91-008 Hansen, Ronald 91-008 HANSEN, RONALD
TIM-n _ -
# U360956
L670PAGE 1993
10-7 1 L L
AT REQLjEoc , Ctr
I T)
6
Ou d&ENANTS RUNRUNNINGG WITH THE LAND APR 10 11379 31
' ")NTT
WHEREAS, Ronald E. Hansen, hereafter referred to as "Owner", owns certain real
property located in the City of Cupertino, County of Santa Clara, commonly known as
22050 Regnart Road and more particularly described in the attached Exhibit 1 Parcel
Map,which is incorporated herein by this reference;and
WHEREAS, the aforementioned property is composed of two distinct and separate lots,
described as Parcel A and Parcel B in the attached Exhibit 1 previously set forth;and
WHEREAS, said approval by the City of Cupertino Planning Commission on June 26,
19F9 per Application 7-TM-89 was conditioned upon a covenant running with the land
in favor of the City of Cupertino to ensure compliance with the regulations prohibiting
transfer of slope density dwelling unit credit;and
WHEREAS, Owner shall formally and legally record the attached Exhibit 1 Parcel Map,
is in the process of recording such parcel map and agrees to be bound by said
conditions a,- set forth in this agreement,specifically:
1. This agreement shall prohibit the transfer of slope density dwelling unit credit:
a. From Parcel A to Parcel B,or/and-.
b. From Parcel B to Parcel A,or/and:
C. From Parcel B or/and Parcel A to any other property located within the
City of Cupertino; and furthermore:
2. This agreement shall prohibit the adjustment of property lines of Parcel A or/and
Parcel B if said adjustment would create additional dwellings, and where the
f
ti
r �
L 670PPIG 1994 -
zdjustment of property lines would not create additional dwellings, such
adjustment shall be prohibited unless approved by the City of Cupertino
Now,THEREFORE, this agreement is intended to be a covenant running with the land,
shall bind and inure to the benefit of the heirs,personal representatives, successors, and
assigns of each present or future owner of the property described herein.
Dated.
Ronald E. Hansen
Dated: Z 1/ Notary PublY-Califonua
-_1 r" c CITY OF CUPERTINO
� ( Cora,' r Mzi; Co n:l. >
6 h;y Commi Io a . 1
Don Brown;City Manager
Attest: Dorot Cornelius,City Clerk
i v• tiJ'• • V D'V 1.) 1 OZZOIAD it 71 • •Ji' 'ia: !.
• - 111+7....• =.?.II=-1 - TO: •.•'�• .....•: - •'•7 •.� - mil • N �:•.
•i
`i
_ '• - -
t
.9
p.
l
RESOLK)TION NO. 8351
EXF3IBIT 1wo
DEVEMPMENT SIN=-FAMILY DWELLING
RONAM E. HANSEN
LOCATION 22050 ROGNART ROAD (APN 366-2-37)
A. Faithful Perform Boni: $ 14,400.00
FUL)PTEEN THOUSAND FOUR HLRR)RED AND 00/100 DOLLARS
B. Labor and Material Bond: $ 14,400.00
FaiRrEm THOUSAND FOUR HtJNDR M AND 00/100 DOLLARS
C. C =Jti yg and Inspection Feet $ 720.00
SEVEN HUN RM TWEMY AND 00/100 DOLLARS
D. Indirect rec"'t City Egom ses: $ 108.00
ONE HUNDRED EIGHT AND 00/100 DOLLARS
E. Develc-3ent Maintenance Deposit: $ 1,000.00
ONE THOUSAND AND 00/100 DOLLARS
F. Story! Drainage Fee: $ 6,631.00
SIX THOUSAND SIX HIDMM TRIM aJE AND 00/100 DOLLARS
G. One Year Power Cost: TI/A
H. Street Trees: By Developer
I. Map aledd nq Fee: $ :210.00
TWO KJNMED TEN AND 00/100 DOLLARS
J. Park Fee: Zone II a/c 480-0000-416-022 $ 31,500.00
THIRTY CNE THOUSAND FIVE HUNDRED AND 00/100 DOLLARS
K. Water Main Extension Deposit: N/A
L. Maps and/or Iqprrn►ement 'Plans: As specified in
Item 23
CBt4 ®f Cuperti"D
103M Torre Avenue P.O.Box SIM
Cupertino,CA 95014-3255 Cupertino,CA 95015-05M
Telephone: (408)252-4505
FAX. 1408)252-07S3
DEPARTMENT OF THE CITY CLERK
March 26, 1991
Ronald E. Hansen
2250 RegnaYt Road
Cupe?tino, CA 95014
IMPROVEMENT AJMREEMMr
Dear Mr. Hansen:
We are enclosing to you for your files one (1) r*py of the Agreement by
and between the City of amino and Ronald E. Hansen, which has been
fully executed by City Officials, alwq with one (1) aapy of Resolution
No. 8351, which has enacted by the City Council of the City of Cupertino,
at their regular meeting of Monday, March 18, 1991.
