11-008 Contract, Granite Rock Company dba Pavex Construction Division, Scenic Circle Access, Project No. 2010-9136CITY OF
Project No. 2010 -9136
DOCUMENT 00520
p69 4 s 7/ L4-
CUPERTINO O'CONTRACT
THIS CONTRACT, dated this 2nd day of February, 2011 , by and between Granite Rock Company DBA
Pavex Construction Division, whose place of business is located at 120 Granite Rock Way, San Jose, CA 95136
Contractor "), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ( "City") acting
under and by virtue of the authority vested in the City by the laws of the State of California.
WHEREAS, City, on the 1st day of February, 20] 1 awarded to Contractor the following Project:
PROJECT NUMBER 2010 -9136
SCENIC CIRCLE ACCESS
NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth, Contractor and City agree
as follows:
Article 1. Work
1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications,
Drawings, and all other terms and conditions ofthe Contract Documents.
Article 2. Agency and Notices to City
2.1 City has designated Terry Greene, City Architect, to act as City's Authorized Representative(s), who will represent
City in performing City's duties and responsibilities and exercising City's rights and authorities in ContractDocuments. City may change the individual(s) acting as City's Authorized Representative(s), or delegate one ormorespecificfunctionstooneormorespecificCity's Representatives, including without limitation engineering,architectural, inspection and general administrative functions, at any time with notice and without liability toContractor. Each City's Representative is the beneficiary of all Contractor obligations to City, including without
limitation, all releases and indemnities.
2.2 City has designated Hill Associates to act as Consulting Engineer. City may change the identity of the
Consulting Engineer at any time with notice and without liability to Contractor.
2.3 City has designated Nova Partners Inc. to act as Construction Managers. City may change the identity of the
Construction Manager at any time with notice and without liability to Contractor.
2.4 All notices or demands to City under the Contract Documents shall be to City's Authorized Representative at:
10300 Torre Avenue, Cupertino, California 95014 or to such other person(s) and address(es) as City shall
provide to Contractor.
Article 3. Contract Time and Liquidated Damages
3.1 Contract Time.
The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a
Notice to Proceed at any time within 30 Days after the Notice ofAward. Contractor shall not do any Work at
the Site prior to the date on which the Contract Time commences to run.
City of Cupertino 00520 - 1 Contract
Scenic Circle Access
Project No. 2010 -9136
Schedule A: Approx. Start Date of February 15, 2011 with work reaching Substantial Completion within65WorkingDaysandFinalCompletionwithin85WorkingDaysfromtheNoticetoProceed.
3.2 Liquidated Damages.
City and Contractor recognize that time is of the essence ofthis Contract and that City will suffer financial lossintheformofcontractadministrationexpenses (such as project management and consultant expenses), if all or
any part of the Work is not completed within the times specified above, plus any extensions thereof allowed inaccordancewiththeContractDocuments. Consistent with Document 00700 (General Conditions), Contractor
and City agree that because of the nature of the Project, it would be impractical or extremely difficult to fix theamountofactualdamagesincurredbyCitybecauseofadelayincompletionofalloranypartoftheWork.
Accordingly, City and Contractor agree that as licuidated damages for delay Contractor shall pay City:
3.2.1 500 for each Working Day that expires after the time specified herein for Contractor to achieve
Substantial Completion as specified above.
3.2.2 500 for each Working Day that expires after the time specified herein for Contractor to achieve Final
Completion of the entire Work as specified above.
3.2.3 5,000 for each occurrence of a violation of Document 00800, Section 1.7 WORK DAYS AND
HOURS.
3.2.4 Three Months Salary for each Key Personnel named in Contractor's SOQ pursuant to Article 2.G of
Document 00450 (Statement of Qualifications for Construction Work) who leaves the Project and/or
Contractor replaces at any point before Final Completion, for any reason whatsoever, that Contractor
can demonstrate to City's satisfaction is beyond Contractor's control.
Liquidated damages shall apply cumulatively and, except as provided below, shall be presumed to be the
damages suffered by City resulting from delay in completion of the Work.
Contractor should be aware that California Department of Fish and Game, and other State and Federal agencies,
may also levy fines and penalties for the harming, harassing or killing of protected wildlife and endangered
species. Contractor hereby agrees to become familiar with and adhere to wildlife and endangered species
protection requirements.
3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss ofpublicusedamagessufferedbyCityasaresultofdelay. Liquidated damages shall not cover the cost of
completion of the Work, damages resulting frorn defective Work, lost revenues or costs of substitute facilities,or damages suffered by others who then seek to recover their damages from City (for example, delay claims of
other contractors, subcontractors, tenants, or other third- parties), and defense costs thereof.
Article 4. Contract Sum
4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents assetforthinContractor's Bid, attached hereto: See Exhibit "A" attached. Work shall include Alternate no. 1:
GraniteCrete Paving — Schedule "A" and no. 2 Fridge Railing Modifications — Schedule "A ".
Article 5. Contractor's Representations
In order to induce City to enter into this Contract, Contractor makes the following representations and warranties:
5.1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the
Contract Documents, Work, Site, locality, actual conditions, as -built conditions, and all local conditions, and
City of Cupertino 00520 - 2 Contract
Scenic Circle Access
Project No. 2010 -9136
federal, state and local laws and regulations that in any manner may affect cost, progress, performance or
furnishing of Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of
construction to be employed by Contractor and safety precautions and programs incident thereto.
5.2 Contractor has examined thoroughly and understood all reports of exploration and tests of subsurface
conditions, as -built drawings, drawings, products specifications or reports, available for Bidding purposes, of
physical conditions, including Underground Facilities, which are identified in Document 00320 (Geotechnical
Data, Hazardous Materials Surveys and Existing Conditions), or which may appear in the Drawings. Contractor
accepts the determination set forth in these Documents and Document 00700 (General Conditions) of the
limited extent of the information contained in such materials upon which Contractor may be entitled to rely.
Contractor agrees that except for the information so identified, Contractor does not and shall not rely on any
other information contained in such reports and drawings.
5.3 Contractor has conducted or obtained and has understood all such examinations, investigations, explorations,
tests, reports and studies (in addition to or to supplement those referred to in Section 5.2 of this Document
00520) that pertain to the subsurface conditions, as -built conditions, underground facilities, and all other
physical conditions at or contiguous to the Site or otherwise that may affect the cost, progress, performance or
furnishing ofWork, as Contractor considers necessary for the performance or furnishing of Work at the Contract
Sum, within the Contract Time and in accordance with the other terms and conditions of the Contract
Documents, including specifically the provisions of Document 00700 (General Conditions); and no additional
examinations, investigations, explorations, tests, reports, studies or similar information or data are or will be
required by Contractor for such purposes.
5.4 Contractor has correlated its knowledge and the results of all such observations, examinations, investigations,
explorations, tests, reports and studies with the terms and conditions ofthe Contract Documents.
5.5 Contractor has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has
discovered in or among the Contract Documents and as -built drawings and actual conditions and the written
resolution thereof through Addenda issued by City is acceptable to Contractor.
5.6 Contractor is duly organized, existing and in good standing under applicable state law, and is duly qualified to
conduct business in the State of California.
5.7 Contractor has duly authorized the execution, delivery and performance of this Contract, the other Contract
Documents and the Work to be performed herein. The Contract Documents do not violate or create a default
under any instrument, contract, order or decree b finding on Contractor.
5.8 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting
Code §4100 et seq. in document 00340 (Subcont- actors List)
Article 6. Contract Documents
6.1 Contract Documents consist ofthe following documents, including all changes, addenda, and modifications
thereto:
Document 00400 Bid Form
Document 00430 Subcontractors List
Document 00450 Statement of Qualifications
Document 00481 Non - Collusion Affidavit
Document 00482 Bidder Certifications
Document 00510 Notice ofAward
Document 00520 Contract
Document 00530 Insurance Forms
Document 00550 Notice to Proceed
Document 00610 Construction Performance Bond
Document 00620 Construction Labor and Material Payment Bond
City of Cupertino 00520 - 3 Contract
Scenic Circle Access
Project No. 2010 -9136
Document 00630 Guaranty
Document 00650 Agreement and Release of Any and All Claims
Document 00660 Substitution Request Form
Document 00680 Escrow Agreement for Security Deposit in Lieu of Retention
Document 00700 General Conditions
Document 00800 Special Conditions
Document 00820 Special Environmental Conditions
Document 00821 Insurance
Document 00822 Apprenticeship Program
Technical Specification/Special Provisions
Addenda(s)
Drawings/Plans
6.2 There are no Contract Documents other than those listed in this Document 00520, Article 6. Document 00320
Geotechnical Data, Hazardous Material Surveys and Existing Conditions), and the information supplied
therein, are not Contract Documents. The Contract Documents may only be amended, modified or
supplemented as provided in Document 00700 (General Conditions).
Article 7. Miscellaneous
7.1 Terms used in this Contract are defined in Document 00700 (General Conditions) and will have the meaning
indicated therein.
7.2 It is understood and agreed that in no instance are the persons signing this Contract for or on behalf of City or
acting as an employee, agent, or representative of City, liable on this Contract or any of the Contract
Documents, or upon any warranty of authority, or otherwise, and it is further understood and agreed that
liability of the City is limited and confined to such liability as authorized or imposed by the Contract
Documents or applicable law.
7.3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the
Contract Documents only in compliance with the Subcontractor Listing Law, California Public Contracting
Code §4100 et seg.
7.4 The Contract Sum includes all allowances (if any).
7.5 In entering into a public works contract or a suacontract to supply goods, services or materials pursuant to a
public works contract, Contractor or Subcontractor offers and agrees to assign to the awarding body all rights,
title and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. §15) or
under the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the Business
and Professions Code), arising from purchases of goods, services or materials pursuant to the public works
contract or the subcontract. This assignment shall be made and become effective at the time City tenders final
payment to Contractor, without further acknowledgment by the parties.
7.6 Copies of the general prevailing rates of per diem wages for each craft, classification, or type of worker needed
to execute the Contract, as determined by Director of the State of California Department of Industrial Relations,
are deemed included in the Contract Documents and on file at City's office, or may be obtained of the State of
California web site http:// www. dir.ca.gov/DLSR/PWD/Northern.html and shall be made available to any
interested party on request. Pursuant to Section 1861 of the Labor Code, Contractor represents that it is aware
ofthe provisions of Section 3700 ofthe 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
Contractor shall comply with such provisions before commencing the performance of the Work of the Contract
Documents.
7.7 Should any part, term or provision of this Contract or any of the Contract Documents, or any document required
herein or therein to be executed or delivered, be declared invalid, void or unenforceable, all remaining parts,
terms and provisions shall remain in full force and effect and shall in no way be invalidated, impaired or
City ofCupertino 00520 - 4 Contract
Scenic Circle Access
Project No. 2010 -9136
affected thereby. If the provisions of any law causing such invalidity, illegality or unenforceability may be
waived, they are hereby waived to the end that this Contract and the Contract Documents may be deemed valid
and binding contracts, enforceable in accordance with their terms to the greatest extent permitted by applicable
law. In the event any provision not otherwise included in the Contract Documents is required to be included by
any applicable law, that provision is deemed included herein by this reference(or, if such provision is required
to be included in any particular portion of the Contract Documents, that provision is deemed included in that
portion).
7.8 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa
Clara, State of California, and governed in all respects by California law (excluding choice of law rules). The
exclusive venue for all disputes or litigation hereunder shall be in Santa Clara County. Both parties hereby
waive their rights under California Code of Civil Procedure Section 394 to file a motion to transfer any action
or proceeding arising out of the Contract Documents to another venue. Contractor accepts the Claims
Procedure in Document 00700, Article 12, established under the California Government Code, Title 1, Division
3.6, Part 3, Chapter 5.
7.9 Contractor and all subcontractors shall comply with the Uniform Administrative Requirements for State and
Local Governments set forth in the Code of Federal Regulations (CFR), Title 49, Part 18. In addition, the
Contractor agrees to comply with the cost principles and procedures set forth in Office of Management and
Budget Circular A -87. The Contractor agrees that a reference to either Office of Management and Budget
OMB) Circular A -87of the Code of Federal Regulations, Title 49, Chapter 1, Part 31, whichever is applicable,
and the Code of Federal Regulations, Title 49, Part 18, will be included in any subcontracts entered into as a
result of this contract.
City of Cupertino 00520 - 5 Contract
Scenic Circle Access
Project No. 2010 -9136
IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year firs - - - . itten.
SCENIC CIRCLE ACCESS 13/-(1
CITY:CONTRACTOR:
CITY OF CUPERTINO, a Municipal Corporation of the Granite Rock Company DBA
State of California Pave I I struction Division
aIS - 111By:
Signature]
Attest:
RODNEY JENNY, VICE PRESIDENTC ;YL1J -e-t Please print name here]
City Clerk: Kimberly S#'nith
Ap..ved as to form by City Attorney:Title:
IfCorporation: Chairman , President, or Vice President]
City ttorney:By:
Signature]
I hereby certify, under penalty of perjury, that David W.Please print name here]
Knapp, City Manager of the City of Cupertino was duly
authorized to execute this document on behalf of the City of Title:
Cupertino.If Corporation: Secretary, Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer]
Dated: 2 ,I <I`i Z 6
State Contractor's License No.Classification
I
P avid W. Knapp, City Manager of the City of Cupertino, a Expiration Date
Municipal Corporation of the State of California
Designated Representative:Taxpayer ID No. ' 1 ` I - C' I C.1 c
Name: Terry W. Greene, AIA Name: RODNEY JENNY, VICE PRESIDENT
Title: City Architect Title:
Address: 10300 Torre Ave., Cupertino, CA 95014 Address: 12-C Y, iic ;: iG i .t _
Phone: 408 - 777 -3354 Phone: 1 - I
Facsimile: 408-777-3333 Facsimile: `3" - I 61
NOTARY ACKNOLEDGEMENT IS REQUIRED. IF A
AMOUNT: $ 170,675.00 CORPORATION, CORPORATE SEAL AND CORPORATE
NOTARY ACKNOWLEDEMENT AND FEDERAL TAX ID ARE
ACCOUNT NUMBER:420 9136930Q.....REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY
FILE NO.: 92,075 3I I NO. IS REQUIRED
END OF DOCUMENT
City of Cupertino 00520 - 6 Contract
Scenic Circle Access
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
RS..i9oa¢,oi@ti+t.,. S..caQi.Ovss..o.. C.v_fGv.C. 'g3..ca.•. s4oii "o.. poi: Aoa) z: sS.: os: asC: o, Qs... v,.-..oe - v.- e
State of California
County of 3Q 1Ul CoCAr4
On 1 TJi 1 before me,j [(C4 8 r Y IAgQ I t C ,
Date Here Insert Name d Title of the O er
personally appeared O. 12 A-A f V\ V 14Name(c igner(
who proved to me on the basis of satisfactory evidence to
be the personM whose name(,) is /efe- subscribed to the
within instrument and acknowledged to me that
he /sko/t iey- executed the same in his herft authorized
capacity(ies}, and that by his/her/their—signature(1) on the
AMY FURMAN instrument the person(), or the entity upon behalf ofComm. No.18461 which the person) acted, executed the instrument.Qi NOTARY PUBLIC• CALIFORNIA
SANTA CLARA COUNTY
My Comm. Expires May 7, 2013 I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hang and official se
Signature A. k or
Place Notary Seal Above Signet e of No ary Public
OPTIONAL
Though the information below is not required by law, it may wove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: C On c_4c_4
Document Date: cZJ /VJNumberofPages:p aC.,,
Signer( Other Than Named Above: it.) ! 0
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Capacity(ies) Claimed
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Signer's Name: QlV lj s Name:
jpdividual 11 Individ .
