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08-062 Cobe Construction, Inc.RECORDING REQUESTED BY City of Cupertino WHEN RECORDED MAIL TO City Clerk's Office City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 NO FEE IN ACCORDANCE WITH GOY. CODE 6103 iimiiiiiliuii~riii6iiriiiimii ~;. _°.-: REGINA ALCOMENDRAS RDE #t 005 SANTA CLARA COUNTY RECORDER 10/02/2008 Recorded at the request of 1 22 PM City (SPACE ABOVE THIS LINE FOR RECORDER'S USE) CERTIFICATE O]F COMPLETION AND NOTICE OF ACCEPTAPICE OF COMPLETION CUPERTINO LIBRARY BOOK DROP MIDIFICATIONS PROJECT t10. 2006-OS Original O For Fast Endorsement City Hall 10300 Torre Avenue Cupertino, CA 95014-3255 (408) 777-3354 CUPERTINO PUBLIC WORKS DEPARTMENT CERTIFICATE CAF COMPLETION AND NOTICE OF ACCEPTANCE OF COMPLETION CUPERTINO LIBRARY BOIJK DROP MODIFICATIONS PROJECT NO. 2006-OS NOTICE IS HEREBY GIVEN THAT I, Ralph A. Qualls, Jr., 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 COBE Construction, Inc., on June 16, 2008, in accordance with the plans and specifications for said work, have been completed to my satisfaction and acceptance of completion was ordered on September 18, 2008. That said work and improvements consisted of fuu-rrishing all labor, materials, tools, and equipment required to complete said project, all as more particularly described in the plans and specifications for said project. 7 ~pR~ Director of Public Works and City Engineer of the City of Cupertino Date: September 22, 2008 "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 th<: laws of the State of California, that the foregoing is true and correct. Executed on the 22nd of September 2008 at Cupertino, California. ~~u ~-~` Grace Schmidt Deputy City Clerk City of Cupertino Project No. 2006-OS DOCUMENT 00520 AGREEMENT ~~ ~ ~~~-~ THIS AGREEMENT, dated this ~~ day of ~ N~ , 20~, by and between COBS Construction Inc. whose place of business is located at 2470 S. Winchester Blvd., Suite D, Campbell, Ca 95008 ("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. PROJECT NUMBER 2006-OS CUPERTINO LIBRARY BOOK DROP MODIFICATIONS 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 of the 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 Contract Documents. City may change the individual(s) acting as City's Authorized Representative(s), or delegate one or more specific functions to one or more specific City's Representatives, including without limitation engineering, architectural, inspection and general administrative functions, at any time with notice and without liability to Contractor. 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 Terry Greene, City Architect, to act as Construction Manager. City may assign all or part of the City Representative's rights, responsibilities and duties to Construction Manager. City may change the identity of the Construction Manager at any time with notice and without liability to Contractor. 2.3 City has designated Sugimura Finney Architects, to act as Consulting Architect. City may change the identity of the Consulting Architect 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: 1030 Torre Avenue, Cupertino, California 95014or 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. NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth, Contractor and City agree as Contractor shall commence Work at the Site on the date established in the Notice to Proceed. City reserves the right to modify or alter the Commencement Date of the Work. Contractor shall achieve Substantial Completion of the Work by August 29, 2008 City of Cupertino 00520 - 1 Agreement Book Drop Project Project No. 2006-OS 3.2 Liquidated Damages. City and Contractor recognize that time is of the essence of this Agreement and that City will suffer financial loss in the form of contract administration expenses (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 in accordance with the Contract Documents. Consistent with Article 15 of 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 the amount of actual damages incurred by City because of a delay in completion of all or any part of the Work. Accordingly, City and Contractor agree that as liquidated damages for delay Contractor shall pay City: 3.2.1 $150.00 for each Day that expires after the time specified herein for Contractor to achieve Final Completion of the entire Work, until achieved. These measures of 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. 