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13-073 Bill's Tree Care & Landscape, Inc. for Removal of Dead Pine Trees Along Baxter Ave Right of Way Pathway AGREEMENT BETWEEN THE CITY OF CUPERTINO AND BILL'S TREE CARE &
LANDSCAPE,INC FOR REMOVAL OF DEAD PINE TREES ALONG BAXTER AVE
RIGHT OF WAY PATHWAY P C /70-0
THIS AGREEMENT, for reference dated_ 4t,, , 2013, is by and between CITY
OF CUPERTINO, a municipal corporation (h mafter referred to as "City"), and
Bill's Tree Care & landscape, Inc, a California corporation whose address is
P.O. Box 24950 San Jose, CA 95154 hereinafter called the Contractor, and is made with
reference to the following:
RECITALS:
A. City is a municipal corporation duly organized and validly existing under the laws
of the State of California with the power to carry on its business as it is now being conducted
under the Constitution and the statutes of the State of California and the Cupertino Municipal
Code.
B. City and Contractor desire to enter into an agreement for
Removal of the marked dead pine trees along the right of way pathway to the west of Baxter Ave
and east of Foothill Blvd. between Starling Dr. and Creston Dr. in accordance with the work
order dated May 7,2013.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as
follows:
1. TERM:
The Contractor shall begin work within fourteen(14) calendar days after receiving notice
from the Trees and R.O.W. Supervisor to commence the work, and shall diligently prosecute the
work to completion before the expiration of ten (10) consecutive working days from the date of
receipt of notice to begin work.
2. SERVICES TO BE PERFORMED:
Contractor agrees, at its own cost and expense, to furnish all labor, tools, equipment,
materials, except as otherwise specified, and to do all work strictly in accordance with the
Exhibit A dated May 7, 2013 (Remove the marked dead pine trees along the right of way
pathway to the west of Baxter Ave and east of Foothill Blvd. between Starling Dr. and Creston
Dr) hereby referred to and expressly made a part hereof with the same force and effect as if the
same were fully incorporated herein.
3. COMPENSATION TO CONTRACTOR:
Contractor shall be compensated for services performed pursuant to this Agreement in the
amount and manner set forth in Contractor's proposal, which is attached hereto as Exhibit "A"
1
and incorporated herein by this reference. Payment will be made in the same manner that claims
of a like character are paid by the City, with checks drawn on the treasury of the City,to be taken
from the general fund.
4. TIME IS OF THE ESSENCE:
Contractor and City agree that time is of the essence regarding the performance of this
Agreement.
5. STANDARD OF CARE:
Contractor agrees to perform all services hereunder in a manner commensurate with the
prevailing standards of like professionals in the San Francisco Bay Area and agrees that all
services shall be performed by qualified and experienced personnel who are not employed by the
City nor have any contractual relationship with City.
6. INDEPENDENT PARTIES:
City and Contractor intend that the relationship between them created by this Agreement
is that of employer-independent contractor. The manner and means of conducting the work are
under the control of Contractor, except to the extent they are limited by statute,rule or regulation
and the express terms of this Agreement. No civil service status or other right of employment
will be acquired by virtue of Contractor's services. None of the benefits provided by City to its
employees, including but not limited to unemployment insurance, workers' compensation plans,
vacation and sick leave are available from City to Contractor, its employees or agents.
Deductions shall not be made for any state or federal taxes, FICA payments, PERS payments, or
other purposes normally associated with an employer-employee relationship from any fees due
Contractor. Payments of the above items, if required,are the responsibility of Contractor.
7. IMMIGRATION REFORM AND CONTROL ACT(IRCA):
Contractor assumes any and all responsibility for verifying the identity and employment
authorization of all of its employees performing work hereunder,pursuant to all applicable IRCA
or other federal, or state rules and regulations. Contractor shall indemnify and hold City
harmless from and against any loss, damage, liability, costs or expenses arising from any
noncompliance of this provision by Contractor.
8. NON-DISCRIMINATION:
Consistent with City's policy that harassment and discrimination are unacceptable
employer/employee conduct, Contractor agrees that harassment or discrimination directed
toward a job applicant, a City employee, or a citizen by Contractor or Contractor's employee on
the basis of race, religious creed, color, national origin, ancestry, handicap, disability, marital
status, pregnancy, sex,age,or sexual orientation will not be tolerated. Contractor agrees that any
and all violations of this provision shall constitute a material breach of this Agreement.
9. HOLD HARMLESS:
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Contractor shall, to the fullest extent allowed by law, indemnify, defend, and hold
harmless the City and its officers, officials, agents, employees and volunteers against any
and all liability, claims, stop notices, actions, causes of action or demands whatsoever
from and against any of them, including any injury to or death of any person or damage
to property or other liability of any nature, arising out of, pertaining to, or related to the
performance of this Agreement by Contractor or Contractor's employees, officers,
officials, agents or independent contractors. Contractor shall not be obligated under this
Agreement to indemnify City to the extent that the damage is caused by the sole
negligence or willful misconduct of City, its agents or employees. Such costs and
expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees
and all other costs and fees of litigation.