L Corporate Officer — Title(,P.I1 Corporate 0 • er — Title(s):
Partner — Limited General RIGHTTHUMBPRINT
Partner — Lim : • General RIGHTTHUMBPRINT
Attorney in Fact OF SIGNER Attorney in Fact OF SIGNER
Trustee Top of thumb here Trustee Top of thumb here
Guardian or Conservator 1 Guardian or Conservator
Other:Other:
Signer Is Representing:Signer Is Representing:
Granite Rock Company DBA
Pavex Construction Division
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2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313 -2402 • www.NationalNotaryorg Item #5907 Reorder: Call Toll -Free 1 -800- 876 -6827
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
State of California
County of S A rr A C L A - IA s)
r:On FEP,RUAY 22, 2.D ii before me, t<IrSTE.N RNE SQUA . ct A t\JoTA2y PUSL1 C.,
pi
Date Here I Name and Title of t Officer
personally appeared DP.vtD w IsNAPP 1
Name(s) of Signer(s)
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who proved to me on the basis of satisfactory s1 ;evidence to be the person.(sj' whose name,(s) is re
subscribed to the within instrument and acknowledged
to me that Ghshe /they executed the same in
i her /their authorized capacityQies), and that by
is/her/their signature(sj on the instrument the
person,K or the entity upon behalf of which the
person executed the instrument.44
I certify under PENALTY OF PERJURY under the IKIRSTENRENEESOUARCIAy
a - ,Commission a 1906898 laws of the State of California that the foregoing
1 ,r Notary Public - California paragraph is true and correct.yS
P r+/Santa Clara County
My Comm. Expires Oct 4, 2014 WITNESS my hand and official seal.
t Signature- 6.,Q y
r ,Place Notary Seal Above Signature of NotaryeKblic POPTIONAL
Though the information below is not required by law, it nay prove valuable to persons relying on the document
and could prevent fraudulent removal and re6ttachment of this form to another document.V
Description of Attached Document
Title or Type of Document: C o u T iL AC"C
t Document Date: C 2- , 20 \t Number of Pages: Co
Signer(s) Other Than Named Above: GRAr iTE Ro -K Co. lc) BA PAN/ EX CotJSTRVC.TIOf.J Ply.V
Capacity(ies) Claimed by Signer(s)V
Signer's Name:Signer's Name:V
Corporate Officer — Title(s):Corporate Officer — Title(s):V
111 Individual RIGHT THUMBPRINT Individual RIGHT THUMBPRINT
OF SIGNER OF SIGNER
Partner — Limited General Top of thumb here Partner — Limited General Top of thumb here
Attorney in Fact Attorney in Fact
Trustee Trustee V
Guardian or Conservator Guardian or Conservator
Other:Other:V
Signer Is Representing:Signer Is Representing:V
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2010 National Notary Association • NationalNotary.org • 1- 800 -US NOTARY (1- 800 -873 -6827)Item #5907
Project No. 2010 -9136
DOCUMENT 00400 EXHIBIT A
BID ]FORM
To be submitted as part of Envelope "A" by the time and date specified in Document 00200 (Instructions to Bidders).
TO THE HONORABLE CITY COUNCIL OF THE CITY OF CUPERTINO
THIS BID IS SUBMITTED BY:
Granite Rock Company DBA
Pavex Construction Division
Firm/Company Name)
Project No. 2010 -9136
SCENIC CIRCLE ACCESS
1.The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into a contract with the City of
Cupertino ( "City ") in the form included in the Contract Documents, Document 00520 (Contract), to perform
and furnish all Work as specified or indicated in the Contract Documents for the Contract Sum and within the
Contract Time indicated in this Bid and in accordance with all other terms and conditions of the Contract
Documents. All portions of this Bid Form must be completed and signed before the bid is submitted. Failure to
do so will result in the bid being rejected as non - responsive.
2.Bidder accepts all ofthe terms and conditions of the Contract Documents, Document 00100 (Advertisement for
Bids), and Document 00200 (Instructions to Bidders), including, without limitation, those dealing with the
disposition of Bid Security. This Bid will remain subject to acceptance for 90 Calendar Days after the day
of Bid openinE.
3.Bidder has visited the Site and performed all tasks, research, investigation, reviews, examinations, and analysis
and given notices, regarding the Project and the Site, as set forth in Document 00520 (Contract), Article 5.
4.Bidder has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has
discovered in or among the Contract Documents and as-built drawings and actual conditions and the written
resolution thereof through Addenda issued by City is acceptable to Contractor.
5.Subcontractors for work included in all Bid items, in accordance with the criteria in the Public Contract Code,
are listed on the attached Document 00430 (Subcontractors List).
6.The undersigned Bidder understands that City reserves the right to reject this Bid.
7.Ifwritten notice ofthe acceptance of this Bid, hereinafter referred to as Notice ofAward, is mailed or delivered
to the undersigned Bidder within the time described in paragraph 2 ofthis Document 00400 or at any other time
thereafter before it is withdrawn, the undersigned Bidder will execute and deliver the documents required by
Document 00200 (Instructions to Bidders) within the times specified therein. These documents include, but are
not limited to, Document 00520 (Contract), Document 00610 (Construction Performance Bond), and Document
00620 (Construction Labor and Material Payment Bond).
8.Notice of Award or request for additional information may be addressed to the undersigned Bidder at the
address set forth below on the signature page.
10. The undersigned Bidder herewith encloses cash, a cashier's check, or certified check of or on a responsible
bank in the United States, or a corporate surety bo:ad furnished by a surety authorized to do a surety business in
the State of California, in form specified in Document 00200 (Instructions to Bidders), in the amount of ten
percent (10 %) ofthe total of Bid and made payable to the "City of Cupertino ".
City of Cupertino Bid Form
Scenic Circle Access 00400 - 1
Project No. 2010-9136
11. The undersigned Bidder agrees to commence Work under the Contract Documents on the date established in
Document 00700 (General Conditions) and to complete all work within the time specified in Document 00520
Contract). The undersigned Bidder acknowledges that City has reserved the right to delay or modify the
commencement date. The undersigned Bidder further acknowledges City has reserved the right to perform
independent work at the Site, the extent of such work may not be determined until after the opening ofthe Bids,
and that the undersigned Bidder will be required to cooperate with such other work in accordance with the
requirements ofthe Contract Documents.
12. The undersigned Bidder agrees that, in accordance with Document 00700 (General Conditions), liquidated
damages for failure to complete all Work in the Contract within the time specified in Document 00520
Contract) shall be as set forth in Document 0052) (Contract).
V J
City of Cupertino Bid Form
Scenic Circle Access 00400 - 2
Granite Rock Company DBA
Pavex Construction Division
Project No. 2010- .9136
SCHEDULE OF BID PRICES
All Bid items, including lump sums and unit prices, must be filled in completely. Allowances and Alternative Bid items
are described in Document 00800 (Special Conditions). Quote in figures and words are specifically requested.
Specialty Items are identified on the Bid Form in the description.
BASE BID
ITEM DESCRIPTION UNIT QTY TOTAL $
1 Construct Scenic Circle Access Using LS 1 Of "7. ?,Schedule "A" for Completion
2
Additional Landscaping AL na 10,000
TOTAL BASE B:[D PRICE 5 ci 3 6r
Total Base Bid Pricekm In u vi M_.Q 41 /X a u lArt
Words) l,- ut v,d f 1 t {-}Unit Legend t1 V1
LS = Lump Sum AL = Allowance
EA = Each SF = Square Feet
LF = Linear Feet
TON = Ton or 2,000 Pounds
CY = Cubic Yards
LB = Pounds
ALTERNATE
Alternate DESCRIPTION UNIT EST ADD or CREDIT TOTAL $
1
GraniteCrete Paving — Schedule "A"LS 1 r
1
GraniteCrete Paving — Schedule "B"LS 1 r
2
Bridge Railing Modifications — Schedule "A"LS 1
2
Bridge Railing Modifications - Schedule "B"LS 1 OD CO 0
3 Complete the Work Using Schedule "B" for LS 1 z ___ 0( .. )Completion
City of Cupertino Bid Form
Scenic Circle Access 00400 - 3
Project No. 2010 -9136
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUMS
Bidder herby acknowledges receipt and examination of all Contract Documents and the following Addenda:
Addendum No.Addendum Date
InO1) P 40r -- ti t6 CMG+-
Bidder proposes and agrees to fully perform the Work within the time stated and in strict accordance with the Contract
Documents for the sums ofmoney listed in this Bid Form.
Granite Rock Company DBA
NAME OF BIDDER:Pavex Construction Division
licensed in accordance }vi pctfor the registration of Contractors, and with license number:
Expiration Date: f ( I
Cal \ -FO r In \ G See Q+ (xCJ --e of C) - 6-F vrf
Where incorporated, ifapplicable P 11 a
Principals
I certify (or declare) under penalty of perjury ur.der the laws o r ate o . ifomia that the foregoing is true
and correct.
O1IPAII'r Aw_I—
Signature of : idde NI
NOTE: IfBidder is a corporation, set forth the legal name of the corporation, state where orated, . _ - er with the
signature of the officer or officers authorized to sign contracts on behalf ofthe corporation. If Bidder is a partnership, set
forth the name ofthe firm together with the signature of the partner or partners authorized to sign contracts on behalf of
the partnership.
Business Address:120 GRANITE ROCK WAY
SAN JOSE, CA 95136
Officers authorized to sign contracts:RODNEY JENNY. VICE PRESIDENT
Typ Full Name:
Telephone Number(s):5 44 "-' / '46 n
Fax Number(s):36).5 9' 5 Lf 8
E -Mail Address:pa \) ex es + l on G1+, V
ra)Ari- rock. Cd0/1
END OF DOCUMENT
City ofCupertino Bid Form
Scenic Circle Access 00400 - 4
4
Graniterock,
GENERAL ENGINEERING CONTRACTOR • LICENSE # 22
PAVEX CONSTRUCTION DIVISION
Granite Rock Company dba Pavex Construction Division
Incorporated in the State of California
OFFICERS OF THE COMPANY
President & CEO Bruce Woolpert
350 Technology Drive
Watsonville, CA 95076
Vice President &Stephen Snodgrass
CFO 350 Technology Drive
Watsonville, CA 95076
Vice President,Thomas H. Squeri
General Counsel 350 Technology Drive
Secretary Watsonville, CA 95076
Vice President &Rodney Jenny
Division Manager of 120 Granite Rock Way
Pavex Construction Division San Jose, CA 95136
Vice President Greg Diehl
Concrete &350 Technology Drive
Building Materials Watsonville, CA 95076
e
oil
San lose Office SFO Office Oakland Office Monterey Bay Region120GraniteRockWay7700EdgewaterDrive, Bldg. B, Suite 300B P.O. Box 50001, Watsonville, CA95077SanJose, CA 95136 San Francisco, CA 94128 Oakland, CA 94621 411 Walker Street, Watsonville, CA95076Phone4085741400Phone650.615.0306 Phone 510 729 5075 Phone 831 768 2700Fax4083658349Fax650.615.0338 Fax 510 729 5079 Fax 831 768 2701
Graniterock,
GENERAL ENGINEERING CONTRACTOR • LICENSE # 22
PAVEX CONSTRUCTION DIVISION
CERTIFICATION OF CORPORATE RESOLUTION
At the meeting of the Directors of Granite Rock Company, a corporation organizedandexistingunderthelawsoftheStateofCalifornia, duly called and held in
accordance with the Articles of Incorporation and Bylaws of the corporation at its
office on June 25, 2005, at which a quorum of the directors were present, thedirectorsresolvedthat:
Each of the following persons is fully authorized to sign bid and
contract documents on behalf of Granite Rock Company, doing
business as Pavex Construction Division, and to bind the corporation
with respect to such documents: Bruce W. Woolpert, Thomas Squeri,
Stephen Snodgrass, Rodney Jenny, and Greg Diehl.
I, Thomas H. Squeri, Vice President and Secretary of Granite Rock Company, doherebycertifythatIamtheVicePresidentandSecretaryofsaidcorporation, and
that the above resolutions of the Board of Directors of said corporation were dulyadoptedatthemeetingsheldonthosedates, and that said resolutions have not been
revoked or rescinded.
In witness whereof, I have hereunto subscribed my name and affixed the seal of
said corporation.
Dated: 101 J2/1 0
Thomas H. Squeri /
Vice President an ecretary
It
San lose Office SFO Office Oakland Office Monterey Bay Region120GraniteRockWay7700EdgewaterDrive, Bldg. B, Suite 300B P.O. Box 50001, Watsonville, CA95077SanJose, CA 95136 San Francisco, CA 94128 Oakland, CA 94621 411 Walker Street, Watsonville, CA95076Phone4085741400Phone650.615.0306 Phone 510 729 5075 Phone 831 768 2700Fax4083658349Fax650.615.0338 Fax 510 729 5079 Fax 831 768 2701
Granite Rock Company DBA
Pavex Construction Division
Project No. 2010 -9136
DOCUMENT 00430
REQUIRED SUBCONTRACTORS LIST
Bidder must provide the following Listed Subcontractor information in conformance with the California Public ContractCodewherethevalueoftheSubcontractor's work is or ex;.eeds '/s ofone percent (.05 %) ofthe Bid on Document 00400.Failure to do so will render Bid Non Responsive.
Bidder is reminded that Listed Subcontractors cannot be substituted by the Apparent Low Bidder after Bid has been
submitted and opened, without City's formal approval.
Subcontractor Name I Address & Phone No. License No. I Trade Value $
Yl (TU3 vd_ 50.,E E CAoftioBz coa -5` a(pD 51nlr k 11 q C/
0\ eki ` t 50.,1A C u
o,n ()J of 331 2-G 5 3z-o M.e4QS 73Z
Cc \awe Etttca fiTlG , 41 in ltiogcXa61514 -LP L1 3 y
5 -4l OEi3
Rv, Luvir T—Q 10 •y3 33i 13314 Glv.J5cu.e YD
Attach additional sheets ifnecessary
VOLUNTARY SUBCONTRACTOR LIST
Bidder is requested to voluntarily provide Subcontractor information listed below for subcontract work whose value is
Less than '/2 ofone percent of the Bid on Document 00400. Failure to do so will have no impact on Bid.