3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss of public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of completion of the Work, damages resulting from 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 as set forth in Contractor's Bid, attached hereto marked Exhibit "A". Article 5. Contractor's Representations In order to induce City to enter into this Agreement, 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 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 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 of Work, 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. City of Cupertino 00520 - 2 Agreement Book Drop Project Project No. 2006-OS 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 of the 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 Agreement, the other Contract Documents and the Work to be performed herein. The Contract Documents do not violate or create a default under any instrument, agreement, order or decree binding on Contractor. 5.8 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting Code §4100 et seq. in document 00340 (Subcontractors List) Article 6. Contract Documents 6.1 Contract Documents consist of the following documents, including all changes, addenda, and modifications thereto: Document 00400 Bid Form Document 00430 Subcontractors List Document 00460 Schedule of Major Equipment and Material Suppliers Document 00482 Bidders Certification Document 00520 Agreement Document 00530 Insurance Forms Document 00550 Notice to Proceed Document 00630 Guaranty Document 00650 Agreement and Release of Any and All Claims Document 00700 General Conditions Document 00800 Supplementary Conditions Document 00821 Insurance Document 00822 Apprenticeship Program Section 01110 Summary of Work Section 01200 Measurement and Payment Section 01250 Modification Procedures Section 01315 Project Meetings Section 01320 Progress Schedules and Reports Section 01350 special Procedures Section 01410 Regulatory Requirements Section 01420 References and Definitions Section 01500 Temporary Facilities and Controls Section 01740 Cleaning Section 01770 Contract Closeout Section 01780 Project Record Document Section 05400 Cold-Formed Metal Framing Addenda(s) Specifications Divisions 1 through 16 Drawings/Plans 6.2 There are no Contract Documents other than those listed in this Document 00520, 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). City of Cupertino 00520 - 3 Agreement Book Drop Project Project No. 2006-OS Article 7. Miscellaneous 7.1 Terms used in this Agreement are deemed in Document 00700 (General Conditions) and Section 01420 (References and Definitions) and will have the meaning indicated therein. 7.2 It is understood and agreed that in no instance are the persons signing this Agreement for or on behalf of City or acting as an employee, agent, or representative of City, liable on this Agreement 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 seq. 7.4 The Contract Sum includes all allowances (if any). 7.5 In entering into a public works contract or a subcontract 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 of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that Code, and 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 Agreement 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 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 Agreement and the Contract Documents may be deemed valid and binding agreements, 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 Agreement 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. City of Cupertino 00520 - 4 Agreement Book Drop Project Project No. 2006-OS IN WITNESS WHEREOF the parties have executed this Agreement in quadruplicate the day and year first above written. ~o -~ ~~zQ CITY: CONTRACTOR: _.