Contractor agrees to obtain executed indemnity agreements with provisions identical to
those set forth here in these sections from each and every subcontractor or any other
person or entity involved by, for, with, or on behalf of Contractor in the performance of
this agreement. If Contractor fails to obtain such indemnity obligations from others as
required here, Contractor agrees to be fully responsible according to the terms of this
section.
10. INSURANCE:
On or before the commencement of the terms of this Agreement, Contractor shall furnish
City with certificates showing the type, amount, class of operations covered, effective dates and
dates of expiration of insurance coverage in compliance with paragraphs 10A,B, C and D. Such
certificates, which do not limit Contractor's indemnification, shall also contain substantially the
following statement: "Should any of the above insurance covered by this certificate be canceled
or coverage reduced before the expiration date thereof, the insurer affording coverage shall
provide thirty (30) days' advance written notice to the City of Cupertino by certified mail,
"Attention: City Manager." It is agreed that Contractor shall maintain in force at all times
during the performance of this Agreement all appropriate coverage of insurance required by this
Agreement with an insurance company that is acceptable to City and licensed to do insurance
business in the State of California. Endorsements naming the City as additional insured shall be
submitted with the insurance certificates.
A. COVERAGE:
Contractor shall maintain the following insurance coverage:
(1) Workers' Compensation:
Statutory coverage as required by the State of California.
(2) Liability:
Commercial general liability coverage in the following minimum limits:
Bodily Injury: $1,000,000
each occurrence
$2,000,000
aggregate-all other
3
Property Damage: $500,000 each occurrence
$1,000,000 aggregate
If submitted, combined single limit policy with aggregate limits in the
amounts of $2,000,000 will be considered equivalent to the required
minimum limits shown above.
(3) Automotive:,
Comprehensive automobile liability coverage in the
following minimum limits:
Bodily injury: $500,000 each occurrence
Property Damage: $500,000 each occurrence
or
Combined Single Limit: $1,000,000 each occurrence
B. SUBROGATION WAIVER:
Contractor agrees that in the event of loss due to any of the perils for which it has agreed
to provide comprehensive general and automotive liability insurance, Contractor shall look
solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer
providing comprehensive general and automotive liability insurance to either Contractor or City
with respect to the services of Contractor herein, a waiver of any right to subrogation which any
such insurer of said Contractor may acquire against City by virtue of the payment of any loss
under such insurance.
C. FAILURE TO SECURE:
If Contractor at any time during the term hereof should fail to secure or maintain the
foregoing insurance, City shall be permitted to obtain such insurance in the Contractor's name or
as an agent of the Contractor and shall be compensated by the Contractor for the costs of the
insurance premiums at the maximum rate permitted by law and computed from the date written
notice is received that the premiums have not been paid.
D. ADDITIONAL INSURED:
City, its City Council, boards and commissions, officers, employees, and volunteers shall
be named as an additional insured under all insurance coverages, except worker's compensation
insurance. The naming of an additional insured shall not affect any recovery to which such
additional insured would be entitled under this policy if not named as such additional insured.
An additional insured named herein shall not be held liable for any premium, deductible portion
of any loss, or expense of any nature on this policy or any extension thereof. Any other
insurance held by an additional insured shall not be required to contribute anything toward any
loss or expense covered by the insurance provided by this policy.
E. SUFFICIENCY OF INSURANCE:
The insurance limits required by City are not represented as being sufficient to protect
Contractor. Contractor is advised to consult Contractor's insurance broker to determine adequate
coverage for Contractor.
11. BONDS:
Contractor is not required to provide bonds..
12. PROHIBITION AGAINST TRANSFERS:
4
Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any
interest therein, directly or indirectly, by operation of law or otherwise, without prior written
consent of City. Any attempt to do so without said consent shall be null and void, and any
assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such
attempted assignment, hypothecation or transfer. However, claims for money by Contractor
from City under this Agreement may be assigned to a bank, trust company or other financial
institution without prior written consent. Written notice of such assignment shall be promptly
furnished to City by Contractor.
The sale, assignment, transfer or other disposition of any of the issued and outstanding
capital stock of Contractor, or of the interest of any general partner or joint venturer or syndicate
member or cotenant, if Contractor is a partnership or joint venture or syndicate or cotenancy,
which shall result in changing the control of Contractor, shall be construed as an assignment of
this Agreement. Control means fifty percent (50%) or more of the voting power of the
corporation.
13. SUBCONTRACTOR APPROVAL:
Unless prior written consent from City is obtained, only those people and subcontractors
whose names are listed in Contractor's bid shall be used in the performance of this Agreement.
Requests for additional subcontracting shall be submitted in writing, describing the scope
of work to be subcontracted and the name of the proposed subcontractor. Such request shall set
forth the total price or hourly rates used in preparing estimated costs for the subcontractor's
services. Approval of the subcontractor may, at the option of City, be issued in the form of a
Work Order.