Bidder is requested not to substitute Subcontractors after Bid has been submitted and opened, without City's informalapproval.
Subcontractor Name I Address & Phone No. I License No. I Trade Value $
Attach additional sheets if necessary
END OF DOCUMENT
City ofCupertino 00430 - 1 Subcontractors ListScenicCircleAccess
Project No. 2010 -9136
DOCUMENT 00481
NON- COLLUSION AFFIDAVIT
PUBLIC CONTRACT CODE §7106
NON - COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID
STATE OF CALIFORNIA
ss.
COUNTY OF3 y ko. Clarot
8ckv\ e P1111/ j being first duly sworn deposes and says that he -er 3he isV •Office of Affiant] of Granite Rock Company DBA Name ofBidder], the party making the foregoing Bid, that the Bid is not made Maffitixii6AligtrOictePlarnjbliiii4lof, any undisclosedperson, partnership, company, association, organization, or corporation; that the Bid is genuine and not collusive orsham; that Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham Bid, andhasnotdirectlyorindirectlycolluded, conspired, connived or agreed with any bidder or anyone else to put in a shamBid, or that anyone shall refrain from bidding, and that the Bidder has not in any manner, directly or indirectly, sought bycontract, communication or conference with anyone to fix the Bid price of Bidder or any other bidder, or to fix anyoverhead, profit or cost element of the Bid price, or of that of any other bidder, or to secure any advantage against theCityofCupertino, or anyone interested in the proposed contract; that all statements contained in the Bid are true; andfurther, that Bidder has not, directly or indirectly, submitted its Bid price or any breakdown thereof, or the contentsthereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation,partnership, company association, organization, Bid depository, or to any member or agent thereof to effectuate acollusiveorshamBid.
Executed under penalty ofperjury under the laws ofthe State of California:
Granite Rock Company DBA
Name Stir)Zodin e_y
5e wv U. •i
Signatur_ ,M.5ehty
5dq(c 5.5.1SubscribedandswornbeforemeA (Y V r vAk d 1/4140 1 C F-0
This I ( day of(RV\U Clef G , 220 AMY FURMAN
J e „ -'ti Comm. No.1846149
I \ r 5 yam NOTARY PUBLIC • CALIFORNIA mlNotaryPublicoftheStateofO.In BANTA CLARA COUNTYInandfortheCountyofttcG[ D My Comm, 5xpires May 7, 2013
My Commission expires q a 0 X Seal)
If Bidder is a partnership or a joint venture, this affidavit must be signed and sworn to by every member of thepartnershiporventure.)
If Bidder [including any partner or venturer of a partnership or joint venture] is a corporation, this affidavitmustbesignedbytheChairman, President, or Vice President and by the Secretary, Assistant Secretary, ChiefFinancialOfficer, or Assistant Treasurer.)
If Bidder's affidavit on this form is made outside the State of California, the official position of the persontakingsuchaffidavitshallbecertifiedaccordingtolaw.)
END OF DOCUMENT
City of Cupertino 00481 - 1 Non - Collusion AffidavitScenicCircleAccess
of 3 originals Project No. 2010 -9136
Bond # 929510253
DOCUMENT 00610 Premium: $461.00
CONSTRUCTION PERFORMANCE BOND
THIS CONSTRUCTION PERFORMANCE BOND ( "Bond'') is dated Feb 8 = • 2011, is in the penal sum of
One Hundred Seventy Thousand, Six Hundred Seventy —Five NO /100 ($170,675.00)
which is one hundred percent of the ContractPrice],
and is entered into by and between the parties listed below to ensure the faithful performance 'of the Construction
Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12,
attached to this page. Any singular reference to Granite Rock Company , d . b . a . * Contractor"),
Continental Casualty Company Surety "), the City of Cupertino, a Municipal Corporation of the
State ofCalifornia (" City ") or other party shall be considered plural where applicable. * Pavex Construct ion Divis ion
Granite Rock Company, d.b.a.CONTRACTOR:SURETY
Pavex Construction Division continental Casualty Company
Maine
Granite Rock Way
Name 555 Mission St., #200
Address Principal Place ofBusiness
San Jose, CA 95136 San Francisco, CA 94105
City /StatelZip City /State /Zip
CONSTRUCTION CONTRACT:
SCENIC CIRCLE ACCESS
PROJECT NUMBER 2010 -9136
at Cupertino, California.
DATED February 8 2011 in the Amount ofS 170, 675.00.the "Penal Sum ")
CONTRACTOR AS PRINCIPAL Granite Rock SURETY
Company: Company d.b.a. Pavex Company: Continental Casualty CompanyCotstructonDivirtayry
Signatt:e:Signature:.u° vC . vi.
Deborah L. Tablak
Name and Title: 6 -/e i /J. d.J 1/P Name and Title: Attorney —gin —Fact
JJ
BOND TERMS AND CONDITIONS
1.Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors
and assigns to City for the complete and proper performance of the Construction Contract, which is
incorporated hereinby reference.
2.If Contractor completely and properly performs all of its obligations under the Construction Contract, Surety
and Contractor shall have no obligationunder this E ond.
3.If there is no City Default, Surety's obligation under this Bond shall arise after.
3.1 City has declared a Contractor Default under the Construction Contract pursuant to the terms of the
Construction Contract and
3.2 City has agreed to pay the Balance ofthe Contract Sum
3.2.1 To Surety in accordance with the terms ofthis Bond and the Construction Contract; or
City ofCupertino 00510 Construction Performance.Bond
Scenic Circle Access
Project No. 2010 -9136
3.2.2 To a contractor selected to perform the Construction Contract in accordance with the terms of this
Bond and the Construction Contract.
4. When City has satisfied the conditions ofparagraph 3, Surety shall promptly (within 30 days) and at Surety'sexpenseelecttotakeoneofthefollowingactions;
4.1 Arrange for Contractor, with consent ofCity, to perform and complete the Construction Contract (butCitymaywithholdconsent, in which case the Surety must elect an option described in paragraphs 4.2,4.3 or 4.4, below); or
4.2 Undertake to perform and complete the Construction Contract itself, through its agents or throughindependentcontractors; provided, that Surety may not select Contractor as its agent or independentcontractorwithoutCity's consent; or
4.3 Undertake to perform and complete the Construction Contract by obtaining bids from qualifiedcontractorsacceptabletoCityforacontractforperformanceandcompletionoftheConstructionContract, and, upon determination by City of the lowest responsible bidder, arrange for a contract to bepreparedforexecutionbyCityandthecontractorselectedwithCity's concurrence, to be secured with
performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the
Construction Contract; and, if Surety's obligations defined in paragraph 6, below, exceed the Balance of
the Contract Sum, then Surety shall pay to City the amount ofsuch excess; or
4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with
reasonable promptness under the circumstances, and, after investigation and consultation with City,determine in good faith its monetary obligation to City under paragraph 6, below, for the performanceandcompletionoftheConstructionContractand, as soon as practicable after the amount is determined,
tender payment therefor to City with full explanation of the payment's calculation. If City acceptsSurety's tender under this paragraph 4.4, City may still hold Surety liable for future damages thenunknownor =liquidated resulting from the Contractor Default. If City disputes the amount of Surety'stenderunderthisparagraph4.4, City may exercise all remedies available to it at law to enforce Surety'sliabilityunderparagraph6, below.
5.IfSurety does not proceed as provided in paragraph 4, above, then Surety shall be deemed to be in default onthisBondtendaysafterreceiptofanadditionalwrittennoticefromCitytoSuretydemandingthatSuretyperformitsobligationsunderthisBond. At all times City shall be entitled to enforce any remedy available toCityatIaworundertheConstructionContractincluding, without limitation, and by way ofexample only, rightstoperformwork, protect work, mitigate damages, advance critical work to mitigate schedule delay, orcoordinateworkwithotherconsultantsorcontractors.
6.Surety's monetary obligation under this Bond is limited by the Amount of this Bond identified herein as the
Penal Sum. This monetary obligation shall augment the Balance of the Contract Sum. Subject to these limits,Surety's obligations under this Bond are commensurate with the obligations of Contractor under theConstructionContract. Surety's obligations shall include:, but are not limited to:
6.1 The responsibilities of Contractor under the Construction Contract for completion of the ConstructionContractandcorrectionofdefectivework;
6.2 The responsibilities of Contractor under the Construction Contract to pay liquidated damages, and fordamagesforwhichnoliquidateddamagesarespecifiedintheConstructionContract, actual damagescausedbynon - performance of the Construction Contract including, but not limited to, all valid andproperbackcharges, offsets, payments, indemnities, or other damages;
63 Additional legal, design professional and delay costs resulting from Contractor Default or resulting fromtheactionsorfailuretoactoftheSuretyunderparagraph4, above (but excluding attorney's fees incurredtoenforcethisBond).
7.No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns.
City ofCupertino 00610 - 2 Construction Performance BondScenicCircleAccess
Project No, 2010-9136
8.Surety hereby waives notice of any change, alteratior. or addition to the Construction Contract or to related
subcontracts, purchase orders and other obligations, including changes of time. Surety consents to all terms of
the Construction Contract, including provisions on changes to the Contract. No extension of time, change,
alteration, modification, deletion, or addition to the Contract Documents, or ofthe work required thereunder,
shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond.
9.Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competentjurisdiction
where a proceeding is pending between City and Coltractor regarding the Construction Contract, or in the
courts of the County of Santa Clara, or in a court of competent jurisdiction in the location in which the work is
located. Communications from City to Surety under paragraph 3.1 of this Bond shall be deemed to include the
necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise.
10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of
this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract).
Actual receipt ofnotice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as
ofthe date received at the foregoing addresses.
11. Any provision in this Bond conflicting with any statutory or regulatory requirement shall be deemed deleted
herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein.
12. Definitions.
12.1 Balance ofthe Contract Sum The total amountpayable by City to Contractor pursuant to the terms ofthe
Construction Contract after all proper adjustmens have been made under the Construction Contract, for
example, deductions for progress payments made, and increases /decreases for approved modifications to
the Construction Contract.
12.2 Construction Contract: The contract between City and Contractor identified on the signature page ofthis
Bond, including all Contract Documents and changes thereto.
12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, toperformorotherwisetocomplywiththetermsoftheConstructionContractincluding, but not limited to,
default" or any other condition allowing a termination for cause as provided in Document 00700
General Conditions).
12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor
progress payments due under the Construction Contract or to perform other material terms of the
Construction Contract, if such failure is the cause of the asserted Contractor Default and is sufficient to
justify Contractor termination ofthe Construction Contract.
END OF DOCUMENT
City ofCupertino 00610 - 3 Construction Performance Bond
Scenic Circle Access
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of
Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called
the CNA Companies "), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois,
and that they do by virtue ofthe signatures and seals herein affixed hereby make, constitute and appoint
Catherine Gustayson, F R Hudson III, Dennis M Carney, David J Bachan, Deborah L Tablak, Jeanette M Mazzarino,
Matthew Reade, John R Ullmer, Individually
ofWatsonville, CA, their true and lawful Attorneys) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on their
behalf bonds, undertakings and other obligatory instruments of similar nature
In Unlimited Amounts -
and to bind them thereby as fully and to the same extent as ifsuch instruments were signed by a duly authorized officer of their insurance companies and
all the acts of said Attomey, pursuant to the authority hereby given is hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly
adopted, as indicated, by the Boards ofDirectors of the insurance companies.
In Witness Whereof, the CNA Companies have caused these presents to be ;.igned by their Senior Vice President and their corporate seals to be
hereto affixed on this 29th day ofSeptember, 2010.
der WsuR Continental Casualty Company
National Fire Insurance Company of Hartford
coavoaAre 1 a' trccdi"Ro American Casualty Company of Reading, Pennsylvania
0 I W JULY 11. i
SEAL tat ! I 1 Ttlea.s o
1897 MARS
Jaci 4 yne ) . Belcastro Senior Vice President
State of Illinois, County ofCook, ss:
On this 29th day of September, 2010, before me personally came Jacquelyne M. Belcastro to me known, who, being by me duly sworn, did depose
and say: that she resides in the City ofChicago, State of Illinois; that she is a Senior Vice President ofContinental Casualty Company, an Illinoisinsurancecompany, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company ofReading,
Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that she knows the seals of said insurance
companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of
Directors of said insurance companies and that she signed her name thereto pursuant to like authority, and acknowledges same to be the act and deed of
said insurance companies.
OFFICIAL SEAL
EWAPRICE
nonlRrwwJt•atAlEaurMOa C5INCOWMENosNH.91M1
My Commission Expires September 17, 2013 Eliza Price Notary Public
CERTIFICATE
I, Mary A. Ribikawskis, Assistant Secretary ofContinental Casualty Company, an Illinois insurance company, National Fire Insurance Company of
Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby
certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of
the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of
the said insurance companies this 8th day of February 2011
CAsu.OLSUR4 r Continental Casualty Company
a tie 1c National Fire Insurance Company ofHartford
F
colwo•Are °Sk g ocoa+ar American Casualty Company of Reading, Pennsylvania
Z a N1LY 11. v SEAI c V e 1902 ar a cogi.,,,,-.&1897 Qt. MARlie
Mary A. ika kis Assistant Secretary
Form F6853- 5/2009
Authorizing By -Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article IXExecution of Documents
Section 3. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Executive, Senior or Group Vice
President may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies of
insurance, bonds, undertakings and other obligatory instruments of like nature. Such attomeys -in -fact, subject to the limitations set forth in their
respective certificates of authority, shall have full power to bind the Company by their signature and execution of any such instruments and to attach the
seal of the Company thererto. The Chairman of the Board of Directors, the President or any Executive, Senior or Group Vice President or the Board of
Directors, may, at any time, revoke all power and authority previously given to any attorney -in- fact."
This Power ofAttorney is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board ofDirectors ofthe
Company at a meeting duly called and held on the 17 day of February, 1993.
Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed by
facsimile on any power of attomey granted pursuant to Section 3 of Article IX of the By -Laws, and the signature of the Secretary or an Assistant
Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any power or certificate bearing such
facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed
and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding an the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article VIExecution of Documents
Section 3 Appointment of Attorney -in -fact. The Chairman ofthe Board of Directors, the President or any Executive or Senior Vice President may,
from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies of insurance, bonds,
undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of
authority, shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company
thereto. The President or any Executive, Senior Vice President or the Board of Directors may at any time revoke all power and authority previously
given to any attorney -in- fact."
This Power ofAttorney is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board ofDirectors of the
Company at a meeting duly called and held on the 17 day of February, 1993.
Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed by
facsimile on any power of attorney granted pursuant to Section 2 of Article VI of the By -Laws, and the signature of the Secretary or an Assistant
Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any power or certificate bearing such
facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed
and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article VIIExecution of Documents
Section 3. Appointment of Attorney -in -Fact. The Chairman of the Board of Directors, the President or any Executive or Senior Vice President
may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf ofthe Company in the execution of policies of insurance, bonds,
undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of
authority shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company
thereto. The Chairman of the Board of Directors, the President or any Executive, Senior Vice President or the Board ofDirectors, may, at any time,
revoke all power and authority previously given to any attorney -in- fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the
Company at a meeting duly called and held on the 17 day of February, 1993.
RESOLVED: That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal of the Insurance
Company may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of Directors on February 17,
1993 and the signature of a Secretary or an Assistant Secretary and the seal of the Insurance Company may be affixed by facsimile to any certificate of
any such power, and any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Insurance Company. Any such
power so executed and sealed and certified by certificate so executed and sealed, shall with respect to any bond or undertaking to which it is attached,
continue to be valid and binding on the Insurance Company."
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
State of California
County of Santa Cruz
On February 8, 2011, before me, Guadalupe Aboytes Jimenez, Notary Public, personally appeared
Deborah L. Tablak, who proved to me on the basis of satisfactory evidence to be the person(s)
whose name(8) ism subscribed to the within instrument and acknowledged to me that h&sheAthey
executed the same in h #herd authorized capacity(), and that by 14.4Whenttheif signature(8)
on the instrument the person(8), or the entity upon behalf of which the person(8) acted,
which the person(8) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
GUADALUPE AB JIMENEZCOMM. # 1889432
u'Notary Public- Calrfornia
VICountyofSantaCruzI'at 'Q f ,F - My Comm. Exp. May 15, 2014
u aldalupe Aboytes Ji e
OPTIONAL
DOCUMENT AND SIGNER
Type:Performance Bond #929510253 3 of 3 originals
Principal:Granite Rock Company, d.b.a. Pavex Construction Division
Obligee:City of Cupertino
Description: Scenic Circle Access
Deborah L. Tablak is Attorney -in -Fact representing Continental Casualty Company
j of• 3 originals Project No. 2010-9136
Bond # 929510253
Premium incl w/ Perf. bond
DOCUMENT 00620
CONSTRUCTION LABOR AND MATERL4L PAYMENT BOND
THIS CONSTRUCTION LABOR AND MATERIAL PAYMENTBOND ("Bond") is dated Feb . 8 , 2011, is in the
penal sum One Hundred Seventy Thousand,. Six Hundred Seventy —Five N0 /100 ($170,675.00)
one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the
payment ofclaimants under the Construction Contract listed below. This Bond consists of this page and the Bond Terms
and Conditions, paragraphs 1 through 14, attached to this page. Any singular reference to
Granite Rock Company, d.b.a.* Contractor"), Continental Casualty Company
Surety "), the City of Cupertino, a Municipal Corporation of the State. of California ( "City ") or other party shall be
considered plural where applicable. * Pavex Construction Division
CONTRACTOR;Granite Rock Company, d.b.a.SURETY:
Pavex Construction Division Continental Casualty Company
N120 Granite Rock Way
iv. Mission St. , #200
Address Principal Place ofBusiness
San Jose, CA 95136 San Francisco, CA 94105
City / State/Zip City /State/Zip
CONSTRUCTION CONTRACT:
SCENIC CIRCLE ACCESS
PROJECT NUNI3ER 2010 -9136
at Cupertino, California.
DATED February 8 20 11 in the Amount es 170,675.00.the "Penal Sum ")
CONTRACTOR ASPRINCIP, Granite Rock SURETY Continental Casualty Company
Compny,'a P aexCompany: Co st is '
v Company: (Corp, Seal
Signature:Signature: tb''"Deborah L Tab1alak
Name and Title: ( r c c,c+ i) T c _ 1, 1, Vt Name and Title:Attorney —in —Fact
BOND TERMS AND CONDITIONS
I.Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors
and assigns to City and to Claimants, to pay for labor, materials and equipment fiunished for use in the
performance ofthe Construction Contract, which is incorporated herein byreference.
2.With respect to City, this obligation shall be null and void if Contractor:
2.1 Promptly makes payment, directly or indirectly, for all sums due Claimants; and
2.2 Defends, indemnifies and holds harndess City from all claims, demands, liens or suits by any person or
entity who furnished Iabor, materials or equipment for use in the performance of the Construction
Contact, provided City has promptly notified Contractor and Surety (at the address set forth on the
signature page of this Bond) of any claims, demands, Liens or suits and tendered defense of such
claims, demands, liens or suits to Contractor and Surety, and provided there is ao City Default.
3.With respect to Claimants, this obligation shall be nth and void ifContractor promptly makes payment, directly
or indirectly through its Subcontractors, for all sums due Claimants. If Contractor or its Subcontractors,
however, fail to pay any of the persons named in Section 3181 ofthe California Civil Code, or amounts due
under the Unemployment Insurance Code with respect to Work or labor performed under the Contract, or for
Cityof Cupertino 00620 - 1 Construction Labor and Material Payment Bond
Scenic Circle Access
Project :No. 2010 -9136
any amounts required to be deducted, withheld, and paid over to the Employment Development Department
from the wages of employees of Contractor or Subcontractors pursuant to Section 13020 of the Unemployment
Insurance Code, with respect to such Work and labor, then Surety shall pay for the same, and also, in case suit
is brought uponthis Bond, a reasonable attorney's fee, to be fixed by the court.
4.Consistent with the California Mechanic's Lien Law„ Civil Code §3082, et seq., Surety shall have no obligation
to Claimants under this Bond unless the Claimant has satisfied all applicable notice requirements.
5.Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited
for any payments made in good faith by Surety under this Bond.
6.Amounts due Contractor under the Construction Contract shall be applied first to satisfy claims, ifany, under
any Construction Performance Bond and second, to satisfy obligations of Contractor and Surety under this
Bond.
7.City shall not be liable for payment of any costs, expenses, or attorney's fees of any Claimant under this Bond,
and shall have under this Bond no obligations to make payments to, give notices on behalfof, or otherwise have
obligations to Claimants under this Bond.
8.Surety hereby waives notice ofany change, including changes oftime, to the Construction Contract or to related
subcontracts, purchase orders and other obligations. Surety further hereby stipulates and agrees that no change,
extension of time, alteration or addition to the terms of the Construction Contract, or to the Work to be
performed thereunder, or materials or equipment to be furnished thereunder or the Specifications accompanying
the same, shall in any way affect its obligations under this Bond, and it does hereby waive any requirement of
notice or any such change, extension oftime, alteration or addition to the terms of the Construction Contract or
to the Work or to the Specifications or any other changes.
9.Suit against Surety on this Bond may be brought by any Claimant, or its assigns, at any time after the Claimant
has furnished the last of the labor or materials, or both, but, per Civil Code §3249, must be commenced before
the expiration of six months after the period in which stop notices may be filed as provided in Civil Code
3184.
10. All notices to Surety or Contractor shall be mailed cr delivered (at the address set forth on the signature page of
this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract).
Actual receipt ofnotice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as
ofthe date received at the foregoing addresses.
11. This Bond has been furnished to comply with the California Mechanic's Lien Law including, but not limited to,
Civil Code § §3247, 3248, et seq. Any provision in this Bond conflicting with said statutory requirements shall
be deemed deleted herefrom and provisions conforming to such statutory or other Iegal requirements shall be
deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a
common law bond.
12. Upon request by any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall
promptly furnish a copy ofthis Bond or shall permit a copy to be made.
13. Contractor shall pay to persons performing labor in and about Work provided for in the Contract Documents an
amount equal to or more than the general prevailing rate ofper diem wages for (1) work of a similar character
in the locality in which the Work is performed and (.2) legal holiday and overtime work in said locality. The per
diem wages shall be an amount equal to or more than the stipulated rates contained in a schedule that has been
ascertained and determined by the Director ofthe State Department of Industrial Relations and City to be the
general prevailing rate ofper diem wages for each craft or type of workman or mechanic needed to execute this
Contract. Contactor shall also cause a copy ofthis determination of the prevailing rate ofper diem wages to be
posted at each Site.
City of Cupertino 00620 - 2 Construction Labor and Material Payment Bond
Scenic Circle Access
Project No. 2010 -9136
14: Definitions.
14.1 Claimant: An individual or entity having a direct contract with Contractor or with a Subcontractor of
Contractor to furnish labor, materials or equipment for use in the performance of the Contract, as
further defined in California Civil Code §3181. The intent of this Bond shall be to include without
limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil,
gasoline, telephone service or rental equipment used in the Construction Contract, architectural and
engineering services required for performance of the Work of Contractor and Contractor's
Subcontractors, and all other items for which a stop notice might be asserted. The term Claimant shall
also. include the Unemployment Development Department as referred to in Civil Code §3248(b).
14.2 Construction Contract: The contract between City and Contractor identified on the signature page of
this Bond, including all Contract Documents and changes thereto.
14.3 City Default: Material failure of City, which has neither been remedied nor waived, to pay the
Contractor as required by the Construction Contact, provided that failure is the cause ofthe failure of
Contractor to pay the Claimants and is sufficient to justify termination of the Construction Contract.
END OF DOCUMENT
City ofCupertino 00620 - 3 Construction Labor andMaterial Payment Bond
Scenic Circle Access
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of
Hartford, an Illinois insurance company, and American Casualty Company ofReading, Pennsylvania, a Pennsylvania insurance company (herein called
the CNA Companies "), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois,
and that they do by virtue ofthe signatures and seals herein affixed hereby make, constitute and appoint
Catherine Gustayson, F R Hudson III, Dennis M Carney, David J Bachan, Deborah L Tablak, Jeanette M Mazzarino,
Matthew Reade, John R Ullmer, Individually
of Watsonville, CA, their true and lawful Attorney(s) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on their
behalfbonds, undertakings and other obligatory instruments of similar nature
In Unlimited Amounts -
and to bind them thereby as fully and to the same extent as ifsuch instruments were signed by a duly authorized officer of their insurance companies and
all the acts of said Attomey, pursuant to the authority hereby given is hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly
adopted, as indicated, by the Boards of Directors of the insurance companies.
In Witness Whereof, the CNA Companies have caused these presents to be s gned by their Senior Vice President and their corporate seals to be
hereto affixed on this 29th day of September, 2010.
oxsui xsuR a Continental Casualty Company
o National Fire Insurance Company of Hartford
F
0o POR "rF 07 *cam? a American Casualty Company of Reading, Pennsylvania
oo SEAL i ULYt. i
1897 NARK 43 111 1 It (eRS U
Tac ..wyne ii . Belcastro Senior Vice President
State of Illinois, County of Cook, ss:
On this 29th day of September, 2010, before me personally came Jacquelyne M. Belcastro to me known, who, being by me duly sworn, did depose
and say: that she resides in the City of Chicago, State of Illinois; that she is a Senior Vice President of Continental Casualty Company, an Illinois
insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading,
Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that she knows the seals of said insurance
companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of
Directors ofsaid insurance companies and that she signed her name thereto pursuant to like authority, and acknowledges same to be the act and deed of
said insurance companies.
7A PRICE
NOTARY 14„;:x.„M canaarc • tawoarwWeaorna
My Commission Expires September 17, 2013 Eliza Price Notary Public
CERTIFICATE
I, Mary A. Ribikawskis, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of
Hartford, an Illinois insurance company, and American Casualty Company of Read:;ng, Pennsylvania, a Pennsylvania insurance company do hereby
certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of
the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of
the said insurance companies this 8th day of February 2011
onsuqT UtR Continental Casualty Company
lf o e ,National Fire Insurance Company of Hartford
o°O c+ocarepaar American Casualty Company ofReading, Pennsylvania
o E a JULY n. Z
V SEAL DI 1902 coeci.,,x2..,1897 NARK
Mary A. ika kis Assistant Secretary
Form F6853- 5/2009
Authorizing By -Laws and Resolutions
ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article IXExecution of Documents
Section 3. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Executive, Senior or Group VicePresidentmay, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies ofinsurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in theirrespectivecertificatesofauthority, shall have full power to bind the Company by their signature and execution ofany such instruments and to attach thesealoftheCompanythererto. The Chairman of the Board of Directors, the President or any Executive, Senior or Group Vice President or the Board ofDirectors, may, at any time, revoke all power and authority previously given to any attorney -in- fact."
This Power ofAttorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board ofDirectors ofthe
Company at a meeting duly called and held on the 17`" day ofFebruary, 1993.
Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed byfacsimileonanypowerofattorneygrantedpursuanttoSection3ofArticleIXoftheBy -Laws, and the signature of the Secretary or an AssistantSecretaryandthesealoftheCompanymaybeaffixedbyfacsimiletoanycertificateofanysuchpowerandanypowerorcertificatebearingsuchfacsimilesignatureandsealshallbevalidandbindingontheCompany. Any such power so executed and sealed and certified by certificate so executedandsealedshall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA:
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article VIExecution of Documents
Section 3 Appointment ofAttorney -in -fact. The Chairman ofthe Board of Directors, the President or any Executive or Senior Vice President may,from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies of insurance, bonds,undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates ofauthority, shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Companythereto. The President or any Executive, Senior Vice President or the Board of Directors may at any time revoke all power and authority previously
given to any attomey -in- fact."
This Power ofAttorney is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of Directors ofthe
Company at a meeting duly called and held on the 17 day of February, 1993.
Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed byfacsimileonanypowerofattorneygrantedpursuanttoSection2ofArticleVIoftheBy -Laws, and the signature of the Secretary or an AssistantSecretaryandthesealoftheCompanymaybeaffixedbyfacsimiletoanycertificateofanysuchpowerandanypowerorcertificatebearingsuchfacsimilesignatureandsealshallbevalidandbindingontheCompany. Any such power so executed and sealed and certified by certificate so executedandsealedshall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Attomey is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the
Company.
Article VIIExecution of Documents
Section 3. Appointment of Attomey -in -Fact. The Chairman of the Board of Directors, the President or any Executive or Senior Vice Presidentmay, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution ofpolicies of insurance, bonds,undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates ofauthorityshallhavefullpowertobindtheCompanybytheirsignatureandexecutionofanysuchinstrumentsandtoattachthesealoftheCompanythereto. The Chairman of the Board of Directors, the President or any Executive, Senior Vice President or the Board of Directors, may, at any time,
revoke all power and authority previously given to any attorney -in- fact."
This Power of Attorney is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of Directors ofthe
Company at a meeting duly called and held on the 17 day of February, 1993.
