~~~~N LIMITS LTR GENERAL LIABILITY ~784559 08/01/2001 08/01/2002 EACH OCCURRENCE $ 3 ,000 , OO(J - X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300,OOCl I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 10,OO(J A -.!. Contractual/broad PERSONAL & ADV INJURY $ I,OOO,OO(J X form prop dam/xcu GENERAL AGGREGATE $ 2,OOO,OO(J - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS, COMP/OP AGG $ 2 ,000 , OO(J I POLICY m ~rgT n LOC ~TOMOBILE LIABILITY 1CAAX62763 08/01/2001 08/01/2002 COMBINED SINGLE LIMIT -.!. ANY AUTO (Ea accidenl) $ 1 ,000 , OO(J ALL OWNED AUTOS BODILY INJURY - (Per person) $ B - SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY - $ X NON-OWNED AUTOS (Per accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ==i ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABILITY rrBD 08/01/2001 08/01/2002 EACH OCCURRENCE $ 8,OOO,OO(J :!] OCCUR D CLAIMS MADE AGGREGATE $ 8,OOO,OO(J B $ ji DEDUCTIBLE $ X RETENTION $ 10 , OOt $ WORKERS COMPENSATION AND 1639761-01 08/01/2001 08/01/2002 X I TO~4' L~MI~S I IOJ~- EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ I,OOO,OO(J C E.L DISEASE - EA EMPLOYEE $ 1 ,000 , OO(J E.L DISEASE, POLICY LIMIT $ 1 ,000 , OO(J OTHER ~ESCRlPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: Marrone Office Building, 555 McGlincey Lane All work in public right-of-way. ~ity of Cambell, City of Campbell Redevelopment Agency, its officers, employees and volunteers are ~amed add'l insured per form G15500 01 00 attached. Waiver of Subrogation requested CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City of Campbell ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Department of Public Works BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY 70 N. First Street OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE /rJ~ Jan Galbraith/TIS633 ACORD 25-5 (7/97) @ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5 (7/97) Certificate issued to City of Campbell Thoits Insurance 08/14/2001 POLICY #: R784SS9 COMMERCIAL GENERAL LIABILITY City of Campbell 07/31/2001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS INCLUDING COMPLETED OPERATIONS SCHEDULED G1SS00 01 00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Campbell Re: Marrone office Building, 555 Mcglincey Lane (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. The definition of "your work" is amended to include: c. "Products-completed operations hazard" for liability anslng out of work or operations performed by you or on your behalf for the additional insured at the designated project. All other terms and conditions of this policy remain unchanged. PRIMARY WORDING This insurance is primary and non-contributory, and our obligations are not affected by any other insurance carried by such additional insured whether primary, excess, contingent, or on any other basis. This additional provision applies only to the person or organization shown in the Schedule. CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. CA License # 0243213 444 Castro Street, Suite 200 Mt. View, CA 94041 Telephone: (650) 934-0300 Facsimile: (650) 934-0495 By: J an Galbraith Direct Line (650) 210-1633 Form eIR AGORD CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDfYY) TM 08/02/2000 PRODUCER ( 6 50) 9 34 - 0 3 00 <.0)0)934-0495 I HI~ ~~. .... ,~~ J t: I~ .J~ut:u A~ A IYlJ\ I 11::1'\ UI- ... ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Thoits Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CA license # 0243213 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 444 Castro Street. Suite 200 INSURERS AFFORDING COVERAGE Mountain View, CA 94041-2017 INSURED Robert A. Bothman INSURER A: Travelers Insurance (PC)* B & B Concrete Construction INSURER B: Pennsylvania Gen Ins Co. 650 Quinn Avenue INSURER C Pacific Eagle Insurance San Jose, CA 95112 INSURER 0: I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'L'i'R' TYPE OF INSURANCE POLICY NUMBER "~k+'E (MMJDDfYY) . DATE (MMJDDfYY) LIMITS GENERAL LIABILITY nC0303X9157 08/01/2000 08/01/2001 EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 300,000 I CLAIMS MADE [8] OCCUR MED EXP (Anyone person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS, COMP/OP AGG $ 2,000,000 ~ r--l PRO, nLOC POLICY JECT AUTOMOBILE LIABILITY 685029 08/01/2000 08/01/2001 COMBINED SINGLE LIMIT - (Ea accident) $ X ANY AUTO 1,000,000 - REC erVE[ ALL OWNED AUTOS )pODIL Y INJURY - Per person) $ SCHEDULED AUTOS B - HIRED AUTOS AVa o It 2000 BODILY INJURY - (Per accident) $ NON.OWNED AUTOS - PUBL C WOAKS PROPERTY DAMAGE $ STRATlO"-. (Per accident) GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY UP331K591-0 08/01/2000 08/01/2001 EACH OCCURRENCE $ 8,000,000 tJ OCCUR D CLAIMS MADE AGGREGATE $ 8,000,000 A $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 4S0000289 08/01/2000 08/01/2001 X I TORY LIMITS I IVER' EMPLOYERS' LIABILITY EL EACH ACCIDENT $ 1,000,000 C EL DISEASE, EA EMPLOYEE $ 1,000,000 E.L DISEASE. POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATlONSlLOCATlONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS e: "'arrone Office Building, 555 "'cGlincey lane All work in public right-of-way. ity of Cambell, Ci ty of Campbell Redevelopment Agency, its officers, employees and volunteers are amed add'l insured per form GNC026 attached. Waiver of Subrogation requested q(p -2bLt CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Ci ty of Campbell -3..lL- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Department of Public Works BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 70 N. First Street OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. Campbell, CA 95008 AUTHORIZED REPRESENTATIVE /rJ~ Jan Galbraith/TIS633 AI..UKU ;0:0-;) \lIl1l' c '" ~.~,IIU....1111111 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively Of negatively amend, extend or alter the coverage afforded by the policies listed thereon. A\,;UKU 25-~ (wrl) Insured: Robert A_ 1 ,hman. Inc_ Policy UDTC0303X9157 CONTRAcrORS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED (Contractors) This endorsemenr mOdifies. insurance provided under th9 following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED (SectIon II) is amended to Include any person or organizalion you are required by wriuen connact: to indude as an in- sured. but only with respect to liability arising out of "Your work~ This coverage does not in, dude liability arising out of the independent acts or omissions of t>uch person or Oiganizatioil. The written contract must be executed prior to the occurrence of any loss. 2, Where required by wrltt~n contract. thIs In- surance Is primary and noncontributing as respects the person or organization included as an insured under this endorsement and any other insurance available to any such person or organization shall be excess and noncontribut- ing with this insurance. 