02-039 Republic Electric - Foothill Blvd. Bike Facility Imp. Proj. No. 9448RECORDING REQUESTED BY
City of Cupertino
WHEN RECORDED MAIL TO
City Clerk's Office
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
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Titles 1 /Pages
Fees....* No Fees
Taxes...
Copies..
AMT PAID
3
E3RENDA DAV I S
`SANTA CLARA COUNTY RECORDER
f~ecorded at the request of
!; i t y
RDE ~ 004
9/23/2002
12 42 PM
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE INACCORDANCE
WITH GOV. CODE 6103
CERTIFICATE Ole COMPLETION
AND
NOTICE OF ACCEPTAI\fCE OF COMPLETION
FOOTHILL BOULEVARD BICYCLE FACILITY IMPROVEMENTS PROJECT
PROJECT NO. 9448
_~ ~,
~ .~
Original
~ For Fast Endorsement
`'~~
CITY OF
CUPEI~TINO
City Hall
10300 Torre Avenue
Cupertino, CA 95014-3255
(408) 777-3354
FAX (408) 777-3333
PUBLIC WORKS DEPARTMENT
CERTIFICATE OF COMPLETION
ANI~
NOTICE OF ACCEPTANCE OF COMPLETION
FOOTHILL BOULEVARD BICYCLE FACILITY IMPROVEMENTS PROJECT,
PROJECT ]v0. 9448
NOTICE IS HEREBY GNEN THAT I, Ra:~ph A. Qualls, Jr., Director of Public Works and
City Engineer of the City of Cupertino, California, coo hereby certify that the work and improvements
hereinafter described in the contract for doing whi~~h was entered into by and between the City of
Cupertino and Republic Electric on May 13, 2002, iti accordance with the plans and specifications for
said work, have been completed to my satisfaction <<nd acceptance of completion was ordered by the
City Council on September 17, 2002.
That said work and improvements consisted of funiishing all labor, materials tools, and equipment
required to complete said project, all as more particularly described in the plans and specifications for
said project.
~'~.c..Q l,.l GC Cam!
L>irector of Public Works and
City Engineer of the City of Cupertino
Date: September 17, 2002
Printed on Recycled Paper
VERIFICATION
I have reviewed this Certificate of Completion and Notice of Acceptance of
Completion. To the best of my knowledge, the information contained herein is true and
complete.
I verify under penalty of perjury under the laws of the State of California, that the
foregoing is true and correct.
Executed on the 19th day of September 2002 at Cupertino, California.
~~~~~~
Administrative Clerk
City of Cupertino
CONTRACT FOR PUBLIC WORKS
This CONTRACT made on (, ~ ~ _, 2002, by the CITY OF CUPERTINO, a
municipal corporation of the State o California, Yereinafter called CITY, and Republic Electric,
7120 Redwood Boulevard, Novato, CA 94945, hereins~fter called CONTRACTOR.
IT IS HEREBY AGREED by CITY and CONTR~.CTOR as follows:
1. THE CONTRACT DOCUMENTS. The complete contract consists of the following
contract documents:
a. Notice to Contractors, Proposal, Time of Completion, Estimated Quantities, Noncollusion
Affidavit, Bidder Qualification Form, Subcontractors Form and Signature Form.
b. Standard Specifications, General Provisions and Special Provisions.
Plans and Specifications for respectively Foothill Boulevard Bike Facility Improvement Project,
Project No. 9448.
d. Faithful Performance Bond and Materials Bond.
e. Insurance Agreement, Certificate of Insurance, Endorsement of Primary Insurance,
Additional Insured Endorsement, Endorsement of Aggregate Limits of Insurance per Project,
Waiver of Subrogation Endorsement Worker'; Compensation Insurance and Notice of Policy
Cancellation Endorsement.
f. This Contract for Public Works.
All of the above documents are intended to coopc;rate so that any work called for in one and not
mentioned in the other, or vice versa, is to be e~:ecuted the same as if mentioned in all of said
documents. The documents comprising the complete contract are sometimes hereinafter referred
to as the Contract Documents. In case of conflict between the Plans and the Specifications on the
one hand, and this Contract on the other, the Plan;; and Specifications shall prevail.