RESOLVED: That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal ofthe InsuranceCompanymaybeaffixedbyfacsimileonanypowerofattorneygrantedpursuanttotheResolutionadoptedbythisBoardofDirectorsonFebruary17,1993 and the signature of a Secretary or an Assistant Secretary and the seal of the Insurance Company may be affixed by facsimile to any certificate ofanysuchpower, and any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Insurance Company. Any suchpowersoexecutedandsealedandcertifiedbycertificatesoexecutedandsealed, shall with respect to any bond or undertaking to which it is attached,
continue to be valid and binding on the Insurance Company."
CALIFORNIA ALL PURPOSE ACKNOWLEDGMENT
State of California
County of Santa Cruz
On February 8, 2011, before me, Guadalupe Aboytes Jimenez, Notary Public, personally appeared
Deborah L. Tablak, who proved to me on the basis of satisfactory evidence to be the person(8)
whose name(s) ism subscribed to the within instrument and acknowledged to me that sheer
executed the same in 14444herAtheir authorized capacity(ics), and that by itisitherAtheip signature(s)
on the instrument the person(s), or the entity upon behalf of which the person(s) acted,
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws ofthe State of California
that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
r GUADALUPE ABOYTES JIMENEZ
N
4 COMM. # 1889432 1 1
u Public - California
v /
Notary
County of Santa Cruz N L.I. AI J
ti ." My Comm. Exp. May 15, 2014E Gu , dalupe A , oytes Ji ' e i
OPTIONAL
DOCUMENT AND SIGNER
Type:Payment Bond #929510253 1 of 3 originals
Principal:Granite Rock Company, d.b.a. Pavex Construction Division
Obligee:City of Cupertino
Description: Scenic Circle Access
Deborah L. Tablak is Attorney -in -Fact representing Continental Casualty Company
CITY OF
Project No. 2010 -9136
DOCUMENT 00630
CUPERTINO GUARANTY
TO THE CITY OF CUPERTINO, a Municipal Corporation of the State of California ( "City"), for construction of
SCENIC CIRCLE ACCESS
PROJECT NUMBER 2010 -9136
CUPERTINO, CALIFORNIA
The undersigned guarantees all construction performed on this Project and also guarantees all material and equipment
incorporated therein.
Contractor hereby grants to City for a period of one year following the date of Final Acceptance, or such longer period
specified in the Contract Documents, its unconditional warranty of the quality and adequacy of all of the Work including,
without limitation, all labor, materials and equipment provided by Contractor and its Subcontractors of all tiers in
connection with the Work.
Neither final payment nor use or occupancy of the Work performed by the Contractor shall constitute an acceptance of
Work not done in accordance with this Guaranty or relieve Contractor of liability in respect to any express warranties or
responsibilities for faulty materials or workmanship. Contractor shall remedy any defects in the Work and pay for any
damage resulting therefrom, which shall appear within one year, or longer if specified, from the date of Final
Acceptance.
If within one year after the date of Final Acceptance, or such longer period of time as may be prescribed by laws or
regulations, or by the terms of Contract Documents, any Work is found to be defective, Contractor shall promptly,
without cost to City and in accordance with City's written instructions, correct such defective Work. Contractor shall
remove any defective Work rejected by City and replace is with Work that is not defective, and satisfactorily correct or
remove and replace any damage to other Work or the work of others resulting therefrom. If Contractor fails to promptly
comply with the terms of such instructions, or in an emergency where delay would cause serious risk of loss or damage,
City may have the defective Work corrected or the rejected Work removed and replaced. Contractor shall pay for all
claims, costs, losses and damages caused by or resulting from such removal and replacement. Where Contractor fails to
correct defective Work, or defects are discovered outside the correction period, City shall have all rights and remedies
granted by law.
Inspection ofthe Work shall not relieve Contractor of any of its obligations under the Contract Documents. Even though
equipment, materials, or Work required to be provided under the Contract Documents have been inspected, accepted, and
estimated for payment, Contractor shall, at its own expense, replace or repair any such equipment, material, or Work
found to be defective or otherwise not to comply with the requirements of the Contract Documents up to the end of the
guaranty period.
All abbreviations and definitions of terms used in this Agreement shall have the meanings set forth in the Contract
Documents, including, without means of limitation, Section 00700 (General Conditions).
The foregoing Guaranty is in addition to any other warranties of Contractor contained in the Contract Documents, and
not in lieu of, any and all other liability imposed on Contractor under the Contract Documents and at law with respect to
Contractor's duties, obligations, and performance under the Contract Documents. In the event of any conflict or
inconsistency between the terms of this Guaranty and any warranty or obligation of the Contractor under the Contract
Documents or at law, such inconsistency or conflict shall be resolved in favor of the higher level of obligation of the
Contractor.
nYIC C C tt 4.al i° 1 \x' I C_` 0: jC r l t C r t <" 1 i V
Contractor's Name
Address
City/State /Zip Date
END OF DOCUMENT
City of Cupertino 00630 - 1 Guaranty
Scenic Circle Access
Project No. 2010 -9136
DOCUMENT 00530
INSURANCE FORMS
INSURANCE FORMS INSTRUCTIONS
FOR ITEMS 3, 4 AND 5, 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 Cupertino - must be completed by the insurance
agent or must provide a certificate on the company's form. They must contain the same
information.
3. Endorsement of Additional Insured and Primary Insurance and Notice of Cancellation - must be
signed by the insurance agent for general liability and automobile liability only.
4. 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.
5. Waiver of subrogation endorsement worker's compensation insurance - must be signed by the
insurance agent for worker's compensation only.
City of Cupertino 00530 - 1 Insurance Forms
Scenic Circle Access
CITY OF
IV Project No. 2010 -9136
CUPERTINO INSURANCE AGREEMENT
A.Contractor is 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 undertake self -
insurance in accordance with the provisions of that Code, and will comply with such provisions
before commencing the performance ofthe work ofthis Contract.
B.Contractor and all subcontractors will carry 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 general liability
insurance, automobile 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, its 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 or that is otherwise acceptable to the City.
D.Before Contractor performs any work at, or prepares or delivers materials to, the site of
construction, Contractor shall furnish certificates of 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 Contract 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 obligations 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 having a Best's Guide Rating of A, Class VII or better or that is
otherwise acceptable to the City.
City of Cupertino 00530 - 2 Insurance Forms
Scenic Circle Access
Project No. 2010 -9136
LIMITS
Worker's Compensation In accordance with the Worker's Compensation
Employers' Liability Act of the State of California — Worker's comp
statutory" per CA Law; Employers' Liability
1,000,000 per occurrence.
General Liability - commercial general liability; Combined single limit of $2.0 million per
including provisions for contractual liability,occurrence; $4.0 million in the aggregate
personal injury, independent contractors and
products — completed operations hazard.
Automobile Liability - comprehensive covering Combined single limit of $1.0 million per
owned, non -owned and hired automobiles.occurrence.
Granite Rock Company DBA 10A
Pavex Construction Division
Contractor's Name)
rDated: t- w r 1 ti ,_ 20 Hi
City of Cupertino 00530 - 3 Insurance Forms
Scenic Circle Access
CITY OF
1i /
Project No. 2010 -9I36
4ytr-
CUPERTINO
CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO
I This certifies to the City ofCupertino that the following described policies have been issued to the 1
insured named below and are in force at this time.
Insured: Granite Rock Company DBA Pavex Construction Division 1
Address: P.O. Box 50001
Watsonville, CA 95077
Description of operations/locations/products insured (show contract name and/or number, ifany):
Job #4149 Scenic Circle Access Project# 2010 -9136
I
WORKER'S COMPENSATION Statutory Min.
Zurich American Ins. Co. Employer's
Liability
name ofinsurer)
1,000,000 1,000,000 1,000,000
Insurance Company's State License No.
I Check Policy Type: COMMERCIAL Each Occurrence 2,000,000
GENERAL
LIABILITY
1 [x] Premises /Operations General Aggregate 4,000,000
ifapplicable)
x] Owners & Contractors
I Protective Aggregate 4,000,000
i [ x ] Contractual for Specific
Contract Per ISO FORM Personal Injury 2,000,000
CG0001 12 - 04
X] Products Liability
x] XCU Hazards
Broad Form P.D.Fire Damage (any one fire) 2,000,000
x ] Severability ofInterest
Clause
x] Personal Injury with Medical Expense NIL
Employee Exclusion Removed any one person)
or Self - Insured
COMMERCIAL GENERAL LIABILITY Retention NIL
Zurich Insurance Company
Westchester Fire Insurance Co.
name of insurer)
1 Policy No. GL03472668 -09 Expiration Date 09 -30 -11
G22009163006
City ofCupertino 00530-4 Insurance FormsScenicCircleAccess
ProjectNo. 2010 -9136
AUTOMOTIVE/VEHICLE LIABILITY BODILY INJURY PROPERTY DAMAGE
Commercial Form Each Person Each Accident
Liability Coverage -
Each Accident
Zurich American Ins. Co.
name ofinsurer)
or
Combined Single Limit 1,000,000
Polio No. BAP3472669 - 09 09 - 30 - 111PolicyExpirationDate
Per IS0 Porn CA0001(03 - 06)
BUILDER'S RISK "ALL RISK"
This is to certify that the following policy has been issued by the below - stated company In
conformance with the requirements of theproject documents and is in force at this time.
N/A
Mane ofinsurer)
PolleyNo.Expiration Date
Limits ofLiability:Deductible:
IBA •IAA..A copy ofall Endorsements to the policy( ies) which in any way
gent's initial)limitthe above - listed types ofcoverage are attached to this
Certificate ofInsurance.
This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the
coverage afforded by the policies listed herein. Notvtithstanding any requirement, term, or
condition of any contract or any other document with respeot to which this Certificate of Insurance
may be issued or may pertain, the insurance afforded by the policies described herein is subject to
all the terms, exclusions and conditions ofsuch policies.
IT 1S HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by
the ement between the City and the insured.
By:Id Dated: February 7 20 11
Je'.ette M. z =`moo
Attach Certificate of Insu •1 and Additional Insured Endorsement on company forms.
City ofCupertino 00510-5 InsuranceForms
Scenic Circle Access
CITY OF
I % ProjectNo.2010 -9136
ADDITIONAL INSURED ENDORSEMENT
and
CUPERTINO ENDORSEMENT OF PRIMARY INSURANCE
and
NOTICE OF POLICY
CANCELLATION ENDORSEMENT
Project Title and Number: Scenic Circle Access Project No. 2010 -9136
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 I
follows:Per Endorsements U — GL - 1175 — B CW and CA 20 48 (09 - 99)
The City ofCupertino ( "City ") and its directors, officers, engineers, agents and employees,
and all public agencies from whom permits will be obtained and their directors, officers, engineers, 1
I agents and employees, and the State of California, and its officers, agents and employees, are
hereby declared to be additional insureds under the terms ofthis 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
I Contract with the City, or acts or omissions of the additional insureds in connection with, but
limited to its general supervision or inspection ofsaid operations.
The insurance afforded by this policy is primary insurance, and no additional insurance held
or owned by the designated additional insured(s) shall be called upon to cover a loss under said I
additional policy.
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
Zurich American Insurance Co.
1. Insurance Company: Westchester Fire Insurance Co.
GL03472668 -09 BA23472669 -09
2. Insurance Policy Number: G22009163006
3. Effective Date ofthis Endorsement:February 7 2011
14. Insured: Granite Rock Company DBA: Pavex Construction Division
AU notices herein provided to be given by the Insurance Company to the City in connection
with this policy and these Endorsements, shall be mailed to or delivered to the City at 10300 Torre I
Avenue; Cupertino, California 95014.
I,Jeanette M. Mazzarino print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature j
hereon do so bind this Company.
City of Cupertino 00530 - 6 Insurance Forms
Scenic Circle Access
Project No. 2010.9136
Signature ofAuthorized Representative: di 0 ,,A. 1
Original signature required on all Endorse (its furnished o the strict)
Names of Jeanette M. Mazzarino
Agent/Agency: McSherry be Hudson Title: Account Manager
Address:P.O. Box 2690 Telephone: (831)724 -3841
Watsonville, CA 95077 Facsimile: (831)724 -7574
License# 0056172
City ofCupertino 00530 - 7 Insurance Forms
Scenic Circle Access
CITY OF Project No. 2010 -9136
COMPREHENSIVE GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
21yss ENDORSEMENT OF AGGREGATE LIMITS OF
CUPERTINO INSURANCE PER PROJECT
IProject Title and Number: Scenic Circle Access Project No .2010 -9136
In consideration ofthe policy premium and notwithstanding any inconsistent statement in the policy i
to which this Endorsement is attached or any other Endorsement attached thereto, it is as follows:
Per Endorsement# CG 2503 (03 - 97)I
This Endorsement modifies the insurance provided under the General Liability Coverage part oftheIbelow- referenced policy of insurance.
The general aggregate limit under LIMITS OF INSURANCE applies separately to the projectdescribedasScenicCircleAccessProjectNo. 2010 - 9136
POLICY INFORMATIOIysurich American Insurance Co .
1. Insurance Company:
Westchester Fire Insurance Co.
GL03472668 -09
12. Insurance Policy Number: 622009163006
3. Effective Date ofthis Endorsement:February 7 20 11
I4. Insured: Granite Rock Company DBA: Pave): Construction Division
5. Additional Insured: City of Cupertino, its directors, officers, agents and employees.
All notices herein provided to be given by the Insurance Company to the City in connection with
this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue;
Cupertino, California 95014.
L Jeanette M. Mazzarino print/type namePtYPe
warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do jsobindthisCompany.
l
Signature of Authorized Representative:I
Original signature required on all Endo ents furnghe to the ct)
I Names of Jeanette M. Mazzarino
Agent/Agency: McShe & Hudson Title: Account Manager
I Address:P.O. Box 2690 Telephone: (831) 724 -3841
Watsonville, CA 95077 Facsimile: (831)724 -7574
License# 0056172
City of Cupertino 00530 - 8 Insurance Forms
Scenic Circle Access
CITY OF
Project No.2010 -9136
WAIVER OF SUBROGATION ENDORSEMENT
WORKER'S COMPENSATION INSURANCECUPERTINO
Project Title and Number: Scenic Circle Access Project No.2010 -9136
In consideration ofthe policy premium and notwithstanding any inconsistent statement in the policyltowhichthisEndorsementisattachedoranyotherEndorsementattachedthereto, it is agreed as follows: {
Per Endorsement# WC000313 (4 — B4)
It is agreed that with respect to such insurance as is afforded by the policy, the Insurance Company j
waives any right of subrogation against the City of Cupertino, and each of its directors, officers, agents,
consultants and employees by reason of any payment Jmade on account of injury, including death j
resulting therefrom, sustained by any employee of the insured, arising out of the performance of theabove- referenced Contract.
POLICY INFORMATION
I. Insurance Company: Zurich American Insurance Co.
2. Insurance Policy Number: WC3472667 -09
3. Effective Date ofthis Endorsement:February 7 2011
4. Insured: Granite Rock Co. DBA: Pavex Construction Division
All notices herein provided to be given by the Insurance Company to the City in connection with
this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue;
Cupertino, California 95014.