In the event that Contractor employs subcontractors, such subcontractors shall be
required to furnish proof of workers' compensation insurance and shall also be required to carry
general and automobile liability insurance in reasonable conformity to the insurance carried by
Contractor. In addition, any work or services subcontracted hereunder shall be subject to each
provision of this Agreement.
14. PERMITS AND LICENSES:
Contractor, at its sole expense, shall obtain and maintain during the term of this
Agreement, all appropriate permits, certificates and licenses, including a City Business License,
that may be required in connection with the performance of services hereunder.
15. REPORTS:
Each and every report, draft, work product, map, record and other document reproduced,
prepared or caused to be prepared by Contractor pursuant to or in connection with this
Agreement shall be the exclusive property of City. Consultant may retain a copy of any report
furnished to the City pursuant to this Agreement.
No report, information nor other data given to or prepared or assembled by Contractor
pursuant to this Agreement shall be made available to any individual or organization by
Contractor without prior approval by City.
Contractor shall, at such time and in such form as City may require, furnish reports
concerning the status of services required under this Agreement.
5
16. RECORDS:
Contractor shall maintain complete and accurate records with respect to sales, costs,
expenses, receipts and other such information required by City that relate to the performance of
services under this Agreement.
Contractor shall maintain adequate records of services provided in sufficient detail to
permit an evaluation of services. All such records shall be maintained in accordance with
generally accepted accounting principles and shall be clearly identified and readily accessible.
Contractor shall provide free access to such books and records to the representatives of City or
its designees at all proper times, and gives City the right to examine and audit same, and to make
transcripts there from as necessary, and to allow inspection of all work, data, documents,
proceedings and activities related to this Agreement. Such records, together with supporting
documents, shall be kept separate from other documents and records and shall be maintained for
a period of three(3) years after receipt of final payment.
If supplemental examination or audit of the records is necessary due to concerns raised by
City's preliminary examination or audit of records, and the City's supplemental examination or
audit of the records discloses a failure to adhere to appropriate internal financial controls, or
other breach of contract or failure to act in good faith, then Contractor shall reimburse City for
all reasonable costs and expenses associated with the supplemental examination or audit.
17. NOTICES:
All notices, demands, requests or approvals to be given under this Agreement shall be
given in writing and conclusively shall be deemed served when delivered personally or on the
second business day after the deposit thereof iin the United States Mail, postage prepaid,
registered or certified,addressed as hereinafter provided.
All notices,demands,requests,or approvals from Contractor to City shall be addressed to
City at:
City of Cupertino
10555 Mary Avenue
Cupertino CA 95014
Attention: Jonathan Ferrante
All notices, demands,requests,or approvals from City to Contractor shall be addressed to
Contractor at:
Bill's Tree Care& Landscape Inc.
P.O. Box 24950
San Jose, CA 95154
Attention: Bill Reulman
18. URBAN RUNOFF MANAGEMENT:
The Contractor shall avoid creating excess dust when breaking asphalt or concrete and
during excavation and grading. If water is used for dust control, contractor shall use as little as
6
necessary. Contractor shall take all steps necessary to keep wash water out of the streets, gutters
and storm drains.
The Contractor shall develop and implement erosion and sediment control to prevent
pollution of storm drains. Such control includes but is not limited to:
A. Use storm drain inlet protection devices such as sand bag barriers, filter fabric
fences, block and gravel filters. (Block storm drain inlets prior to the start of the rainy season
(October 15), in site de-watering activities and saw-cutting activities; shovel or vacuum saw-cut
slurry and remove from the site).
B. Cover exposed piles of soil or construction material with plastic sheeting. All
construction materials must be stored in containers.
C. Sweep and remove all materials from paved surfaces that drain to streets, gutters
and storm drains prior to rain as well as at the end of the each work day. At the completion of
the project, the street shall be washed and the wash water shall be collected and disposed of
offsite in an appropriate location.
D. After breaking old pavement, Contractor shall remove all debris to avoid contact
with rainfall or runoff.
E. Contractor shall maintain a clean work area by removing trash, litter,and debris at
the end of each work day. Contractor shall also clean up any leaks, drips,and other spills as they
occur.
The objective is to ensure that the City and County of Santa Clara County-Wide Clean
Water Program is adequately enforced. These controls should be implemented prior to the start
of construction, up-graded as required, maintained during construction phases to provide
adequate protection,and removed at the end of construction.
These recommendations are intended to be used in conjunction with the States Best
Management Practices Municipal and Construction Handbooks, local program guidance
materials from municipalities, Section 7.1.01 of the Standard Specifications and any other
appropriate documents on storm water quality controls for construction.
Failure to comply with this program will result in the issuance of noncompliance notices,
citations, project stop orders or fines. The fine for noncompliance of the above program is two
hundred and fifty dollars ($250.00) per occurrence per day. The State under the Federal Clean
Water Act can also impose a fine on the contractor., pursuant to Cal. Water Code ' 13385.
19. TERMINATION:
In the event Contractor fails or refuses to perform any of the provisions hereof at the time
and in the manner required hereunder, Contractor shall be deemed in default in the performance
of this Agreement. If such default is not cured within a period of two (2) days after receipt by
Contractor from City of written notice of default, specifying the nature of such default and the
steps necessary to cure such default, City may terminate the Agreement forthwith by giving to
the Contractor written notice thereof.