2. THE WORK. CONTRACTOR agrees to furnish all of the labor, methods of process, tools,
machinery, and materials necessary to perform and complete in a good and working order, the work
of traffic signal modifications and upgrades, as called for, and in the manner designated in, and in
strict conformity with, the Plans and Specifications prepared by the Engineer and adopted by CITY,
which Plans and Specifications are entitled, Foothill Boulevard Bike Facility Improvement Project,
Project No. 9448, and which -Plans and Specifications are identified by the signatures of the parties
to this Contract. It is understood and agreed that: said tools, equipment, apparatus, facilities, labor,
transportation and materials shall be furnished, and that said work shall be performed and
completed as required in said Plans and Specifications under the sole direction of CONTRACTOR,
but subject to the inspection and approval of CITY, or its representative. CITY hereby designates as
its representative for the purpose of this Contract the Engineer, Ralph A. Qualls, Jr.
Contract Page 1 of 6
3. CONTRACT PRICE. CITY agrees to pay, and CONTRACTOR agrees to accept, in full
payment for the work above agreed to be dc-ne, the sum of $86,450.00 (EIGHTY-SIX
THOUSAND FOUR HUNDRED FIFTY AND I)0/100 DOLLARS) subject to additions and/or
deductions as provided in the Contract Documents, per Exhibit A attached hereto.
4. DISPUTES PERTAINING TO PAYMENT FOR WORK. Should any dispute arise
respecting the true value of the work done, or any work omitted, or any extra work which
CONTRACTOR may be required to do, or respecting the size of any payment to
CONTRACTOR during the performance of this Contract, said dispute shall be determined either
by reference to the Unit Prices bid, if applicable. or in accordance with agreement of prices, if
applicable, or in accordance with the agreement of the parties, or in accordance with Section 6,
paragraph "f' of the General Provisions.
5. PERMITS, COMPLIANCE WITH LAW,. CONTRACTOR shall obtain and bear all
expense for all necessary permits, licenses and ea:;ements for the construction of the project, give
all necessary notices, pay all fees required by law, and comply with the laws, ordinances and
regulations relating to the work and to the preserv;~tion of the public health and safety.
6. INSPECTION BY THE CITY. CONTRACTOR shall at all times maintain proper
facilities and provide safe access for inspection by CITY to all parts of the work, and to the shops
wherein the work is in preparation. Where the Specifications require work to be specially tested
or approved, it shall not be tested or covered up without timely notice to CITY of its readiness
for inspection and without the approval thereof ~~r consent thereto by CITY. Should any such
work be covered up without such notice, approv~il, or consent, it must, if required by CITY, be
uncovered for examination at CONTRACTOR'S expense.
7. EXTRA OR ADDITIONAL WORK AND CHANGES. Should CITY at any time during
the progress of the work require any alteration:;, deviations, additions or omissions from the
Plans and Specifications or the Contract Documents, CITY shall have the right to do so, and the
same shall in no way affect or make void the Contract, but the cost or value thereof will be added
to, or deducted from, the amount of the Contract price, as the case may be, by a fair and
reasonable valuation, which shall be determined. either by reference to the Unit Prices bid, if
applicable, the Standard Specifications, or in accordance with the agreement of the parties. No
extra work shall be performed or change be made except by a written order from CITY, duly
authorized by resolution of the City Council, and. by all agencies whose approval is required by
law, stating that the extra work or change is authorized, and no claim for an addition to the
Contract sum shall be valid unless so ordered.
8. CHANGES TO MEET ENVIRONMENT~~L REQUIREMENTS. CITY shall have the
right to make changes in this Contract during th<; course of construction to bring the completed
improvements into compliance with environmental requirements or standards established by
State and Federal statutes and regulations after the Contract has been awarded or entered into.
CONTRACTOR shall be paid for such changes either by reference to the Unit Prices bid, if
applicable, or in accordance with the agreement of the parties.
Contract Page 2 of 6
9. TERMINATION, AMENDMENT OR iv[ODIFICATION. This Contract may be
terminated, amended or modified, with the mutual consent of the parties. The compensation
payable, if any, for such termination, amendment or modification, shall be determined either by
reference to the Unit Price bid, if applicable, the Standard Specifications, or in accordance with
the agreement of the parties.
10. TIME FOR COMPLETION. All work under this Contract shall be completed in
accordance with the Time for Completion section in the Proposal and the Specifications of this
project. If CONTRACTOR shall be delayed in the work by the acts or neglect of CITY, or its
employees, or those under it by contract or otherwise, or by changes ordered in the work, or by
strikes, lockouts by others, fire, unusual delay in transportation, unavoidable casualties or any
causes beyond CONTRACTOR'S control, or by delay authorized by CITY, or by any cause
which CITY shall determine justifies the delay, then the time of completion shall be extended
accordingly. This paragraph does not exclude thf; recovery of damages for delay by either party
under other provisions in the Contract Documents.