1, Jeanette M. Mazzarino print/type name)
warrant that I have authority to bind the below Iisted Insurence Company and by my signature hereon do
I so bind this Company.
Signature ofAuthorized Representative:
Original signature required on all Endo e r wts furnished to e Dis
INamesof Jeanette M. Mazzarino
Agent/Agency: McSherry & Hudson Title: Account Manager
I Address:P.O. Box 2690 Telephone: (831) 724 -3841
Watsonville, CA 95077 Facsimile: (831) 724 -7574
License# 0056172
END OF DOCUMENT
City ofCupertino 00530-9 Insurance Forms
Scenic Circle Access
Additional Insured — Automatic — Owners Lessees Or
Contractors ZURICH
Policy No.Eff. Date of Pol. Exp Date of Agency No.Addl. Return Prem.
Pol.Prem.
GLO 3472668 -09 9/30/2010 9/30/2011 McSherry & Hudson
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II — Who Is An Insured is amended to include as an insured any person or organization who you
are required to add as an additional insured on this policy under a written contract or written agreement.
B. The insurance provided to the additional insured person or organization applies only to "bodily injury",
property damage" or "personal and advertising itjury" covered under SECTION I - Coverage A - Bodily
Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury
Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising
injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf; and resulting directly from:
a. Your ongoing operations performed for the additional insured, which is the subject of the written
contract or written agreement; or
b. "Your work" completed as included in the "products- completed operations hazard ", performed for
the additional insured, which is the subject: of the written contract or written agreement.
C. However, regardless of the provisions of paragraphs A. and B. above:
1. We will not extend any insurance coverage to any additional insured person or organization:
a. That is not provided to you in this policy; or
b. That is any broader coverage than you are required to provide to the additional insured person or
organization in the written contract or written agreement; and
2. We will not provide Limits of Insurance to any additional insured person or organization that exceed
the lower of:
a. The Limits of Insurance provided to you in this policy; or
b. The Limits of Insurance you are required to provide in the written contract or written agreement.
D. The insurance provided to the additional insured person or organization does not apply to:
Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure
to render any professional architectural, engineering or surveying services including:
1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
Includes copyrighted material of Insurance Services Office, Inc., with its permission U -GL- 1175 -B CW
3/2007)
Page 1 of 2
2. Supervisory, inspection, architectural or engineering activities.
E. The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or suit will promptly be brought against any policy
issued by another insurer under which the additional insured may be an insured in any capacity. This
provision does not apply to insurance on which the additional insured is a Named Insured, if the writ-
ten contract or written agreement requires that this coverage be primary and non - contributory.
F. For the coverage provided by this endorsement:
The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV —
Commercial General Liability Conditions: This insurance is primary insurance as respects our
coverage to the additional insured person or organization, where the written contract or written
agreement requires that this insurance be primary and non - contributory. In that event, we will not
seek contribution from any other insurance policy available to the additional insured on which the addi-
tional insured person or organization is a Named Insured.
1. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV —
Commercial General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an
additional insured, in which the additional insured on our policy is also covered as an additional in-
sured by attachment of an endorsement to another policy providing coverage for the same occur-
rence", claim or "suit". This provision does not apply to any policy in which the additional insured is a
Named Insured on such other policy and where our policy is required by written contract or written
agreement to provide coverage to the additional insured on a primary and non - contributory basis.
G. This endorsement does not apply to an additional insured which has been added to this policy by an en-
dorsement showing the additional insured in a Schedule of additional insureds, and which endorsement
applies specifically to that identified additional insured.
Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to
apply as written.
Includes copyrighted material of Insurance Services Office, Inc., with Its permission. U -GL -1175 B CW (312007)
Page 2 of 2
Policy Number: GLO 3472668 -09
Zurich American Insurance Co,
Effective: 9/3012010
Commercial General Liability Coverage Part
Severability of Interest
The insurance afforded by this policy applies severally as to each insured except that the
inclusion of more than one insured shall not operate to increase the limit of the company's liability
and the inclusion hereunder of any person or organization as an insured shall not affect any right
which such person or organization would have as a claimant if not so included.
Waiver of Subrogation
The Company waives any right of recovery the Company may have against the person or organization shown in
the Schedule because of payments the Company makes for injury or damage arising out of the named insured's
ongoing operations or work done under a contract with that person or organization and included in the "products -
completed operations hazard ".
Schedule
Name of Person or Organization: Any person or organization that requires that the named insured waive the
named insured's rights of recovery in a written contract or agreement with the named insured that is executed prior
to the accident or loss.
Notice of Cancellation
If the Company cancels this Coverage Part by written notice to the first Named Insured for any reason other than
nonpayment of premium, the Company will mail a copy of such written notice of cancellation to the person or or-
ganization shown in the Schedule at least 30 days prior to the effective date of the cancellation. If the Company
cancels this Coverage Part by written notice to the first Named Insured for nonpayment of premium, the Company
will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule at least
10 days prior to the effective date of such cancellation. If the Company reduces the coverage afforded by this
Coverage Part, the Company will mail a written notice of such reduction in coverage to the person or organization
shown in the Schedule at least 30 days prior to the effective date of the reduction in coverage.
Schedule
Name of Person or Organization: Any person or organization to whom the named insured is required by written
contract or agreement to mail prior written notice of cancellation and /or reduction in coverage.
Policy Number: GLO 3472668 -09 COMMERCIAL GENERAL LIABILITY
Zurich American Insurance Co.CG 25 03 03 97
Effective: 9130/2010
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Projects:
A GENERAL AGGREGATE LIMIT APPLIES TO EACH CONSTRUCTION PROJECT WHERE REQUIRED BY
WRITTEN CONTRACT OR AGREEMENT.
If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable.)
A. For all sums which the insured becomes legally c. Persons or organizations making claims
obligated to pay as damages caused by "occur-or bringing "suits ".
rences" under COVERAGE A (SECTION 1), and
for all medical expenses caused by accidents 3. Any payments made under COVERAGE A for
under COVERAGE C (SECTION I), which can be damages or under COVERAGE C for medical
attributed only to ongoing operations at a single expenses shall reduce the Designated
designated construction project shown in the Construction Project General Aggregate Limit
Schedule above:for that designated construction project. Such
payments shall not reduce the General
1. A separate Designated Construction Project Aggregate Limit shown in the Declarations
General Aggregate Limit applies to each des-nor shall they reduce any other Designated
ignated construction project and that limit is Construction Project General Aggregate Limit
equal to the amount ofthe general Aggregate for any other
Limit shown in the Dedications.designated construction project shown in the
Schedule above.
2. The Designated Construction Project General
Aggregate Limit is the most we will pay for the 4. The limits shown in the Declarations for Each
sum of all damages wider COVERAGE A, ex-Occurrence, Fire Damage and Medical Ex-
cept damages because of "bodily injury" or pense continue to apply. However, instead of
property damage" included in the "products-being subject to the General Aggregate Limit
completed operations hazard" and for medical shown in the Declarations, such limits will be
expenses under COVERAG— C regardless of subject to the applicable Designated
the number of:Construction Project General Aggregate Limit.
a. Insureds;B. For all sums which the insured becomes legally
b. Claims made or "suits" brought; or obligated to pay as damages caused by 'occur -
Page 1 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97
rences' under COVERAGE A (SECTION 1), and bodily injury" or "property damage" included in
for all medical expenses caused by accidents the "products - completed operations hazard" will
under COVERAGE C (SECTION I), which cannot reduce the Products - Completed Operations
be attributed only to ongoing operations at a Aggregate Limit, and not reduce the General
single designated construction project shown in Aggregate Limit nor the Designated Construction
the Schedule above:Project General Aggregate Limit.
1. Any payments made under COVERAGE A for
damages or under COVERAGE C for medical
expenses shall reduce the amount available D. If the applicable designated construction project
under the General Aggregate Limit or the has been abandoned, delayed, or abandoned and
Products- Completed Operations Aggregate then restarted, or if the authorized contracting
Limit, whichever is applicable; and parties deviate from plans, blueprints, designs,
specifications or timetables, the project will still be
2. Such payments shall not reduce any deemed to be the same construction project
Designated Construction Project General
Aggregate Limit.
E. The provisions of Limits Of Insurance (SECTION
C. When coverage for liability arising out of the III) not otherwise modified by this endorsement
products- completed operations hazard' is shall continue to apply as stipulated.
provided, any payments for damages because of
Page 2 of 2 Copyright, Insurance Services Office, Inc., 1996 CG 25 03 03 97
POLICYNUMBER: BAP 3472669 -09 COMMERCIAL AUTO
ZURICH AMERICAN INS. CO.CA 20 48 02 99
EFFECTIVE DATE: 9/30/2010
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ Ti' CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under thefollowing:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified bythis en-
dorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the
Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes thepolicy effective on the inception date of the policy unless another date is indicated below.
Endorsement Effective:Countersigned By:
9-30-10
Authorized Representative)
SCHEDULE
Name ofPerson(s) or Organizatfon(s):
ANY PERSONS OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED
TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS
ON A PRIMARY, NON CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR
WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT
OR AGREEMENT IS PROHIBITED BY LAW.
Eno entry appears above, information required to complete this endorsement will be shown in the Declarations as applica-
ble to the endorsement.)
Each person or organization shown in the Schedule isan "insured" for Liability Coverage, butonly to the extent that person or
organization qualifies as an'9nsured" under the Who Is AnIn:,ured Provision contained in Section Ill of the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of1 0
Policy Number: BAP 3472669 -09
Zurich American Ins. Co.
Effective Date: 9/30/2010
Commercial Automobile Coverage Part
Severability of Interest
Except with respect to the limit of insurance, the coverage afforded applies separately to each
insured who is seeking coverage or against whom a claim or suit is brought.
Waiver of Subrogation
The Company waives any right of recovery the Company may have against the designated
person or organization shown in the schedule because of payments the Company makes for
injury or damage caused by an "accident" or `loss" resulting from the ownership, maintenance, or
use of a covered "auto" for which a Waiver of Subrogation is required in conjunction with work
performed by the named insured for the designated person or organization.
Schedule
Name of Person or Organization: All persons and/or organizations that require by written contract
or agreement with the named insured, executed prior to the accident or loss, that waiver of
subrogation be provided under this policy.
Notice of Cancellation
If the Company cancels or non - renews this Coverage Part by written notice to the first Named
Insured for any reason other than nonpayment of premium, the Company will mail a copy of such
written notice of cancellation or non - renewal to the person or organization shown in the Schedule
at least 30 days prior to the effective date of the cancellation or non - renewal. If the Company
cancels this Coverage Part by written notice to the first Named Insured for nonpayment of
premium, the Company will mail a copy of such written notice of cancellation to the person or
organization shown in the Schedule at least 10 days prior to the effective date of such
cancellation. If the Company reduces the coverage afforded by this Coverage Part, the Company
will mail a written notice of such reduction in coverage to the person or organization shown in the
Schedule at least 30 days prior to the effective date of the reduction in coverage.
Schedule
Name of Person or Organization: Any person or organization to whom the named insured is
required by written contract or agreement to mail prior written notice of cancellation and /or
reduction in coverage
WORKERS COMPENSATION AND EMPLOYERS LIAEIILITY INSURANCE POLICY WC 000313
Ed. 4 -84)
WAIVER OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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
ALL PERSONS AND /OR ORGANIZATIONS THAT REQUIRE. BY WRITTEN
CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER
THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND /OR
ORGAN! ZATION.
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 ofthe policy.)
Endorsement Effective: 9/30/10 Policy No.: WC 3472667 -09
Insurance Company Zurich American Insurance Company
WC 00 03 13
Ed. 4 -84)
Notice of Cancellation
If the insurer cancels this policy by written notice to the named insured for any reason other than nonpayment of premium,
the insurer will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule.
Notification to such person or organization will be provided at least 30 days prior to the effective date of the cancellation. If
the insurer cancels this policy by written notice to the named insured for nonpayment of premium, the insurer will mail a
copy of such written notice of cancellation to the person or organization shown in the Schedule at least 10 days prior to
the effective date of such cancellation. If the insurer reduces the coverage afforded by this policy, the insurer will mail a
written notice of such reduction in coverage to the person or organization shown in the Schedule at least 30 days prior to
the effective date ofthe reduction in coverage.
Schedule
Name of Person or Organization: Any person or organization to whom the named insured is required by written contract or
agreement to mail prior written notice of cancellation and/or reduction in coverage.
'I.
Form W•9
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
Name (as shown on your income tax return)
Check appropriate box: D Individual/Sole proprietor ~' Corporation D Partnership
D Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) "° ______ _ D Exempt
payee D Other (see instructions) ""
Address (number, street, and apt. or suite no.) 'Requester's name and address (optional)
'/'20 ()..,.V\ t '+e J{_ WQL
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Social security number
or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
'IL/ i 51ac: lo number to enter.
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign
Here
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it {the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Date P.. 2-·-:;--} {
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States ·are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership ·
conducting a trade or business in the United States is in the
following cases:
• The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10·2007)
Form W -9 (Rev. 10 -2007)Page 2
The U.S. grantor or other owner of a grantor trust and not the 4. The IRS tells you that you are subject to backuptrust, and withholding because you did not report all your interest and
The U.S. trust (other than a grantor trust) and not the dividends on your tax retum (for reportable interest and
beneficiaries of the trust.dividends only), or
Foreign person. If you are a foreign person, do not use Form 5. You do not certify to the requester that you are not subject
W -9. Instead, use the appropriate Form W -8 (see Publication to backup withholding under 4 above (for reportable interest and
515, Withholding of Tax on Nonresident Aliens and Foreign dividend accounts opened after 1983 only).
Entities).Certain payees and payments are exempt from backup
Nonresident alien who becomes a resident alien. Generally,withholding. See the instructions below and the separate
only a nonresident alien individual may use the terms of a tax Instructions for the Requester of Form W -9.
treaty to reduce or eliminate U.S. tax on certain types of income.Also see Special rules for partnerships on page 1.
However, most tax treaties contain a provision known as a Penaltiessavingclause." Exceptions specified in the saving clause may
permit an exemption from tax to continue for certain types of Failure to furnish TIN. If you fail to furnish your correct TIN to aincomeevenafterthepayeehasotherwisebecomeaU.S.requester, you are subject to a penalty of $50 for each suchresidentalienfortaxpurposes.failure unless your failure is due to reasonable cause and not to
If you are a U.S. resident alien who is relying on an exception willful neglect.
contained in the saving clause of a tax treaty to claim an Civil penalty for false information with respect toexemptionfromU.S. tax on certain types of income, you must withholding. If you make a false statement with no reasonableattachastatementtoFormW -9 that specifies the following five basis that results in no backup withholding, you are subject to aitems:500 penalty.