__ CITY OF CUPERTINO, a Municipal Corporation of the LOBE Construction I ~ ~-~ State aliforni /i `J By: ~ G . /~. ~~ avid W. Knapp, City Mana er Attest: G •~B-o~ City Clerk Approved as to form by City Co el• ~/ City Attorney -_~~ , By ignature] [Please print name here] Title: ~~~1 G~E~JIi1 [If Corporation: Chairman ,President, or Vice President] By: [Please print name here] , Title: [If Corporation: Secretary, Assist t Secretary, Chief Financial Officer, or Assistant Treasurer] '~3 512Z-- ~~ State Contractor's License No. Classification ~~i ~~~ Expira 'on Date Taxpayer ID No. Designated Representative: Name: Terry W. Greene, AIA Title: City Architect Address: 10300 Tone Ave., Cupertino, CA 95014 Phone: 408-777-3244 Name: 2.1/1 Q ~ $ d ~ Title: Pres i ~ e t'1 'Z.y~Tv ~ ~ Vs. ~ Q s i~r ~ . , c~..1~ , Address: CCa rw~o l~ e. 1 l ~ ~ e/ S D~ Q Phone: ~ ~' .~~ ~ ' 3~-f'O C~ Facsimile: 408-777-3 3 33 CONTRACT AMOUNT: $ 42,895.00 ACCOUNT NUMBER: 420-9239-9300 FILE NO.: 51,203.07W Facsimile: ~ ~ ~ ,3~ ~ ' ~ ~ U ~ Notary Acknoledgement is required. If a Corporation, Corporate Notary Acknowledgement and Federal Tax I.D. are required. If not a Corporate Social Security No. is required. END OF DOCUMENT ~ 3 / ~ City of Cupertino 00520 - 5 ( Agreement Book Drop Project CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of ~.v~.9• ~-~~9~2~ Or~u~vi /6 ~O~Y before me, ff2rr~A /~~,~i./s, ~vo>~9-.~s~ Tc~~~G , Date ,. ere Insert ame and Title of the icer personally appeared O,Cso ~ who proved to me on the basis of satisfactory evidence to be the person(~whose name(~'J is/arksubscribed to the within instrument and acknowledged to me that he/sk~e~tlaey executed the same in his/Weif#+ieir authorized capacity(ies~, and that by his/~~ signature{s1 on the instrument the person(a'~ or the entity upon behalf of which the persons acted, executed the instrument. ARMA ATKINS Commisalon ~ 1727397 . -d Notary Public - Californla _ ' • Contra Coata County MyComm•~ 'x'2011 Place Notary Seal Above 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 sea Signatu Signature of Notary Pu OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document ~~u""~.r>> vDrae.O Title or Type of Document: 62 ~E.~i£ir/1 Document Date:4~ ~ ~~ Number of Pages: ~ Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Nam .~ dr-..~ ~ . ~f~.rJ Sig emir's Name: ^ Individual ^ Corporate Officer -Title(s): _ ^ Partner - ^ Limited ^ General ^ Attorney in Fact ^ Trustee ^ Guardian or Conservator ^ Other: Signer Is Representing Top of thumb here ^ Ind ^ Corporate Offl -Title(s): ^ Partner - ^ Limite General ^ Attorney in Fact \ ^ Trustee ^ Guardian or Conservator ^ Other: Signer Is Representing: ©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 ~~~IBIT A Project No. 2006-OS J DOCUMENT 00400 BID FORM To be submitted as part of Envelope "A" by the time and date specified in Document 00200 (Instructions to Bidders). THIS BID IS SUBMITTED BY: ~~ I..ON~t~ ! ,~lJCyo.J ~./G . (Firm/Company Name) Re: PROJECT NUMBER 2006-05, CUPERTION LIBRARY BOOK DROP MODIFICATIONS 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 asnon-responsive. 2. Bidder accepts all of the 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 Days after the day of Bid opening. 3. Bidder has visited the Site and performed all tasks, reseazch, 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. If written notice of the acceptance of this Bid, hereinafter referred to as Notice of Awazd, is mailed or delivered to the undersigned Bidder within the time described in pazagraph 2 of this 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 Awazd 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 bond 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%) of the total of Bid and made payable to the "City of Cupertino". 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 City of Cupertino Bid Form Book Drop Project 00400 - 1 .• ~ Project No.2006-OS (Contract). The undersigned Bidder acknowledges that C ity has reserved the right to delay or m odify 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 of the Bids, and that the undersigned Bidder will be required to cooperate with such other work in accordance with the requirements of the Contract Documents. ' 12. The u ndersigned Bidde r a grees t hat, in accordance with Document 0 0700 (General C onditions), 1 iquidated 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 00520 (Contract). City of Cupertino Bid Form Book Drop Project 00400 - 2 Project No. 2006-OS B1L LUMP SUM BASE BID TOTAL FOR LIBRARY BOOK DROP MODIFICATIONS PROJECT $ y,?, S9S -" (Numbers) Total Bid Price: ~•~~T~~'-~'~~'~~~~~~^~7'~'~ ~° (Words) City of Cupertino Bid Form Book Drop Project 00400 - 3 Project No.2006-OS ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUMS Bidder herby acknowledges receipt and examination of all Contract Documents and the following Addenda: Addendum No. Addendum Date Bidder proposes and agrees to fully perform the Work within the time stated and in strict accordance with the Contract Documents for the sums of money listed in this Bid Form. NAME OF BIDDER: G'o~~ Go~/~dG ice.) ~.va . licensed in accordance with an act for the registration of Contractors, and with license number: 8.3.5//~.