City shall have the option, at its sole discretion and without cause, of terminating this
Agreement by giving seven (7)days'prior written notice to Contractor as provided herein. Upon
termination of this Agreement, each party shall pay to the other party that portion of
compensation specified in this Agreement that is earned and unpaid prior to the effective date of
termination.
7
20. COMPLIANCES:
Contractor shall comply with all laws, state or federal and all ordinances, rules and
regulations enacted or issued by City.
21. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State of
California excepting any choice of law rules which may direct the application of laws of another
jurisdiction. The Agreement and obligations of the parties are subject to all valid laws, orders,
rules, and regulations of the authorities having jurisdiction over this Agreement (or the
successors of those authorities.) Any suits brought pursuant to this Agreement shall be filed
with the courts of the County of Santa Clara, State of California.
22. ADVERTISEMENT:
Contractor shall not post, exhibit, display or allow to be posted, exhibited, displayed any
signs, advertising, show bills, lithographs, posters or cards of any kind pertaining to the services
performed under this Agreement unless prior written approval has been secured from City to do
otherwise.
23. WAIVER:
A waiver by City of any breach of any term, covenant, or condition contained herein,
shall not be deemed to be a waiver of any subsequent breach of the same or any other term,
covenant, or condition contained herein,whether of the same or a different character.
24. INTEGRATED CONTRACT:
This Agreement represents the full and complete understanding of every kind or nature
whatsoever between the parties hereto, and all preliminary negotiations and agreements of
whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be
held to vary the provisions hereof. Any modification of this Agreement will be effective only by
written execution signed by both City and Contractor.
25. SAFETY REQUIREMENT
All work performed under this Agreement shall be performed in such a manner as to
provide safety to the public and to meet or exceed the safety standards outlined by CAL-OSHA.
City reserves the right to issue restraints or cease and desist orders to Contractor when unsafe or
harmful acts or conditions are observed or reported relative to the performance of the work under
this Agreement.
Contractor shall maintain the work sites free of hazards to persons and/or property
resulting from his or her operations. Any hazardous condition noted by Contractor, which is not
a result of his or her operations, shall immediately be reported to City.
26. HOURS OF OPERATION
8
Contractor shall be allowed to operate only for the hours of 8:00 a.m. to 3:30 p.m. unless
prior written approval has been secured from City to do otherwise.
27. REQUIREMENT TO PAY PREVAILING WAGES
Consistent with the City's policy to pay prevailing wage rates, Contractor shall
comply with the City's Labor Compliance Program and all other requirements set forth in Labor
Code section 1770 et seq. The City shall require payment of the general rate of per diem wages
or the general rate of per diem wages for holiday and overtime work. Contractor will submit
(monthly or biweekly) certified payroll records to the City for all employees and subcontractors
in a preapproved format or a City provided form. Any delay in remitting certified payroll reports
to the City upon request from the City will result in either delay and/or forfeit of outstanding
payment to Contractor.
28. INSERTED PROVISIONS:
Each provision and clause required by law to be inserted into the Agreement shall be
deemed to be enacted herein, and the Agreement shall be read and enforced as though each were
included herein. If through mistake or otherwise, any such provision is not inserted or is not
correctly inserted, the Agreement shall be amended to make such insertion on application by
either party.
9
/)0 ,enr -
29. CAPTIONS:
The captions in this Agreement are for convenience only, are not a part of the Agreement
and in no way affect, limit or amplify the terms or provisions of this Agreement.
IN WITNESS WHE , the p.i,ies have caused the Agreement to be executed on the
day and year first above en.
CONTRACTOR V CITY OF CUPERTINO
Bill's Tree Care& landsca.- A Municipal Corporation
By, .. By
Tile F' Title �„
Date 65) / Date_4/6/i3
RECOMM (PPR= • AL:
By l - � /j
Title'_ i .ervok ���
APPROVED AS TO FORM:
By
fb✓City Attorney
+t ATTEST:
City Clerk l/'
1 I -- 6q07 - 701 '1
(1/ ra c+ /}vvl o✓^4- : " 10) 000, or)
6.103
10
T.,77-L We al,S CJ& cADi+r ---- I
BILL'S TREE CARE & LANDSCAPE, INC. WORK ORDER
-_- . .•',t P.Q.Box 24950 CERTIFIED
• �; ...• 4' San Jose,CA 95154•• 0 / _ = 27942
(408)44&3956 (650)941-8200 Fax(408)377-1174
l:.,..j:' �:Yl ti� bilistreecareesbcglobal.net E 7%°—
r �1F',,, wacto illstreel se#76
DocuSign Envelope ID:0208121A-3172-4886-A720-E1F8A3DF71E7
CITY OF
\-.„.:01/1,/
IIP
CUPERTINO
CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO
This certifies to the City of Cupertino that the following described policies have been issued to the j
linsured named below and are in fierce at this time.