1. The treaty country. Generally, this must be the same treaty Criminal penalty for falsifying information. Willfully falsifyingunderwhichyouclaimedexemptionfromtaxasanonresidentcertificationsoraffirmationsmaysubjectyoutocriminalalien.penalties including fines and /or imprisonment.2. The treaty article addressing the income.Misuse of TINs. If the requester discloses or uses TINs in3. The article number (or location) in the tax treaty that violation of federal law, the requester may be subject to civil andcontainsthesavingclauseanditsexceptions.criminal penalties.
4. The type and amount of income that qualifies for the
exemption from tax.Specific Instructions
5. Sufficient facts to justify the exemption from tax under the Nametermsofthetreatyarticle.
Example. Article 20 of the U.S. -China income tax treaty allows If you are an individual, you must generally enter the name
an exemption from tax for scholarship income received by a shown on your income tax return. However, if you have changed
Chinese student temporarily present in the United States. Under your last name, for instance, due to marriage without informing
U.S. law, this student will become a resident alien for tax the Social Security Administration of the name change, enter
purposes if his or her stay in the United States exceeds 5 your first name, the last name shown on your social security
calendar years. However, paragraph 2 of the first Protocol to the card, and your new last name.
U.S. -China treaty (dated April 30, 1984) allows the provisions of If the account is in joint names, list first, and then circle, theArticle20tocontinuetoapplyevenaftertheChinesestudentnameofthepersonorentitywhosenumberyouenteredinPart IbecomesaresidentalienoftheUnitedStates. A Chinese of the form.
student who qualifies for this exception (under paragraph 2 of Sole proprietor. Enter your individual name as shown on yourthefirstprotocol) and is relying on this exception to claim an income tax return on the "Name" line. You may enter yourexemptionfromtaxonhisorherscholarshiporfellowshipbusiness, trade, or "doing business as (DBA)" name on theincomewouldattachtoFormW -9 a statement that includes the Business name" line.information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to Limited liability company (LLC). Check the "Limited liability
backup withholding, give the requester the appropriate company" box only and regar the appropriate
ity, " "
code for the tax
completed Form W -8.classification ("D" for disregarded entity, "C" for corporation, "P"
for partnership) in the space provided.
What is backup withholding? Persons making certain payments For a single- member LLC (including a foreign LLC with atoyoumustundercertainconditionswithholdandpaytothedomesticowner) that is disregarded as an entity separate fromIRS28% of such payments. This is called "backup withholding."its owner under Regulations section 301.7701 -3, enter thePaymentsthatmaybesubjecttobackupwithholdingincludeowner's name on the "Name" line. Enter the LLC's name on theinterest, tax - exempt interest, dividends, broker and .barter Business name" line.exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate For an LLC classified as a partnership or a corporation, enter
transactions are not subject to backup withholding.the LLC's name on the "Name" line and any business, trade, or
You will not be subject to backup withholding on payments DBA name on the "Business name" line.
you receive if you give the requester your correct TIN, make the Other entities. Enter your business name as shown on required
proper certifications, and report all your taxable interest and federal tax documents on the "Name" line. This name should
dividends on your tax retum.match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBAPaymentsyoureceivewillbesubjecttobackupnameonthe "Business name" line.withholding if:Note. You are requested to check the appropriate box for your1. You do not furnish your TIN to the requester,status (individual /sole proprietor, corporation, etc.).
2. You do not certify your TIN when required (see the Part II Exempt Payeeinstructionsonpage3fordetails),
3. The IRS tells the requester that you furnished an incorrect If you are exempt from backup withholding, enter your name as
TIN,described above and check the appropriate box for your status,
then check the "Exempt payee" box in the line following thebusinessname, sign and date the form.
Form W -9 (Rev. 10 -2007)Page 3
Generally, individuals (including sole proprietors) are not exempt Part I. Taxpayer Identificationfrombackupwithholding. Corporations are exempt from backup Number (TIN)withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should Enter your TIN in the appropriate box. If you are a residentstillcompletethisformtoavoidpossibleerroneousbackupalienandyoudonothaveandarenoteligibletogetanSSN,withholding.your TIN is your IRS individual taxpayer identification number
The following payees are exempt from backup withholding:ITIN). Enter it in the social security number box. If you do not
1. An organization exempt from tax under section 501(a), any have an ITIN, see How to get a TIN below.
IRA, or a custodial account under section 403(b)(7) if the account If you are a sole proprietor and you have an EIN, you may
satisfies the requirements of section 401(0(2),enter either your SSN or EIN. However, the IRS prefers that youuseyourSSN.2. The United States or any of its agencies or If you are a single- member LLC that is disregarded as aninstrumentalities,9
entity separate from its owner (see Limited liability company3. A state, the District of Columbia, a possession of the United LLC) on page 2), enter the owner's SSN (or EIN, if the ownerStates, or any of their political subdivisions or instrumentalities,has one). Do not enter the disregarded entity's EIN. If the LLC is
4. A foreign government or any of its political subdivisions,classified as a corporation or partnership, enter the entity's EIN.
agencies, or instrumentalities, or Note. See the chart on page 4 for further clarification of name
5. An international organization or any of its agencies or and TIN combinations.
instrumentalities.How to get a TIN. If you do not have a TIN, apply for oneimmediately. To apply for an SSN, get Form SS -5, ApplicationOtherpayeesthatmaybeexemptfrombackupwithholdinginclude:for a Social Security Card, from your local Social Security
Administration office or get this form online at www.ssa.gov. You6. A corporation,may also get this form by calling 1- 800 - 772 -1213. Use Form7. A foreign central bank of issue,W -7, Application for IRS Individual Taxpayer Identification
8. A dealer in securities or commodities required to register in Number, to apply for an ITIN, or Form SS 4, Application for
the United States, the District of Columbia, or a possession of Employer Identification Number, to apply for an EIN. You can
the United States,apply for an EIN online by accessing the IRS website at
www.irs.gov /businesses and clicking on Employer Identification9. A futures commission merchant registered with the Number (EIN) under Starting a Business. You can get Forms W -7CommodityFuturesTradingCommission,and SS -4 from the IRS by visiting www.irs.gov or by calling10. A real estate investment trust,1- 800 - TAX -FORM (1- 800 - 829 - 3676).
11. An entity registered at all times during the tax year under If you are asked to complete Form W -9 but do not have a TIN,the Investment Company Act of 1940,write "Applied For" in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend12. A common trust fund operated by a bank under section payments, and certain payments made with respect to readily584(a),tradable instruments, generally you will have 60 days to get a13. A financial institution,TIN and give it to the requester before you are subject to backup
14. A middleman known in the investment community as a withholding on payments. The 60 -day rule does not apply to
nominee or custodian, or other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to15. A trust exempt from tax under section 664 or described in the requester.section 4947.
Note. Entering "Applied For" means that you have alreadyThechartbelowshowstypesofpaymentsthatmaybeappliedforaTINorthatyouintendtoapplyforonesoon.exempt from backup withholding. The chart applies to the Caution: A disregarded domestic entity that has a foreign ownerexemptpayeeslistedabove, 1 through 15.must use the appropriate Form W -8.
IF the payment is for ...THEN the payment is exempt Part II. Certificationfor...
To establish to the withholding agent that you are a U.S. person,Interest and dividend payments All exempt payees except or resident alien, sign Form W -9. You may be requested to signfor9bythewithholdingagentevenifitems1, 4, and 5 below indicate
Broker transactions Exempt payees 1 through 13.otherwise.
Also, a person registered under For a joint account, only the person whose TIN is shown in
the Investment Advisers Act of Part I should sign (when required). Exempt payees, see Exempt1940whoregularlyactsasaPayeeonpage2.
broker Signature requirements. Complete the certification as indicated
Barter exchange transactions Exempt payees 1 through 5 in 1 through 5 below.
and patronage dividends 1. Interest, dividend, and barter exchange accounts
Payments over $600 required Generally, exempt payees opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do nottobereportedanddirect1through7havetosignthecertification.sales over $5,000'
2. Interest, dividend, broker, and barter exchange
See Form 1099 -MISC, Miscellaneous Income, and its instructions.accounts opened after 1983 and broker accounts considered
inactive during 1983. You must sign the certification or backuppaymentsmadetoacorporation (including gross withholding will apply. If ou are subject to backup
PHowever, the following
proceeds paid to an attorney under section 6045(f), even if the attomey is a g you 1 p withholding
corporation) and reportable on Form 1099 -MISC are not exempt from and you are merely providing your correct TIN to the requester,
backup withholding: medical and health care payments, attorneys' fees, and you must cross out item 2 in the certification before signing thepaymentsforservicespaidbyafederalexecutiveagency.form.
Form W -9 (Rev. 10 -2007)Page 4
3. Real estate transactions. You must sign the certification.Secure Your Tax Records from Identity TheftYoumaycrossoutitem2ofthecertification.
Identity theft occurs when someone uses your personal4. Other payments. You must give your correct TIN, but you information such as your name, social security number (SSN), ordonothavetosignthecertificationunlessyouhavebeenotheridentifyinginformation, without your permission, to commitnotifiedthatyouhavepreviouslygivenanincorrectTIN. "Other fraud or other crimes. An identity thief may use your SSN to getpayments" include payments made in the course of the a job or may file a tax return using your SSN to receive a refund.requester's trade or business for rents, royalties, goods (otherthanbillsformerchandise), medical and health care services To reduce your risk:
including payments to corporations), payments to a Protect your SSN,nonemployee for services, payments to certain fishing boat crew Ensure your employer is protecting your SSN, andmembersandfishermen, and gross proceeds paid to attorneys Be careful when choosing a tax preparer.including payments to corporations).
Call the IRS at 1- 800 - 829 -1040 if you think your identity has5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,been used inappropriately for tax purposes.
qualified tuition program payments (under section 529), IRA,Victims of identity theft who are experiencing economic harm
Coverdell ESA, Archer MSA or HSA contributions or or a system problem, or are seeking help in resolving tax
distributions, and pension distributions. You must give your problems that have not been resolved through normal channels,
correct TIN, but you do not have to sign the certification.may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll -free case intake line
What Name and Number To Give the Requester at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishingForthistypeofaccountGivenameandSSNof:schemes. Phishing is the creation and use of email and
1. Individual The individual websites designed to mimic legitimate business emails and
2. Two or more individuals (joint The actual owner of the account or,websites. The most common act is sending an email to a user
account)if combined funds, the first falsely claiming to be an established legitimate enterprise in an
individual on the account attempt to scam the user into surrendering private information
Y theft. identityforbthatwillbeuseordentit3. Custodian account of a minor The minor tha
Uniform Gift to Minors Act)The IRS does not initiate contacts with taxpayers via emails.4. a. The usual revocable savings The grantor - trustee Also, the IRS does not request personal detailed informationtrust (grantor is also trustee)through email or ask taxpayers for the PIN numbers, passwords,b. So- called trust account that is The actual owner or similar secret access information for their credit card, bank, ornotalegalorvalidtrustunderotherfinancialaccounts.state law
5. Sole proprietorship or disregarded The owner'If you receive an unsolicited email claiming to be from the IRS,
entity owned by an individual forward this message to phishing@irs.gov. You may also report
For this type of account:Give name and EIN of:misuse of the IRS name, logo, or other IRS personal property totheTreasuryInspectorGeneralforTaxAdministrationat6. Disregarded entity not owned by an The owner 1 -800- 366 -4484. You can forward suspicious emails to theindividualFederalTradeCommissionat: spam@uce.gov or contact them at7. A valid trust, estate, or pension trust Legal entity °www.consumer.gov /idtheft or 1- 877- IDTHEFT(438- 4338).8. Corporate or LLC electing The corporation
corporate status on Form 8832 Visit the IRS website at www.irs.gov to learn more about
9. Association, club, religious,The organization identity theft and how to reduce your risk.
charitable, educational, or other
tax- exempt organization
10. Partnership or multi- member LLC The partnership
11. A broker or registered nominee The broker or nominee
12. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
List first and circle the name of the person whose number you furnish. If only one person
on a joint account has an SSN, that person's number must be furnished.
Circle the minors name and furnish the minors SSN.
You must show your individual name and you may also enter your business or "DBA"
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity Itself Is not designated in
the account title.) Also see Special rules for partnerships on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federalnontaxcriminallaws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax retum. Payers must generally withhold 28% of taxable interest, dividend, and certain otherpaymentstoapayeewhodoesnotgiveaTINtoapayer. Certain penalties may also apply.
County of Santa Clara GaUArT,Finance Agency O
Office of the County Clerk- Recorder f` !"` A1
County Government Center
70 W. Hedding Street, East Wing 1 floor k
San Jose, California 95110 -1705 1A, i o
408) 299 -2481
March 11, 2011
City of Cupertino
10300 Torre Avenue
Cupertino, Ca 95014
Re: CALIFORNIA ENVIRONMENTAL QUALITY ACT POSTINGS
Dear Lead Agency:
Enclosed please find the public copy posited in Santa Clara County
Clerk- Recorder's Office for 30 days per CALIFORNIA CODES PUBLIC RESOURCES
CODE SECTION 21152 (c)
Sincerely,
REGINA ALCOMENDRAS, Santa Clara County Clerk- Recorder
By:Laura Luna
Clerk Recorder Office Specialist
Board of Supervisors: Mike Wasserman, George ShirakaNa, Dave Cortese, Ken Yeager, Liz Kniss
County Executive: Jeffrey V. Smith
01/01/2010
Santa Clara County Clerk- Recorder's Office
State of California
County of Santa Clara CouN No.:N of pe ee:13
Business Division
16476
Office ofthe County Clerk- Recorder
Fil end posted On: 2/04/20111111111va
3/06/2011ZCountyGovernmentCenter.y4'Y L 98363,«Through:
T Q R0 Order Number:383480
70 West Hedding Street, E. Wing, 1 Floor Fee Total:2,094.00
San Jose, California 95110 (408) 299 -5665 REGINA ALCOMENDRAS, County Clerk- Reco er
CEQA DOCUMENT DECLARATION by Laura Luna, Deputy Clerk- Recorder,
ENVIRONMENTAL FILING FEE RECEIPT
PLEASE COMPLETE THE FOLLOWING:
