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23-041 Amendment #1 dated 6-28-23 Alvernaz Construction for Concrete Repair and Replacement for Various City Projects1 FIRST AMENDMENT TO AGREEMENT 632 BETWEEN THE CITY OF CUPERTINO AND ALVERNAZ CONSTRUCTION FOR CONCRETE REPAIR AND REPLACEMENT FOR VARIOUS CITY PROJECTS This First Amendment to Agreement 632 between the City of Cupertino and Alvernaz Construction is by and between the City of Cupertino, a municipal corporation (hereinafter "City") and Alvernaz Construction, a Sole Proprietorship/Individual (“Contractor”) whose address is PO Box 366, San Martin, CA 95046, and is made with reference to the following: RECITALS: A. On May 30, 2023 Agreement 632 (“Agreement”) was entered into by and between City and Contractor for Concrete Repair and Replacement for Various City Projects. B. City and Contractor desire to modify the Agreement on the terms and conditions set forth herein. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. Paragraph 4.1 of the Agreement is modified to read as follows: Maximum Compensation. City will pay Contractor for satisfactory performance of the Work a total amount that will based upon actual costs but that will be capped so as not to exceed $175,000 (“Contract Price”), based upon the Scope of Work in Exhibit A and the budget and rates included. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. 2. Except as expressly modified herein, all other terms and covenants set forth in the Agreement shall remain the same and shall be in full force and effect. SIGNATURES CONTINUE ON THE FOLLOWING PAGE 2 IN WITNESS WHEREOF, the parties hereto have caused this modification of Agreement to be executed. CITY OF CUPERTINO By Title Date APPROVED AS TO FORM City Attorney ATTEST: City Clerk Date ALVERNAZ CONSTRUCTION By Title Date EXPENDITURE DISTRIBUTION Item PO Number Amount Original Agreement 2023-010 60,000 SO 1 Memorial Park Veterans Memorial Concrete Work 2023-516 14,800.00 First Amendment Increase contract to $175,000 115,000 Total - 175,000 Michael Alvernaz Owner Jun 28, 2023 Christopher D. Jensen Interim Director of Public Works Jun 28, 2023 Jun 28, 2023 THI3 CER'IFICA'E 13 ISSUED AS A NATTER OF IXfORXA?IOII OI{LY AXD COXFER3 XO RIOHTS UPOI' THE CERNFICATE I{OI.OER. IHIS CERTIFICATE OO€5 XOT AFFIR ATIVELY G I{E6ATIVEl.Y AIE]{O. EITEI{D OR ALTER 'HE COVERAGE AFFOROED BY THE POI-rcleS B€LOW. THrS CERTTFTCATE (r TXSURAT{CE aro€s rO? OOXS?I?UIE A C(,IITRAC? EETWEET{ THE t3SUtraG TXSURER(S}. AUTHORIZEO REPRESEf,TATM OR PR@UCER, AIIO THE CERTIFICATE XOLI'€R IXFORIAXI: ll lt ..dic.t hold.r h .n AITOfiIOI{AL If,SUREO, Or. pollcy(L.) g.t hd. ADOIIO]{AL If,SURED F@i.aon. or b. .ndd..d, ll SUBROGAIIoI{ lS WArVEO, .sbl.cl lo lh. t.rm. -rd colldlll,onr 6t Oi. polkr, cafialtr pollcaaa lnay ,aqui.. an .ndon irnt A rLt ttr.nt o.r thia carllfcaL do.r not con ra to tha c.&'ticata holata. in lbu ot auch T 1200 i nrur.n cdEO.llp!,.4r. goltt !'d!,.taqal ^ttoto..o covEx^ot &.4r,..1 tord O.E..l t^.e..E CorD.n, l?18-7?2o &rra.fi Fonrt 9.6.r.l ln.u'.nc. A.clrLni Fund 6.Erl lr.l,.nc. un 1230,4 12304 711,a95 , cfu c CERTIFICATE TUXBER: CANCELLAfiON Clty of Cup.nlno Publlc Worlq 10300 Tor't AY.nu. Cup.rtino, CA t5017 Attn: B.i.n Grt !.rt st{oulo aiiY c THE ltovE oEtctllcD }oLrctES !a catcErlEo tErotrrHE EIPIR TIOi "AIE TXEXEC, ITOIICE wlLL 'E OELIVETED Ii ACCOIDA,{CE wltx rlc PqJGY proYEroxtn 4Oht4a, 6 l 0tt-20 1 5 AcoRo coRPoRArpN. all rlglil r.r..v.d s CERTIFICATE OF LIABILITY INSURANCE REVEO XUXBER THIS I3 IO CERTTFY THAT IHE POLICI€S OF IiISUR XC€ LISTEO AELOW HAVE EEEN ISSUEO TO TTIE IIISUREO NATIEO ABOVE FOR TX€ PO{.ICY PERIq) INUCATED TIOTWITXSTAI{OING AIiY RECT,IREII€I{T, TERM OR COiIDITIOI{ (T ANY COI{TR CT OR OTHER MCUTT€XT wlTH RESP€CT TO WHlc$ THIS C€RTIFICATE i'AY BE ISSUEO OR I'AY P€NTAIII. THE TNST.RlNCE AFFORO€O BY lt€ POLCIES OESCP€EO XER€II.I IS SUBJECI TO AU- THE TERIS €XCLU$OTS AND COi{DIIIO'{S OF SUCH PO-ICI€s UllITt SHo|VN II Y HAIG B€EN RETXJCED 6Y PAID CIA'rrIi UITI'x':1xleX _ 2-000,000 50,000 5po0 't-000.000 .!000p00 2,000.000 PD O.d 1000 GENER L A6Gf,EO^'E Ftoouc rS - corP/e a66 E^alr occriitr.cE orgcE rarExIEF D Y GLSrSrC000rroc021 0i/0!r:t022 roc cet rtt qqat-r-f rtY : .r,o..r X *,.. El D.d 1000 JECI _?n$*tl lrffi' EO lp ( rr q.. r-rr) 0J0lril02l ,trto,ra a ^or, NrtY 'X ^r{y ^uro- v- o$aEolt ,\ uYd.rr Y\-r- rrrlED,\ uYos orY rriorolt-E !rl&trrY 1.000r000 Y GLS|STC00r6023 e@rY IrJr.aY Pr,.rrd) -Z\, ^Lyoa ^- ^u()s d.!Y 0t/03r:I022 09iOy2O?3 loo(YlxJi.FY(Pr..o..r{l GLStSTC00ogtcl!23 tc . €rcx occ(rilNct IX 2 0EXCE5' LA' 2,000!q00occua foa(Eta coaacra^roi ^ro ErrLoYtia' u^alltlY aY rrGl€rqPlr1xEn qlcutna 6FloEi/Lra€a Erq.loEot l! E CIACG|OET{i Ir2n1tm22 11n1n027 . !! q!!!!Ei!41!qg4q t - 1721241 .202t Ef orsEAlE - t(rcY Lml ! i_r ^rllc _l 1,000,000 1.000p00 Oclcrtlror. C Oali^lloa rLocltiqa rlfl{Cl'Ea ( C@ Itl. L.Lia LEt adtdrl...n t.-cria, 'r- r.- L.i.r.!al Clty ol CuDar{nq Board and Comntl.riont, Oticrt, OtflcLl3, aeant3, inployaat, contultartr md vEluntaatr acoRD 25 (202U12),ry, oL ?4 BELL PLA;ZA IXTURAIiCE tza C.mlno O.lYa S.nt Clrr., CA 95050 Lic.n..t:0lolaOe Iikr Alvamaz AlYamE Conrtrucdon P. O. Bor 346 stn Lrrln a t4Alf cA e snla ! t t t I 03r0!/:t022 mr03r202r o f rre U?*-' Iha ACORD n.m..'td loeo .t r.gbr.r.d m.ttr of ACOnD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE GONDITION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other lnsurance Condition and supersedes any provision to the contrary: Primary And Noncontributory lnsurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named lnsured under such other insurancei and COMMERCIAL GENERAL LIABILIry GLSlSTC000996021 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 72$l 4.LL @ lnsurance Services Office, lnc.,2012 Page 1 of 1 L4 AFGIC AIE GL OO1 318 Policy Number: GLSISTC000996021 Add*ionarnsureds: City of Cupertino, and commissions, officers, officials, agents, employees, consultants and volunteers Policy Number: GLSlSTC000996023 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM Wath respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modifed by the endorsement. This endorsement is effective on the inception date of the policy SECTION ll - LIABILITY COVERAGE 1. WHO lS AN INSURED is amended to include as an "insured" the person(s) or organization(s) named in the Schedule below, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. You are authorized to act for the additional insured named in the Schedule in all matters pertaining to this insurance. SCITEDU].E All other terms and conditions of this Policy remain unchanged. Page 1 of 'l {L lu AFGIC APE OO OI 3I8 6 ?,L ?4 Accident Fund General Insurance Company 2m Nonh Grand Avcnuc . L:nsing, MI 48933- I 288 THIS ENMRSEMENT CHANGES TTIE ROLICY. PLEASE NEAD TT CAREFULLY, ACCIDE\T FUND GENENAL NSLTANCE COMPANY COMMENCIAL GENENAL LIABILITY FOLICY ADDITIONAL L\TSUTED. STATE OI' POLTTICAL SUADTVISIONS - LICENSF This codorscmcnt modifi?s insurulcc providcd undcr thc following: CO}tr\TENChL GENENAL LIABILITY COVEN^GE PANT. Sbte or Po$tlcd SubdlvEon: City of Cupcnino, boards and commissions, officcn, offrcials, agcns, employccs, consultants and voluntcers. (tf no roEy rppcrrs rbovc. fic ilrformrtion rrquircd o complctc thir cndorrcmcnt will bc $own in thc Dachdiont rs applicrblc ro dli! cndorrcmqrl.) Sccdor m - vyho lt Aa llror.d it .ItEodcd b includc I ul ddiriond iorurld lny rut! or tovc(fittrcntd .lcocy c subdivirion r politicd ruMiviriofl tbo*r in thc Schcduh, subjc{t to tlE follovillt proviriolr: t. This iNurrncc rpplica only *ith rrtpoct to opcrdiollr pgforncd by you q on yqrr bchrlf for vhich thc 3]rL or tovcmnrcntrl rtcncy or rubdivilion ( politic.l subdivision hrs i$uad . pqmit. 2. Thir insurucc docs not rpply o: & "Bodily injwy', 'proprrty drm8c" or "pcriord Id dvrrri$t hjury' rilint orr of opcrltiotls pcrformcd for thc ftdcnl Sovcrnncsl ststc q mur cipality; or b. "Bodily injury" s'prcpcrty d&rrtc" iocludcd eithio thc "producu-complctcd opcrrdoos hrzltd" . Covcngc for rny rddiaiood ioruFd ir 8ovlnrcd by thc trrmr, corditions, &d crcluiqrt of lhit policy ud dl cndorsrEots, ircludint tIE l$uring Agrlcmsrt. Thc covcngc providcd for .ny dditiond inrurcd is only to tlE crtrrll of.nd in thc proponion thc rdditionrl lnsurcd i. h.H lirblc for tlE ncgligcacc r rcia lirbility/cooducl/rcrt of lhc Nrred lasutrd. No covc[8c ir providcd for lirbility brrcd upon thc &tr. crron or omi$iont of thc Additiond Insurcd. Erccpr rt acr fonb .bovc, dl of tlE tcrm1 conditiqu ud crclurions of lhi5 policy rpply ud Gmrin iD Gffccr- Policy No.: GLSISTC000996O2I Accidcnt Fund Gcncnl tn$rmcs Compuy DaE tuo8t2022 W,%=-l*b; A €.&;Dd noUUi gtti&orporrrc Sccrarry Timc: l2:01 s.m Page I ol 1 ?)[dza AFG|C ArE GOV P 00 0l 0318 Accident Fund General Insurance Company 200 Nonh Grand Avenuc r Lansing, MI 48933- 1288 THIS ENIX)RIiEMENT CIIANGES THE FOIJCY. PLEASE READ IT CANEFULLY. ACCIDENT FUND GENETAL INSURANE COMPANY COMMENCIAL GENEBAL LIAAILITY P'OLICY ORGANUZATION INCLUDING PRIMATY COVENAGE This cndorscmcnt modifics insur&cc ptovided under thc following: COMMENCIAL GENENAL LIABILITY COVERAGE PANT. (lf rc cnry rppct[ tbovc, 0!s ioformrtioo tDquirrd b complclc thir crdonsncm vill ba thorn is thr Dc.l|r$ionr lr rgplic.blc to this ctdoEcmror. ) A. S.cdoa III . Who I5 A! bur.d it uaadcd to itEludc rr rn rddiaiood i!tu,!d rhc F!on(r) or o8rniaaioo(3) shoen in thc Schodulc, but oaly eith rrsFct to lirbility fo( -bodily irjury," 'FoFny drtt[tc'c "Ftond rnd dv€(tiritl! injury" crutcd, io wholc or ir prlr, by: L Your rca or o[utsions: o. 2. Thc rcts or omirsionr of thorc rring on your bchdf: ir 0E pcrformucc of your ongoini opcrrtions Frfonncd during thc policy pcriod for lhc ddidond inrurrd(t) rt thc locruoo(t) daigutcd rbovc. E. Thb insur&cr docs nor rgply io "bodily injury" 6'propcrty drugc" thrt trbr phcr rfllr, rnd thc Additiood l!5urrd't 3rrrur rt rn dditbnd htulcd tcrminrtr3, upoo thc cslicr of r,h3a: l. All worL, ircludint mrtlridt, p{tr or cquipmcrt fun*had by tlc Nmcd lntutEd in conncctioo with such *odq on thc Fojcct (o0E( th.tl Ervicr. rlt.hrrorE q rEFit!) ro bc pcrfcncd by q qr bchdf of thc dditiond inrurcd(t) d dE loc.rion of 0E covcrcd oFrionr hu bcso clmplctldi or 2. Thet ponioo of )our n ort" out of irhich thc injury or d.natc rri$s h$ bclo put lo it! intcrdcd utc by rny pcllon or ortrnizrtion othcr lh.n rDothc, contnctor cntrgcd h pcrformiq opcrrtiollt for r principd .s Fn of 0E :rmc prcjecr. C. lf crprcssly rtquircd by r writrn ud lG8dly enforccrblc conrrct cnrrcd into by thc Nrmcd Inrurcd pnor to commcoccmcnt of *ork by thc Nrmcd ln$rcd fc( th. Addiliond Inrurcd, thc iruunncc dfor@ by thc policy to 0E Additioml lnturd(!) li$ad iD thc Schcdulc for 0E &scrib.d locrtion(t) it primrry inturrncc. Any oth.r insurrocc or rlf-insur.ncc mrinriDcd dircctly b, ttE Additiond larurcd(r) is crcc$ of thi! inrurrncc rrd shdl Dot contributc to iL Covcr.gc fc llly dditiond inlutld ir towmcd by tE llrms, condidons, rsd crcludont of fiir policy rd dl cndoftcmcllB, includint thc l$uriDt ASIlanEnt. Thc covcngc prcvid€d for ltly dditiond iruurcd ir only !o thc crtcnt of .rd in Uc Foponion th. dditiond InturEd is hcld lirblc for lhc rESligrG 6 leict lirbilityrcorducurt! of thc NrflEd l,!sul!d. No corrc tc is Fovidcd fa lirbility b$cd upotl tlrc rtt c(rwr or omisbnt of thc Additiotd losurld Excrpt .r sct fmh rbow, dl of thc trrm!, conditionr rrd cr.clurioN of tht polky ryply rrd rEmrin in cficc! Policy No.: GLSISTC-000996O21 Acrid€ot Fund GcoCIrl Inrurncc Compray By Timc:l2:01rm..A/\ A f@;.ad6fi AFtrorpotzrascclcrery AFGrC ArE OOP 00 01 0r 1? Stcvc Coopcr, NrE o( Addldold llrnrcd: City of Cupcnino, borrds lad corrEisions, officcrs, offrcidr, qcot!, cEployccs, cootuluDts rId rclunlcc[s. Drrc: IA0fr'2O22 ,* rr r.1ZW , il*1,' Accident Fund General Insurance Company 200 Nonh Grand Avcnue . L.ansing, MI 48933-1288 ACCIDENT FT'IID GENENAL TI{SURANCE COMPANY COMMERCIAL GE]EIAL LI AILITY POLICY OnGANIjZATIo,T- NCLUDING WAIVEA OF SUBROGATION This endoncrEnt modifid iruurulcc ptovidrd unda thc follo*in8: COMMERCIAL GENENAL LIABILITY COVERAGE PART. Nrnc d Addltloul laanr:d: City of Cupgtino, bdrds and commirsiqrs, ofEccn, olficidr" rgcnt!, arPloycc3, congultrnr urd volunrcr. ltri (tf no qttry rppcrrt .bovc, tlE infqmrtio[ rcquid !o coflrplcc $ir c[do.rcmctrt will bc Oown in thc Dcclrrerionr s .pplicrblc to lhis codorlern nL) A. S.ct oD Ul . l+to L Ao llsur.d b rmcndcd to inclu& rs rn tdditiond insurcd lhc Frson(t) or orguizrtion(!) thown in thc Schcdulc. but ooly rvilh rlcpcct io li.bility fq 'bodily iqjury," "proFny d.In.tc" c "pcrtood .rd dvcatiri[t i[jury" crutcd, in vholc c in p{t by: You, &ts or omi$ions; ot Thc lcB or omitsiont of Uprc rtirS otl ytrrr bddf; ia thc pcrformucc of your ongoilS opcrrtionr pcrfornrcd during thc policy pcriod for thc ddiriond itEurcd(t) .l dE lcrdo(r) dctignrtcd .bovc. B. Thit inlunocc do6 nol rpply ro "bodily injuy" a'ptoFry d.rm8c'lhlr tlllr phc. .flc . lt,ld lhc Addiriond lnlurcdl ! ut l! ln .dditioad intu,rd tcrmiltllrs, uPon thc cdicr of whan: I . AU worl, inclding mrrcridr, plttt o r GquipflEt fumithcd by thc Nurcd lnrurcd in conncction wilh tuch worl, on lhc projccl (otbc. lh.s &rvics, mriotcmnc! ( rrprh) ro ba Ffonrrd by a oa bchdf of thc edditiond insured(r) rt thc hcrtior of dr clvcrEd oFrrion! hlt bccn complctcd: or 2. Thd po.tioo of )our worl" our of rrirhh thr iojury or d!rl|!c .ritcr h.t b.ro Frt to it! irlcodcd u!. by lry Flon or ortlni,:uon odE th.r laolhar contrrctor colrgcd iD Fforming opcrrtioar for a principd r! p.n of $r xmc projccl. C. If crFlssly llquirld by r erirat rrd ldrlly cnforEcrblc cootrrt caE'td inro by thc N.mad lrturd Fitr to commcocan€nt of u,od by &. Nlt'.d lErrd fa tbc Addtloarl burcd, thcn wc wriw uy ri jht of rubmtrrioo wG fliry hrvc {liatr rn cnriry lhd ir lt,t Addltlold hrurd F lhc Ermt of rbis codqtcmanr bccrusc of pryltlcrlrt urc m*c fa inj[y a dlltllgc .rilint o{n of '}our lrlrt" pcrformcd uodcr such wriuan tnd lcldly cnforcabh contrrct with lhrr MdldoEal burtd. Covcrrgc fc ury rdditiond htuEd i! Sovcricd by lhG trflnr, cooditions. .nd crclulionr of thir policy rnd dl codort€tDslrr, iDcludi[8 aha l[urin8 Aglcntcol. Thc covcntc providcd for 8|y rdditiood illurrd L only !o Ulc crlcflr of ltd in thc pmponion thc rddidond lBurd i! hcld lilblc fa thc ncllifpn c or 3trix li.bility/cordlE rtt of th. Nl'Ed Inrurld. No covcntc it p.ovi&d fq lLbility b.scd upon lbc rrr' Gfiert o( omit.irt of thc Additiond lnrured. Exccpt r. tcr foflh &ovc, rll of th3 Erlrt' coditbor rtld Grcludfir of lhis policy .pdy .d Emdn in dfcct. Policy No.: GLSISTC0@99@21 Acci&ar Fuod Crcrrrrl Intuffic ComFny Datc tvo8t2022 I ., &s; t c@:d Bobbi El[dJorponG Sccrctery Pao€ r ol IAFG|C ArE O@WOS O0 01 C3r8 'k"** ?f,nil Timc: 12:01 r"m. 2m North Grand Avcnuc . l-ansing, MI 48933- 1288 THIS ENDONSEMENT CTIANGES THE FOLICY. PLEASE NEAI' IT CANEFULLY. ACCIDENT FUND GENEf,AL INSUNANCE COITPANY COMMERCIAL GENERAL LIABILITY POLICY A-DDITIONAL INSURED. STATE ON POLTTICAL SUEDIY! TONS - LICENSE This cndorscmcnt modifils ittsur.nc. providcd undcr thc folloc,ilt: COMMERCIAL GENENAL LIAEILITY COVEN^GE PART. st ll or Foliticrl subdividon: City of Cupcrtino, boards and commissions, offrccrs, officials, agcnts, cmployccs, consultants and voluntccfs. (lf no cnuy eppcrs rbovc, thc infomrrioo rrquLld to cornplctc this codqlcmcnt $,ill be thoen io tll Dcclsrrionr lr spplisrblc to lhis cadGsrmctll) Secttoa ttr - wlro b AB hrurtd it rtllcndld o inclu& s u rdditiond in3urcd rny nrr! or govcrnocntal tgency or subdivision or politicd subd.ivilifl Govn in thc Schcdulc, subicct to thc follosirt pmvirions: L Thir inrunnce rgplier oaly with rcrpcct o opcrlrioor pcrformcd by you c on your behtu for ehich thc sura a tovcramcltd rgcncy or subdivitioo or politicd iubdivtion b$ iarucd . pcrmil. 2. This inrunncc docs mt epgly to: r. 'Bodily iojury', -PtoPctty dlm.!c" or "Ffiond rrd dvcrtisiry injuy'uiritrg oul of oFrrdoas pcrformcd for drc ftdcrrl govcramcnL sr{c or municigdity; or b. "Bodily iojury' or 'ptoFty drmttc" includcd withit! thc "PtoducB{omPlctcd opentioas hlzrd". Covcngc for roy dditiord irurrEd ir tovcrncd by thc tarma coditionr, sd cxclurioru of thir Policy rrd dl cndonsrcntq iocluding Oc lnsring Agccnrnt. Tlrc covcrrtc providcd fa rDy rrtdiriond iosurcd i3 mly to drc crlcnt of lnd in lh. ptoponion thc ddidond IBurcd i! hctd lirblc for $c rEgligcncc or rrict lirbility/cooduc/rc$ of thc Nrmcd lnsurcd. No covcngc is providcd for li$iliy bercd upor thc r1!, crtort e qnissiotrt of thc Additiood lDturcd. Ercrpr rs scr fodh rbovc, dl d thc &rm!. cooditioru |lrd ercludoG of rhir policy rpply rrd rEmrin in cfr€(r. Policy No.: CLSISTC00099602I Accidcnt Fuad Gcncrd lnrunacc Compray Datc tuoa2022 '&4*-- Strvc Coopcr. Pr6idcnt L4t; s t@;oa Bobbi EUiot-torpordc Scctctary Timc l2:01 r.m *i,tfrPage r ol l Accident Fund General Insurance Company AFGIC ArE GOV P O0 01 dlrt Accident Fund General Insurance Company 200 North Grand Avcnuc r l-ansing, Ml 48933-1288 ACCTDENT TUND GENEf,AL INST'RANCE COMPANY COMMENCIAL GENERAL LIABILITY FOLICY ADDITIONAL NSURED.OWNENS. LESSEES OT CONTRACTORS (COIIIUETCIAL ONLY} Tbi! cndoncnrcnt modilicr ituurulcc providcd undsr rhc fotlo*i[t: COMMEXCTAL GENENAL LTAIILITY COVERAGE PATT. SCIIEDUT.E Nrpc ol Addlltood I!rytd: City of Cupcnino. borrdr ]d commissioos, officcr1 officirls, rgcnB, cmployccs, coNultlrB rd voluntc.6. (tf no c6Ey rppc.'t rbovc, tlE infomrtioo llquilGd to complct! Uis cndor$mcDt will ba thow[ ill thc Dcclurdonr rs spplic.blc to this .ndortctDcol ) Scctioo Ill - Wbo ls A[ lD$rad i! rmcndcd lo includ. rt lll rdditiord insurad thc pcriotl(t) or orSmiarion(3) Cnwa in thc Schcdulc, but osly with rc+act to lirbilily fa "bodily injury." "propcrty drnlrgc" or "psrlotlrl rnd dv.'titint i[jury" cru!.d, h *holG or b prfl" by: l. Th. Nlmcd ltlturld'r lcB or omisiion3i o! 2. The ectr or omirrion! of thorc rctint ql 6c Nrmcd lnrurcd'r bc.ltdf ir thc pcrformrrc of .your s6rt" for tt dditionrl intuodt) ll thc locrrim(t) d.ritn&d rbovc. Cowr.gc for rtly dditiood hturrd is govcrr.d by th3 tctmr, caodiaiotrt, rld dcludont of thit polic, rtld dl ctdorlqlglllt, including lhc ltrturint Atrccmcnt. Thc cowrlSc plovidcd fo ray rdditioad inrurcd ir only b dE crtrot of urd in th. Foponioo lhc dditionrl lo$rrd is hcld lirblc for rhc nctlitarcc or *rict li$ility/cotducuEtt of tic Nurad lnrurcd. No covcnlc it pmvidcd for li&ility bu.d upon th. rts. cfiors or omigionr of thc Addidond lnrurcd. Policy No.: GLSISTC(D99602 t D.E: luov2o22 Timc: 12:01 r-m. Acci&nt Fuad Gcncral Insurarc. Comp$y f-+\ s C@;d Bobbi EUi*-torpo nrc Sccnrrry Page I ol 1 u0z AFGrC ArE COM (E 01 0i|16 ,*" 1't/ Byr Accident Fund General Insurance Company 200 Nonh Grand Avcnuc r Lansing, MI 48933- 1288 ACCIDENT FUND GENENAL f,ISUNANCE COMPANY COMMERCIAL GENERAL LIAEILITY FOLICY SCEEDTJI.ED PETSON ORGANIZATION ONGOING OPERATIONS ONLY Thi! cndortcrrclr rrodifics iorurucc providcd un&r lh! follorrilt: COMMENCNL GENENAL LTABILTTY COVENAGE PANT. NrE-elAtd&o.Uradi City of Cupcrtino, bord: rnd commicsionr, oftccn, offcirlr, rgcor:, cmployccr, con3ullnB tnd volunrccrs (If m anEy .pFEr &ovq rbc inforrIllridl rcquild 10 c$rpbrc thir cndortcmcat will bc lhovn h &c Dachntimt .t rpplicsblc Io thir ctdorrttlcol) .A- S.cdfi Itr - Who lr Ar helrcd ir rnandcd !o ircldc I ltl ddiaio[d in$rcd th. Frrco(r) q orgrnizdon(r) rhom in thc ScHuL, but only wilb Ilsrcl ro li.bility fq "bodily injury", 'proFrty &rartc" or'pcrrood rad dvcnirint iljury'crutcd. il vholc c ir prrr, byi l. Your rtr or omistiont; q 2. Thc r1r or omi$ionr of thorc rtiq oa yor bchdf: ia rhc pcrformrncc of your ontoirt opcrltioni pcrfamcd durint thc policy pcriod for lhc dditiond ill3urrd(!) rr lh. locdoo(t) dcttDrrd &ovc. B. Thir in$rlacG doc3 nd +ply ro "bodily injury"c "Fopcrty dll tc" lhrt rlct plrcc .ftcr, lld lhc Addilioad llcrrldt lr[lt r ra lddiliood inturd lErlul&r icrminrrcr, upon thc crrlicr of: I . All sort, ilcludiry tDrt!f,irh, plnt or c$ipm firmirhcd by thc NlDcd lnlurd b conretiqr wirh tuch wort, on Urc p@jcst (oahcr thD tcrvicc, mri c[.trcc s Icpdrl) to bc FrfaDrd by o( oa bcbelf of thc dditiold ioturd(t) lt lhc bcrtioo of ahc covrrcd opcretioar ha bccn cooplacd: ol 2. Tbrr ponion of ')olrr wfit" oua of uhich thc injury o( drmtc rrir6 hr3 boal Fra to iB itr3crd.d ulc by rtty Fsoo q orlrnizrrioD dlEr & lrdlrcr cooEacror cotatcd ir Frf6nitr! oFlEora for r principd u pst of 0lc trmc projccl Covcrrg! for rly dditiood in$rcd is tovcm.d by thc l!flDc. conditionr, |ad crclusiorrs of this policy .nd dl cndoncmcnc, ircludiat thc Inturiu AtlrcnEnt. Tbc covcngc providcd fq ray ldditiotrd in$rcd ii ooly !o lhc crllot of lrd in ihc proponioo lhc ddidood lnrulld i! hcld lirblc fr tlE rEtligcscc or tEicl lirbility/cqducr&rs of thc N.ncd llturEd. No covcsrtc it provi&d for lilbility blt.d updl ur lcr3, cncr o, omisioru of thc Additiond lnlurcd. Erctpt .3 s.i farh $ovc, dl of thc ttrmt' conditioot rd crclutid!3 of lhb policy rpply rrd rcauia in cffcct. Policy No.: GLSIST()@996021 Acsidcor Fuod Ccncrd Inrururcc Cornpuy'#lo A1€ A CM Bobbi E[i&-torporitc Sccrctary Timc I2:01 e-m AFG|C ArE ONO m 0r 03lE Pao€ldl *f,wz\ D.tc: 1U08r2022 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 1721281-2022 (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule City of Cupertino, Board and Commissions, Officers, Officials, agents, employees, consultants and Volunteers. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Insured Insurance Company StateFund 1721281-2022 (Ed. 4-84) @ 1983 National Council on Compensation Insurance. Effective Policy No. 1721281-2022 Endorsement No. J Prem� Countersigned by ___ ?'i7�_,.,....., __ ��--�--------- P,O, BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE u /1' NA L4 NA Thrs is to certity that w9 h.ve issued r valid Worke.s' Compensstion insurance policy in a form approved by the Calilornia lnsurance Commissioner to tho omployer nam€d bslow for th€ policy P6riod indjcat€d. This certificate oI insur.nc6 is not an insuranc€ policy .nd do€s not aanond, oxtend or alter the coverage afforded by the policy lisled herain. Notwithstending .ny requirem6nt, term or condition of .ny conlrsct or other document with respect to which this cgrtificate ol insurance may bE issued or lo which it may pertain, the insurancg alforded by the policy describ€d her6in is subject to all the terms, exclusions. and conditions, of such policy. CITY OF CUPERTIU' 1O3OO TORRE AVE cuPERTIix) CA 950 t 4-3202 /L,.-. o{-;-..- ISSUE DATE: O5-O4-2O23 EIVPLOYER GROUP: POLICV NUMBER: 17212A1-2022 CERTIFICATE lD: lO CERTIFICATE EXPIRES: l2-Ol -2023 12-O 1 - 2022 / 1 2 - O 1 - 202? Authorized Rep.esentative President and CEO UNLESS INOICATEO OTHERTISE BY ENDORSEI{EITT, COVERAGE UNDER THIS POLICY EXCLUOES THE FOLLOTITG: TTX'SE NAT'EO IN THE POLICY DECLARATIONS AS AN INDIVIIUAL EXPLOYER OR A TI'SBAND ANO TIFE ETPLOYER; E PLOYEES COVEREO ON A @TPREHENSIVE PERSONAL LIABILITY INSURAIiICE POLICY ALSO AFFORDING CALIFORNIA ITORKERS/ COMPENSATION BENEFITS; Ei{PLOYEES EXCLUDED UNDER CALIFORNIA HORKERS' CO PENSATION LAH. EITPLOYER'S LIABILIfY Llt{lT II,ICLUDIt{G DEFENSE COSTS: $1,Ooo,OOO PER OCCIJRRET€E ? ALVERNAZ, iIIC+IAEL A CONSTRUCTION P0 Box 366 SAT{ IiARTIN CA 95048 IFYA,CN] PRIt{TED: 05-04-2023 DBA ALVERNAZ NA €- STATE FUND CERTHOLDER COPY This policy is not subject to cancelletion by th€ Fund except upon iO days advance writton notice to the employer. We will .lso oive you lO deys adv.nce notice should this policy be caocsllod prior to its normal 6xpiration. ENDORSEI'ENT #2570 ENTITLED YAIVER OF SUBROGATION EFFECTIVE 2022-'I2-O1 IS ATTAclIEo rO AiID FORIS A PART 0F THIS POLICY. THIRo PARYY IIAIE r CITY OF CI,PERTIM' FUND ISSUE DATE: O5-O4-2023 EI!!PLOYER POLICYHOLDER COPY NA P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Thrs policy rs not subjoct to c.ncellation by th6 Fund exc€pt upon lO d.ys advance wfltlen notace to the employer We will also qive you lOdsys advahce notice should this policy be csncelled prior to its normel expiralion. This c€rtificat€ of insurance is not an insur.nce policy and does not am6nd, ext€nd or alter the coverago .tford€d by the policy listed h6rein. Notwithstandang any requirement. term or condition of rny contract or other document with respgct lo which this cartificate o, insur.nce may be issued or to which it mey pgrtain. the insurance afforded by the policy described herein is subj€ct to all th€ terms, exclusions, and conditions. of such policy. This is to certify that we have issued. v.lid Workers' Compensation insurance policy in a torm approved by the Californie lnsurance Commissioner to tho omployer namod below for ths policy period indiceted. /,---' J;*- P.ssidcnt ard CEO NA Authorizod Representative EITPLoYER'S LIABILITY LIHIT INCLUDING DEFENSE COSTS: $l,OOO,OOO PER OCCURRENCE. CITY OF CUPERTINO I03@ TORRE AVE cuPERTtio cA 95014-3202 ENDORSE ENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2022-12-01 IS ATTACHED TO AND FORI4S A PART OF THIS POLICY, THIRD PARTY I{ATIE: CITY OF CI,JPERTIM) UNLESS INDICATED OTHERHISE BY ENOORSETEiIT, CIVERAGE UNDER THIS POLICY EXCLUOES THE FOLLOHIT{G: TT€SE NAflED IN THE POLICY OECLARATIONS AS AN INDIVIi'UAL EXPLOYER OR A I{ISBATD AND TIFE E}'PLOYER; E PLOYEES C{'VERED ON A q' PREHENSIVE PERSONAL LIAAILITY INSURTNCE POLICY ALSO AFFORDING CALIFORNIA XORKERS' qIIPENSATION BE EFITS; EXPLOYEES EXCLUDED UNDER CALIFORNIA UORKERS' CI'TPENSATION LAU. ALVERNAZ, IICIIAEL A OBA: ALVERT{AiZ CONSTruCTION P0 BOX 3A6saN ARTIN CA 95046 ?t1 (REV.7-2014) NA PRINTEO IFYA,CN] 05-04-2023 7h GROUP: POLICY NUMAER: 17212A1-2022 CERTIFICATE lO: lO CERTIFICATE ExPIRES: t 2-ot -2o23 1 2 -O 1 - 2022 / 1 2 - O 1 - 2023 STATE M 6. WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for j ob: Sample Rate: Regular Premium equals: Surcharge: Additional Waiver charge: Total premium equals $ 684.95 (665.00 + 19.95) $5, ooo. o0 13.30% s 665.00 3.00% $ 19.9s v'- tt -qrE 6 ? Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 1 of 12 ON-CALL PUBLIC WORKS CONTRACT WITH ALVERNAZ CONSTRUCTION 1. PARTIES This On-Call Public Works Contract (“Contract”) is made by and between the City of Cupertino, a municipal corporation (“City”), and Alvernaz Construction (“Contractor”) a Sole Proprietorship/Individual for Concrete Repair and Replacement for Various City Projects , and is effective on the last date signed below (“Effective Date”). 2. SCOPE OF WORK 2.1 Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies, transportation and any other items or work necessary to perform and complete the work described in the Scope of Work (“Work”), attached and incorporated here as Exhibit A, on an as- needed basis. The Work must comply with this Contract and with each Service Order issued by the City’s Project Manager or his/her designee, in accordance with the following procedures, unless otherwise specified in Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 2.2 Service Orders. Before issuing a Service Order, the City Project Manager will request that Work be done in writing and hold a meeting with Contractor to discuss the Service Order. Contractor will submit a written proposal that includes a specific Scope of Work, Schedule of Performance, and Compensation, which the Parties will discuss. Thereafter, City will execute a Service Order Form for the Work, attached and incorporated here as Exhibit B. The Service Order will specify the Scope of Work, Schedule of Performance, Compensation, and any other conditions applicable to the Service Order. Issuance of a Purchase Order is discretionary. The City Project Manager is authorized to streamline these procedures based on the City’s best interests. In particular, in emergency situations, the City Project Manager may execute a Service Order for emergency work based on oral conversations with the Contractor, without adhering to the full process outlined in this section. Contractor will not be compensated for Work performed without a duly authorized and executed Service Order. 3. TIME OF PERFORMANCE 3.1 Term. This Contract begins on the Effective Date and ends on June 30, 2025 (“Contract Time”), unless terminated earlier as provided herein. The City’s appropriate department head or City Manager may extend the Contract Time through a written amendment to this Contract, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy. 3.2 Schedule of Performance. Contractor must complete the Work within the time specified in each Service Order, and under no circumstances should the Work go beyond the Contract Time. Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 2 of 12 3.3 Time is of the essence for the performance of all the Work required in this Contract and in each Service Order. Contractor must have sufficient time, resources, and qualified staff to deliver the Work on time. Contractor must respond promptly to each Service Order request. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work based upon actual costs and capped so as not to exceed $60,000.00 (“Contract Price”), based upon the Scope of Work in Exhibit A and the budget and rates included. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. 4.2 Per Service Order. Compensation for Work provided under a Service Order will be based on the rates set forth in the Service Order, which shall not exceed the capped amount specified in the Service Order. 4.3 Invoices and Payments. Contractor must submit an invoice on the first day of each month, describing the Work performed during the preceding month, itemizing labor, materials, equipment, and any incidental costs incurred. Contractor will be paid ninety-five percent (95%) of the undisputed amounts billed within thirty (30) days after City receives a properly submitted invoice. Any retained amounts will be included with Contractor’s final payment within sixty (60) days of City’s acceptance of the Work pursuant to a specific Service Order as complete. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Work and for the persons hired to work under this Contract. Contractor is not entitled to health benefits, worker’s compensation, or other benefits from the City. 5.2 Contractor’s Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Work as required by law and have procured a City Business License, if required by the Cupertino Municipal Code. Contractor shall possess a California Contractor’s License in good standing for the following classification(s): B-General Building , which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor’s employees are authorized to work under this Contract. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials, and Equipment. Contractor will supply all tools, materials, and equipment required to perform the Work under this Contract. 5.6 Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Contract and any similar federal or state taxes. Contractor Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 3 of 12 and any of its employees, agents, and subcontractors shall not have any claim under this Contract or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any court, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS), the Internal Revenue Service or the State Employment Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this Contract, or to promptly remit to City any payments due by the City as a result of such determination, so that the City’s total expenses under this Contract are not greater than they would have been had the determination not been made. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor’s request for a change order must specify the proposed changes in the Work, Contract Price, and Contract Time. Each request must include all the supporting documentation, including but not limited to plans/drawings, detailed cost estimates, and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign, hypothecate, or transfer this Contract or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs, successors, and permitted assigns. 8. PUBLICITY / SIGNS Any publicity generated by Contractor for the Project during the Contract Time, and for one (1) year thereafter must credit City contributions to the Project. The words “City of Cupertino” must be displayed in all pieces of publicity, flyers, press releases, posters, brochures, interviews, public service announcements, and newspaper articles. No signs may be posted or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces, except that Contractor may hire qualified subcontractors to perform up to 25% of the Work under any give Service Order, provided that each subcontractor is required by contract to be bound by the provisions of this Contract and any applicable Service Order. Contractor must provide City with written proof of compliance with this provision upon request. Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 4 of 12 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor’s Work falls short of the requirements of this Contract or constitutes grounds for rejection under the Public Contract Code. If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor’s Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within fifteen (15) days after City accepts the Work under a particular Service Order if the Work involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Work pursuant to a Service Order. The reports must describe the Work and specific tasks performed, the number of workers, the hours, the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the reports, but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical, electrical and plumbing work; HVAC systems; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail, and the location of all main runs, piping, conduit, ductwork, and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles, which must be available for City review and audit, kept separate from other records, and maintained for four (4) years from the date of City’s final payment. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers, and Contractors (“Indemnitees”), through legal counsel acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation and dispute resolution proceedings), of every nature, arising directly or indirectly from this Contract or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees, agents, servants, or subcontractors; (c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and (d) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 5 of 12 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim, in accordance with California Public Contract Code Section 9201. At City’s request, Contractor will assist City in the defense of a claim, dispute, or lawsuit arising out of this Contract. 11.3 Contractor’s duties under this entire Section 11 are not limit ed to Contract Price, Workers’ Compensation, or other employee benefits, or the insurance and bond coverage required in this Contract. Nothing in the Contract shall be construed to give rise to any implied right of indemnity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor’s payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract, a purchase order or other transaction. 11.5 Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in this Section 11 from each and every subcontractor, or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this Contract. Failure of City to monitor compliance with these requirements imposes no additional obligations on City and will in no way act as a waiver of any rights hereunder. 11.6 This Section 11 shall survive termination of the Contract. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit C, and must maintain the insurance for the Contract Time, or longer as required by City. City will not execute the Contract until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor’s compensation or terminating the Contract. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state, and federal laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor’s ability to perform. Contractor is responsible for verifying the employment authorization of employees p erforming the Work, as required by the Immigration Reform and Control Act. 13.2 Labor Laws. a. The following provisions apply to any Service Order of $1,000 or more: i. In General. For purposes of California labor law, this is a public works contract subject to the provisions of Part 7 of Division 2 of the California Labor Code (Sections 1720 et seq.). In accordance with Labor Code Section 1771, Contractor and all subcontractors shall pay not less than current prevailing wage rates as determined by the Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 6 of 12 California Department of Industrial Relations (“DIR”) to all workers employed on this project. In accordance with Labor Code Section 1815, Contractor and all subcontractors shall pay all workers employed on this project 1 ½ the basic rate of pay for work performed in excess specified hour limitations. The work performed pursuant to this Contract is subject to compliance monitoring and enforcement by the Department of Industrial Relations. ii. Registration. Contractor and all subcontractors shall not engage in the performance of any work under this Contract unless currently registered and qualified to perform public work pursuant to section 1725.5 of the California Labor Code. Contractor represents and warrants that it is registered and qualified to perform public work pursuant to section 1725.5 of the Labor Code and will provide its DIR registration number, along with the registration numbers of any subcontractors as required, to the City. iii. Posting. Contractor shall post at the job site the determination of the DIR director of the prevailing rate of per diem wages together with all job notices that are required by regulations of the DIR. iv. Reporting. Contractor and any subcontractors shall keep accurate payroll records in accordance with Section 1776 of the Labor Code and shall furnish the payroll records directly to the Labor Commissioner in accordance with the law. v. Report on Prevailing Rate of Wages. The City has obtained the general prevailing rate of per diem wages in the vicinity of the project for each type of worker needed, a copy of which is on file at the City of Cupertino City Hall, and shall be made available to any interested party upon request. vi. Employment of Apprentices. Contractor’s attention is directed to the provisions in Sections 1777.5 and 1777.6 of the Labor Code concerning the employment of apprentices by the Contractor or any subcontractor. It shall be the responsibility of the Contractor to effectuate compliance on the part of itself and any subcontractors with the requirements of said sections in the employment of apprentices. Information relative to apprenticeship standards, wage schedules, and other requirements may be obtained from the Director of Industrial Relations, ex-officio the Administrator of Apprenticeship, San Francisco, California, or from the Division of Apprenticeship Standards and its branch offices. vii. Penalties. Contractor’s attention is directed to provisions in Labor Code Sections 1775 and 1813. In accordance with Labor Code Section 1775, Contractor and subcontractors may be subject to penalties for Contractor’s and subcontractors’ failure to pay prevailing wage rates. In accordance with Labor Code Section 1813, Contractor or subcontractors may be subject to penalties for Contractor’s or subcontractors’ failure to pay overtime pay rates for hours worked by workers employed on this project in excess specified hour limitations. b. Contractor must compensate workers who are paid less than prevailing wages or required to work more than a legal day’s work. Contractor will also be required to pay City a penalty of $200.00 per worker for each day of violation. c. As required by Labor Code Section 1861, by signing this Contract Contractor certifies as follows: “I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self - insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the work of this contract.” Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 7 of 12 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS), or any other protected classification. Contractor shall comply with all anti -discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777, and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor’s employees or subcontractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. 13.4 Conflicts of Interest. Contractor, its employees, subcontractors, servants, and agents, may not have, maintain, or acquire a conflict of interest in relation to this Contract in violation of law, including Government Code section 1090 and Government Code section 81000 and their accompanying regulations. No officer, official, employee, consultant, or other agent of the City (“City Representative”) may have, maintain, or acquire a “financial interest” in the Contract, as that term is defined by state law, or in violation of a City ordinance or policy while serving as a C ity Representative or for one year thereafter. Contractor, its employees, subcontractors, servants, and agents warrant they are not employees of City nor do they have any relationship with City officials, officers, or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of Title 2 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of this Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements, or terminating this Contract. City reserves all other rights and remedies available under the law and this Contract, including the right to seek indemnification under Section 11 of this Contract. 14. BONDS For any Service Order of $25,000 or more, Contractor must obtain a payment bond and a performance bond, each in the penal sum of 100% of the compensation pursuant to the Service Order, using the Bond Forms attached and incorporated here as Exhibit D. Each bond must be issued by a surety admitted in California, with a financial rating from A.M. Best Company of Class A- or higher, or as otherwise acceptable to City. If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a surety acceptable to City within seven (7) calendar days after written notice from City. If Contractor fails to do so, City may in its sole discretion and without prior notice, purchase bonds at Contractor’s expense, deduct the cost from payments due Contractor, or terminate the Service Order or Contract. City will not authorize work under a Service Order until the required bonds are submitted. 