' Insured: Bill's Tree Care
Address: PO Box 24950, San Jose, CA 95154
1
Description of operations/locations/products insured (show contract name and/or number, if any):
C27 and D49 licensed tree care and landscape company performing landscape
maintenance, landscape construction and tree work. Client uses the TCIA Certified
Safety Program, which i s SB899 compl i ant. _ _ _�_ ___^ _ __.._ ____ --- —
I WORKER'S COMPENSATION * Statutory Min.
* Employer's
I State Compensation Ins. Fund Liability
(name of insurer)
$ 1,000,000 $ 1,000,000 $ 1,000,000
1 Insurance Company's State License No. ---�_�__
Check Policy Type:T Each Occurrence $ 1,000,000
COMPREHENSIVE GENERAL
LIABILITY
1 [x] Premises/Operations General Aggregate $ 2,000,000
(if applicable)
If ] Owners&Contractors
• Protective Aggregate $ 2,000,000
[ ] Contractual for Specific
Contract Personal Injury
$
[ ] Products Liability
[ ] XCU Hazards
[ ] Broad Form P.D. Fire Damage(any one fire) $ 300,000
111 ] Severability of Interest
Clause
1 [ ] Personal Injury with Medical Expense $ 10,000
Employee Exclusion Removed (any one person)
or Self-Ir.sured
1 COMMERCIAL GENERAL LIABILITY Retention $ 1,000
Hartford Underwriters Insurance Company
(name of insurer)
Policy No._57uuNQY8466 Expiration Date 09/22/2013
I
City of Cupertino
00530-4 Insurance Forms
DocuSign Envelope ID:0208121A-3172-48B6-A720-E1F8A3DF71E7
1 AUTOMOTIVE/VEHICLE LIABILITY BODILY INJURY PROPERTY DAMAGE
Commercial Form Each Person Each Accident
' Liability Coverage
$ $
Each Accident
Hartford Underwriters Ins. Co.
(name of insurer)
$ or
Combined Single Limit $
1,000,000
Policy No. 57uUNQY8466 Expiration Date 09/22/2013
BUILDER'S RISK "ALL RISK"
This is to certify that the following policy has been issued by the below-stated company in
l conformance with the requirements of the project documents and is in force at this time.
i
N/A
(Name of insurer)
Policy No. Expiration Date
f Limits of Liability: Deductible:
VG A copy of all Endorsements to the policy(ies) which in any way
(agent's initial) limit the above-listed types of coverage are attached to this
Certificate of Insurance.
This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the
coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or
condition of any contract or any other document with respect to which this Certificate of Insurance
may be issued or may pertain, the insurance afforded by the policies described herein is subject to
!all the terms,exclusions and conditions of such policies.
IT IS HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by
the Agreement between the City and the insured.
Vanessa Gilbert Dated: 5/29/2013 20
By:
Attach Certificate of Insurance and Additional Insured Endorsement on company forms.
City of Cupertino
Qg530-5 Insurance Forms
DocuSign Envelope ID:0208121A-3172-4886-A720-E1F8A3DF71E7
CITY Of
ADDITIONAL INSURED ENDORSEMENT
wy t9�. and
CuPERTINO ENDORSEMENT OF PRIMARY INSURANCE
and
NOTICE OF POLICY
CANCELLATION ENDORSEMENT
Project T itle and Number: Removal of Dead Pine Trees Along Baxter Ave. Right of Pathway
In consideration of the policy premium and notwithstanding any inconsistent statement in the policy
to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as
follows:
The City of Cupertino ("City") and its 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 of this policy, but only with respect to the
operations of the Contractor at or upon any of the premises of the City in connection with the I
Contract with the City, or acts or omissions of the additional insureds in connection with, but 1
limited to its general supervision or inspection of said operations.
is is
The insurance afforded by this policy 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 l
additional policy. j
Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided,f{
canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior I
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
{ Hartford Underwriters Ins. Co.
1. Insurance Company:
57uuNQ'8466
2. Insurance Policy Number:
r 22, 20 12
3. Effective Date of this Endorsement: Septembe_
4. Insured: Bill's Tree Care and Landscape, Inc.
All 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
Avenue; Cupertino, California 95014.
vanessa Gilbert T _ (print/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
City of Cupertino
00530-6 Insurance Forms
DocuSign Envelope ID:0208 121A-3172-4886-A720-E1 F8A3DF71 E7
DoouSigned by:
Vaiu-SS0. 4:00U
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
Names of
Agent/Agency: McGee & Thielen Insurance Brokers Title:
Account Manager
Address: 3780 Rosin Court, Suite 120 Telephone: 916.561.4609
Sacramento, CA 95834 Facsimile: 916.561.4656
City of Cupertino
00530-7 Insurance Forms
DocuSign Envelope ID:02081 21A-3172-48B6-A720-E1 F8A3DF71 E7
CfTTY OF
` COMPREHENSIVE GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
ENDORSEMENT OF AGGREGATE LIMITS OF
CUPERTINO INSURANCE PER PROJECT
Removal of Dead Pine Trees Along Baxter Ave. Right of Pathway
Project Title and Number:
In consideration of the 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:
This Endorsement modifies the insurance provided under the General Liability Coverage part of the
below-referenced policy of insurance.