1. LEAD AGENCY: City of Cupertino
2. PROJECT TITLE: Scenic Circle Access to Stevens Creek Trail and Blackberry Farm Park
3. APPLICANT NAME: City of Cupertino PHONE: 408 - 777 -3354
4. APPLICANT ADDRESS: 10300 Torre Avenue, Cupertino, CA 95014
5. PROJECT APPLICANT IS A: 0 Local Public Agency School District Other Special District State Agency Private Entity
6. NOTICE TO BE POSTED FOR 30 DAYS.
7. CLASSIFICATION OF ENVIRONMENTAL DOCUMENT
a. PROJECTS THAT ARE SUBJECT TO DFG FEES
1. ENVIRONMENTAL IMPACT REPORT (PUBLIC RESOURCES CODE §21152)2,839.25 0.00
0 2. NEGATIVE DECLARATION (PUBLIC RESOURCES CODE §21080(C)2,044.00 2,044.00
3. APPLICATION FEE WATER DIVERSION (STATE WATE1 RESOURCES CONTROL BOARD ONLY) 965.50 0.00
4. PROJECTS SUBJECT TO CERTIFIED REGULATORY PROGRAMS 949.50 0.00
5. COUNTY ADMINISTRATIVE FEE (REQUIRED FOR a -1 THROUGH a-4 ABOVE) 50.00 50.00
Fish & Game Code §711.4(e)
b. PROJECTS THAT ARE EXEMPT FROM DFG FEES
1. NOTICE OF EXEMPTION ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED) 50.00 0.00
2. A COMPLETED "CEQA FILING FEE NO EFFECT DETERMINATION FORM" FROM THE
DEPARTMENT OF FISH & GAME, DOCUMENTING THE DFG'S DETERMINATION THAT THE PROJECT
WILL HAVE NO EFFECT ON FISH, WILDLIFE AND HABITAT, OR AN OFFICIAL, DATED RECEIPT /
PROOF OF PAYMENT SHOWING PREVIOUS PAYMENT OF THE DFG FILING FEE FOR THE * SAME
PROJECT IS ATTACHED ($50.00 COUNTY ADMINISTRATIVE FEE REQUIRED)
DOCUMENT TYPE: ENVIRONMENTAL IMPACT REPORT NEGATIVE DECLARATION 50.00 0.00
c. NOTICES THAT ARE NOT SUBJECT TO DFG FEES OR COUNTYADMINISTRATIVE FEES
NOTICE OF PREPARATION NOTICE OF INTENT NO FEE NO FEE
8. OTHER:FEE (IF APPLICABLE): $
9. TOTAL RECEIVED 2,094.00
NOTE: "SAME PROJECT' MEANS NO CHANGES. IF THE DOCUMENT SUBMITTED IS NOT THE SAME (OTHER THAN DATES), A "NQ EFFECT
DETERMINATION" LETTER FROM THE DEPARTMENT OF FISH AND GAME FOR THE SUBSEQUENT FILING OR THE APPROPRIATE`FEES ARE
REQUIRED.
THIS FORM MUST BE COMPLETED AND ATTACHED TO THE FRONT OF ALL CEQA DOCUMENTS LISTED ABOVE (INCLUDING COPIES)
SUBMITTED FOR FILING. WE WILL NEED AN ORIGINAL (WET SIGNATURE) AND THREE COPIES. (YOUR ORIGINAL WILL BE RETURNED TO
YOU AT THE TIME OFFILING.)
CHECKS FOR ALL FEES SHOULD BE MADE PAYABLE TO: SANTA CLARA COUNTY CLERK - RECORDER
PLEASE NOTE: FEES ARE ANNUALLY ADJUSTED (Fish & Game Code § °'l1.4(b); PLEASE CHECK WITH THIS OFFICE AND THE DEPARTMENT
OF FISH AND GAME FOR THE LATEST FEE INFORMATION.
NO PROJECT SHALL BE OPERATIVE, VESTED, OR FINAL, NOR SHALL LOCAL GOVERNMENT PERMITS FOR THE PROJECT BE VALID,
UNTIL THE FILING FEES REQUIRED PURSUANT TO THIS SECTION ARE PAID." Fish & Game Code §711.4(c)(3)
12-22 -2009 (FEES EFFECTIVE 01 -01 -2010)
File#: 18478 2/04/2011
OFFICE OF THE DIRECTOR OF PUBLIC WORKS
4c, 9,CITY HALL
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
CUPERTINO TELEPHONE: (408) 777 -3354 • FAX: (408) 777 -3333
February 3, 2011
County of Santa Clara
Office of the County Clerk- Recorder
Attn.: Business Division
70 W. Hedding Street
San Jose, CA 95110
Re: Notice of Determination, Scenic Circle Access
Enclosed are the original and three copies of the Notice of Determination, Environmental
Declaration, and CEQA Document Declaration environmental filing fee receipt for the following
project:
Project 9136, EA- 2011 -01
Scenic Circle Access to Stevens Creek Trail and Blackberry Farm Park
21979 San Fernando Avenue, Cupertino, CA 95014
Blackberry Farm Park, Cupertino, CA)
Please post the documents per applicable requ irements, and return a stamped copy to the City of
Cupertino at the conclusion of the posting period.
Sincerely,
AIL]c,&
Gail Seeds
Project Manager
Department of Public Works
Enclosures
CITY OF
10300 Torre Avenue
Cupertino, California 95014
Telephone: (408) 777 -3354
I 19,FAX:408) 777 -3333
C U P E RT I N O DEPARTMENT OF PUBLIC WORKS
February 2, 2011
NOTICE OF DETERMINATION
Project 9136, EA- 2011 -01
Applicant: City of Cupertino
At its meeting of February 1, 2011, the Cupertino City Council held a public meeting to
consider Scenic Circle Access to Stevens Creek Trail and Blackberry Farm Park, Project
9136. The proposed project would construct an approximately 270 foot long trail to
connect Scenic Circle to the existing Stevens Creek Trail in Blackberry Farm Park via an
existing pedestrian bridge over Stevens Creek. Also included is construction of
approach ramps, stairway, retaining wall, access point at Scenic Circle, and plantings.
The decision of the City Council was to a.Dprove said project. The City Council by
adopting a Mitigated Negative Declaration for this project on February 1, 2011, has
determined that the project is consistent with the General Plan and there are no
significant environmental impacts. The Mitigated Negative Declaration has been
prepared pursuant to the provisions of State and City guidelines. A copy of said
Mitigated Negative Declaration is available :in the Office of the City Clerk, 10300 Torre
Avenue, Cupertino, California.
Karen Bernard - Guerin
Administrative Assistant
City of Cupertino
CITY OF CUPERTINO
MITIGATED NEGATIVE DECLARATION
As provided by the Environmental Assessment I'rocedure adopted by the City Council of the
City of Cupertino on May 27, 1973, and amended!. on March 4, 1974, January 171977, May 1,
1978, and July 7, 1980, the following described project was granted a Mitigated Negative
Declaration by the City Council of the City of Cupertino on February 1, 2011
PROJECT DESCRIPTION AND LOCATION
Application No.:Project 9136, EA- 2011 -01
Applicant:City of Cupertino
Location:Scenic Circle Access to Stevens Creek Trail and Blackberry Farm Park
City -owned property)
DISCRETIONARY ACTION REQUEST
Proposed project would construct an approximately 270 foot long trail to connect Scenic Circle
to the existing Stevens Creek Trail in Blackberry Farm Park via an existing pedestrian bridge
over Stevens Creek. Also included is construction of approach ramps, stairway, retaining wall,
access point at Scenic Circle, and plantings.
FINDINGS OF DECISIONMAKING BODY
The City Council granted a Mitigated Negative Declaration since the project is consistent with
the General Plan and there are no significant environmental impacts.
The applicant shall adhere to all of the conditions required by the City Council on February 1,
2011 including but not limited to the mitigations as listed in the attached report.
rden
Director of Public Works
CERTIFICATE OF THE CITY CLERK
This is to certify that the above Mitigated Negative Declaration was filed in the Office of the
City Clerk of the City of Cupertino on rib l'IA..cu 2 1(
WAN.. i
City Clerk
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Project No. 2010 -9136
RECEIVED
PUBLIC WORKS DEPARTMEN 1
DOCUMENT 00650
AUG 11 2fti:AGREEMENT AND RELEASE OF ANY AND ALL CLAIMS
SCENIC CIRCLE ACCESS 43PROJECTNUMBER2010 -9136
THIS AGREEMENT AND RELEASE OF ANY AND ALL CLAIMS ( "Agreement and Release "), de and entered
into this 8th day of August, 2011, by and between the City of Cupertino ( "City "), and Granite Rock Co. DBA Pavex
Construction Division ( "Contractor "), whose place of business is at 120 Granite Rock Way, San Jose, CA 95136.
RECITALS
A.City and Contractor entered into Contract with a P O. # 57144 (the "Contract ").
B.The Work under the Contract has been completed.
Now, therefore, it is mutually agreed between City and Contractor as follows:
AGREEMENT
1.Contractor will not be assessed liquidated damages except as detailed below: NONE
Original Contract Sum 170,675.00
Modified Contract Sum 180,382.70 elk_
Payment to Date 161,674.38
Liquidated Damages 0
Payment Due Contractor 18,708.32 (includes 10% Retention & Landscape Maintenance final pmt.)
2.Subject to the provisions of this Agreement and Release, City will forthwith pay to Contractor the sum of
Eighteen Thousand and Seven Hundred and Eight Dollars and Thirty Two Cents ($ 18,708.32) under the
Contract, less any amounts withheld under the Contract or represented by any Notice to Withhold Funds on file
with City as of the date of such payment.
3.Contractor acknowledges and hereby agrees that there are no unresolved or outstanding claims in dispute
against City arising from the Contract, except for the claims described in paragraph 4 of this Document 00650.
It is the intention of the parties in executing this Agreement and Release that this Agreement and Release shall
be effective as a full, final and general release of all claims, demands, actions, causes of action, obligations,
costs, expenses, damages, losses and liabilities of Contractor against City, and all if its agents, employees,
consultants (including without limitation Consulting Cupertino), inspectors, representatives, assignees and
transferees except for the Disputed Claims set forth in paragraph 4 of this Document 00650. Nothing in this
Agreement and Release shall limit or modify Contractor's continuing obligations described in paragraph 6 of
this Document 00650.
City ofCupertino 00650 - 1 Agreement and Release of Any and All Claims
Scenic Circle Access
Project No. 2010 -9136
4.The following claims are disputed (hereinafter, the "Disputed Claims ") and are specifically excluded from the
operation of this Agreement and Release:
Claim No.Date Submitted Description of Claim Amount of Claim
NONE
5.Consistent with California Public Contract Code Section 7100, Contractor hereby agrees that, in consideration
of the payment set forth in paragraph 2 of this Document 00650, Contractor hereby releases and forever
discharges City, and all of its agents, employees, consultants, inspectors, assignees and transferees from any and
all liability, claims, demands, actions or causes of action of whatever kind or nature arising out of or in any way
concerned with the Work under the Contract
6.Guarantees and warranties for the Work, and any other continuing obligation of Contractor, shall remain in full
force and effect as specified in the Contract Documents.
7.Contractor shall immediately defend, indemnify and hold harmless the City of Cupertino, Santa Clara County,
its Architect, any of their Representatives, and all of their agents, employees, consultants, inspectors, assignees
and transferees, from any and all claims, demands, actions, causes of action, obligations, costs, expenses,
damages, losses and liabilities that may be asserted against them by any of Contractor's suppliers and /or
Subcontractors of any tier and /or any suppliers to them for any and all labor, materials, supplies and equipment
used, or contemplated to be used in the performance of the Contract, except for the Disputed Claims set forth in
paragraph 4 ofthis Document 00650.
8.Contractor hereby waives the provisions of California Civil Code Section 1542, which provides as follows:
A general release does not extend to claims that the creditor does not know or
suspect to exist in his favor at the time of executing the release, which if known
by him, must have materially affected his settlement with the debtor.
9.The provisions of this Agreement and Release are contractual in nature and not mere recitals and shall be
considered independent and severable, and if any such provision or any part thereof shall be at any time held
invalid in whole or in part under any federal, state, county, municipal or other law, ruling, or regulation, then
such provision, or part thereof shall remain in force and effect only to the extent permitted by law, and the
remaining provisions of this Agreement and Release shall also remain in full force and effect, and shall be
enforceable.
10. Contractor represents and warrants that it is the true and lawful owner of all claims and other matters released
pursuant to this Agreement and Release, and that it has full right, title and authority to enter into this instrument.
Each party represents and warrants that it has been represented by counsel of its own choosing in connection
with this Agreement and Release.
11. All rights of City shall survive completion of the Work or termination of the Contract, and execution of this
Agreement and Release.
City of Cupertino 00650 - 2 Agreement and Release of Any and All Claims
Scenic Circle Access
Project No. 2010 -9136
CAUTION: THIS IS A RELEASE - READ BEFORE EXECUTING * * *
THE CITY OF CUPERTINO,
a Municipal Corpo .tion ofthe State of California
r
By:Jr
Its:Mdt
ATTEST:
ENNiiii/Lifar
City Clerk
Granite Rock Company DBAICON %
At
ACTOR] Pavex Construction Division
By:1
Name:
Its: RODNEY JENNY, VICE PRESIDENT
By:
Name:
Its:
REVIEWED AS TO FORM:
74'1.ror)
City Atto ey
16 20 it
END OF DOCUMENT
City ofCupertino 00650 - 3 Agreement and Release of Any and All Claims
Scenic Circle Access
DOCUMENT: 21272896 Pages:3
RECORDING REQUESTED BY Fees .... No Fees
Taxes..
Copies
City of Cupertino AMT PA I D
WHEN RECORDED MAIL TO REG 1 NA ALCOMENDRAS RDE # 014
SANTA CLARA COUNTY RECORDER 8/10/2011
City Clerk's Office Recorded at the request of 1 1 : 36 AM
City of Cupertino City
10300 Torre Avenue
Cupertino, CA 95014 -3255
SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 27383
CERTIFICATE OF COMPLETION
AND
NOTICE OF ACCEPTANCE OF COMPLETION
SCENIC CIRCLE ACCESS
CITY PROJECT NUMBER 2010 -9136
1l Original
0 For Fast Endorsement
City Hall
p
10300 Torre Avenue1(1, CuCupertino, CA 95014 -3255
408) 777 -3354
C U P E RT I N O PUBLIC WORKS DEPARTMENT
CERTIFICATE OF COMPLETION
AND
NOTICE OF ACCEPTANCE OF COMPLETION
SCENIC CIRCLE ACCESS
CITY PROJECT NUMBER 2010 -9136
NOTICE IS HEREBY GIVEN THAT I, Timm Borden, Director of Public Works and
City Engineer of the City of Cupertino, California, do hereby certify that the work and
improvements in hereinafter described in the contract which was entered into, by, and between
the City of Cupertino and Granite Rock Company DBA Pavex Construction Division, February
2, 2011, in accordance with the plans and specifications for said work, have been completed to
the City's satisfaction and acceptance of completion was ordered on August 2, 2011.
That said work and improvements consisted of furnishing all labor, materials, tools, and
equipment required to complete said project, all as more particularly described in the plans and
specifications for said project.
irector o Public Works and
City Engineer of the City of Cupertino
Date: August 3, 2011
NO FEE"
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 8 day of August, 2011 at Cupertino, California.
f
Kirsten Squarcia
City Clerk's Office
City of Cupertino