3_ B_ Subpart (1 )(3) of exclusion e. do~s not apply to YOll or any slJch p.;rson or organization insured under Paragraph 1. of this endOfS9- ment if the "bodily injury" or "property damage" arises out of 'your work" performed on premises whlch are owned or rented by such person or organization at the tima '-your work" is performed. b, Subpart (l)(d)(i) of excfw;ion e. does not apply to any such person or organization in. sured under Paragraph L of this endorse- ment If the "bodily injury' or "property damage" arise:; out of"your work" performed on premises which arB own9d or filmed by such pm:;oil or organization at i:he time "your work" i3 performed. 4. This Insurance with respecI to. any engineers, architects, or surveyors does not apply to "bodily injury," "property damag~:~ "per60nal injury" or "advenising injury" arising out of the rendering of or the failure to render any professional services. includIng: a) Th9 preparing, approving or fal!lng to prepare or approve maps, drawings, opInions. reports, surveys, change orders, desIgns or specificatIon; and b} Supervisory. inspection or engineering ser, VIces. This insurance does not apply to "bodily injury" or "property damagE" arising out of .your work" in, duded In the "products,completed operations . hazard" unless you are requIred to provlds such coverage by written contract and thell only for the period of time required by the contract, but In no event beyond the expiration dare of the policy. GNCOZ60195 CopyrIght. The Travelers Indemnity Company Page 1 of 1 005676 CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. CA License # 0243213 444 Castro Street, Suite 200 Mt. View, CA 94041 Telephone: (650) 934-0300 Facsimile: (650) 934-0495 By: Jan Galbraith Direct Line (650) 21 0-l63 3 Form erR C ~EII'Illlml\-.tiC\EI.]I.8111"~IN~llr>'Nm&>>> A 0 R D :::>.:::::::::,::::::::<:::<>;o;o;.;:::;::S!::::::::::::::::::::::::.::::J~::.)..!))!:Q:>:.:.:::}:)i!':~::::>>,::::::: TM .................................. ..................................... ................................... ................................... ............................ .................................. ..-...- ......-...-.................. ................................ ................................................."................ ...................................................""............. ....... ........................................................... FAX 650-853-3882 ......................................... ....................................... DATE (MM/DDIYY) 07/22/1999 ... ........... ..............................................'...'.', .. ............... .................... .......... ..,-- .............................................. ...'....... PRODUCER ( 6 5 0) 3 2 4 - 0 6 0 6 hoits Insurance 250 Cambridge Avenue #300 Palo Alto, CA 94306-0190 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Attn: Lauri e Phi ri ppi di s INSURED Ext: 623 COMPANY A Travelers Insurance Robert A. Bothman, Inc. DBA; B&B Concrete Construction 650 Quinn Ave. San Jose, CA 95112 COMPANY B Pennsyl vani a Gen. Ins. Co. COMPANY C Republic Indemnity Compnay of California COMPANY D r,.;) "'--'~" ~...,~ ., t.~ f "~ i,__ " ~,,_"'~ f \,,:., ,:,.. . VERA' E ............................................................................................................................................................................................................................................................................. ..... .... .............................................................................................:-............................................................................:........................................................................................................................................................................:-..:.............................................................................................................................................................................................. .. . . .............................................. ............................................................................................................................... ................................................................................................. :VHisisT8g~~fl~~f~lf+~~~6t,61~~6~1~~LZ:Jg~U~f~6~~C6W~10~~~~~,~~J~gf6f8~;~~J~~6~1~~gl~6JElJH~~df[th~~~,6g}P INDICATED, NOlWlTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 'WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS s~!J$! i"~ AI,L 1Hf; ;1!!3MS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.~;: ,CT~::~ ~.'l:.' ',.' :-1'....I'~. ON POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DDIYY) DATE (MM/DDIYY) CO LTR TYPE OF INSURANCE POLICY NUMBER LIMITS GARAGE LIABILITY ANY AUTO GENERALAGGRECATE $ 2 000 000 PRODUCTS, COMP/OP AGG $ 2,000,000 PERSONAL & ADV INJURY $ 1 000 000 08/01/1999 08/01/2000 EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE (Anyone fire) $ 100 000 MED EXP (Anyone person) $ 10,000 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY $ (Per person) 08/01/1999 08/01/2000 BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ AUTO ONLY. EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ 8 000 000 08/01/1999 08/01/2000 AGGREGATE $ 8,000,000 $ 08/01/1999 08/01/l000 1 000 EL DISEASE. POLICY LIMIT $ 1,000,000 EL DISEASE, EA EMPLOYEE $ 1,000.000 Limits $150,000 / $1,000 Ded 08/01/1999 08/01/2000 Installation Floater GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR A TC0303X9157 X OWNER'S & CONTRACTOR'S PROT X contractual/broad X form prop dam/XCU AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS B 176333 X HIRED AUTOS X NON,OWNED AUTOS EXCESS LIABILITY A X UMBRELLA FORM UP331K591-0 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C THE PROPRIETOR! 33860-03 INCL PARTNERS/EXECUTIVE OFFICERS ARE: EXCL OTHER Builders Risk A DTC0303X9157 DESCRIPTION OF OPERATlONSlLOCATIONSNEHICLESlSPECIAL ITEMS -, I e: Marrone Office Building, 555 McGlincey Lane All work in public right-of-way. - ~~ ity of Cambell, City of Campbell Redevelopment Agency, its officers, employees and volunteers are amed add'l insured per form GNC026 attached. Waiver of Subrogation requested City of Campbell Department of Public Works 70 N. Fi rst St reet Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIll ENDEAVOR TO MAIL --3..!l..