11. INSPECTION AND TESTING OF MATERIALS. CONTRACTOR shall notify CITY
a sufficient time in advance of the manufacture, production or testing of materials to be supplied
under this Contract, in order that CITY may arrange for mill, factory or laboratory inspection and
testing of same.
12. TERMINATION FOR BREACH OR IrISOLVENCY. If CONTRACTOR should be
adjudged a bankrupt, or should make a general assignment for the benefit of creditors, or if a
receiver should be appointed on account of insolvency, or if CONTRACTOR or any
subcontractor should violate any of the provisions of the Contract, CITY may serve written
notice upon CONTRACTOR and CONTRACTOR'S surety of its intention to terminate the
Contract. Such notice shall contain the reasons for CITY'S intention to terminate the Contract,
and unless within ten (10) days after serving of such notice, such violation shall cease and
satisfactory arrangements for corrections thereof 1>e made, the Contract shall, upon the expiration
of said ten (10) days, cease and terminate. In 1:he event of any such termination, CITY shall
immediately serve notice thereof upon CONTR~~CTOR'S surety and CONTRACTOR, and the
surety shall have the right to take over and perform the Contract; provided, however, that, if the
surety within fifteen (15) days after the serving upon it of notice of termination does not give
CITY written notice of its intention to take over and perform the Contract, or does not commence
performance thereof within thirty (30) days from the date of the serving of such notice, CITY
may take over the work and prosecute the san:ie to completion by contract, or by any other
method it may deem advisable, for the account and at the expense of CONTRACTOR, and
CONTRACTOR AND CONTRACTOR'S surety shall be liable to CITY for any excess cost
occasioned by CITY thereby, and in such event CITY may, without liability for so doing, take
possession of, and utilize in completing the work, such materials, appliances, plant and other
property belonging to CONTRACTOR as maybe on the site of the work and necessary therefor.
13. THE CITY'S RIGHT TO WITHHa~LD CERTAIN AMOUNTS AND MAKE
APPLICATION THEREOF. In addition to amounts which CITY may retain under other
provisions of the Specifications until final completion and acceptance of all work covered by the
Contract, CITY may withhold from payment to (CONTRACTOR such an amount or amounts as
in its judgment may be necessary to pay just claims against CONTRACTOR or subcontractors
for labor and services rendered and materials furnished in and about the work.
Contract Page ?~ of 6
City may apply such withheld amount or amounts to the payment of such claims in its discretion.
In doing so, CITY shall be deemed the agent of (:ONTRACTOR, and any payment so made by
CITY shall be considered as a payment made un~3er the Contract by CITY to CONTRACTOR,
and CITY shall not be liable to CONTRACTORZ for any payment made in good faith. Such
payment may be made without prior judicial determination of the claim or claims. With respect
to any retention of payment by CITY to ensure ~~erformance of the Contract, CONTRACTOR
will be entitled to substitute securities as provided in Section 4590 of the California Government
Code as more fully described in CITY'S Notice to Contractors.
14. NOTICE AND SERVICE THEREOF. Airy notice from one party to the other under this
Contract shall be in writing, and shall be dated and signed either by the party giving such notice,
or by a duly authorized representative of such party. Any such notice shall not be effective for
any purpose whatsoever unless served in the fo:~lowing manner: (a) if the notice is given to
CITY, either by personal delivery thereof to the F~,ngineer of CITY, or by depositing same in the
United States mails, enclosed in a sealed envelope, addressed to CITY OF CUPERTINO; 10300
TORRE AVENUE; CUPERTINO, CA 95014; postage prepaid and certified; (b) if the notice is
given to CONTRACTOR, either by personal delivery thereof to CONTRACTOR, or to
CONTRACTOR'S duly authorized representative at the site of the project, or by depositing same
in the United States mails enclosed in a sealed envelope, addressed to REPUBLIC ELECTRIC,
7120 REDWOOD BOULEVARD, NOVATO, C.~ 94945, postage prepaid and certified; and (c)
if notice is given to CONTRACTOR'S surety or any other person, either by personal delivery
thereof to CONTRACTOR'S surety or other person, or by depositing same in the United States
mails, enclosed in a sealed envelope, addressed to CONTRACTOR'S surety or person, as the
case may be, at the address of CONTRACTO[~'S surety or the address of the person last
communicated by such person to the party giving the notice, postage prepaid and certified.