Sin y, /
DDFdYIW CMW IUS
CITY C-ERK
CITY OF CUPERTINO
DC/so
encl.
cc: Department of Public Works
AGREEMENT
22050 REGNART RD.
APN #366-2-37
Thi, AMMMMU made and entered into this i !��"J day
of .e.�.-e,•c� , l� y�, by and between the OF
CUPFUYNO, a municipal corporation of the State of California, hereinafter
designated as CITY, and RONALD E. RANSEN
hereinafter designated as DEVELOPER.
WITNESSETH
WHEREAS, the DEVELOPER has made application to the CITY for a
PARCEL MAP
to constrict and maintain a
hereinafter referred to as nproject.n
'r4 s, CITY hereby approves the inj=mement plans and specifications
prepared for the Project by KIRKEBY AND ASSOCIATES ;
a true copy of which iWrovement plans and specifications are on file in
the office of the City Engineer of Q.pertino; and
WWMAS, the same are incorporated herein by reference, the same as
though set out in full;
NM, TMMCM, said inpnNemrat plans and spec;ifio tiaras shall be
hereinafter called the "Plans," and the work to be done. =er the Plans
shall be called the "Work."
FILE: 51,866
. 1
WAS, pursuant to the provisions of t1ds AaPE04W, the CI'dY hereby
established the amotmts of Bonds, Fees, and Deposits as set forth in the
following schedule:
SCgMJIE OF BMW, FEES AND DEPOSITS
Street Improvement Category:
PART A. Faithful Performance Bond:
FOURTEEN THOUSAND FOUR HUNDRED DOLLARS AND N0/100 $14 ,400.00
PART B. Labor and Material Bond:
FOURTEEN THOUSAND FOUR HUNDRED DOLLARS AND N0/100 $14,400.00
PART C. checking and Inspection Fee:
SEVEN HUNDRED TWENTY DOLLARS AND NO/100 $ 720.00
PART D. Irxlirer:t City Expenses:
ONE HUNDRED EIGHT DOLLARS AND NO/100 $ 108.00
PART E. Development Maintenance Deposit:
ONE THOUSAND DOLLARS AND NO/100 $ 1,000.00
PART F. Storm Drainage Fee:
SIX THOUSAND, SIX HUNDRED THIRTY ONE. DOLLARS AND NO1100 $ 6,631.00
PART G. One Year Power Cost:
N/A
PART H. Street i'ree3: By Developer
PART I. Map Checking Fee:
TWO HUNDRED TEN DOLLARS AND NO/100 $ 210.00
PAE`i' J. Park Fee: Zone II a/c 480-0000-416-022
THIRTY ONE THOUSAND FIVE HUNDRED DOLLARS AND N01100 $31,500.00
PART K. Water Main nctension Deposit:
N/A
PART L. Maps a rid/or Improvement Plans:
AS SPECIFIED IN ITEM #23
2
NOW, URE, rr IS HEREE't MUM ALLY AG= by and between the
parties hereto as follows, TO WIT:
1. DEDICATION
A. The DEVELOPER offers to dedicate the real property shown on
Exhibit "A", which is attached hereto and made a part hereof by reference.