15. UTILITIES, TRENCHING, AND EXCAVATION 15.1 Contractor must call the Underground Service Alert (“USA”) 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits, City’s Service Center must be called at (408) 777 - Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 8 of 12 3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing, and wait for instructions if one of the conditions below is found at the worksite. City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believed to be hazardous waste under Health and Safety Code Section 25117, and which requires removal to a Class I, Class II, or Class III disposal site pursuant to law; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor; and (c) Unknown physical conditions at the Project worksite of any unusual nature, materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For Service Orders where compensation is $25,000 or higher that require excavation or involve trenches five feet or more in depth, Contractor must submit a detailed plan for City approval, per Labor Code Section 6705, prior to commencing work. The plan must show the design of shoring, bracing, sloping, and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards, it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal, state, and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets, gutters, and storm drains. Prior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of storm drains, and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at t he end of construction and completion of the Work. Such controls must include, but will not be limited to, the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences, and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season, October 15 through June 15, storm drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum saw-cut slurry and remove from the Work site; (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; (c) Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain and at the end of each work day. When the Work is completed, wash the streets, collect and dispose of the wash water offsite in lawful manner; (d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 9 of 12 (e) Maintain a clean work area by removing trash, litter, and debris at the end of each work day and when Work is completed. Clean up any leaks, drips, and other spills as they occur. These requirements must be used in conjunction with the California Stormwater Quality Association and California Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor’s failure to comply with this Section will result in the issuance of noncompliance notices, citations, Work stop orders and regulatory fines. 17. PROJECT COORDINATION City Project Manager. The City assigns Brian Gathers as the City’s representative for all purposes under this Contract, with authority to oversee the progress and performance of the Scope of Work. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Michael Alvernaz as its single Representative for all purposes under this Contract, with authority to oversee the progress and performance of the Work. Contractor’s Project manager is responsible for coordinating and scheduling the Work in accordance with City instructions, service orders, and the Schedule of Performance. Contractor must regularly update the City’s project manager about the status, progress and any delays with the work. City’s written approval is required prior to Contractor substituting a new Representative which shall result in no additional costs to City. 18. ABANDONMENT AND TERMINATION 18.1 City may abandon or postpone the Work or parts thereof at any time. Contractor will be compensated for satisfactory Work performed through the date of abandonment and will be given reasonable time to close out Work under a Service Order. With City’s pre-approval in writing, the time spent in closing out Work under a Service Order will be compensated up to ten percent (10%) of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment will not be made until Contractor delivers the Work and provides records documenting the Work, products, and deliverables completed. 19. GOVERNING LAW, VENUE, AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public Contract Code Section 20104, et seq., incorporated here by reference, apply to this Contract and Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings of law and fact. Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 10 of 12 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. 21. SIGNS/ADVERTISEMENTS No signs may be displayed on or about City’s property, except signage which is required by law or by the Contract, without City’s prior written approval as to size, design and location. 22. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. 24. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality, and free from defective workmanship and materials, and that the Work will be free from material defects not intrinsic in the design or materials. All Work, materials, and equipment should pass to City free of claims, liens, or encumbrances. Contractor warrants the Work and materials for one year from the date of City’s acceptance of the Work as complete (“Warranty Period”), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor’s Warranty Work, except any wear and tear or damage resulting from improper use or maintenance. 25. ENTIRE AGREEMENT This Contract and the attachments, documents, and statutes attached, referenced, or expressly incorporated herein, including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If there is any inconsistency between any term, clause, or provision of the main Contract and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Contract shall prevail and be controlling. 26. SEVERABILITY/PARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal, invalid, or unenforceable, the legal portion of said provision and all other contract provisions will remain in full force and effect. Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 11 of 12 27. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all provisions regarding warranties, indemnities, payment obligations, insurance, and bonds, shall remain in full force and effect after the Work is completed or Contract ends. 28. INSERTED PROVISIONS Each provision and clause required by law for this Contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 29. HEADINGS The headings in this Contract are for convenience only, are not a part of the Contract and in no way affect, limit, or amplify the terms or provisions of this Contract. 30. COUNTERPARTS This Contract may be executed in counterparts, each of which is an original and all of which taken together shall form one single document. 31. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth (5th) calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: Brian Gathers Email: briang@cupertino.org To Contractor: Alvernaz Construction PO Box 366 San Martin, CA 95046 Attention: Michael Alvernaz Email: michaelalvernaz@alvernazconstruction.com 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. This Contract may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. SIGNATURES CONTINUE ON THE FOLLOWING PAGE Concrete Repair and Replacement for Various City Projects On-Call Public Works Contract/ July 2022 Page 12 of 12 IN WITNESS WHEREOF, the parties have caused the Contract to be executed. CITY OF CUPERTINO A Municipal Corporation By Name Title Date ALVERNAZ CONSTRUCTION By Name Title Date APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Michael Alvernaz Michael Alvernaz Owner May 30, 2023 Christopher D. Jensen Jimmy Tan Assistant Director of Public Works May 30, 2023 May 30, 2023 Alvernaz Construction P.O. Box 366 San Martin, CA. 95046 State License #711435 (408)595-2817 michaelalvernaz@alvernazconstruction.com Rate Sheet for City of Cupertino: Hourly Rate: $ 135.00 per hour Overtime Rate: $ 225.00 per hour Emergency Rate: $ 325.00 per hour Thank you, Michael Alvernaz Exhibit A CITY OF CUPERTINO MASTER AGREEMENT CONSULTANT SERVICES SERVICE ORDER NO. MA Date:Master Agreement Contract #: Maximum Compensation: Consultant:Firm Name: Address: Contact: Ph: Project Name: Description: (simple project description if appropriate) Attachment A: Includes Description of Project, Scope of Service, Schedule of Performance and Compensation City Project Management Managing Department: Public Works Project Manager: Fiscal/Budget : SO Acc't #:PO #: Project #:Date: Approvals Signatures: Date: Date: Appropriation Certification: I hereby certify that an unexpended appropriation is available in the above fund for the above contract as estimated and that fund are available as of this date of signature City Finance:Date: Encumbrance this Service Order: MA End Date: Consultant/ Contractor Manager/ Supervisor: Management Analyst Master Agreement Maximum Compensation: Master Agreement Unencumbered Balance: Total Previously Encumbered to Date: City of Cupertino Master Agreement Service Order 191002 Exhibit B n Choose Insurance Requirements for On-Call Public Works Construction Contracts Version: Jan. 2021 1 Contractor shall procure and maintain for the duration of the contract, and for five years following the completion of the Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (“CGL”): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an “occurrence” basis, written on a comprehensive general liability form, and must include coverage for liability arising from Contractor’s or Subcontractor’s acts or omissions, including Contractor’s protected coverage, blanket contractual, products and completed operations, vehicle coverage and employer’s non-ownership liability coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all liability for personal injury, death, property damage or destruction, and personal and advertising injury. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO CG 20 10 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO Form CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers’ Compensation: As required by the State of California, with Statutory Limits, and Employer’s Liability Insurance of no less than $1,000,000 per accident for bodily injury or disease, or as otherwise required by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, duly authorized by the DIR. ☐ N/A if box checked (Contractor provides written verification it has no employees). 4. Professional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. ☒ N/A if box checked (Contract is not design/build).. 5. Builder’s Risk. Course of Construction insurance utilizing an “All Risk” (Special Perils) coverage form, with limits equal to the completed value of the project and no coinsurance penalty provisions. ON-CALL PUBLIC WORKS CONSTRUCTION CONTRACTS Insurance Requirements: Exhibit C Insurance Requirements for On-Call Public Works Construction Contracts Version: Jan. 2021 2 ☒ N/A if box checked (Project does not involve construction or improvements/installations to property). 6. Contractors’ Pollution Legal Liability and/or Asbestos Legal Liability and/or Errors and Omissions with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 policy aggregate. ☒ N/A if box checked (Project does not involve environmental hazards) If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. Self-Insured Retentions. Self-insured retentions must be declared to and approved by City. At City’s option, either: (1) Contractor shall cause the insurer to reduce or eliminate self-insured retentions as respects City, its officers, officials, employees, and volunteers; or (2) Contractor shall provide a financial guarantee satisfactory to City guaranteeing payment of losses and related investigations, claim administration, and defense expenses. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or the City. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed by or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Project, Contractor’s insurance coverage shall be “primary and non-contributory” and at least as broad as ISO CG 20 01 04 13 with respect to City, its officers, officials, employees and volunteers, and shall not seek contribution from City’s insurance. If the limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a “primary and non-contributory” basis for the benefit of City. Notice of Cancellation Each insurance policy required shall provide that coverage shall not be canceled, except with notice to the City. Each certificate of insurance must state that the coverage afforded by the policy is in force and will not be reduced, cancelled or allowed to expire without at least 30 days advance written notice to City, unless due to non-payment of premiums, in which case ten days advance written notice must be provided to City. Such notice must be sent to City via certified mail and addressed to the attention of the City Manager. Builder’s Risk Contractor may submit Builder’s Risk insurance in the form of Course of Construction coverage, which shall name the City as a loss payee, as its interest may appear. The Builder’s Risk policy must be issued on an occurrence basis, for all-risk coverage on a 100% completed value basis on the insurable portion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstruction, City may elect, acting in its sole discretion, to accept an Installation Floater policy instead of Builder’s Risk. For such projects, the Property Installation Floater shall include improvement, remodel, modification, alteration, conversion or adjustment to existing buildings, structures, processes, machinery and equipment, and shall provide property damage coverage for any Insurance Requirements for On-Call Public Works Construction Contracts Version: Jan. 2021 3 building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the performance of the Work, including during transit, installation, and testing at the City’s site. Waiver of Subrogation Each required policy must include an endorsement providing that the carrier agrees to waive any right of subrogation it may have against City. Contractor agrees to waive rights of subrogation which any insurer of Contractor may acquire from Contractor by virtue of the payment of any loss. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation. The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors. Acceptability of Insurers Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California, and each insurer must have an A.M. Best’s financial strength rating of “A” or better and a financial size rating of “VII” or better. Verification of Coverage Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a form at least as broad as CG 20 38 04 13. Surety Bonds As required by Contract and described in the Contract Documents. The Payment and Performance Bonds shall be in a sum equal to the applicable Service Order Price. If the Performance Bond provides for a one-year warranty a separate Maintenance Bond is not necessary. If the warranty period specified in the Contract is for longer than one year a Maintenance Bond equal to 10% of the Contract Price is required. Bonds shall be duly executed by a responsible corporate surety, authorized to issue such bonds in the State of California and secured through an authorized agent with an office in California. Special Risks or Circumstances City reserves the right to modify these requirements, based on the nature of the risk, prior experience, insurer, coverage, or other circumstances. 1325217.1 THI3 CER'IFICA'E 13 ISSUED AS A NATTER OF IXfORXA?IOII OI{LY AXD COXFER3 XO RIOHTS UPOI' THE CERNFICATE I{OI.OER. IHIS CERTIFICATE OO€5 XOT AFFIR ATIVELY G I{E6ATIVEl.Y AIE]{O. EITEI{D OR ALTER 'HE COVERAGE AFFOROED BY THE POI-rcleS B€LOW. THrS CERTTFTCATE (r TXSURAT{CE aro€s rO? OOXS?I?UIE A C(,IITRAC? EETWEET{ THE t3SUtraG TXSURER(S}. AUTHORIZEO REPRESEf,TATM OR PR@UCER, AIIO THE CERTIFICATE XOLI'€R IXFORIAXI: ll lt ..dic.t hold.r h .n AITOfiIOI{AL If,SUREO, Or. pollcy(L.) g.t hd. ADOIIO]{AL If,SURED F@i.aon. or b. .ndd..d, ll SUBROGAIIoI{ lS WArVEO, .sbl.cl lo lh. t.rm. -rd colldlll,onr 6t Oi. polkr, cafialtr pollcaaa lnay ,aqui.. an .ndon irnt A rLt ttr.nt o.r thia carllfcaL do.r not con ra to tha c.&'ticata holata. in lbu ot auch T 1200 i nrur.n cdEO.llp!,.4r. goltt !'d!,.taqal ^ttoto..o covEx^ot &.4r,..1 tord O.E..l t^.e..E CorD.n, l?18-7?2o &rra.fi Fonrt 9.6.r.l ln.u'.nc. A.clrLni Fund 6.Erl lr.l,.nc. un 1230,4 12304 711,a95 , cfu c CERTIFICATE TUXBER: CANCELLAfiON Clty of Cup.nlno Publlc Worlq 10300 Tor't AY.nu. Cup.rtino, CA t5017 Attn: B.i.n Grt !.rt st{oulo aiiY c THE ltovE oEtctllcD }oLrctES !a catcErlEo tErotrrHE EIPIR TIOi "AIE TXEXEC, ITOIICE wlLL 'E OELIVETED Ii ACCOIDA,{CE wltx rlc PqJGY proYEroxtn 4Oht4a, 6 l 0tt-20 1 5 AcoRo coRPoRArpN. all rlglil r.r..v.d s CERTIFICATE OF LIABILITY INSURANCE REVEO XUXBER THIS I3 IO CERTTFY THAT IHE POLICI€S OF IiISUR XC€ LISTEO AELOW HAVE EEEN ISSUEO TO TTIE IIISUREO NATIEO ABOVE FOR TX€ PO{.ICY PERIq) INUCATED TIOTWITXSTAI{OING AIiY RECT,IREII€I{T, TERM OR COiIDITIOI{ (T ANY COI{TR CT OR OTHER MCUTT€XT wlTH RESP€CT TO WHlc$ THIS C€RTIFICATE i'AY BE ISSUEO OR I'AY P€NTAIII. THE TNST.RlNCE AFFORO€O BY lt€ POLCIES OESCP€EO XER€II.I IS SUBJECI TO AU- THE TERIS €XCLU$OTS AND COi{DIIIO'{S OF SUCH PO-ICI€s UllITt SHo|VN II Y HAIG B€EN RETXJCED 6Y PAID CIA'rrIi UITI'x':1xleX _ 2-000,000 50,000 5po0 't-000.000 .!000p00 2,000.000 PD O.d 1000 GENER L A6Gf,EO^'E Ftoouc rS - corP/e a66 E^alr occriitr.cE orgcE rarExIEF D Y GLSrSrC000rroc021 0i/0!r:t022 roc cet rtt qqat-r-f rtY : .r,o..r X *,.. El D.d 1000 JECI _?n$*tl lrffi' EO lp ( rr q.. r-rr) 0J0lril02l ,trto,ra a ^or, NrtY 'X ^r{y ^uro- v- o$aEolt ,\ uYd.rr Y\-r- rrrlED,\ uYos orY rriorolt-E !rl&trrY 1.000r000 Y GLS|STC00r6023 e@rY IrJr.aY Pr,.rrd) -Z\, ^Lyoa ^- ^u()s d.!Y 0t/03r:I022 09iOy2O?3 loo(YlxJi.FY(Pr..o..r{l GLStSTC00ogtcl!23 tc . €rcx occ(rilNct IX 2 0EXCE5' LA' 2,000!q00occua foa(Eta coaacra^roi ^ro ErrLoYtia' u^alltlY aY rrGl€rqPlr1xEn qlcutna 6FloEi/Lra€a Erq.loEot l! E CIACG|OET{i Ir2n1tm22 11n1n027 . !! q!!!!Ei!41!qg4q t - 1721241 .202t Ef orsEAlE - t(rcY Lml ! i_r ^rllc _l 1,000,000 1.000p00 Oclcrtlror. C Oali^lloa rLocltiqa rlfl{Cl'Ea ( C@ Itl. L.Lia LEt adtdrl...n t.-cria, 'r- r.- L.i.r.!al Clty ol CuDar{nq Board and Comntl.riont, Oticrt, OtflcLl3, aeant3, inployaat, contultartr md vEluntaatr acoRD 25 (202U12),ry, oL ?4 BELL PLA;ZA IXTURAIiCE tza C.mlno O.lYa S.nt Clrr., CA 95050 Lic.n..t:0lolaOe Iikr Alvamaz AlYamE Conrtrucdon P. O. Bor 346 stn Lrrln a t4Alf cA e snla ! t t t I 03r0!/:t022 mr03r202r o f rre U?*-' Iha ACORD n.m..'td loeo .t r.gbr.r.d m.ttr of ACOnD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE GONDITION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other lnsurance Condition and supersedes any provision to the contrary: Primary And Noncontributory lnsurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named lnsured under such other insurancei and COMMERCIAL GENERAL LIABILIry GLSlSTC000996021 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 72$l 4.LL @ lnsurance Services Office, lnc.,2012 Page 1 of 1 L4 AFGIC AIE GL OO1 318 Policy Number: GLSISTC000996021 Add*ionarnsureds: City of Cupertino, and commissions, officers, officials, agents, employees, consultants and volunteers Policy Number: GLSlSTC000996023 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM Wath respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modifed by the endorsement. This endorsement is effective on the inception date of the policy SECTION ll - LIABILITY COVERAGE 1. WHO lS AN INSURED is amended to include as an "insured" the person(s) or organization(s) named in the Schedule below, but only with respect to their legal liability for acts or omissions of a person for whom Liability Coverage is afforded under this policy. You are authorized to act for the additional insured named in the Schedule in all matters pertaining to this insurance. SCITEDU].E All other terms and conditions of this Policy remain unchanged. Page 1 of 'l {L lu AFGIC APE OO OI 3I8 6 ?,L ?4 Accident Fund General Insurance Company 2m Nonh Grand Avcnuc . L:nsing, MI 48933- I 288 THIS ENMRSEMENT CHANGES TTIE ROLICY. PLEASE NEAD TT CAREFULLY, ACCIDE\T FUND GENENAL NSLTANCE COMPANY COMMENCIAL GENENAL LIABILITY FOLICY ADDITIONAL L\TSUTED. STATE OI' POLTTICAL SUADTVISIONS - LICENSF This codorscmcnt modifi?s insurulcc providcd undcr thc following: CO}tr\TENChL GENENAL LIABILITY COVEN^GE PANT. Sbte or Po$tlcd SubdlvEon: City of Cupcnino, boards and commissions, officcn, offrcials, agcns, employccs, consultants and voluntcers. (tf no roEy rppcrrs rbovc. fic ilrformrtion rrquircd o complctc thir cndorrcmcnt will bc $own in thc Dachdiont rs applicrblc ro dli! cndorrcmqrl.) Sccdor m - vyho lt Aa llror.d it .ItEodcd b includc I ul ddiriond iorurld lny rut! or tovc(fittrcntd .lcocy c subdivirion r politicd ruMiviriofl tbo*r in thc Schcduh, subjc{t to tlE follovillt proviriolr: t. This iNurrncc rpplica only *ith rrtpoct to opcrdiollr pgforncd by you q on yqrr bchrlf for vhich thc 3]rL or tovcmnrcntrl rtcncy or rubdivilion ( politic.l subdivision hrs i$uad . pqmit. 2. Thir insurucc docs not rpply o: & "Bodily injwy', 'proprrty drm8c" or "pcriord Id dvrrri$t hjury' rilint orr of opcrltiotls pcrformcd for thc ftdcnl Sovcrnncsl ststc q mur cipality; or b. "Bodily injury" s'prcpcrty d&rrtc" iocludcd eithio thc "producu-complctcd opcrrdoos hrzltd" . Covcngc for rny rddiaiood ioruFd ir 8ovlnrcd by thc trrmr, corditions, &d crcluiqrt of lhit policy ud dl cndorsrEots, ircludint tIE l$uring Agrlcmsrt. Thc covcngc providcd for .ny dditiond inrurcd is only to tlE crtrrll of.nd in thc proponion thc rdditionrl lnsurcd i. h.H lirblc for tlE ncgligcacc r rcia lirbility/cooducl/rcrt of lhc Nrred lasutrd. No covc[8c ir providcd for lirbility brrcd upon thc &tr. crron or omi$iont of thc Additiond Insurcd. Erccpr rt acr fonb .bovc, dl of tlE tcrm1 conditiqu ud crclurions of lhi5 policy rpply ud Gmrin iD Gffccr- Policy No.: GLSISTC000996O2I Accidcnt Fund Gcncnl tn$rmcs Compuy DaE tuo8t2022 W,%=-l*b; A €.&;Dd noUUi gtti&orporrrc Sccrarry Timc: l2:01 s.m Page I ol 1 ?)