15. ASSIGNMENT OF CONTRACT. Neither the Contract, nor any part thereof, nor moneys
due or to become due thereunder, shall be assigned by CONTRACTOR without the prior written
approval of CITY.
16. COMPLIANCE WITH SPECIFICATIONS OF MATERIALS. Whenever in the
Specifications, any material or process is indicated or specified by patent or proprietary name, or
by name of manufacturer, such Specifications rr~ust be met by CONTRACTOR, unless CITY
agrees in writing to some other material, process or article offered by CONTRACTOR which is
equal in all respects to the one specified. It shall be CONTRACTOR'S responsibility to prove
equality of any such material, process or article offered as a substitution to the one(s) specified.
17. WORKER'S COMPENSATION INSURANCE AND EMPLOYER'S LIABILITY
INSURANCE. CONTRACTOR shall take out and maintain during the life of this
Contract Worker's Compensation Insuran~~e and Employer's Liability Insurance for all of
CONTRACTOR'S employees employed at the site of the project. In case any work is
sublet, CONTRACTOR shall require an.y and all subcontractors similarly to provide
Worker's Compensation and Employer''s Liability Insurance for all of the latter's
employees unless such employees are covered by the protection afforded to the
CONTRACTOR.
Contract Page 4 of 6
In signing this Contract CONTRACTOR makes the following certification, required by Section
1861 of the Labor Code: "I am aware of the provisions of Section 3700 of the Labor Code which
requires every employer to be insured against liability for worker's compensation or to undertake
self insurance in accordance with the provisions c~f the Labor Code, and I will comply with such
provisions before commencing the performance ol'the work of this Contract."
18. ACCIDENT PREVENTION. Precaution s1~a11 be exercised at all times for the protection
of persons (including employees) and property,. The safety provisions of applicable laws,
building codes and construction codes shall be observed. Machinery, equipment and other
hazards shall be guarded or eliminated in accordance with the safety provisions of the
Construction and Safety Orders issued by the Industrial Accident Commission of the State of
California.
19. CONTRACTOR'S RESPONSIBILITY FOR THE WORK. CONTRACTOR shall not be
responsible for the cost of repairing or restoring damage to the work caused by Acts of God.
NEVERTHELESS, CONTRACTOR shall, if the insurance premium is a separate bid item,
obtain the insurance to indemnify CITY for any damage to the work caused by Acts of God.
"Acts of God" shall include only the follov~ing occurrences or conditions and effects:
earthquakes and tidal waves, when such occurrences or conditions and effects have been
proclaimed a disaster or state of emergency by the President of the United States or by the
Governor of the State of California, or were of a magnitude at the site of the work sufficient to
have caused a proclamation of disaster or state of emergency having occurred in a populated area.
Subject to the foregoing, CITY shall not, in any way or manner, be answerable or suffer loss,
damage, expense or liability for any loss or dam~ige that may happen to said building, work, or
equipment or any part thereof, or in, on, or abort the same during its construction and before
acceptance.
20. CONTRACTOR'S GUARANTEE. CON"CRACTOR unqualifiedly guarantees the first-
class quality of all work and of all materials, ~ipparatus and equipment used or installed by
CONTRACTOR or by any subcontractor or supplier in the project which is the subject of this
Contract, unless a lesser quality is expressly authorized in the Plans and Specifications, in which
event CONTRACTOR unqualifiedly guarantee; such lesser quality; and that the work as
performed by CONTRACTOR will conform wirh the Plans and Specifications or any written
authorized deviations therefrom. In case of any defect in the work, materials, apparatus or
equipment, whether latent or patent, revealed to CITY within one (1) year of the date of
acceptance of completion of this Contract by CITY, CONTRACTOR will forthwith remedy such
defects without cost to CITY.
21. DEFERRED ALTERNATE SELECTION. The City reserves the right for the term of the
Contract, the deferred selection of none, any or all alternate bid items at the bid price. The
alternates chosen would be for any sites currentl~~ under construction or to be constructed in the
future.
Contract Page 5 of 6
P.O. No.
IN WITNESS WHEREOF, the parties have e:Kecuted this Contract, in duplicate, the day and
year first hereinabove written.