- 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. AUTHORIZED REPRESENTATIVE A cORb.......I&.IIIrnI.I-'lleWI~.llllftjlll.D,...'rY..E.: TM ," .................................. ................................ DATE (MM/DDIYY) .............................. ............................................ .............................. ............................................ .............................. ......................................... .................... ......., ....................................... .....................................................................-.-.......-... .......-...........'...............-.....................'..... ....................................................................... PROOUCERC(50)32:;=o6()6 .. '.. ...........FAX6S 0 =853=3882.... hoits Insurance 250 Cambridge Avenue #300 Palo Alto, CA 94306-0190 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE Robert A. Bothman, DBA; B&B Concrete Ext: 622 Inc. RECEIVED Construction J U"l f 3 1999 PUBLIC WORKS ADMINISTRATION COMPANY A The Travelers/AEtna Attn: Joanna Gi 1 bri de INSURED COMPANY B Republic Indemnity 650 Quinn Ave. San Jose, CA 95112 COMPANY C COMPANY o ,............................................. .................................................................... ,..... ...-.............................. ................................................................. ............................... ................................................ ..................... ...... ........................ ......................................................................................................................................-.......................................................................................................................................................... ....................................... ,."... ..,......,.,.,."..............................................................,......,...................................................................................................................................................... ......................................................"........",...,...........................................................,.........................................................,.......................................................,...................................... ..................................................................................."................................................................................................................................................................................................... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DDIYY) DATE (MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ 2 000 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2 000,000 CLAIMS MADE X OCCUR PERSONAL & ADV INJURY $ 1 000 000 A TC0303X9157 07/14/1998 08/01/1999 X OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ ,000,000 X contractual/broad FIRE DAMAGE (Anyone fire) $ J~~,OOO X form prop dam/XCU MED EXP (Anyone person) $ 10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ X ANY AUTO 1 000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS A 10- 303X915 7 07/14/1998 08/01/1999 HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT $ ANY AUTO EACH AGGREGATE EXCESS LIABILITY EACH OCCURRENCE 8,000,000 . .............................. A X UMBRELLA FORM UP33IK591-0 07/14/1998 08/01/1999 AGGREGATE 8, 000,000 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND X EMPLOYERS' LIABILITY B THE PROPRIETOR! 33860-02 08/01/1998 08/01/1999 INCL EL DISEASE - POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE, EA EMPLOYEE $ 1,000,000 OTHER Limits $150,000 Ded uil de rs Risk / $1,000 A DTC0303X9157 07/14/1998 08/01/1999 Installation Floater DESCRIPTION OF OPERA TlONSlLOCA TlONSNEHICLESlSPECIAL ITEMS e: Marrone Office Building, 555 McGlincey Lane All work in public right-of-way. ity of Cambell, City of Campbell Redevelopment Agency, its officers, employees and volunteers are amed add'l insured per form GNC026 attached. Waiver of Subrogation requested ::e,~~f~f,]ls.:~~~::::,::::'!:?:::::j::!::::::::::::::?!?!!!!!!!t::::::::::::::::::::::::::!!'??!j::::::::):i:i!:!'!:!":?::?:":: .... ......:.....:.CANCElLATJON.:.. .... :,'....: .,::.. .' ....,..:.......:".,.::/.:-:,:...:....... .......... .... :.:::x;::::::;:;:;:::::;:::::::::::::::::::::::::.:::;:: ....... :::::::::::::.:::::.:::::.:.:::::::::.:. :.:.:.:.;.:.;:;:;:;:::::.:.:........' .'. "';:::::::::::::::;:::;:;:::;:;:;:;:::':':':': ....................................................,............ City of Campbell Department of Public Works 70 N. Fi rst St reet Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL --3.1L- 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. AUTHORIZED REPRESENTATIVE /lJ\)J'M)L.; :::/:::::::f}:':::,"':::,:?~:::J::~::t::~::~::":"{::~':';::(:::~::~:::J::t:t:i::~,,:~,t'~:::~:{:,,::,:/{,:::{:::'::'$fi9WM1BMDEm::,=!::::,:: :li9lfli!i!:I1mIMt::::/:::}}'{{'}::':::::}:::j::::I}}:{::::::::::{{{::::'}':'{j::}::::':':::':::::":::::{:::::'::::::::::::::::::':'::: ACOR Ext: 622 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY The Travel ers/ AEtna A l,,10DUCER (650) 324-0606 hoits Insurance 250 Cambridge Avenue #300 Palo Alto, CA 94306-0190 Attn: Joanna Gi 1 bri de INSURED Robert A. Bothman, Inc. DBA: B&B Concrete Construction 650 Quinn Ave. San Jose, CA 95112 COMPANY B Republic Indemnity c." L:' C ,....! , IlL -.r::: \lED SEP J 7 1998 PUul AD I c., .' , ' '1 K '" '" MINIST '..'1 '" RAT THIS IS TO CERTI Y THAT THE P L1CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN URED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MM/DDIYY) DATE (MM/DDIYY) GENERAL AGGREGATE $ 2,000,000 COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGG $ 2,000 000 CLAIMS MADE X OCCUR $ 1,000,000 A DTC0303X9157 07/14/1998 07/14/1999 OWNER'S & CONTRACTOR'S PROT $ 1,000,000 $ 50 000 $ 5,000 COMBINED SINGLE LIMIT $ ANY AUTO 1 000 000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS A 810-303X9157 07/14/1998 07/14/1999 HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE AUTO ONLY, EA ACCIDENT $ ANY AUTO EACH EXCESS LIABILITY EACH OCCURRENCE 3,000,000 A X UMBRELLA FORM CUP331K591-0 07/14/1998 07/14/1999 AGGREGATE 3,000,000 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 1,000,000 B 133860-02 08/01/1998 08/01/1999 THE PROPRIETOR! INCL EL DISEASE, POLICY LIMIT 1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE - EA EMPLOYEE $ 1,000,000 : OTHER Limits $150,000 / $1,000 Oed Builders Risk A DTC0303X9157 07/14/1998 07/14/1999 Installation