The general aggregate limit under LIMITS OF INSURANCE applies separately to the project!
described as Removal of Dead Pine Trees Along Baxter Ave. Right of Pathway
POLICY INFORMATION
I. Insurance Company: Hartford underwriters Insurance Co.
12. Insurance Policy Number: 57uuNQv8466
3. Effective Date of this Endorsement:
September 22, 20 12
Bill's Tree Care and Landscape, inc.
4. Insured:
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.
vanessa Gilbert
I, (print/type name)
warrant that 1 have authority to bind the below listed Insurance Company and by my signature hereon do
so bind this Company. o«uSigned by:
J.i t,SS-. a nt
Signature of Authorized Representative:
(Original signature required on all Endorsements furnished to the District)
j Names of
Agent/Agency: McGee & Thielen insurance Brokers Title: Account Manager
j Address: 3780 Rosin Court, suite 120 Telephone: 916.561.4609
Sacramento, CA 95834 Facsimile: 916.561.4656
City of Cupertino
00530-8 insurance Forms
DocuSign Envelope ID:0208121A-3172-4886-A720-E1F8A3DF71E7
C(TY OF
t
J,4-,1,r WAIVER OF SUBROGATION ENDORSE
WORKER'S COMPENSATION INSURANCE
CUPERTINO
Project Title and Number: Removal of Dead Pine Trees Along Baxter Ave. Right of Pathway
1 In consideration of the policy premium and notwithstanding any inconsistent statement in the policy j
to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows:
It is agreed that with respect to such insurance as is afforded by the policy, the Insurance Company
waives any right of subrogation against the City of Cupertino, and each of its directors, officers, agents,
consultants and employees by reason of any payment made on account of injury, including death
resulting therefrom, sustained by any employee of the insured, arising out of the performance of the
above-referenced Contract. 1
POLICY INFORMATION i
I 1. Insurance Com an State Compensation Insurance Fund
p' y:
2. Insurance Policy Number: 9017821-2012
i 3. Effective Date of this Endorsement: May 23, 20 13
Bill's Tree Care and Landscape, Inc.
14. Insured:
1 All notices herein provided to be given by the Insurance Company to the City in connection with
j this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue;
Cupertino, California 95014.
I, vanessa Gilbert (print/type name)
warrant that i have authority to bind the below listed insurance Company and by my signature hereon do
so bind this Company. Doeusi9ned by:
I Vatn.t,ssa 6:0 ,Yt
1 Signature of Authorized Representative: .0
(Original signature required on all Endorsements furnished to the District)
Names of
McGee & Thielen Insurance Co. Account Manager
Agent/Agency: Title:
3780 Rosin Court, Suite 120 916.561.4609
Address: Telephone:
Sacramento, CA 95834 Facsimile: 916.561.4656
City of Cupertino
00530-9 Insurance Forms
A C°® CERTIFICATE OF LIABILITY INSURANCE DA x;°" 0"3'"'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER McGee&Thielen Insurance Brokers, Inc. CONTACT NAME:
3780 Rosin Court Suite 120 PHONE(A/C.No.Extl: 916-646-1919 FAX(A/C,No): 916-646-0995
Sacramento, CA 95834
E-MAIL ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC
www.mcgeethielen.com 0633187 INSURER A: Hartford Underwriters Insurance Company
INSURED INSURER B: State Compensation Insurance Fund
Bill's Tree Care and Landscape, Inc.
P.O. Box 24950 INSURER C
San Jose CA 95154 INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 16468669 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 01=ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP UNITS
LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY)
A GENERAL LIABILITY ,/ 57UUNQY8466 9/22/2012 9/22/2013 EACH OCCURRENCE $ 1,000,000
✓ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 300,00
CLAIMS-MADE ✓ OCCUR MED EXP(Any one person) $ 10,000
✓ PD Deductible$1,000 PERSONAL BADVINJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
71 POLICY ■ PRO- LOC $
A AUTOMOBILE LIABILITY ✓ 57UUNQY8466 9/22/2012 9/22/2013 COMBINED a accident)SINGLE LIMIT $ 1,000,000
✓ ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
✓ AUTOS U SwNED (Per a d E
HI D AUTOS A cient) $
✓ Comprehensive Ded.$500 $
✓ Collision Ded.$500 $
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
$
WORKERS COMPENSATION ✓ 9017821-2012 7/1/2012 7/1/2013 ./ ORY IMi s ER
AND EMPLOYERS'LIABILITY
B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? Y N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
City,its City Council,boards and commissions,officers,employees,and volunteers shall be named as an additional insured under the general
liability per the attached endorsement form HG0001 06 05 and under the auto liability per the attached endorsement form HA 99 16. The insurance is
primary per form HG001 06 05. Per project aggregate applies per attached form HS 25 41 06 08. Worker Comp waiver of subrogation is included per the
attached endorsement 10217. 30 Day Notice of Cancellation attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Jonathan Ferrante ACCORDANCE WITH THE POLICY PROVISIONS.