CIT F CUP RTINO:
By: S r 3. o z
City Manager
Attest: L
City C rk
Date: yYl 13 , 2002
ity Clerk
APPROVED AS TO FORM:
City Atto y
CONTRACTOR:
Republic Electric
Nomacknowledgment is required. If a
corporation, corporate seal and corporate
notary acknowledgment and Federal Tax
I.D. are required. If not a corporation, a
Social Security No. is required.
Social Security #
(~~3 - 02~C~'~-"z~-
Federal Tax I.D. #
Contractor's License No. ~"a'I S4-
PROJECT NAME & NUMBER: Foothill Bo~zlevard Bike Facility Improvement Project,
Project No. !448
CONTRACTOR NAME
& ADDRESS
CONTRACT AMOUNT:
ACCOUNT NUMBER:
Republic Electric
7120 Redwood Boulevard
Novato, CA 94945
$86,450.00
270-9448-7014
FILE NO.: 74,009.15
Contract Page 6 of 6
CALIFORNIA ALL-PURPOSE ACKNOWLEDiGMENT
State of California
l~t ~ n ss.
County of
On ~ ' ~ "d~ before
Date _
Name and Ft(~ of OKicer (e.g., "Jane Doe, Notary
personally appeared
LAURA J. KIRWAN-BENSON
_ Commission # 1331537 Z
Notary Public - Califomia ~
Merin County
My Comm. E>~Ires Nov 22, 2005
Name(s) of Signer(s)
rsonally own to me
^ proved to me on the basis of satisfactory
evidence
to be the person( whose name( is/~
subscribed to the within instrument and
acknowledged to me that he/she/t4~ley executed
the same in his/h /t r authorized
capacity(i and the by his/fy(~r/tlj6ir
signature(~on the instrument the person, or
the entity upon behalf of which the person
acted, executed the instrument. ~_
WI NESS my an and offici seal.
ig ature of Not ubl'
OPTIONAL
Though the information below is not required bylaw, it may prove valuable to persons relying on the document and could prevent
fraudulent removal and reattachmen.' o/this form to another document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name:
^ Individual Top of thumb here
^ Corporate Officer -Title(s):
^ Partner - ^ Limited ^ General
^ Attorney-in-Fact
^ Trustee
^ Guardian or Conservator
^ Other:
Signer Is Representing:
®1999 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatswonh, CA 91313-240:! • www.nationalnotary.org Prod. No. 5907 Reorder: Call Toll-Free 1-800-876-6827
INSURANCE FORM;i INSTRUCTIONS
FOR ITEMS 3, 4, 5 AND 6, THE FORMS PROVIDED BY THE CITY OF CUPERTINO
MUST BE USED. FORMS OTHER THAN THESE WILL NOT BE ACCEPTED.
ALL DOCUMENTS MUST BE ORIGINALS -SUBMIT IN TRIPLICATE
1. Insurance Agreement -Must be signed by Contractor.
2. Certificate of Insurance to the City of Cuperti~lo -must be completed by the insurance agent
or must provide a certificate on the company's for.•m. They must contain the same information.
3. Endorsement of Primary Insurance -must be signed by the insurance agent for general
liability and automobile liability only.
4. Additional insured endorsement -must be signed by the insurance agent for general liability
and automobile liability only.
5. Comprehensive general liability/commercial general liability endorsement of aggregate limits
of insurance per project - must be signed by the insurance agent for general liability only.
6. Waiver of subrogation endorsement worker's c;ompensation insurance - must be signed by the
insurance agent for worker's compensation only.
7. Notice of policy cancellation endorsement - muust be signed by the insurance agent or must be
on the company's certificate of insurance form for all insurances.
L~~' '
CUPEIIaTINO INSURANCE AGRIE:EMENT
A. Contractor is aware of the provisions of Section 3700 of the Labor Code, which requires
every employer to be insured against liability i or worker's compensation or undertake self-
insurance in accordance with the provisions of that Code, and will comply with such provisions
before commencing the performance of the work of this Contract.
B. Contractor and all subcontractors will c~ury worker's compensation insurance for the
protection of its employees during the progress of'the work. The insurer shall waive its rights of
subrogation against the City, the City's officers, agents and employees and shall issue an
endorsement to the policy evidencing same.