Said dedicated property shall be free and clear of all liens or
encumbrances except those which the CITY shall waive in writing. The
DEVELOPER agrees not to revoke said offer of dedication, and to keep said
offer open until the CITY accepts offer by resolution..
B. Upon execution of this AGMUMMV the L-EVELAPER agrees to
deliver a properly executed grant deed to the CITY of the real property
described in Exhibit 19A", and such other executed conveyances, or
instruments necessary to omwey clear title as herein required. The
DEVELOPER shall provide, at the DEVELOPER'S sole cost and expense, to the
city:
(1) A preliminary title report issued by a title insurance
ecmrpany relating to the property offered for dedication.
(2) A standard policy of title insurance issued by a title
insurance company and insuring the CITY in the sun of: N/A, and
which shall show said property free and clear of all liens or
encumbrances except those as the Crl"i shall expressly waive in
writing; said policy shall be furnished at the time of acceptance
of dedication and recordation of deed.
C. Upon the condition precedent that the DE.VEMPER ,hall
perform each and evesv covenant and condition of this AGREEKWr, the CITY
agrees to accept said real property offered for dedication.
2. L'JSTAI=ON OF WOM
It is further agreed that:
A. The DEVELOPER shall install and oomplete the Work within one (1)
year fr m the date of execution of this AGREDMERr, or such longer period
as may be specifically authorized in writing by the City Engineer. In the
event the DEVELOPER fails or refuses to complete the Work within the
specified period of time, the CITY, at its sole option, shall be
authorized to complete the Work in whatever manner the CITY shall decide.
In the event the CM oamplete- the Work, the CITY may recover any and all
costs incurred thereby from the DEVE OPI2 *or the DEVELOPER'S surety or
both.
B. The DEVE'IOPER shall install and complete the Work in a good and
workmanlike manner in accordance with the plans as approved by the City
Engiucteer of Cupertino. The Work shall be done in accordance with existing
ordinances and resolutions of the CITY and in accordance with all plans,
specifications, stars, sizes, lines, and grades approved by the City
Engineer. The Work shall be done in accordance with all -State and. County
Statutes applicable hereto,. The decision of the City Engineer shall be
final as to whether any material or workmanship meets the standards,
specifications, plans, sizes, lines and grades as set forth.
3 1 .
C. It is further agreed that the Work shall be dam in accordance
with, the uaost carte standard Specifications of the DqmrWayt of Public
Works, California Department of Itansportation, State of California," and
in accordance with the specifications; of the Cupertino Sanitary District
where applicable.
wherever the words "State" or "California Division of Highways" are
mentioned in the State Specifications, it shall be considered as
referring to the CITY of Cupertino; also wherever the "Director" or
"Director of Public Works" is mentioned, it shall be considered as
referring to the City Engineer.
In case of conflict between the State Spec and the
specifications of .the CITY and/or the Qipertino Sanitary District, the
specifications of the CITY and/or the Cupertino Sanitary District shall
take precedence over and be used in lieu of such conflicting portions.,
3. M(CAVATION PERMIT
It is farther agreed that the DEVEMPER shall ompply with se+cti m
Mires of Or inat>ce No. 130 of the aN by obtaining an eumvation permit
from the City Engineer before the eons, -i-eIna of -any excavation in, on,
or under the surface of any existing public street, lane, alley, sidewalk,
or other public place. It is further agreed that the DEVELOPER shall
notify the city Engineer of the exact date and time when the proposed
excavation is to vammence.
4. QLT11XIAIM DEED
It is further agreed that the DEVEMPER, when requested by the CITY,
shall quitclaim all his rights and interests in, and shall grant to CITY
authorization to extract water from the undLemground strata lying beneath
said project and DEVMPER agrees to execute a "Quitclaim Deed and
Authorization" in favor of CITY, when presented to him for signature.