10555 Mary Avenue _
Cupertino CA 95014 AUTHORIZED REPRESENTATIVE /fr--�
A14.4K-John Bradford
©1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 1 of 15
57UUNQY8466 5/24/2013
Bill's Tree Care and Landscape, Inc.
have all your rights and duties under this Coverage 5. Nonowned Watercraft
Part. With respect to watercraft you do not own that Is less
e. Unnamed Subsidiary than 51 feet long and is not being used to carry
Any subsidiary, and subsidiary thereof, of yours persons for a charge, any person is an insured while
which is a legally incorporated entity of which you operating such watercraft with your permission. Any
own a financial interest of more than 50% of the other person or organization responsible for the
voting stock on the effective date of the Coverage conduct of such person is also an insured, but only
Part. with respect to liability arising out of the operation of
The insurance afforded herein for any subsidiary the watercraft, and only if no other insurance of any
kind is available to that person or organization for this
not named in this Coverage Part as a named liability.
insured does not apply to injury or damage with
respect to which an insured under this Coverage However, no person or organization is an insured with
Part is also an insured under another policy or respect to:
would be an insured under such policy but for its a. "Bodily injury" to a co-"employee" of the person
termination or the exhaustion of its limits of operating the watercraft;or
insurance. b. "Property damage"to property owned by,rented to,
3. Newly Acquired or Formed Organization in the charge of or occupied by you or the employer
Any organization you newly acquire or form, other than of any person who is an insured under this
a partnership,joint venture or limited liability company, provision.
and over which you maintain financial interest of more 6. Additional Insureds When Required By Written
than 50% of the voting stock, will qualify as a Named Contract,Written Agreement Or Permit
Insured if there is no other similar insurance available The following person(s) or organization(s) are an
to that organization. However: additional insured when you have agreed, in a written
a. Coverage under this provision is afforded only until contract, written agreement or because of a permit
the 180th day after you acquire or form the issued by a state or political subdivision, that such
organization or the end of the policy period, person or organization be added as an additional
whichever is earlier; insured on your policy, provided the injury or damage
b. Coverage A does not apply to "bodily injury" or occurs subsequent to the execution of the contract or
"property damage" that occurred before you agreement.
acquired or formed the organization;and A person or organization is an additional insured under
c. Coverage B does not apply to "personal and this provision only for that period of time required by
advertising injury" arising out of an offense the contract or agreement.
committed before you acquired or formed the However, no such person or organization is an insured
organization. under this provision if such person or organization is
4. Mobile Equipment included as an insured by an endorsement issued by
us and made a part of this Coverage Part.
With respect to "mobile equipment" registered in your
name under any motor vehicle registration law, any a. Vendors
person is an insured while driving such equipment Any person(s)or organization(s) (referred to below
along a public highway with your permission.Any other as vendor), but only with respect to "bodily injury"
person or organization responsible for the conduct of or"property damage" arising out of"your products"
such person is also an insured,but only with respect to which are distributed or sold in the regular course
liability arising out of the operation of the equipment, of the vendor's business and only if this Coverage
and only if no other insurance of any kind is available Part provides coverage for "bodily injury" or
to that person or organization for this liability. However, "property damage" included within the "products-
no person or organization is an insured with respect to: completed operations hazard".
a. "Bodily injury" to a co-"employee" of the person (1) The insurance afforded the vendor is subject to
driving the equipment;or the following additional exclusions:
b. "Property damage"to property owned by, rented to, This insurance does not apply to:
in the charge of or occupied by you or the employer "
of any person who is an insured under this (a) "Bodily injury" or "property damage" for
which the vendor is obligated to pay
provision. damages by reason of the assumption of
liability in a contract or agreement. This
exclusion does not apply to liability for
damages that the vendor would have in the
absence of the contract or agreement;
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(b) Any express warranty unauthorized by you; c. Lessors of Land or Premises
(c) Any physical or chemical change in the Any person or organization from whom you lease
product made intentionally by the vendor; land or premises, but only with respect to liability
(d) Repackaging, except when unpacked solely arising out of the ownership, maintenance or use of
for the purpose of inspection, demonstration, that part of the land or premises leased to you.
testing, or the substitution of parts under With respect to the insurance afforded these
instructions from the manufacturer, and then additional insureds the following additional
repackaged in the original container; exclusions apply:
(e) Any failure to make such inspections, This insurance does not apply to:
adjustments,tests or servicing as the vendor 1. Any "occurrence" which takes place after you
has agreed to make or normally undertakes cease to lease that land;or
to make in the usual course of business, in 2. Structural alterations, new construction or
connection with the distribution or sale of the demolition operations performed by or on behalf
products; of such person or organization.