C. Contractor shall carry at all times, on all operations hereunder, commercial or
comprehensive general liability insurance, autorrlobile liability insurance and builder's all risk
insurance. All insurance coverage shall be in amounts required by the City and shall be
evidenced by the issuance of a certificate in a form prescribed by the City and shall be
underwritten by insurance companies satisfactory to the City for all operations, sub-contract
work, contractual obligations, product or completed operations, all owned vehicles and non-
owned vehicles. Said insurance coverage obtained by the Contractor, excepting worker's
compensation coverage, shall name the City, it:; engineer, and each of its directors, officers,
agents and employees, as determined by the City, as additional insureds on said policies. Insurers
must be licensed to do business in the State of California. The Insurers must also have an "A"
policyholder's rating and a financial rating of at least Class VII in accordance with the current
Best's Guide Rating.
D. Before Contractor performs any work at, or prepares or delivers materials to, the site of
construction, Contractor shall furnish certificates ~~f insurance evidencing the foregoing insurance
coverages and such certificates shall provide the; name and policy number of each carrier and
policy and that the insurance is in force and will not be canceled or modified without thirty (30)
days written notice to the City. Contractor shall maintain all of the foregoing insurance
coverages in force until the work under this Co~itract is fully completed. The requirement for
carrying the foregoing insurance shall not derogate from the provisions for indemnification of the
City by Contractor under this Contract and for the duration of the warranty period.
Notwithstanding nor diminishing the obligation; of Contractor with respect to the foregoing,
Contractor shall maintain in full force and effect: during the life of this Contract, the following
insurance in amounts not less than the amounts ;specified and issued by a company admitted in
California and having a Best's Guide Rating of A., Class VII or better.
Worker's Compensation Liability In accordance with the Worker's Compensation
Act cif the State of California - $1,000,000 per
occurrence.
Insurance Agreement Page I of 2
Public Liability -either commercial general Combined single limit of $1.0 million per
liability or comprehensive general liability; occurrence; $2.0 million in the aggregate.
including provisions for contractual liability,
personal injury, independent contractors and
property damage coverages.
Automobile Liability -comprehensive covering
owned, non-owned and hired automobiles.
Combined single limit of $1.0 million per
occurrence.
Consultants only: Errors and Omissions liability
$1.0 million per occurrence.
(Contractor's Name)
Date : ~ ~ , 2002
Insurance Agreement Page 2 of 2
F
CUPEI~TINO CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO
This certifies to the City of Cupertino that the following described policies have been issued to
the insured named below and are in force at this time.
Insured:
Address:
Description of operations/locations/products insured (show contract name and/or number, if any):
WORKER'S COMPENSATION * Statutory DQin.
* Employer's
Liability
(name of insurer)
$ $
Insurance Company's State License No.
$
Check Policy Type: Each Occurrence $
COMPREHENSIVE GENERAL
LIABILITY
[ ] Premises/Operations General Aggregate $
(if applicable)
[ ] Owners & Contractors
Protective Aggregate $
[ ] Contractual for Specific
Contract Personal Injury $
[ ] Products Liability
[ ] XCU Hazards
[ ] Broad Form P.D. Fire ]damage (any one fire) $
[ ] Severability of Interest
Clause
[ ] Personal Injury with Medical Expense $
Employee Exclusion Removed (any one person)
or Self-:[assured
COMMERCIAL GENERAL LIABILITY Retention $
(name of insurer)
Policy No. Expiration Date
Certificate of Insurance Page 1 of 2
AUTOMOTNE/VEHICLE LIABILITY BODILY INJURY
Commercial Form Each Person
Liability Coverage
$_
Each Accident
(name of insurer)
PROPERTY DAMAGE
Each Accident
$ or
Combined Single Limit $
~ Policy No.
Expiration Date
A copy of all Endorsements to the policy(ies) which in any way
(agent's initial) limit the above-listed types of coverage are attached to this
Certificate of Insurance.
This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the
coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or
condition of any contract or any other document with respect to which this Certificate of
Insurance maybe issued or may pertain, the insur~ince afforded by the policies described herein is
subject to all the terms, exclusions and conditions of such policies.
IT IS HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by
the Agreement between the City and the insured.
BY~
Dated:
~ Attach Certificate of Insurance and Additional Insured Endorsement on company forms.
2002
Certificate of Insurance Page 2 of 2
~~~-
f
CUPEIIiTINO ENDORSEMENT OF PRIMARY INSURANCE
In consideration of the policy premium and notwithstanding any inconsistent statement in the
policy to which this Endorsement is attached or any other Endorsement attached thereto, it is
agreed as follows:
The insurance afforded by this policy is primary insurance, and no additional insurance
held or owned by the designated additional insureds) shall be called upon to cover a loss under
said additional policy.