5. BONDS AND 01M SECURITY
A. Upon the execution of this AG Pr,' the DEVEMPER shall file
with the CITY a faithful performauvca bond to assure his full and faithful
performance of this AGREHMV. The penal sum of said faithful performance
bond shall be the Rill oast of any payment to be made under this
AGREEMENT, the vplus of any land agreed to be dedicated, and any
improvements toa be made under' this AGREEMENT. In the event that
improvements are to be made under this , the DEVELDPER shall, in
addition to said faithful performance, file with the CITY a labor and
materials bond in a penal sum adequate to assure fall payment of all labor
and materials required to construct said ovements. The amp of said
bonds shall be as designated by the City Engineer. Said bows shall be
execrated by a surety company authorized to transact a surety business in
the State of California and must be apyLoved by the City Attorney as to
form and by the City Engineer as to sufficieaycy. In the event that the
DEVEMPER shall fail, faithfully to perform the covenants and conditions of
this AGREEMaM, or to make any payment, or any dedication of land, or any
improvements herein required, the CITY shall call on the surety to perform
this AGE or otbeuwise indemnify the Cat for the DEVEIDPER's failure
to so do.
A
B. in lieu of a,surety bond, the MVELDMR may elect to serum this
Aalr by depositing with the CITY:
1. Cash; or,
2. A cashier's check, or a certified check payable to
the order of the City of ojpertino; or,
3. A Certificate of deposit, or instrument of credit meeting
the requirements of Goterrament Code Section 66499 (b) or
(C) .
C. The amount of said cash, rhedJcs, certificate of deposit, or
instrument of credit shall be as designated by the City Engineer, and
sha11 be the equivalent to that which would have been reqUired had the
D=DPER t=nished the CITY with a surety bond. In the event that the
DEMOPM shall fail faithf'ully to perform the covenants and conditions of
this Fir, or to make any payment, or any dedication of land, or any
improvements herein required, the CTPY may apply the proceeds of said
security thereto.
D. No release of surety band, cash deposit, check, or certificate of
deposit, shall be made except upon approval of the City Council.
E. No interest shall be paid an any security deposited with the
CITY.
6. CHECKM AND INSPECrICN FEE
it is further agreed that MVEIDPER shall pay any and all necessary
direct expenses for inspection, checking, etc., incurred by CITY in
Connection with said Project, and that CAPER shall have deposited with
CITY, prior to execution of this AGOMMM, the amount as set forth herein
at Page 2 (Part C) . Should construction coat vary materially frcem the
estimate from which said sum is calculated, the City Engineer shall notify
DE VEMPER oyff�any
gpladditional sum due and owing as a result thereof.
. INDn::U EXPENSES
It is further agreed that MVEMPER shall pay to cny, prior to
execution of this AGREMMr, indirect expense allocable to processing
these impr fements, the amount as set forth herein at Page 2 (Part D) .
a. MAP CHEMM4G FEE
It is flurthw agreed that the MMEMPER shall deposit with CI'I`Y, prior
to exeoaticn of this AMMOUM, for office checking of final map and
field checking of street m um eats, in conpliance with section 4:1 of
Ordinance No. 47 (Revised 12/04/61) of CTrYY, the amount as set forth
herein at Page 2 (Part I) .
9. DEVELOPMENT HATfnlY ONCE; DEPOSIT
It is further age that the DwaDPER stall pay to the CITY, prior
to wmOJticn of this Ate.', the ammunt sat forth herein at Page 2
(Part E) as a develapwnt maintenance deposit to insure proper dust
control ani cleaning during the oonstruction period. The developuent
maintenance deposit may be utilized for repairs of defects and
imperfections arising out of or due to faulty workmarship and/or materials
appearing in said work during the period until release of the luprovement
bonds by the CITY. Should the DEVELOPER omplete the required repairs to
the entire satisfaction of the CITY, the unused balance will be returned
after the release of the .improvement bond.