Floater DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlSPECIAL ITEMS e: Marrone Office Building, 555 McGlincey Lane All work in public right-of-way. ity of Cambell, City of Campbell Redevelopment Agency, its officers, employees and volunteers are amed add'l insured per form GNC026 attached. Waiver of Subrogation requested City of Campbell Department of Public Works 70 N. First Street Campbell, CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE CONTRACTUAL INSURANCE REQUIREMENTS The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms. If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 250 Cambridge Avenue, Third .Floor Palo Alto, CA 94306-0190 Telephone: (650) 324-0606 Facsimile: (650) 853-3882 By: Joanna Gilbride Direct Line (650) 617-0622 In~~red: Robert A. Bo'- ~an, Inc. ~ Policy #DTC0303X9157 ~ . ~ ~ l'f CONTRACTORS liABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Contractors) TJ11s endorsement modifies insurance provided under th'=1 following: COMMERCIAL GENERAL LiABILITY COVERAGE PART 1. WHO IS AN INSURED (Section II) is amended to Include any person or organization you are required by wrinan contract \0 include as an in- sured, but only with respect to liability arising out of "your work," Thls coverage does not in- clude liability arising out of the independent acts or omissions of such person or organization. The written contract must be executed prior to the occurrence of any loss. 2. Where required by written contract. this in- surance Is prlmary and noncontributing as respects the person or organization included as an insured under this endorsement and any ather insurance available to any such person or organization shall be excess and noncontribut- ing with this insurance. 3. s. Subpart (1 )(a) of exclusion e. does not apply to you or any Sl..lch pF;rSQn or Qrganization insured under Paragraph 1. of this endorse- ment if the "bodily injllry" or "property damage" arises aut ot "your work" performed on premises whIch are owned or rented by such person or organization at the time "your work" is performed. , b. Subpart (1)(d)(i) of exclUSion e. does not apply to any such person or organization in. sured under Paragraph 1. of this endorse- ment If the "bodily injury' or "property damage" arises out or"your work" performed on premises which are owned or ren\ed by such person or organization at the time "your work" is performed. 4. This Insurance with respect' to, any engineers, architects, or surveyors does not apply to "bodily injury," "property damage.", "personal lnjury" or "advertising injury" arising out ot the rendering of or the failure to render any professional services, includIng: a) The prsparlng, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or speclflcatlon; and b) Supervisory, inspection or engineering ser- vices. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" in- cludGd in the "products-completed operations . hazard" unless you afe required to provide such coverage by written contract and then only far the period of time required by the contract, but In no event beyond the expiration dale of the policy. GN Co 26 01 95 Copyright. The Travelers Indemnity Company. Page' of' 006&76 i' ::::::...Jfc'(5RD....::::::::B:.:B.:I:llml::I.o.PI:::::..':':::1111'1:1'1:1" ..:' ":::::IRBII:r'::"II:m:lt:::::,:::::::::::,:,::::::::,:::,::::,:,:,:::::::::::,:'" ...DATE.jM.MiooiYh.....::::. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE hoi ts Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 250 Cambri dge Avenue #300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pa loA 1 to, CA 94306-0190 COMPANIES AFFORDIN~O~RAGE COMAANY the Travelers/AEtna ole e eEl" ~~~~E:oR:bner~a7.agB::hman, Inc. Ext: COM~ANY Republi c Indemnity 0 SEll 12 E 0 DBA: B & B Concrete Construction ~ 650 Qui nn Avenue COMtANY . PUULIC., 0 San Jose, CA. 95112 4DMINIS;~{,)f<J(:J COMPANY 4 "Otv D ::8RYe!f::::::E~t:::::::::::ff:ttt:ffffit::t::::::t:f't:m:::i:i:i:f':m:=m::::f:::ttt:i:i:m:':::::i:'::::::::::::::m::::::::::::f::::fff:ttt:::::ffffmm:m:t:f::i:fitt:::::::ffi:::::i:im:ttttt:m:fit:::fi:f:t:f::::::::::=mf:::tmfffffffffff::::::::::::::::i:::::':::::::::fmt:fffffffff::::::::i:::i:'::t::::::::::: . ......fi-iisfsTOCERTiFvfi-iAHHE pbLiciE'S'OF'iN'SURANCELisTEO'BELOWHAVE'BEENissUE[)'Tbfi-i'EiNSURE'D'NAM'EoAsoVEFORfi-iEPOUC'(PERfOO.......... .......H. INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DDNY) DATE (MM/DDNY) LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY : CLAIMS MADE X OCCUR' DTC0303X9157 OWNER'S & CONTRACTOR'S PROT , 07/14/1997 : ~E~.~~.A.~~.R.EGATEHH........$.... ......~..,.().()9..!.99.(). PRODUCTS, COMP/OP AGG $ 2 , 000 , 000 , PERSONAL & ADV INJURY $ 1 000 000 07/14/1998 ,.. .................. ............P..................... , EACH OCCURRENCE $ 1, 000 , 000 , .:I.R~ D~A~E (Anyone fire) $......... .5.9..,.999. , MED EXP (Anyone person) $ 5 000 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS A X HIRED AUTOS X NON,OWNED AUTOS COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ 810-303X9157 07/14/1997 07/14/1998 BODILY INJURY (Per accidenl) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO : AUTO ONLY. EA ACCIDENT $ , OTHER THAN AUTO ONLY: ...................... .. .................. ................... ................... ................" .. ................. .... ............. .. .........', ........ ",..... ..... .................. .................. ............ EACH ACCIDENT $ EXCESS LIABILITY A UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY CUP331K591-0 AGGREGATE $ : EACH OCCURRENCE $ 07/14/1997 07/14/1998: AGGREGATE $ $ .... .? ,. 9.9.9... .0.9.9.. 2,000,000 B THE PROPRIETORl PARTNERS/EXECUTIVE OFFICERS ARE: OTHER INCL EXCL 133860-01 08/01/1997 08/01/1998 ..................... : EL DISEASE - POLICY LIMIT $ $ 1000000 1000000 1000000 : EL DISEASE - EA EMPLOYEE $ DESCRlPTlON OF OPERA TlONSlLOCA TlONSNEHICLESlSPECIAL ITEMS e: Marrone Office Building, 555 McGlincey Lane All Work in Public right-of-way. ity of Campbell, City of Campbell Redevelopment Agency, It's officers, employees and volunteers are re named Additional Insured as respects to liability /Waiver of Subrogation requested SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Campbell Department of Public Works ~K~KK~~~~R~X~~KKXX 70 N. First Street ~~RK~~~~~~XXXXXXX Campbe 11, CA 95008 AUTHORIZED REPRESENTATlV~ / //.:;/. :IRm~~%I~:~U"Mf:!'::::::::::::::::::::::::::::::::}:::,i,:,:i::,:::::::,:!:::!:::::::::::::::::::::::::::::::fiii::f::':':':::~:':':::':':':":::::":::::::::::::::::::::::::::::::::::,::::::::::::m::::m::m:m::m::J:[it::1:::i:::::::f:ii:[i;if:f::,:::,,::i;&;@:j:~J::i::iJ::::t:::::::::mr:;::'::~< EXPIRATlON DATE THEREOF, THE ISSUING COMPANY WILL ~~ MAIL --30..- DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. /;:--~~. . .<~ ;,-~ . ":.""" .o~. ... PQRA' ']!QH"1geS . .. .. ..... ::::::::::::::::::::::~:::::::::::::::::::::f::::::::::::::::::~:::~:::::::::::::::~:~:::::::::::::::::: CONTRACTORS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL V. BLANKET ADDITIONAL INSURED (Contractors) TI,ls ~ndorsemenr l'Mdifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED (SectIon II) is amended to Include any person or organization you are required by wriuen contract to include as an in- sured, but only with respect to liability arising out of "your work." This coverage does not in- clude liability arising out of the independent acts or omissions of such person or organization. The written contract must be executed prior to the occurrence of any loss. 2. Where required by written contract. this In- surance Is primary and noncontributing as respects the person or organization included as an insured under this endorsement and any other insurance available to any such person or organization shall be excess and noncontribut- ing with this insurance. 3. 8. Subpar! (1)(a) of exclusion e. does not apply to you or any sl..lch person or organization insured under Paragraph 1. of this endorse- ment if the "bodily inJLlrY" or "property damage" arises aut of "your work" performed an premises which are owned or rented by such person or organization at the time "your workll is performed. GN Co 26 01 95 b. Subpart (1)(d)(i) of exclusion e. does not apply to any such person or organization in. sured under Paragraph 1. of this endorse- ment If the "bodily injury" or "property damage" arises out of "your work" performed on premises which are owned or rented by such person or organization at the time "your warklt is performed. 4. This Insurance with respect to any engineers, architects, or surveyors does not apply to "bodily injury," "property damage," "personal injury" or "advertising injury" arising out at the rendering of or the failure to render any professional services, inCludIng: a) The preparIng, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specification; and b) Supervisory, inspection or engineering ser- vices. This insurance does not apply to Itbodily injury" or "property damage" arising out of "your work" in- cluded in the "products-completed operations . hazard" unless you are required to provide such coverage by written contract and thel) only for the perlod of time required by the contract. but In no event beyond the expiration date of the policy. Copyright. The Travelers Indemnity Company. Page 1 of 1 005&75 ContractuaUnsurance Requirements The attached Certificate of Insurance is provided as part of our service to our client, the Insured. If special endorsements have been provided, they also are indicated attached. You may find that these documents do not comply with all the terms and conditions of the underlying contract between the Certificate Holder and the Insured due to the insurance company's insuring conditions, limitations, exclusions and other terms If you have any questions, please contact the undersigned. Thoits Insurance Service, Inc. 250 Cambridge Avenue, Third Floor Palo Alto, CA 94306-0190 Telephone: (415) 324-0606 Facsimile: (415) 853-3882 By: Robin Campagna Direct Line (415) 617-0633 WORKER'S COMPENSATION INSURANCE INFORMATION The following worker's compensation insurance information is required for all Applicants and Contractors. One of the following items for each Applicant and Contractor must be submitted prior to working under a Public Works permit or contract. WORKERS' COMPENSATION INFORMATION: Name of Contractor! Applicant o A Certificate of Consent to Self-Insure issued by the Director of Industrial Relations; OR o A Certificate of Workers' Compensation Insurance Insurance Co. Policy No. Expiration Date . OR ,- o A signed Certificate of Exemption from the Workers' Compensation laws as printed below. CERTIFICA TE OF EXEMPTION I certify that in the performance of the work for this contract, I shall not employ any person in a manner so as to become subject to the Workers' Compensation Laws 'of California."A.# /.?~. A ' //~- r~C/V{r~-1 Signed p;r ~ // Date / - OJ..{<) '. I 'J Title p,Gt~..../ /~,vf.ue-"'--_ NOTICE TO APPLICANT/CONTRACTOR: If after signing this Certificate of Exemption, you should become subject to the Workers' C9mpensation pr.ovision of the Labor Code, you must forthwith comply with such provisions or the Permit or Contract will be cancelled or revoked. j: \fonns\workcomp(rev6/96) Ke- : ( ).) ~ ."1 c\\ ,...... e.A- f ~.-..''t '?Yl---' o~ . CAtl1 . /.><9 t- ' ,('<' - ("'" u .. ~ " .:.. '" ",' ORC H!\ R'O CITY OF CAMPBELL Public Works Department August 13, 2001 Robert Bothman, Inc. B & B Concrete 650 Quinn A venue San Jose, CA 95112-2604 SUBJECT: PERMIT NO. 96-264 LOCATION: 555 McGlincey Lane MAINTENANCE INSPECTION - ACCEPTANCE Gentlemen: The City of Campbell has made the final 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 Bond for Faithful Performance and Bond for Labor and Material which we are returning to you.] Ala om Senior Public Works Inspector MQ f' '.\- cc: Permit 96-264 Public Works/Maintenance Division The American Insurance Co., 777 San Marin Dr., Novato 94998 H:\permits\96-264maint accept(mp) 70 North First Street. Campbell, California 95008,1423 TEL 408.866.2150 . FAX 408.376.0958 . TOO 408.866.2790 e(L.vvJ'J [!J e-d{,,- 'i I DPtN Of'C,,<'11 !..~.~.o~t!' ... r' U r'" . . ... ... 10 <. ~. ,,' O"CH~"U' i@/26 t ~ CITY OF CAMPBELL Public Works Department. Maintenance Division February 18, 1998 Pacific Gas & Electric Co. 10900 Blaney Ave. Cupertino, Ca. 95014 Attention: Phyllis Goble SUBJECT: Request for addition to Campbell Municipal Lighting District billing and request for pole number Phyllis, G.A.B. Electric has installed 1 new street light in front of this commercial development. The City's Signal & Lighting Shop has inspected and approved the installation and according to PG & E's Tom Copeland, PG & E has already made the service connection to the street light. Please add it to the Campbell Municipal Lighting District billing under the LS-2A rate. The light fixture is a 240 volt, 55 watt Low Pressure Sodium unit. Please let me know what the number will be for the new pole. The City of Campbell will number the pole. The following is the location of the new street light and the connection point: Pole Location (Address) Service Point (Secondarv box or Riser) 555 McGlincey Lane 555 McGlincey Lane Ifthere are any questions, I can be reached at 408-364-2827 or you can page me at 408- 631-1815. The fax here at Signals & Lighting is 408-374-9738. cc: Tom Copeland, PG & E Public Works Inspector PG& E file 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2145 . FAX 408.370.3304 . TDD 408.866.2790 MARRONE BROS., INC. GENERAL CONTRACTORS POST OFFICE BOX FC LOS GATOS. CA 95031 TEL 408.371.4003 FAX 408.371.4035 }f<t:~ !t7f) I; ~ \'v~' } r,) ..'