POLICY INFORMATION
1. Insurance Company:
2. Insurance Policy Number:
3. Effective Date of this Endorsement:
4. Insured:
2002
All notices herein provided to be give~l by the Insurance Company to the City in
connection with this policy and this Additional. Insured Endorsement, shall be mailed to or
delivered to the City at 10300 Torre Avenue; Cul-ertino, California 95014.
I, (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representative:
(Original signature required on all Endorsf;ments furnished to the District)
Name of
Agent/Agency:
I Address:
Primary Endorsement Page 1 of 1
Title:
Telephone:
Facsimile:
1
CUPEIZTINO ADDITIONAL INSURED ENDORSEMENT
In consideration of the policy premium and notwithstanding any inconsistent statement in the
policy to which this Endorsement is attached or any other Endorsement attached thereto, it is
agreed as follows:
The City of Cupertino ("City") and its direct~~rs, officers, engineers, agents and employees,
and all public agencies from whom permits v~~ill be obtained and their directors, officers,
engineers, agents and employees are hereby declal-ed to be additional insureds under the terms of
this policy, but only with respect to the operations of the Contractor at or upon any of the
premises of the City in connection with the Contract with the City, or acts or omissions of the
additional insureds in connection with, but limited to its general supervision or inspection of said
operations.
POLICY INFORMATION
Insurance Company:
2. Insurance Policy Number:
3. Effective Date of this Endorsement:
4. Insured:
2002.
All notices herein provided to be given by thy: Insurance Company to the City in connection
with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the
City at 10300 Torre Avenue; Cupertino, California 95014.
I, (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
Names of
Agent/Agency:
Address:
Title:
Telephone:
Facsimile:
Additional Insured Endorsement Page 1 of 1
Ct-G-
CUPERTINO COMPREHENSIVE GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT
In consideration of the policy premium and notwithstanding any inconsistent statement in the
policy to which this Endorsement is attached or any other Endorsement attached thereto, it is
agreed as follows:
This Endorsement modifies the insurance provided under the General Liability Coverage part
of the below-referenced policy of insurance.
The general aggregate limit under LIMITS OF' INSURANCE applies separately to the project
described as
POLICY INFORMATION
1. Insurance Company:
2. Insurance Policy Number:
3. Effective Date of this Endorsement: ,2002
4. Insured:
5. Additional Insured: City of Cupertino, its directors, officers, agents and employees.
All notices herein provided to be given by th~~ Insurance Company to the City in connection
with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the
City at 10300 Torre Avenue; Cupertino, California 95014.
I, (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
Names of
Agent/Agency:
Address:
Title:
Telephone:
Facsimile:
Aggregate Limits F'age 1 of 1
1
CUPEI~TIN~
WAIVER OF SUBROGATION ENDORSEMENT
WORKER'S COMPENSATION INSURANCE
In consideration of the policy premium and notwithstanding any inconsistent statement in the
policy to which this Endorsement is attached or any other Endorsement attached thereto, it is
agreed as follows:
It is agreed that with respect to such insurance as is afforded by the policy, the Insurance
Company waives any right of subrogation it may require against the City of Cupertino, and each
of its directors, officers, agents, consultants and employees by reason of any payment made on
account of injury, including death resulting therefrom, sustained by any employee of the insured,
arising out of the performance of the above-referenced Contract.
POLICY INFORMATION
1. Insurance Company:
2. Insurance Policy Number:
3. Effective Date of this Endorsement:
4. Insured:
2002
All notices herein provided to be given by th~~ Insurance Company to the City in connection
with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the'
City at 10300 Torre Avenue; Cupertino, California 95014.
I, (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
Names of
Agent/Agency:
Address:
Title:
Telephone:
Facsimile:
Waiver of Subrogation Endorsement Page 1 of 1
1
CUPEI~TINO
NOTICE OF' POLICY
CANCELLATION ENDORSEMENT
In consideration of the policy premium anti notwithstanding any inconsistent statement in
the policy to which this Endorsement is attached ter any other Endorsement attached thereto, it is
agreed as follows:
Cancellation Notice. The insurance afforded by this policy shall not be suspended,
voided, canceled, reduced in coverage or in limits, or materially altered, except after thirty (30)
days' prior written notice by certified mail, return receipt requested, has been given to the City of
Cupertino ("City"). Such notice shall be addressed to the City as indicated below.