10. SZCM DRAINAGE FEE
It is further agreed that the DEVEMPER shall deposit with the CITY,
prior to execution of this AGREEMENT, a storm drainage charge in
connection with the said Project in accordance with the requirements
established in Resolution 4422, Mare 21, 1977, in the amount as set forth
herein at Page 2 (Part F) .
11. WATER MAIN EXMSION DEPOSIT
The DEVELOPER further agrees to deposit with the CITY those monies
required to oomply with "Policy on Water Main Extensions Work and
Deposits" dated 9/30/77. The deposit shall be held by the CITY until said
monies are needed to implement isprovements outlined by the Director of
Public Works or improvements cutlined within the adopted Water Master
Plan.
The amount shaven herein at Part K, Page 2, shall be the full amount
due.
12. ONE YEAR TOWER COST
It is further agreed that the DEVELOPER shall pay to CITY prior to
execution of this AGREEMF1U, the amount as set forth herein at Page 2
(Part G), which amount represents the power cost for street lights for one
year.
13. THE INSTALLATION OF SnUM TREES
It is further agreed that the DEVELOPER shall, at such time as deemed
appropriate by the City Engineer, plant street trees in conformance with
the standards of the City of Cupertino. 'Variety of tree shall be selected
from the City approved list.
14. PARK FED
It is further agreed that the DEVELOPER shall pay such fees and/or
dedicate such land to the CITY, prior to execution, as is required within
Section 18-1.602 Park Land Dedication, C-,pertino Municipal Code, and which
is further stipulated under Part J, Page 2 herein.
6
14-A. PA t FEZ ADJU52MM '-O-�ICNS
Me value of the land used in establishing the "Park Fee" outlined
herein' on Page 2, Part J, requires formal confirmation. The CITY
shall es play a qualified local appraiser to provide a market value of the
land. 'Dze City will calculate the "Park Fee" bayed an the appraisal. The
Developer agrees to pay for any deficiency:within thirty. (30) days and the
City agrees to refund average within thirtj► (3 0) days. Adjustments shall
be made prior to acceptance of the subdivision inptrovements.
13. lit:Tti"IT` CF FX�RK
It is ful..Iter agreed that the DEVEIDPFUR shall maintain the Work until
all deficiencies in the Work are corrected to conform to the Plans and the
City standards and specifications for the Work. The DEVELDPER shall, upon
written notice thereof, ;Rmediately repair or replace, without c^st or
c^bligaticn to the. City of Cunerrtina, and to the entire satisfaction of
said C'1''IY, all defscts and imperfecti=s arising out of or due to faulty
wor!cra hip and/or materials appearing in said Work.
16. SANY= DISTRICT
It is fu-ther agreed that the DE=PER shall file with CITY, =on
execution of this AG Nr, a letter frctn the C=ertino Sanitary District
sratinq that the DEVII'.DPE.R has entered into a separate AG? 'T with the
said Dist=-,ct to in—mall sanitary sewers to serve all lots within said
Project and stating that a bowl to insure full and faithful performance of
the cons`v'tual on of the said sanitary sewers and to insure maintenance of
said sanitary sewer in conformance with. the provisions as set forth in
Paragraph 15 above has been filed.
17. COVMM NT CODE
It is furthesr agreed that DEVELOPER, shall file with CITY, upon
execution of, 'J- i s AGREEMENIr, substantial evidence that all provisions of
Section 66493, Article 8, Chanter 4 of the Government Code, pertaining to
special assessments or bonds, have been flied with.
18. CENTRAL Fin DISTRICT
it is further agreed that the DEVELOPER. shall file with the CITY, upon
execution of this AGRMUM, a letter from he Central Fire Protection
District of Santa Clara County, stating thou:, the MMOPFR has entered
into an ACC with said Di.stxlct to install fire hydrants to serve
said Project and stating that all necessary fees have been deposited with
said District to insure installation and five (5) year rental fee of said..
hydrants.