-. "\ 199 ,. f!,' -n "'. ,,;/ . "'/1) ~ i\:' / ;,; It:: ATTN: Randy Westfall Public Works Inspector SUBJECT: PERMIT # 96264 LOCATION: 555 McGlincy Ln. Dear Randy, Response to your letter of November 7, 1997, "Preliminary Inspection Report". Item #1 to be completed within 90 days of occupancy. Items #2 through #9 completed. Item # 1 0 to be completed as soon as I get the Pole Number from the Gods at PG&E. Item # 11 to be completed by the Engineer of Record and forwarded to your office by 11-21-97. In can be of any further service please feel free to call me at (408) 371-4003. Sincerely, %~ cc: Building Division Westfall Engineers, Inc. o \'. CA~ 4: .il~ f.,.,. ~ ... '(" U t"" '0 I?CH'\1." .. 1- .. CITY OF CAMPBELL November 7, 1997 Public Works Department T. J. Marrone Marrone Properties 17818 W. Vine land Avenue Monte Sereno, CA 95030 SUBJECT: PERMIT NO: 96-264 LOCA nON: 555 McGlincey Lane PRELIMINARY INSPECTION REPORT - DEFECIENCIES Dear Mr. Marrone: 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 11/7/97. 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 need to make the necessary arrangements to provide the one-year maintenance surety in the amount of $2,850.00, which will be used to replace the performance surety currently held by the City. At your option, the Performance Bond can be maintained for the one year maintenance period. If you have any questions, please call me at (408) 866-2165. MQ~ Attachment: Deficiency List cc: Buiilding Division Pennit #96-264 Inspector File B&B Concrete Construction, 211 Ryland Avenue, San Jose, CA 95110 GAB. Electric (fax 280-6453) H:\ WORD\PERMITS\96264DEF(JD) 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.376.0958 . TDD 408.866.2790 Permit 96-264 555 McGlincey Lane Deficiency List November 7, 1997 1. Install street tree, landscaping, and irrigation. 2. Sweep and clean gutter. 3. Install AC conform from new sidewalk with 8.33% maximum slope. 4. Backfill to within 1" of finish concrete grade at all new concrete. 5. Complete installation of inlet drain, and connection to curb drain pipes. 6. Since no separate service pull box was installed, the 30 amp fuse holder must be installed in the PG&E vault. Install the fuse holder so that there is sufficient wire to pull the "loop" up to your knees when standing next to the pull box. Make sure there is additional spare wire for PG&E to connect to. 7. The bond wire must be bare, so either strip off all of the insulation from the wire that was used, or replace it with bare stranded bond wire. 8. Replace the 10 amp fuses in the street light pull box with the correct 3 amp fuses. 9. Remove the skirting from around the anchor bolts. 10. Install pole number decals (Brady labels) when PG&E assigns the number. 11. Submit as-built drawings, stamped "Record Drawings", and signed by the Engineer. H:\ WORD\PERMITS\96264DEF(JD) ENO.....'0ACHMENT PERMIT ISSUANCE CT~.'CK LIST ;j" Encroachment Permit 'No. 1 tJ? - Zw 'i City of Campbell Department of Public Works l,..r' ITEMS REOUlRED FOR PERMIT APPLICATION: ./ V G:/0 /' .' v Applicant section complete Applicant signature and date (front and back) Permit Application Fee $225.qo paid - Receipt Number qf!6/1 Engineer's Estimate submitted ( uYkfleri/[ h()- Cdt (L"td attzukcl) Plan Check Deposit paid (2 % of Engineer's Estimate, $500 min) -;. b~ .~ ~-<! Receipt Number Q90rv -!2oJ! (Jve.r fo CP'flsYUC7UvL _J;tJh~ 1 Five sets of improvement plans submitted ~ ITEMS REOUlRED PRIOR TO PUBLIC WORK CLEARANCE FOR BUILDING PERMITS l -""4I,-C'n v' 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 . E!!,gineer's Estimate required; $30,000 minimum deposit). fll, 3(p8 o~ L.-- ,:,-ee 1pt/q~ft.,.r ffU/LP//1/G PC',;!/y/T- ~L'~"f'" /<, . '\-.U!>. ""'\<9 4-Cf Security for Faithful Perfonnance and Labor and Materials, 100% each of Engineer's Estimate, supplied or paid. Amount $ ii '-IOO.-f.9nn LD. # -g~/?,p/4g PE~/y// ) /;! !J..J!3 t!.ntcrelL Construction Emergency Cash Deposit: 4% of Engineer's Estimate. ($500 minimum, $10,000 ---- -... m~im~) , Amount $ SDO Receipt No. ?88/<. ?3 /I1,?,p//f/4 PC72h/ '/ .J bl ;-:r J'f~~'tmL '-~-'9, Worker~ Compensation Insurance Information Sheet received for Appli,cant. G'//C CO/'y -- t --=Ll~'" All other Public Works requirements listed in the Conditions of Approyal of the deve!o'p'~ent. \G.='S .eDS7V~ D,l!JtfD ~ ~~, 4-u:.1~t=' ::=.((b~4q-3b.~lJl.~C;;Il!:>.6tp) REOUlRED PRIOR TO ISSUANCE OF ENCROACHMENT PERMIT: ~l ~ v Contractor's signature added to the permit application (front and back) Worker's Compensation Insurance Infonnation Sheet received from Contractor. ----- 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, PER1\HT MAY BE ISSUED. Issuer: Initial and date and file with permit. UPON ISSUANCE, INITIATE CHECK REQUEST FOR PLAN CHECK DEPOSIT REFUND j:\mq\ld\pmtcklst rev. 6/96 f11t s0J /-it ~lt'U:'tl ch 1997 , . 41 r-. ~rtY- I ~ I?-U I -1'~ -.~ -u,vJ , 0 ~ . ij '. iJ o ().P.i f, V-,u,.l ~\ <) r ~Ll t I t}\t 117 ,,;^I~' ~lIJ &,l "\ f ~ MARRONE BROS., INC. GENERAL CONTRACTORS POST OFFICE BOX FC LOS GATOS, CA 95031 TEL 408.371.4003 FAX 408.371.4035 Michele Quinney City Engineer City of Campbell 70 North First street Campbell, CA 95008 Dear Michele, Please be advised that Marrone Bros., Inc. has every intention of contracting B & B Construction to perform the work in the encroachment at the property known as 555 McGlincey Ln. B & B Construction will be able to meet your requirements for the Insurance Certificate, and to post a Bond for Faithful Performance and Labor and Materials in the amount of$11,400.00 as you have requested in the Engineers Estimate. I apologize for the delays regarding the posting of the bond but we are at the mercy of PG&E to perform their work in order to see that revisions to the scope of the work in the encroachment will not be necessary, and to see that new work performed in the encroachment will not be in the way of the work required by PG&E. Marrone Bros., Inc. also acknowledges that it will perform all of the work in the encroachment prior to occupancy or use of the building. Thank you for your attention to this matter. Sincerely, ?/~ h. Marrone VP \. o \'. c..tJt( f.,.4..~.o-Jl~ U ~ . . . .. "- -So ... f!'