POLICY INFORMATION
Insurance Company:
2. Insurance Policy Number:
3. Effective Date of this Endorsement:
4. Insured:
2002
All notices herein provided to be given by thy: Insurance Company to the City in connection
with this policy and this Additional Insured Endorsement, shall be mailed to or delivered to the
City at 10300 Torre Avenue; Cupertino, California 95014.
I, (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
Names of
Agent/Agency:
Address:
Title:
Telephone:
Facsimile:
Cancellation Endorsem~:nt Page ] of I
FAITHFUL PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENT:
THAT WE,
Principal,
and
Surety,
as
(contractor's name)
(bonding company's name)
as
are held and firmly bound unto the City of Cupertino, State of California, in the sum of
lawful
money of the United States, for the payment of which will and truly to be made, we bind
ourselves, our heirs, executors, successors and ,assigns, jointly and severally, firmly by these
presents.
THE CONDITION of the foregoing obligation is such that,
WHEREAS, the Principal has enterf;d into a contract with the City dated
20 with the obligee to do and perform the following work to-
wit:
NOW, THEREFORE, if the said principal shall well and truly perform the work
contracted to be performed under said contract, :hen this obligation shall be void; otherwise to
remain in full force and effect.
IN WITNESS WHEREOF, this instrument has been duly executed by Principal and
Surety this day of _, 20_
(To be signed by Principal and Surety, Notary acknowledgment required)
CONTRACTOR
Principal
Surety
Street Address:
City, State, Zip
By:
Attorney-In-Fact
The above bond is accepted and approved this __day of , 20
Faithful Performance Page 1 of 1
LABOR AND MATERIAL BOND
KNOW ALL MEN BY THESE PRESENT:
WHEREAS, the City of Cupertino, State of California, and
hereinafter designated as "Principal" have entered into or are about to enter into a contract
providing for the installation, construction, and erection by Principal of
more particularly described in said contract; and i~rcorporated herein by reference.
WHEREAS, said principal is required to i'urnish a bond in connection with said contract,
providing that if said Principal, or any of his or its subcontractors, shall fail to pay for materials,
provisions, provender or other supplies or teams used in, upon, for or about the performance of
work contracted to be done, or for any work or labor done thereon of any kind, the Surety on said
bond shall pay the same to the extent hereinafter set forth;
NOW, THEREFORE, WE, as Principal,
(contractor's name)
and as Surety,
(bonding company':> name)
firmly bind ourselves, our executors, administrators, successors and assigns, jointly and
severally, unto the City of Cupertino, and any and all materialmen, persons, companies, or
corporations furnishing materials, provisions, provender or other supplies used in, upon, for or
about the performance of the aforesaid work cor.~tracted to be executed or performed under the
contract hereinabove mentioned, and incorporated herein by reference, and all persons,
companies or corporations lending or hiring teams, implements or machinery, for or contributing
to said work to be done, and all persons who I-erform work or labor upon the same, and all
persons who supply both work and materials, whose claim has not been paid by Principal or by
any other person, in the just and full sum of
THE CONDITION OF THIS OBLIGATION IS SUCH THAT if said principal, his or its
subcontractors, heirs, executors, administrators, ;successors or assigns, shall fail to pay for any
materials, provisions, provender or other supplies or teams used in, upon, for or about the
performance of the work contracted to be done, or for any work or labor thereon of any kind, or
for amounts due under the Unemployment Insurance Act with respect to such work or labor, or
any and all damages arising under the original contract, then said Surety will pay the same and
also will pay in case suit is brought upon this bend, such reasonable attorney's fee as shall be
fixed by the court.
This bond shall insure to the benefit of an.y and all persons, companies, and corporations
entitled to file claims under Section 1184.1 of th-: Code of Civil Procedure, so as to give a right
of action to them or their assigns in any suit brought upon this bond.
Labor and Material Page 1 of 2
And the said Surety, for value received, hereby stipulates, and agrees that no change,
extension of time, alteration or addition to the terms of the contract or to the work to be
performed thereunder or the specifications accompanying the same shall in any wise affect its
obligations on this bond, and it does hereby waive notice of any such change, extension of time,
alteration or addition to the terms of the contract or to the work or to the specifications.
IN WITNESS WHEREOF, this instrum~;nt has been duly executed by Principal and
Surety this day of _, 20_
(To be signed by Principal and Surety. Notary ac]cnowledgments required.)
CONTRACTOR
Principal
Surety
Street Address:
City, State, Zip
By:
Attorney-In-Fact
The above bond is accepted and approved this __day of , 20
Labor and Material Page 2 of 2