. i
19. PACIFIC GAS AND =4MaC/PACMC HELL :
i
it is further agreed that the DEVELOPER shall pay to Pacific Gas and
Electric Company and/or to PACMC EELL C=pany any and all fees required
for installation og. overhead a*of ua7di wring circuits to all
eleCtrvl{err within ,said property and any and' all fees required for -
undergrounding as pravided in Ordinary No. 331 of cny when mvErzopm is
notified by either the City Engineer or the Pacific Gas and Electric
C many and/or PAt3 c HT Company that said fees are due and payable.
7
20. EA AM RIGH1-OF-Why
It is further agreed that any easement and right-of-way necessary for
vcpletion of the Project shall be acquired by the DEVELOPER at his own
cost and expense. It is provided, however, that in the event eminent
domain proceedings are rid by the CITY for the purpose of securing
said easement and right-of-way, that the DOVELOPER shall deposit with CITY
a sutra covering the reasonable market value of the land proposed to be
taken and to be included in said sum shall be a reasonable allowance for
severance damages, if any. It is further provided that in addition
thereto, such sums as may be required for legal fees and costs,
engineering, and other incidental costs in such reasonable amounts as the
CITY may require, shall be deposited with the City of Cupertino.
21. HOLD FSS
It is further agreed that, couvencirg with the performance of the Work
by the DEVELOPER or his contractor and continuing until the completion of
the r. of the Work, the DEVELOPER shall indemnify, hold harmless
and defend the CITY from and against any or all lose, coat, expense,
damage or liability, or claim thereof, occasiorked by or in any way
whatsoever arising out of the performance or n rVerformanoe of the Work or
the negligence or willful misconduct of the DEVELOPER or the DEVELOPER'S
agents, employees and independent contractors.
22. INSURANCE
It is further agreed that: The WMDPER shall take out, or shall
require any contractor engaged to perform the Work to take out, and
maintain at all times during the performance and maintenance of the Work
called for or required to be done hereunder, a policy of insurance naming
the CITY and members of the City Council of the City of Cupertino,
individually and collectively, and the officers, agents and employees of
the City individually and collectively, as insured. Said separate policy
shall provide bodily injury and property damage coverage to the foregoing
named CITY and individuals covering all the Work performed by, for, or on
behalf of said DEVELOPER. Both bodily injury and property damage insurance
mist be on an ovcurrexm basis; and said policy or policies shall provide
that the coverage afforded thereby shall be primary coverage to the full
limit of liability stated in tcie declarations, and if the city, its
members of the City Council individually and collectively, and the
officers, agen.t®, and employees of the CITY, individually and
, collectively, have other insurance against the loss covered by said policy
or policies, that other insurance shall be eras insurance only.
The insurance carrier shall provide proof of their ratings. All ratings
shall be a minimum of "Best A-7" in accordance with ABAG policies.
A. Each of said- policies of insure:>�e shall provide coverage in the
following minis amotzits: For bodily injury, $100,000 each person;
$300,000 each o0casreace, property damage, $50,000 on account of any
one occurrence with an aggregate limit of not less than $200,000.
B. The DEVELOPER shall file with the City Enngiraer at or prior to
the time of execution of this AL IT by the DEVELOPER such evidence
of said foregoing policy or policies of insurance as shall be
satisfactory to said City Engineer. Each such policy or policies shall
bear an endorsement precliz ing the cancellation or reduction in
coverage without giving the City Engineer at least ten (10) days
advance notice thereof.
C. In the event that the Project covered herein should be mutually
situated in or affect the area of jurisdiction of a separate
mmicipality or political subdivisicn of the State of California, the
policies of insurance required herein and above shall co-name such
municipality or political subdivision and the provision set forth
herein and above for the protection of the CITY shall equally apply to
municipality and political subdivision.