. ,,' O~CHA\l\)' CITY OF CAMPBELL Public Works Department November 5, 1996 Anthony J. Marrone 500 E. McGlincey Lane, Unit C Campbell, CA 95008 Dear Mr. Marrone: Attached please find another copy of the packet that we distribute for obtaining an encroachment permit for work within the public right of way. To date, we have been reviewing your plans, but have not received your application for a permit, nor a plan check deposit. Please provide these as soon as possible so that we may continue to review these plans and work towards the issuance of a permit for the work required at 555 McGlincey Lane. Please fill out and return the two page Encroachment Permit along with the required application fee and deposit. I have also indicated the amounts that will be required for the future fees, deposits, and bonds. Please let me know if you have any questions. I can be reached at 866-2159. Sincerely, ~ . ~fl.i ~t~t~. ee/ ~( Ul,l-~'} Michelle Quinney City Engineer cc: 555 McGlincey S-95-14 j:\rnq\951401(WORD) 70 North First Street. Campbell, California 95008.14:23 . TEL 408.866.:2150 . FAX 408.379.257:2 . TOO 408.866.2790 NEW PW FAX # L1f\n,'l~"" "",..n . ,""'" I .~ Of' C 4. A_ -l.'~'''.o~ ~ ~ ... . t"" U l"" . . .... .. 1- ... ~. ~' O-'CHA9.0. ., .~ , CITY OF CAMPBELL Public Works Department November 4, 1996 Anthony J. Marrone Denise J. Marrone Cheryl Driver Gregory Marrone c/o Marrone Bros., Inc. 500 E. McGlincey Lane, Unit C Campbell, CA 95008 Dear Property Owners: We have received your letter agreement dated October 28, 1996 which you have provided to satisfy condition of approval #10A of your site approval S 95-14. We are returning to you one copy of the agreement along with the referenced drawing by Nolte and Associates showing the potential future street alignment. The original agreement will be given to the City Clerk for fIling in the City vault, and a copy of the agreement will remain in the project fIle. If you have any questions, please give me a call at 866-2159. Sincerely, /Jtuli~( (Q UP, Michelle Quinney City Engineer Attachments: Letter agreement dated October 28, 1996 w/attached.plan cc: Kirk Heinrichs, Redevelopment Agency File 555 McGlincey (S 95-14) Anne Bybee, City Clerk (w/original agreement) J:\MQ\555MCGl ~~~aMo~FV;4ht~ 70 North First Street. Campbell, California 95008.1423 . TEL 408.866.2150 . FAX 408.379.2572 . TDD 408.866.2790 NEW PW FAX. # 408-376-0958 / r if I ~ 19 ~ ~(, :ss)' n~),uP'! S 1S--1Y P.O. Box FC Los Gatos, CA 95031 28 October 1996 RECE'V~'\) OCT 29 1996 Ms. Michele Quinnex City Engineer City of Campbell 70 N. First Street Campbell, CA 95008 ....1 i.J.............: ,,~ ~DMiN/STRA;:lo:\j We, Anthony J. Marrone, Denise J. Marrone, Cheryl K. Driver and Gregory J. Marrone~ as owners of the property commonly known as 555 McGlincey Ln., Campbell CA (APN 412-31-01)~ agree to the following: When the City of Campbell requests such, we will make a dedication of right-of- way, relinquishment of easements and/or acceptance of excess right-of-way to accommodate the alignment of the future street along the easterly side of the property as shown in a preliminary drawing by Nolte and Associates, copy attached. This agreement of future dedication is limited to the area within the existing easement. a <7' tf.- Anthony 1. attbne ~~~ ~.~ Denise 1. Ma e . I~ - ';<-<1'.1' date }tr2~4J, date ~~ k:: j)~rD/J<,/1~ Cheryl K. nver date /0 ~6/r-b date CITY OF CAMPBEll Date: / I/? /9(, , . TRANSMITTAL FROM THE PUBLIC WORKS DEPARTMENT TO: FROM: SUBJECT: E/'l0L~ EyhMdz (J We are forwarding the following: hlv/'/J/;1j ,vOl//' eS7z/naLz ~ 1.UaY~ arztlt..Ut~ '#u.. ,,:Jt../bl/c rljU 1 ~cu; C)f fA.}1'H, a. ~fJ'j 1 t}v/ VIJ///' M-u/~J. f Sss- # c.4;;/7 ~ _ esnJ1A~ 1 'flu Dro VI d./;" "'.JC)u I [) lU<<k -,h-. Remarks: 7k E/l:JJ/tIU./Y's F)l-n'Yl~ 11' k> j~ "l//'ov/~d o,S/~ l1u (~I;'s- tl/1/f 1/1/1 aJ "ser t!7v/' C[D,u:hd Le..JJ!irerdz " - -' (P-t{ it r ~ ~sft~ ,;, "'i: :' : \8 .:.. '!); >:";:';;~;;:;::Z:~:~f%.;t;;:;::;:,::::-..':':.:n.,:,::::~:..:;..;.y.:..:: -',0...........- . ''':;.:; ':'~' ... : ,',.,.;;:: ~~;;.'-'- -." -. ..... ..y.,:.""............;....: ; :~.';.,~,::.-,.:,,::::;;...:...,..;..,....~. .,...:.;,.:.....,.,....;......:...:: -,-..0_.-..... . ,:' 'c'-, ',.., ',,-: _'.., ,: ::, ::= ,,';':',":.: ..~.,...,.,.,:::,..:.,....::.<..:,w..._._:,.;: p. ":::",:;::w..;. .::. t.-'" .;.,,.:.:.:'::.-~:::-'i::,,. ...,..' '.n.w... ;"...:.... ..",_.-,_..;,.,...." >,_~. :;':'::.:";;';:~M"C:;:<<'::>:::~:;~::':::::': .C.': ".::;;;',).-,,;,S;;,';;;:',.:~:/:. "::. .: ::~' .:, .;~;:; :,,;.;-:~..., ,:~,"-::'" ,::::; :;:':'::''',.:,,-,... '>:: f;'..)1 ;(,:,:~~ ", . .....:.:..:,'<::.;.:'.-l-:':.:.;>;;.:.:.:.:~ ' ::::""'::::;'X':':':;:-~'" ,,:;~::::::::p:r . ,~~~,,,:,:;,. ;"""~<::'<::;::;g"';,,--:::-::::~\:<:/?::;:;~:;-; ,~.. :-""';':~::::"'<;;?-::?-:':<::';:':;:;::K%:f::;::n....-.-,..--:.;.;.:.;'-, ::-'::;:::':?,>. :. ~:'...,::::~ ,.,.....,.:'\p:yf>:Wf. '}:>';::: '1::::::'?~~:}D5~i::::~~TftC:?:'E::~~7:I?q#@t~c~f~':'Y~:~,:7:~'ffl;}Y::3V~: _/..(:..., ::~'-':>:-:::f';:-'~.::-:':>" cc.. File EP# 96 -.u:1 ,5) He 6/dIC{ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WESTFALL ENGINEERS 14583 Big Basin Way Saratoga, CA 95070 Telephone (408) 867-0244 . . . . . . . . . . . . . . . . . . . . . . . . . . . . PRELIMINARY **** CONSTRUCTION COST ESTIMATE **** Job: MARRON 555 McGlincey Lane improvements ~ ! C ~ , ,,:~ ~ _ . . OCr 8i 1996 .'...; 't.o,.... 4.DMiNI5/'RA i :,~ Estimate Date: 31 October 1996 By: Jitka Quantity Unit Cost *** SITE PREPARATION & GRADING *** Contractor Mobilization: Mobilization....................... LS Contractor Mobilization Subtotal: Demolition/Removal: Curb and Gutter.................... 21. 5 LF 6.50 DemOlition/Removal Subtotal: SITE PREPARATION & GRADING Total: *** SANITARY SEWERS *** Miscellaneous: Cleanouts. . . . . . . . . . . . . . . . . . . . . . . . . . 1 EA 500.00 Miscellaneous Subtotal: SANITARY SEWERS Total: *** ROADWAY/STREET IMPROVEMENTS *** Pavements: Aspha 1 t. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6" PCC Curb & Gutter............... PCC S idewa lk. . . . . . . . . . . . . . . . . . . . . . . 43 SF 22.5 LF 415 SF 2.10 15.00 4.50 Pavements Subtotal: Page 1 of 3 Item Total 500.00 500.00 139.75 139.75 639.75 500.00 500.00 500.00 90.30 337.50 1,867.50 2,295.30 Construction Cost Estima' - MARRON Quantity Unit Cost Item Total Pavement Base: Subgrade Preparation............... 730 SF 0.25 182.50 ------------- Pavement Base Subtotal: 182.50 ROADWAY/STREET IMPROVEMENTS Total: 2,477.80 *** UTILITIES *** Miscellaneous: street Lights...................... 1 EA 2,000.00 2,000.00 ------------- Miscellaneous Subtotal: 2,000.00 UTILITIES Total: 2,000.00 *** AMENITIES & SPECIAL CONSTRUCTION *** Common Area Improvements: Landscaping........................ 