[dza AFG|C ArE GOV P 00 0l 0318 Accident Fund General Insurance Company 200 Nonh Grand Avenuc r Lansing, MI 48933- 1288 THIS ENIX)RIiEMENT CIIANGES THE FOIJCY. PLEASE READ IT CANEFULLY. ACCIDENT FUND GENETAL INSURANE COMPANY COMMENCIAL GENEBAL LIAAILITY P'OLICY ORGANUZATION INCLUDING PRIMATY COVENAGE This cndorscmcnt modifics insur&cc ptovided under thc following: COMMENCIAL GENENAL LIABILITY COVERAGE PANT. (lf rc cnry rppct[ tbovc, 0!s ioformrtioo tDquirrd b complclc thir crdonsncm vill ba thorn is thr Dc.l|r$ionr lr rgplic.blc to this ctdoEcmror. ) A. S.cdoa III . Who I5 A! bur.d it uaadcd to itEludc rr rn rddiaiood i!tu,!d rhc F!on(r) or o8rniaaioo(3) shoen in thc Schodulc, but oaly eith rrsFct to lirbility fo( -bodily irjury," 'FoFny drtt[tc'c "Ftond rnd dv€(tiritl! injury" crutcd, io wholc or ir prlr, by: L Your rca or o[utsions: o. 2. Thc rcts or omirsionr of thorc rring on your bchdf: ir 0E pcrformucc of your ongoini opcrrtions Frfonncd during thc policy pcriod for lhc ddidond inrurrd(t) rt thc locruoo(t) daigutcd rbovc. E. Thb insur&cr docs nor rgply io "bodily injury" 6'propcrty drugc" thrt trbr phcr rfllr, rnd thc Additiood l!5urrd't 3rrrur rt rn dditbnd htulcd tcrminrtr3, upoo thc cslicr of r,h3a: l. All worL, ircludint mrtlridt, p{tr or cquipmcrt fun*had by tlc Nmcd lntutEd in conncctioo with such *odq on thc Fojcct (o0E( th.tl Ervicr. rlt.hrrorE q rEFit!) ro bc pcrfcncd by q qr bchdf of thc dditiond inrurcd(t) d dE loc.rion of 0E covcrcd oFrionr hu bcso clmplctldi or 2. Thet ponioo of )our n ort" out of irhich thc injury or d.natc rri$s h$ bclo put lo it! intcrdcd utc by rny pcllon or ortrnizrtion othcr lh.n rDothc, contnctor cntrgcd h pcrformiq opcrrtiollt for r principd .s Fn of 0E :rmc prcjecr. C. lf crprcssly rtquircd by r writrn ud lG8dly enforccrblc conrrct cnrrcd into by thc Nrmcd Inrurcd pnor to commcoccmcnt of *ork by thc Nrmcd ln$rcd fc( th. Addiliond Inrurcd, thc iruunncc dfor@ by thc policy to 0E Additioml lnturd(!) li$ad iD thc Schcdulc for 0E &scrib.d locrtion(t) it primrry inturrncc. Any oth.r insurrocc or rlf-insur.ncc mrinriDcd dircctly b, ttE Additiond larurcd(r) is crcc$ of thi! inrurrncc rrd shdl Dot contributc to iL Covcr.gc fc llly dditiond inlutld ir towmcd by tE llrms, condidons, rsd crcludont of fiir policy rd dl cndoftcmcllB, includint thc l$uriDt ASIlanEnt. Thc covcngc prcvid€d for ltly dditiond iruurcd ir only !o thc crtcnt of .rd in Uc Foponion th. dditiond InturEd is hcld lirblc for lhc rESligrG 6 leict lirbilityrcorducurt! of thc NrflEd l,!sul!d. No corrc tc is Fovidcd fa lirbility b$cd upotl tlrc rtt c(rwr or omisbnt of thc Additiotd losurld Excrpt .r sct fmh rbow, dl of thc trrm!, conditionr rrd cr.clurioN of tht polky ryply rrd rEmrin in cficc! Policy No.: GLSISTC-000996O21 Acrid€ot Fund GcoCIrl Inrurncc Compray By Timc:l2:01rm..A/\ A f@;.ad6fi AFtrorpotzrascclcrery AFGrC ArE OOP 00 01 0r 1? Stcvc Coopcr, NrE o( Addldold llrnrcd: City of Cupcnino, borrds lad corrEisions, officcrs, offrcidr, qcot!, cEployccs, cootuluDts rId rclunlcc[s. Drrc: IA0fr'2O22 ,* rr r.1ZW , il*1,' Accident Fund General Insurance Company 200 Nonh Grand Avcnue . L.ansing, MI 48933-1288 ACCIDENT FT'IID GENENAL TI{SURANCE COMPANY COMMERCIAL GE]EIAL LI AILITY POLICY OnGANIjZATIo,T- NCLUDING WAIVEA OF SUBROGATION This endoncrEnt modifid iruurulcc ptovidrd unda thc follo*in8: COMMERCIAL GENENAL LIABILITY COVERAGE PART. Nrnc d Addltloul laanr:d: City of Cupgtino, bdrds and commirsiqrs, ofEccn, olficidr" rgcnt!, arPloycc3, congultrnr urd volunrcr. ltri (tf no qttry rppcrrt .bovc, tlE infqmrtio[ rcquid !o coflrplcc $ir c[do.rcmctrt will bc Oown in thc Dcclrrerionr s .pplicrblc to lhis codorlern nL) A. S.ct oD Ul . l+to L Ao llsur.d b rmcndcd to inclu& rs rn tdditiond insurcd lhc Frson(t) or orguizrtion(!) thown in thc Schcdulc. but ooly rvilh rlcpcct io li.bility fq 'bodily iqjury," "proFny d.In.tc" c "pcrtood .rd dvcatiri[t i[jury" crutcd, in vholc c in p{t by: You, &ts or omi$ions; ot Thc lcB or omitsiont of Uprc rtirS otl ytrrr bddf; ia thc pcrformucc of your ongoilS opcrrtionr pcrfornrcd during thc policy pcriod for thc ddiriond itEurcd(t) .l dE lcrdo(r) dctignrtcd .bovc. B. Thit inlunocc do6 nol rpply ro "bodily injuy" a'ptoFry d.rm8c'lhlr tlllr phc. .flc . lt,ld lhc Addiriond lnlurcdl ! ut l! ln .dditioad intu,rd tcrmiltllrs, uPon thc cdicr of whan: I . AU worl, inclding mrrcridr, plttt o r GquipflEt fumithcd by thc Nurcd lnrurcd in conncction wilh tuch worl, on lhc projccl (otbc. lh.s &rvics, mriotcmnc! ( rrprh) ro ba Ffonrrd by a oa bchdf of thc edditiond insured(r) rt thc hcrtior of dr clvcrEd oFrrion! hlt bccn complctcd: or 2. Thd po.tioo of )our worl" our of rrirhh thr iojury or d!rl|!c .ritcr h.t b.ro Frt to it! irlcodcd u!. by lry Flon or ortlni,:uon odE th.r laolhar contrrctor colrgcd iD Fforming opcrrtioar for a principd r! p.n of $r xmc projccl. C. If crFlssly llquirld by r erirat rrd ldrlly cnforEcrblc cootrrt caE'td inro by thc N.mad lrturd Fitr to commcocan€nt of u,od by &. Nlt'.d lErrd fa tbc Addtloarl burcd, thcn wc wriw uy ri jht of rubmtrrioo wG fliry hrvc {liatr rn cnriry lhd ir lt,t Addltlold hrurd F lhc Ermt of rbis codqtcmanr bccrusc of pryltlcrlrt urc m*c fa inj[y a dlltllgc .rilint o{n of '}our lrlrt" pcrformcd uodcr such wriuan tnd lcldly cnforcabh contrrct with lhrr MdldoEal burtd. Covcrrgc fc ury rdditiond htuEd i! Sovcricd by lhG trflnr, cooditions. .nd crclulionr of thir policy rnd dl codort€tDslrr, iDcludi[8 aha l[urin8 Aglcntcol. Thc covcntc providcd for 8|y rdditiood illurrd L only !o Ulc crlcflr of ltd in thc pmponion thc rddidond lBurd i! hcld lilblc fa thc ncllifpn c or 3trix li.bility/cordlE rtt of th. Nl'Ed Inrurld. No covcntc it p.ovi&d fq lLbility b.scd upon lbc rrr' Gfiert o( omit.irt of thc Additiond lnrured. Exccpt r. tcr foflh &ovc, rll of th3 Erlrt' coditbor rtld Grcludfir of lhis policy .pdy .d Emdn in dfcct. Policy No.: GLSISTC0@99@21 Acci&ar Fuod Crcrrrrl Intuffic ComFny Datc tvo8t2022 I ., &s; t c@:d Bobbi El[dJorponG Sccrctery Pao€ r ol IAFG|C ArE O@WOS O0 01 C3r8 'k"** ?f,nil Timc: 12:01 r"m. 2m North Grand Avcnuc . l-ansing, MI 48933- 1288 THIS ENDONSEMENT CTIANGES THE FOLICY. PLEASE NEAI' IT CANEFULLY. ACCIDENT FUND GENEf,AL INSUNANCE COITPANY COMMERCIAL GENERAL LIABILITY POLICY A-DDITIONAL INSURED. STATE ON POLTTICAL SUEDIY! TONS - LICENSE This cndorscmcnt modifils ittsur.nc. providcd undcr thc folloc,ilt: COMMERCIAL GENENAL LIAEILITY COVEN^GE PART. st ll or Foliticrl subdividon: City of Cupcrtino, boards and commissions, offrccrs, officials, agcnts, cmployccs, consultants and voluntccfs. (lf no cnuy eppcrs rbovc, thc infomrrioo rrquLld to cornplctc this codqlcmcnt $,ill be thoen io tll Dcclsrrionr lr spplisrblc to lhis cadGsrmctll) Secttoa ttr - wlro b AB hrurtd it rtllcndld o inclu& s u rdditiond in3urcd rny nrr! or govcrnocntal tgency or subdivision or politicd subd.ivilifl Govn in thc Schcdulc, subicct to thc follosirt pmvirions: L Thir inrunnce rgplier oaly with rcrpcct o opcrlrioor pcrformcd by you c on your behtu for ehich thc sura a tovcramcltd rgcncy or subdivitioo or politicd iubdivtion b$ iarucd . pcrmil. 2. This inrunncc docs mt epgly to: r. 'Bodily iojury', -PtoPctty dlm.!c" or "Ffiond rrd dvcrtisiry injuy'uiritrg oul of oFrrdoas pcrformcd for drc ftdcrrl govcramcnL sr{c or municigdity; or b. "Bodily iojury' or 'ptoFty drmttc" includcd withit! thc "PtoducB{omPlctcd opentioas hlzrd". Covcngc for roy dditiord irurrEd ir tovcrncd by thc tarma coditionr, sd cxclurioru of thir Policy rrd dl cndonsrcntq iocluding Oc lnsring Agccnrnt. Tlrc covcrrtc providcd fa rDy rrtdiriond iosurcd i3 mly to drc crlcnt of lnd in lh. ptoponion thc ddidond IBurcd i! hctd lirblc for $c rEgligcncc or rrict lirbility/cooduc/rc$ of thc Nrmcd lnsurcd. No covcngc is providcd for li$iliy bercd upor thc r1!, crtort e qnissiotrt of thc Additiood lDturcd. Ercrpr rs scr fodh rbovc, dl d thc &rm!. cooditioru |lrd ercludoG of rhir policy rpply rrd rEmrin in cfr€(r. Policy No.: CLSISTC00099602I Accidcnt Fuad Gcncrd lnrunacc Compray Datc tuoa2022 '&4*-- Strvc Coopcr. Pr6idcnt L4t; s t@;oa Bobbi EUiot-torpordc Scctctary Timc l2:01 r.m *i,tfrPage r ol l Accident Fund General Insurance Company AFGIC ArE GOV P O0 01 dlrt Accident Fund General Insurance Company 200 North Grand Avcnuc r l-ansing, Ml 48933-1288 ACCTDENT TUND GENEf,AL INST'RANCE COMPANY COMMENCIAL GENERAL LIABILITY FOLICY ADDITIONAL NSURED.OWNENS. LESSEES OT CONTRACTORS (COIIIUETCIAL ONLY} Tbi! cndoncnrcnt modilicr ituurulcc providcd undsr rhc fotlo*i[t: COMMEXCTAL GENENAL LTAIILITY COVERAGE PATT. SCIIEDUT.E Nrpc ol Addlltood I!rytd: City of Cupcnino. borrdr ]d commissioos, officcr1 officirls, rgcnB, cmployccs, coNultlrB rd voluntc.6. (tf no c6Ey rppc.'t rbovc, tlE infomrtioo llquilGd to complct! Uis cndor$mcDt will ba thow[ ill thc Dcclurdonr rs spplic.blc to this .ndortctDcol ) Scctioo Ill - Wbo ls A[ lD$rad i! rmcndcd lo includ. rt lll rdditiord insurad thc pcriotl(t) or orSmiarion(3) Cnwa in thc Schcdulc, but osly with rc+act to lirbilily fa "bodily injury." "propcrty drnlrgc" or "psrlotlrl rnd dv.'titint i[jury" cru!.d, h *holG or b prfl" by: l. Th. Nlmcd ltlturld'r lcB or omisiion3i o! 2. The ectr or omirrion! of thorc rctint ql 6c Nrmcd lnrurcd'r bc.ltdf ir thc pcrformrrc of .your s6rt" for tt dditionrl intuodt) ll thc locrrim(t) d.ritn&d rbovc. Cowr.gc for rtly dditiood hturrd is govcrr.d by th3 tctmr, caodiaiotrt, rld dcludont of thit polic, rtld dl ctdorlqlglllt, including lhc ltrturint Atrccmcnt. Thc cowrlSc plovidcd fo ray rdditioad inrurcd ir only b dE crtrot of urd in th. Foponioo lhc dditionrl lo$rrd is hcld lirblc for rhc nctlitarcc or *rict li$ility/cotducuEtt of tic Nurad lnrurcd. No covcnlc it pmvidcd for li&ility bu.d upon th. rts. cfiors or omigionr of thc Addidond lnrurcd. Policy No.: GLSISTC(D99602 t D.E: luov2o22 Timc: 12:01 r-m. Acci&nt Fuad Gcncral Insurarc. Comp$y f-+\ s C@;d Bobbi EUi*-torpo nrc Sccnrrry Page I ol 1 u0z AFGrC ArE COM (E 01 0i|16 ,*" 1't/ Byr Accident Fund General Insurance Company 200 Nonh Grand Avcnuc r Lansing, MI 48933- 1288 ACCIDENT FUND GENENAL f,ISUNANCE COMPANY COMMERCIAL GENERAL LIAEILITY FOLICY SCEEDTJI.ED PETSON ORGANIZATION ONGOING OPERATIONS ONLY Thi! cndortcrrclr rrodifics iorurucc providcd un&r lh! follorrilt: COMMENCNL GENENAL LTABILTTY COVENAGE PANT. NrE-elAtd&o.Uradi City of Cupcrtino, bord: rnd commicsionr, oftccn, offcirlr, rgcor:, cmployccr, con3ullnB tnd volunrccrs (If m anEy .pFEr &ovq rbc inforrIllridl rcquild 10 c$rpbrc thir cndortcmcat will bc lhovn h &c Dachntimt .t rpplicsblc Io thir ctdorrttlcol) .A- S.cdfi Itr - Who lr Ar helrcd ir rnandcd !o ircldc I ltl ddiaio[d in$rcd th. Frrco(r) q orgrnizdon(r) rhom in thc ScHuL, but only wilb Ilsrcl ro li.bility fq "bodily injury", 'proFrty &rartc" or'pcrrood rad dvcnirint iljury'crutcd. il vholc c ir prrr, byi l. Your rtr or omistiont; q 2. Thc r1r or omi$ionr of thorc rtiq oa yor bchdf: ia rhc pcrformrncc of your ontoirt opcrltioni pcrfamcd durint thc policy pcriod for lhc dditiond ill3urrd(!) rr lh. locdoo(t) dcttDrrd &ovc. B. Thir in$rlacG doc3 nd +ply ro "bodily injury"c "Fopcrty dll tc" lhrt rlct plrcc .ftcr, lld lhc Addilioad llcrrldt lr[lt r ra lddiliood inturd lErlul&r icrminrrcr, upon thc crrlicr of: I . All sort, ilcludiry tDrt!f,irh, plnt or c$ipm firmirhcd by thc NlDcd lnlurd b conretiqr wirh tuch wort, on Urc p@jcst (oahcr thD tcrvicc, mri c[.trcc s Icpdrl) to bc FrfaDrd by o( oa bcbelf of thc dditiold ioturd(t) lt lhc bcrtioo of ahc covrrcd opcretioar ha bccn cooplacd: ol 2. Tbrr ponion of ')olrr wfit" oua of uhich thc injury o( drmtc rrir6 hr3 boal Fra to iB itr3crd.d ulc by rtty Fsoo q orlrnizrrioD dlEr & lrdlrcr cooEacror cotatcd ir Frf6nitr! oFlEora for r principd u pst of 0lc trmc projccl Covcrrg! for rly dditiood in$rcd is tovcm.d by thc l!flDc. conditionr, |ad crclusiorrs of this policy .nd dl cndoncmcnc, ircludiat thc Inturiu AtlrcnEnt. Tbc covcngc providcd fq ray ldditiotrd in$rcd ii ooly !o lhc crllot of lrd in ihc proponioo lhc ddidood lnrulld i! hcld lirblc fr tlE rEtligcscc or tEicl lirbility/cqducr&rs of thc N.ncd llturEd. No covcsrtc it provi&d for lilbility blt.d updl ur lcr3, cncr o, omisioru of thc Additiond lnlurcd. Erctpt .3 s.i farh $ovc, dl of thc ttrmt' conditioot rd crclutid!3 of lhb policy rpply rrd rcauia in cffcct. Policy No.: GLSIST()@996021 Acsidcor Fuod Ccncrd Inrururcc Cornpuy'#lo A1€ A CM Bobbi E[i&-torporitc Sccrctary Timc I2:01 e-m AFG|C ArE ONO m 0r 03lE Pao€ldl *f,wz\ D.tc: 1U08r2022 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 1721281-2022 (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule City of Cupertino, Board and Commissions, Officers, Officials, agents, employees, consultants and Volunteers. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Insured Insurance Company StateFund 1721281-2022 (Ed. 4-84) @ 1983 National Council on Compensation Insurance. Effective Policy No. 1721281-2022 Endorsement No. J Prem� Countersigned by ___ ?'i7�_,.,....., __ ��--�--------- P,O, BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE u /1' NA L4 NA Thrs is to certity that w9 h.ve issued r valid Worke.s' Compensstion insurance policy in a form approved by the Calilornia lnsurance Commissioner to tho omployer nam€d bslow for th€ policy P6riod indjcat€d. This certificate oI insur.nc6 is not an insuranc€ policy .nd do€s not aanond, oxtend or alter the coverage afforded by the policy lisled herain. Notwithstending .ny requirem6nt, term or condition of .ny conlrsct or other document with respect to which this cgrtificate ol insurance may bE issued or lo which it may pertain, the insurancg alforded by the policy describ€d her6in is subject to all the terms, exclusions. and conditions, of such policy. CITY OF CUPERTIU' 1O3OO TORRE AVE cuPERTIix) CA 950 t 4-3202 /L,.-. o{-;-..- ISSUE DATE: O5-O4-2O23 EIVPLOYER GROUP: POLICV NUMBER: 17212A1-2022 CERTIFICATE lD: lO CERTIFICATE EXPIRES: l2-Ol -2023 12-O 1 - 2022 / 1 2 - O 1 - 202? Authorized Rep.esentative President and CEO UNLESS INOICATEO OTHERTISE BY ENDORSEI{EITT, COVERAGE UNDER THIS POLICY EXCLUOES THE FOLLOTITG: TTX'SE NAT'EO IN THE POLICY DECLARATIONS AS AN INDIVIIUAL EXPLOYER OR A TI'SBAND ANO TIFE ETPLOYER; E PLOYEES COVEREO ON A @TPREHENSIVE PERSONAL LIABILITY INSURAIiICE POLICY ALSO AFFORDING CALIFORNIA ITORKERS/ COMPENSATION BENEFITS; Ei{PLOYEES EXCLUDED UNDER CALIFORNIA HORKERS' CO PENSATION LAH. EITPLOYER'S LIABILIfY Llt{lT II,ICLUDIt{G DEFENSE COSTS: $1,Ooo,OOO PER OCCIJRRET€E ? ALVERNAZ, iIIC+IAEL A CONSTRUCTION P0 Box 366 SAT{ IiARTIN CA 95048 IFYA,CN] PRIt{TED: 05-04-2023 DBA ALVERNAZ NA €- STATE FUND CERTHOLDER COPY This policy is not subject to cancelletion by th€ Fund except upon iO days advance writton notice to the employer. We will .lso oive you lO deys adv.nce notice should this policy be caocsllod prior to its normal 6xpiration. ENDORSEI'ENT #2570 ENTITLED YAIVER OF SUBROGATION EFFECTIVE 2022-'I2-O1 IS ATTAclIEo rO AiID FORIS A PART 0F THIS POLICY. THIRo PARYY IIAIE r CITY OF CI,PERTIM' FUND ISSUE DATE: O5-O4-2023 EI!!PLOYER POLICYHOLDER COPY NA P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Thrs policy rs not subjoct to c.ncellation by th6 Fund exc€pt upon lO d.ys advance wfltlen notace to the employer We will also qive you lOdsys advahce notice should this policy be csncelled prior to its normel expiralion. This c€rtificat€ of insurance is not an insur.nce policy and does not am6nd, ext€nd or alter the coverago .tford€d by the policy listed h6rein. Notwithstandang any requirement. term or condition of rny contract or other document with respgct lo which this cartificate o, insur.nce may be issued or to which it mey pgrtain. the insurance afforded by the policy described herein is subj€ct to all th€ terms, exclusions, and conditions. of such policy. This is to certify that we have issued. v.lid Workers' Compensation insurance policy in a torm approved by the Californie lnsurance Commissioner to tho omployer namod below for ths policy period indiceted. /,---' J;*- P.ssidcnt ard CEO NA Authorizod Representative EITPLoYER'S LIABILITY LIHIT INCLUDING DEFENSE COSTS: $l,OOO,OOO PER OCCURRENCE. CITY OF CUPERTINO I03@ TORRE AVE cuPERTtio cA 95014-3202 ENDORSE ENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2022-12-01 IS ATTACHED TO AND FORI4S A PART OF THIS POLICY, THIRD PARTY I{ATIE: CITY OF CI,JPERTIM) UNLESS INDICATED OTHERHISE BY ENOORSETEiIT, CIVERAGE UNDER THIS POLICY EXCLUOES THE FOLLOHIT{G: TT€SE NAflED IN THE POLICY OECLARATIONS AS AN INDIVIi'UAL EXPLOYER OR A I{ISBATD AND TIFE E}'PLOYER; E PLOYEES C{'VERED ON A q' PREHENSIVE PERSONAL LIAAILITY INSURTNCE POLICY ALSO AFFORDING CALIFORNIA XORKERS' qIIPENSATION BE EFITS; EXPLOYEES EXCLUDED UNDER CALIFORNIA UORKERS' CI'TPENSATION LAU. ALVERNAZ, IICIIAEL A OBA: ALVERT{AiZ CONSTruCTION P0 BOX 3A6saN ARTIN CA 95046 ?t1 (REV.7-2014) NA PRINTEO IFYA,CN] 05-04-2023 7h GROUP: POLICY NUMAER: 17212A1-2022 CERTIFICATE lO: lO CERTIFICATE ExPIRES: t 2-ot -2o23 1 2 -O 1 - 2022 / 1 2 - O 1 - 2023 STATE M 6. WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for j ob: Sample Rate: Regular Premium equals: Surcharge: Additional Waiver charge: Total premium equals $ 684.95 (665.00 + 19.95) $5, ooo. o0 13.30% s 665.00 3.00% $ 19.9s v'- tt -qrE 6 ? On-Call PW MA Services Contract, Alvernaz Construction 632 Final Audit Report 2023-05-30 Created:2023-05-26 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAeZ92U8rZA69j6W2B77zWhAXbG7GTP5Zv "On-Call PW MA Services Contract, Alvernaz Construction 632" History Document created by City of Cupertino (webmaster@cupertino.org) 2023-05-26 - 0:40:57 AM GMT- IP address: 98.97.57.92 Document emailed to Julia Kinst (juliak@cupertino.org) for approval 2023-05-26 - 0:43:38 AM GMT Document approved by Julia Kinst (juliak@cupertino.org) Approval Date: 2023-05-26 - 0:44:29 AM GMT - Time Source: server- IP address: 98.97.57.92 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2023-05-26 - 0:44:32 AM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2023-05-30 - 2:54:53 PM GMT - Time Source: server- IP address: 73.170.27.253 Document emailed to michaelalvernaz@alvernazconstruction.com for signature 2023-05-30 - 2:54:56 PM GMT Email viewed by michaelalvernaz@alvernazconstruction.com 2023-05-30 - 3:14:40 PM GMT- IP address: 107.77.214.58 Signer michaelalvernaz@alvernazconstruction.com entered name at signing as Michael Alvernaz 2023-05-30 - 3:50:59 PM GMT- IP address: 107.77.214.58 Document e-signed by Michael Alvernaz (michaelalvernaz@alvernazconstruction.com) Signature Date: 2023-05-30 - 3:51:01 PM GMT - Time Source: server- IP address: 107.77.214.58 Document emailed to christopherj@cupertino.org for signature 2023-05-30 - 3:51:04 PM GMT Email viewed by christopherj@cupertino.org 2023-05-30 - 3:52:09 PM GMT- IP address: 104.47.73.126 Signer christopherj@cupertino.org entered name at signing as Christopher D. Jensen 2023-05-30 - 3:52:24 PM GMT- IP address: 64.165.34.3 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2023-05-30 - 3:52:26 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Jimmy Tan (jimmyt@cupertino.org) for signature 2023-05-30 - 3:52:28 PM GMT Email viewed by Jimmy Tan (jimmyt@cupertino.org) 2023-05-30 - 5:35:53 PM GMT- IP address: 104.47.73.254 Document e-signed by Jimmy Tan (jimmyt@cupertino.org) Signature Date: 2023-05-30 - 5:36:09 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2023-05-30 - 5:36:12 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2023-05-30 - 5:36:30 PM GMT- IP address: 104.47.73.126 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2023-05-30 - 5:37:24 PM GMT - Time Source: server- IP address: 64.165.34.3 Agreement completed. 2023-05-30 - 5:37:24 PM GMT Alvernaz Construction for Concrete Repair and Replacement for Various City Projects Final Audit Report 2023-06-28 Created:2023-06-27 By:City of Cupertino (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAGoq4RbMiAnLSMgtn9-DZZdc3kZOKI2oX "Alvernaz Construction for Concrete Repair and Replacement fo r Various City Projects" History Document created by City of Cupertino (webmaster@cupertino.org) 2023-06-27 - 8:03:44 PM GMT- IP address: 35.229.54.2 Document emailed to Jindy Garfias (jindyg@cupertino.org) for approval 2023-06-27 - 8:08:15 PM GMT Document approved by Jindy Garfias (jindyg@cupertino.org) Approval Date: 2023-06-27 - 8:17:44 PM GMT - Time Source: server- IP address: 174.85.68.51 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2023-06-27 - 8:17:48 PM GMT Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2023-06-27 - 8:34:48 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to michaelalvernaz@alvernazconstruction.com for signature 2023-06-27 - 8:34:51 PM GMT Email viewed by michaelalvernaz@alvernazconstruction.com 2023-06-28 - 9:12:53 AM GMT- IP address: 144.64.239.151 Signer michaelalvernaz@alvernazconstruction.com entered name at signing as Michael Alvernaz 2023-06-28 - 9:16:22 AM GMT- IP address: 144.64.239.151 Document e-signed by Michael Alvernaz (michaelalvernaz@alvernazconstruction.com) Signature Date: 2023-06-28 - 9:16:24 AM GMT - Time Source: server- IP address: 144.64.239.151 Document emailed to christopherj@cupertino.org for signature 2023-06-28 - 9:16:27 AM GMT Email viewed by christopherj@cupertino.org 2023-06-28 - 10:02:04 AM GMT- IP address: 104.28.111.136 Signer christopherj@cupertino.org entered name at signing as Christopher D. Jensen 2023-06-28 - 11:33:23 AM GMT- IP address: 136.24.22.194 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2023-06-28 - 11:33:25 AM GMT - Time Source: server- IP address: 136.24.22.194 Document emailed to Chad Mosley (chadm@cupertino.org) for signature 2023-06-28 - 11:33:28 AM GMT Email viewed by Chad Mosley (chadm@cupertino.org) 2023-06-28 - 3:12:36 PM GMT- IP address: 104.47.73.254 Document e-signed by Chad Mosley (chadm@cupertino.org) Signature Date: 2023-06-28 - 3:12:54 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2023-06-28 - 3:12:57 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2023-06-28 - 3:16:07 PM GMT- IP address: 104.28.111.132 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2023-06-28 - 3:29:42 PM GMT - Time Source: server- IP address: 67.188.176.248 Agreement completed. 2023-06-28 - 3:29:42 PM GMT