~~ Expiration Date: 3/j/~.ZO/O f3en 2.OI~,n Where incorporated, if applicable Principals I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. S' afore of Bidder NOTE: If Bidder is a corporation, set forth the legal name of the corporation, state where incorporated, together with the signature of the officer or officers authorized to sign contracts on behalf of the corporation. If Bidder is a partnership, set forth the name of the firm together with the signature of the partner or partners authorized to sign contracts on behalf of the partnership.. Business Address: Z 470 ,5'; LJi.a(',N~ ~GdD ,5'ui %~ a P ~A 9Szb Officers authorized to sign contracts: Typed Full Name: Telephone Number(s): S/og - =7 ! - 3y00 Fax Number(s): t(O$ - 3 7 ! ' 3 y0 ~ E-Mail Address: ,~,J Q (~O,@~,/NG . C~oM END OF DOCUMENT City of Cupertino Bid Form Book Drop Project 00400 - 4 Project No. 2006-OS DOCUMENT 00430 SUBCONTRACTORS LIST Bidder submits the following information as to the subcontractors Bidder intends to employ if awarded the Contract. Full Name of Subcontractor and Address Description of Work: Reference To Bid Items Subcontractor's License No. ~.T ~'bP~ .4PA,~~.~' G'c,~~, . ~,,P~nwo C~+. ~,~,i~I ,~.1~rvc feA,r+,~, y ~vveyw~c.i 3~7 7,5~ g' Bidd er to attach additional sheets if necessarvl END OF DOCUMENT City of Cupertino 00430 - 1 Subcontractors List Book Drop Project Project No. 2006-OS DOCUMENT 00481 NON-COLLUSION AFFIDAVIT PUBLIC CONTRACT CODE §7106 NON-COLLUSION AFFIDAVIT TO BE EXECUTED BY BIDDER AND SUBMTITED WITH BID STATE OF CALIFORNIA ) ss. COUNTY OF being first duly sworn, deposes and says that he or she is [Office of Affiant] of [Name of Bidder], the party making the foregoing Bid, that the Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Bid is genuine and not collusive or sham; that Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham Bid, and has not directly or indirectly colluded, conspired, connived or agreed with any bidder or anyone else to put in a sham Bid, or that anyone shall refrain from bidding, and that the Bidder has not in any manner, directly or indirectly, sought by agreement, communication or conference with anyone to fix the Bid price of Bidder or any other bidder, or to fix any overhead, profit or cost element of the Bid price, or of that of any other bidder, or to secure any advantage against the City of Cupertino, or anyone interested in the proposed contract; that all statements contained in the Bid aze true; and further, that Bidder has not, directly or indirectly, submitted its Bid price or any breakdown thereof, or the contents thereof, 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 a collusive or sham Bid. Executed under penalty of perjury under the laws of the State of California: (Name of Bidder) (Signature of cipal) Subscribed and sworn before me This day of Notary Public of the State of In and for the County of My Commission expires- (Seal) (If Bidder is a partnership or a joint venture, this affidavit must be signed and sworn to by every member of the partnership or venture.) (If Bidder [including any partner or venturer of a partnership or joint venture] is a corporation, this affidavit must be signed by the Chairman, President, or Vice President and by the Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer.) (If Bidder's affidavit on this form is made outside the State of California, the official position of the person taking such affidavit shall be certified according to law.) END OF DOCUMENT 20_ City of Cupertino 00481 - 1 Non-Collusion Affidavit Book Drop Project Project No. 2006-OS DOCUMENT 00530 INSURANCE AND BOND 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 Book Drop Project 00530 - 1 Insurance Forms