300 SF 1.50 450.00 ------------- Common Area Improvements Subtotal: 450.00 AMENITIES & SPECIAL CONSTRUCTION Total: 450.00 *** MAJOR CATEGORY TOTALS: SITE PREPARATION & GRADING: SANITARY SEWERS: ROADWAY/STREET IMPROVEMENTS: UTILITIES: AMENITIES & SPECIAL CONSTRUCTION: 639.75 500.00 2,477.80 2,000.00 450.00 ------------- TOTAL ESTIMATED COST: 6,067.55 NOTES: 1. Since Westfall Engineers has no control over the cost of labor, materials, or equipment, or over the contractor's methods of determining prices, or over competitive bidding or market conditions, our opinions of probable project cost or construction cost provided for herein are to be made on the basis of our experience and qualifications and represent our Page 2 of 3 Construction Cost Estimao' - MARRON best judgment as design professionals familiar with the construction industry, but Westfall Engineers cannot, and does not, guarantee that proposals, bids, or the construction cost will not vary from opinions of probable cost prepared by the firm. -~ Page 3 of 3 CITY OF CAMPBELL PUBLIC WORKS DEPARTMENT ENGINEER'S ESTIMATE Address: 555 Me GUNCEY Dale: Applicalion No 1111/96 Encroachmenl Permit No. 96-264 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < S30K S30 K 10 SISO K > SISO K S AMOUNT 1. SURFACE CONSTRUCTION MOBILIZATION I LS S 500.00 S 500.00 CONSTRUCTION TRAFFIC CONTROLCONTROUPHASING 1 LS S 250.00 S 250.00 CONSTRUCTION STAKING LS S - CONSTRUCTION TESTING 1 LS S 150.00 S 150.00 II. DEMOLmON/CLEARING 1. CLEARING & GRUBBING LS 2. SAWCUT P.C.C.lA.c.(UP TO 6") 30 LF $4.50 S3.00 S2.00 S 135.00 3. P.C.C. REMOVAL SY $30.00 S23.00 SIO.OO 4. CURB AND GUTIER REMOVAL 22 LF $6.00 $3.00 $2.00 $ 132.00 S. MEDIAN REMOVAL SF $4.50 $2.25 $1.25 6. DEMOLISH EXISTING INLETIPLUG RCP'S EA III. STORM DRAINAGE l. 12" R.C.P. (CLASS V) LF S60.00 $40.00 S20.00 S - 2. IS" R.C.P. (CLASS III) LF S65.00 $48.00 S38.00 3. 18" R.C.P. (CLASS III) LF S70.00 S60.00 $52.00 4. 24" R.C.P. (CLASS III) LF S80.00 S68.00 SS9.00 S. 30" R.C.P. (CLASS III) LF S90.00 $75.00 S65.00 6. T.V. INSPECTION (12") LF S 1.20 $0.75 $0.60 S - - - 7. STD. DRAINAGE INLET EA SI,600.00 SI,300.oo SI,OOO.oo (C.C. DETAIL 9) 8. FLAT GRATE INLET EA SI,4OO.oo SI,loo.oo S900.oo S - (C.C. DETAIL 6) 9. STANDARD MANHOLE EA S2,OOO.00 SI,600.00 SI,300.00 S , (c.SJ. DETAIL D-lI) (INCLUDES FRAME & LID) 10. BREAK AND ENTER M.H./D.l. EA S7OO.OO S550.OO $450.00 Page 1 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY < S30K S30 K 10 SI50 K > SI50 K S AMOUNT IV. CONCRETE IMPROVEMENTS 1. SIDEWALK 425 SF $6.50 $4.50 S2.75 S2.762.50 2. DRIVEWAY APPROACH SF S7.50 S5.50 S3.75 S - 3. CURB AND GUTfER 22.5 LF S22.OO SI8.00 SI5.00 S 495.00 4. V ALLEY GUTfER SF S12.50 SIO.OO S8.25 5. HANDICAP RAMP EA SI.200.00 $800.00 $700.00 6. TYPE B- I CURB LF SI2.00 $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 10 SF $4.50 $3.75 $3.00 $45.00 V. PAVEMENT 1. ASPHALT D1GOUT AND REPLACE 22.5 CF $5.00 S3.50 S2.50 S 112.50 2. PAVEMENT WEDGE CUT (6') LF $5.00 $2.50 $LSO 3. PAVEMENT GRINDING SF SO.80 SO .50 SO. 35 $ - 4. PAVEMENT FABRIC (PETRO-MAT) SY S2.00 $1.85 S LSO 5. ASPHALT CONCRETE (TYPE A) T $80.00 $50.00 $35.00 $ - (1235')( 13 ')( 1.5 ")(0.0775') 6. AGGREGATE BASE (CLASS 2) T $40.00 $20.00 $12.00 7. SLURRY SEAL (TYPE IO SF SO.07 $0.06 SO.05 8. SLURRY SEAL (TYPE III) SF SO.II SO.09 SO.07 VI. TRAFFIC SIGNALS/LIGHTS 1. DETECTOR LOOP (6' ROUND) EA $450.00 $300.00 $250.00 - -' 2. DETECTOR LOOP (6' x 30') EA S650.00 $540.00 $440.00 3. DETECTOR LOOP (6' x 50') EA $900.00 $750.00 $640.00 4. ELECTROLIER I EA S2.600.00 $2.200.00 $1.800.00 $ 2,600.00 5. I 1/2" RIGID CONDUIT 25 LF S9.00 S7.00 S5.00 $ 22S.00 6. 2" RIGID CONDUIT LF SI7.00 $13.00 SIO.OO 7 CONDUCTOR 50 LF SO.70 SO.55 SO.45 $35.00 Page 2 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY <S30K S30 K to SI50 K > SI50 K S AMOUNT 8 PULL BOX (NO.3 1/2) 2 EA S300.00 S24O.00 SISS.OO $600.00 9 PULL BOX (NO.5) EA $400.00 S350.00 $300.00 VII. STRIPING AND SIGNS 1. REMOVE PVMT. MARKINGS (PAINT) SF S2.50 S !.SO S1.00 2. REMOVE PVMT. MARKINGS (THERMO) SF S3.00 S2.00 SI.4O 3. REMOVE PVMT STRIPING LF SI.4O SO. 80 SO.4O 4. STRIPING DETAIL 9 LF SI.35 SO.SS SO.35 5. STRIPING DETAIL 29 LF S2.2S SI.6S S 1.20 6. STRIPING DETAIL 32 LF S2.4O SI.75 SI.2S 7. STRIPING DETAIL 37 (THERMO) LF SI.SS S !.SO SI.OO 8. STRIPING DETAIL 38 (THERMO) LF S2.50 SI.SS S1.15 9. STRIPING DETAIL 39 LF S!.SO SO.SS SOA5 10. STRIPING DETAIL 40 LF S2.20 SI. 70 SI.OO II. LIMIT LINE LF SI.35 SI.05 SO.90 12. CROSSWALK LF SI.35 SI.05 SO. 90 13. PAVEMENT MARKINGS (PAINT) SF S2.50 SI.90 SI.60 14. PAVEMENT MARKINGS (THERMO) SF SS.sO S3.80 S2.60 15. PAVEMENT MARKER (NON-REFL.) EA $4.50 S3.00 S2.20 16. PAVEMENT MARKER (REFLECTIVE) EA S6.00 $4.15 S3.15 17. TYPE K MARKER EA S95.00 S80.00 S70.00 18. TYPE N MARKER EA S95.00 S80.00 $70.00 - -' 19. SALVAGE ROAD SIGN EA SSS.OO $75.00 S6S.00 20. RELOCATE ROAD SIGN EA SIOO.OO S85.00 $75.00 21. INST. RD. SIGN ON EXIST. POLE EA S200.00 SI45.00 SIIO.OO 22. ROAD SIGN WITH POST EA S300.00 S240.00 SI95.00 VIII. LANDSCAPING I. IRRIGATION, PLANTING WORK 310 LS S6.00 $1.860.00 (62)(5)= 310 SF 2. PRUNE TREE ROOTS EA SI2S.00 SIOO.OO SSS.OO Page 3 ITEM UNIT PRICES FOR PROJECT AMOUNT NO. DESCRIPTION UNIT QTY <S30K S30 K 10 SISO K > SISO K S AMOUNT 3. TREE REMOVAL EA S650.oo $SOO.OO S4OO.oo 4. ROOT BARRIER (12") LF S20.OO $10.00 $6.00 S. ROOT BARRIER (18") LF $25.00 $IS.oo SIO.OO 6. STREET TREE (24" BOX) I EA $4S0.00 $325.00 $250.00 $4S0.OO 7. STREET TREE (36" BOX) EA $700.00 $SSO.OO $400.00 8. TOP SOIL BACKFILL CY $15.00 (119)(7)(12")/27= IX. MISCELLANEOUS 1. PEDESTRIAN BARRIER LF $7S.00 $60.00 $50.00 2. CHAIN UNK FENCE (6') LF $15.00 $11.50 $9.25 3. RAISE MISC. BOX TO GRADE EA $300.00 $200.00 $175.00 4. RAISE MANHOLE TO GRADE EA S4OO.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 $10,352.00 PREPARED BY: ~ \. \ - 4- -9c.... JdJ 10% SECURITY ENFORCEMENT FEE $ 1,03S.20 REVIEWED BY: TOTAL ESTIMATE FOR FAITHFUL $11,387.20 APPROVED BY: PERFORMANCE SECURITY $11.400.00 ~ .See Section 66499.4 of the Map Act. - -' H:\555MCGLI(rnp)exc. Page 4 ;11 " I j ". .1 ~a~"~(A~ . C. " 0 (A ~....~ 0< t' H ); II .u .. -I 4 ~ .... - ~O~~"'~ X....2: ~ .... ~ at ~gt" ~~""O~)ll't (A~a(A 00 ''l:I 2: 0< l"J a~l'I tIJ 2:...tlJ2:(A (A"'O ,,(IS :C~"'2 ~ a Ui~ " ~ ~ (A02: ~= ~ O~ t'lI 0<>< ....~(Aa(A)lC E)I)I<~ ~ ~ 2: " .... )I:CO<C)I C Z (A....... < " C :z a ....l"J ,"(A t'4(1S(A::Ia:o" (A (ISO ~ .... " tI Cl " .... (A 2: (AtIJ~ (A ~ ~.... tIJ(IS (IS :C(A O(A II U) "c Z .".... . tIJ tIJ 2: (IS.... 2::C l'. ~ (IS )lZ X" ~a )I o )I tj 0 tIJ ....a . 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