23. MAPS AND/CR nGMVEMERr PLANS
It is further agreed that the CITY shall obtain: the following map
and/or plans at the DEVELOPER'S expense:
A. A mylar sepia and seven (7) prints of fully executed paroel map.
B. A mylar sepia and ten (10) prints of fully executed improvement
plans.
C. A direct duplicating silver negative microfilm aperature card of
all executed improvement plans and map.
The DEVELOPER agrees to pay the CITY fxnm the development maintenance
deposit the cast for all pints of plans and map required under Item 23.
24. SUCCESSORS
This AGREEMENT shall bind the heirs, administrators, executors,
successor, assignee and txanmsferzees of the DEVELOPER. The assignment of
this AGREEMENT shall not be made without approval by the City Council of
the City of 04=tino.
f
o
GENERAL
r
• State of California ) On this the Sth day of March, 1991,
before me, Rcberta Arm Wolfe, the
County of SaritaGlara } undersigned Notary Public, personally
pioved to me on the basis of
` satisfactory evidencss to be the
person(s) whose name(a) eat! subscribed
r ' to the within and
' acknowledged that executed it.
S 1, .i.iNESS my hand and official seal.
t /
IN W1'gi EW MUMOF, ' W has cast its tea to be hereunto affixed by
its Mayor and City Clerk, theo duly autliori.aed by resolution of the
city Council and rs�aiidy DEVELOPER has heroxft caul his name to be affixed
the day and year first above written.
CAM OF :
Approved as to foria:
J�(��a4--IL2-
Mayor
f
City Attorney
City Clerk
DEVELOPER:
Notary Ac)a=1edqpmt Required!
t
CITY OF CUPERTINO
INTERDEPARTMENTAL Date March 20, 1991
SUMI
From PUBLIC WORKS--
To CITY CLERK _
Cj Information MESSAGE: RONALD E. HANSEN PRO.;ECT (CC 3/18/91)
C1 Implement 22050 REGNART ROAD
Investigate
Discuss 1 Three sets of agreement for processing.
See me
Reply 2 Certificate of Insurance, 2/19/91.
3. Bond, Maximum Yield Certificate, Great Western Bank,
on file in Finance.
sm
attach.
onald E. Hansen
Reply: 22050 Regnart Road —
Cupertino, CA 95014
SIGNED: DATE _
Send parts 1 and 2; retain part 3 for follow-up; part 2 to be returned with reply
• lihis form is.®r-� 't'S!e EVhange or Company designated on the reverse side as number 3 _
issued by tJ
A%ace;n safe company.here,,caked the ro nv:3ry Cay ana Este
' E-4'15S
Named insured . 'RONALD E HANSEN Ist Editn
22050 REGART 96 71 354 90466 41 43
CUPERTINO CA 95014 _
Agent Polley Number
EllectiveNT
PART i CERTIFICATE AS TO EVIDENCE OF INSURANCE ® APPLICABLE APPLICABLE
p,_ �C e t eC �� T I rangy �
TFIS ;;; .:s AF .r,StSRAt�tCt: _�ttC- ?NI _ f_.i:_Y �, �ERI r�tT14�� Of ItvStJrtP,fu�E If 00�., �0� iP At��Y �a�., ai.l,,,. t��x�E �i) OR
ALTER ',H[ UO) [_Pi AGE PROV!OE1"> BY 'l-i( t','L!OES t.';i'f€? BEL Ovi
COVERAGE IS INDICATED BY AN 'X' v LIMITS OF LIABILITY
X I Bodily Injury& Property Damage Lability _! _ $ 500 ,000 each occurence —
Location of 22050 REGNART
Property or CUPERTINO CA 95014
Equipment
$ retained limit
_ Umbrella Liability $ each occurrence
POLICY NUMBER
$ aggregate
Description YEAR AND TRADE NAME IDENTIFICATION NUMBER
nl LAST 3
Equipment DIGITS
SHOWN
This certificate is subject to a(i of the terms,conditions and limitations set forth in the policy(tes)and endorsements attached to it. It is furnished as a matter
of Information only and does not change, modify or extend the policy in any way. It supersedes all previously issued certificates.
PART iI _ ADDITIONAL. INSURED ENDORSEMENT K-1 APPLICABLE CI APPLICABLE
We agree with you that the ,additional insured named below is covered for Bodily Injury and Property
Damage Liability arising from acts or omissions of the insured or insured person as owner or who has care, custody
or control of the insured property or equipment described above.
The coverage provided by this endorsement will not apply to:
a. liability arising out of the negligence of the additional insured named below,
its agents or employees, or
b. any defect of material, design or workmanship in any property or equipment.
The additional insured shall not be construed or deemed to be a subscriber to the Company issuing this policy.
The additional insured shad not be or become liable for any premium payments due upon this policy.
The insurance afforded by the policy described above is subject to all terms of the policy and any endorsements attached
to it, This endorsement does not increase the limits of the policy.
Upon cancellation or termination of this
policy or policies from any cause
we will mail 10 __ days notice in
writing to the other interest shown Wow.
Additional • CITY OF CUPERTINO AND MEMBERS OF THE CITY CONSUL OF THE CITY OF
Insured • CUPERTINO, INDIVIDUALLY AND COLLECTIVELY AND OFFICERS, AGENT
• AND EMPLOYEES OF THE CITY OF CUPERTINO, INDIVIDUALLY AND
COLLECTIVELY
HG 2-19-91 Countersigned'
914158 IST EDITION I INStlREn COPY Authorize ignature G4WI51
"AM All S,IF ANY.
�s
PROTECTOR PLUS
y 9
FIRE INSURANCE EXCkiAh0E, LOS ANGELES, CALIFORNIA
�..
e
AMENED. WITH E4158
AGENT—EARLS NUNES—PH• 4-15/459-1877
cT15-9 c �' 3-91 1= -W1 AM .
iacked ,this I�, w cantinas far successive poficl►pesleds as follow: al;
renew this policy it you pay the Wpred S,xl V eacl! J� 1'S lti
forms then in effect You Plus,. imy us,60! % 11! i', ' the C,.,!ei}i, y it 3 mortgage. ice+
named in this plop, we will confinue this insurance for tfle mortgawe '=. Oteres to,, of ter!n+nation to
Vile nwrtgagse and then this pony will termiriata.
RONALD E HANSEN F 90466 41 43
22050 REGNART
CUPERTINO CA 95314 96-71`-354
Same as nm!lnq aaatesS wilp i,
+ +r+ 0 0 8 8 R DESELMS
% R HANSEN
22050 REGNART RD
CUPERTINO CA 95OO14
We provide icsurjn� .)niv tor
_..r _ -- -
A - C.ael!inr; l t; �,=.r,..:�lE ,���i. EARTHQUAKE
or Moblie Horrini 5luc?:r ;; GLASS
261,0 0 81,1 195,75—, 13C, CC S0CQC0C 1,00C
Incur AWNER
ProtectionPremium 6r)up
- ---
E6179 ED 4 E4 a14 8.rCC <E170 1ED 1
!
t
Deductible - Gov. A, B or C S ,C C D f=-tceo o l L...
In case of a loss under Cov. A. 13, or tC we cover o"Ov thl'! P401 t2t ,
'For Landlords Protector, Coverage h is t at Ren-. C(Nelarfe
5C
0 D d 8 R DESELMS C4
22050AREGNART RO 'P.O. SOX 1897 Y
CUPERTINO CA 95014 iPLEASANTON, CA 9456b [[ii , C2—�15-91
10% EARTHQUAKE DEO APPLIES SEPARATELY TO COV A#B,C AMOOJ TS, OF INS
NON—SMOKER
This Declarations page is part of your polir� it SUIersed s and L::,' i r; to _?ii other lerP1S
of the policy. '
Countersigned
ss.< ,a,a-ea MOM S mveme Side for Under's Loss P4pbla End. o"'DETACH HERE"y Authorized Re l y
a.a lwoi