(f) Demonstration, installation, servicing or d. Architects, Engineers or Surveyors
repair operations, except such operations
performed at the vendor's premises in Any architect, engineer, or surveyor, but only with
connection with the sale of the product; respect to liability for "bodily injury", "property
(g) Products which, after distribution or sale by damage" or "personal and advertising injury"
you, have been labeled or relabeled or used caused, in whole or in part, by your acts or
as a container, part or ingredient of any omissions or the acts or omissions of those acting
other thing or substance by or for the on your behalf:
vendor;or (1) In connection with your premises;or
(h) "Bodily injury" or "property damage" arising (2) In the performance of your ongoing operations
out of the sole negligence of the vendor for performed by you or on your behalf.
its own acts or omissions or those of its With respect to the insurance afforded these
employees or anyone else acting on its additional insureds, the following additional
behalf. However, this exclusion does not exclusion applies:
apply to:
(i)The exceptions contained in Sub- This insurance does not apply to "bodily injury",
ara ra hs(d)or "property damage" or "personal and advertising
p g p ( ) (f);or injury" arising out of the rendering of or the failure
(ii) Such inspections, adjustments, tests or to render any professional services by or for you,
servicing as the vendor has agreed to including:
make or normally undertakes to make in 1. The preparing, approving, or failing to prepare
the usual course of business, in or approve, maps, shop drawings, opinions,
connection with the distribution or sale of reports, surveys, field orders, change orders or
the products. drawings and specifications;or
(2) This insurance does not apply to any insured 2. Supervisory, inspection, architectural or
person or organization, from whom you have engineering activities.
acquired such products, or any ingredient, part e. Permits Issued By State Or Political
or container, entering into, accompanying or Subdivisions
containing such products.
b. Lessors of Equipment Any state or political subdivision, but only with
respect to operations performed by you or on your
(1) Any person or organization from whom you behalf for which the state or political subdivision
lease equipment; but only with respect to their has issued a permit.
liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in With respect to the insurance afforded these
whole or in part, by your maintenance,operation additional insureds, this insurance does not apply
or use of equipment leased to you by such to:
person or organization. (1) "Bodily injury", "property damage" or "personal
(2) With respect to the insurance afforded to these and advertising injury" arising out of operations
additional insureds this insurance does not performed for the state or municipality;or
apply to any "occurrence" which takes place (2) "Bodily injury" or "property damage" included
after the equipment lease expires. within the "products-completed operations
hazard".
HG 00 01 06 05 Page 11 of 18
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f. Any Other Party c. Persons or organizations making claims or bringing
Any other person or organization who is not an "suits".
insured under Paragraphs a. through e. above, but 2. General Aggregate Limit
only with respect to liability for "bodily injury", The General Aggregate Limit is the most we will pay
"property damage" or "personal and advertising for the sum of:
injury" caused, in whole or in part, by your acts or a. Medical expenses under Coverage C;
omissions or the acts or omissions of those acting
on your behalf: b. Damages under Coverage A, except damages
(1) In the performance of your ongoing operations; because of "bodily injury" or "property damage"
(2) In connection with your premises owned by or included in the "products-completed operations
,and
rented to you or hazard
(3) In connection with "your work" and included c. Damages under Coverage B.
within the "products-completed operations 3. Products-Completed Operations Aggregate Limit
hazard",but only if The Products-Completed Operations Aggregate Limit
(a) The written contract or agreement requires is the most we will pay under Coverage A for damages
you to provide such coverage to such because of "bodily injury" and "property damage"
additional insured;and included in the "products-completed operations
(b) This Coverage Part provides coverage for hazard".
"bodily injury"or"property damage"included 4. Personal and Advertising Injury Limit
within the "products-completed operations Subject to 2. above, the Personal and Advertising
hazard". Injury Limit is the most we will pay under Coverage B
With respect to the insurance afforded to these for the sum of all damages because of all "personal
additional insureds, this insurance does not apply and advertising injury"sustained by any one person or
to: organization.
"Bodily injury", "property damage" or"personal and 5. Each Occurrence Limit
advertising injury" arising out of the rendering of, or Subject to 2. or 3. above, whichever applies, the Each
the failure to render, any professional architectural, Occurrence Limit is the most we will pay for the sum
engineering or surveying services,including: of:
(1) The preparing, approving, or failing to prepare a. Damages under Coverage A;and
or approve, maps, shop drawings, opinions, b. Medical expenses under Coverage C
reports, surveys, field orders, change orders or because of all "bodily injury" and "property damage"
drawings and specifications; or arising out of any one"occurrence".
(2) Supervisory, inspection, architectural or 6. Damage To Premises Rented To You Limit
engineering activities.
Subject to 5. above, the Damage To Premises Rented
The limits of insurance that apply to additional insureds To You Limit is the most we will pay under Coverage A
under this provision is described in Section III —Limits for damages because of"property damage"to any one
Of Insurance. premises, while rented to
p you, or in the case of
How this insurance applies when other insurance is damage by fire, lightning or explosion, while rented to
available to the additional insured is described in the you or temporarily occupied by you with permission of
Other Insurance Condition in Section IV—Commercial the owner.
General Liability Conditions. In the case of damage by fire, lightning or explosion,
No person or organization is an insured with respect to the the Damage to Premises Rented To You Limit applies
conduct of any current or past partnership,joint venture or to all damage proximately caused by the same event,
limited liability company that is not shown as a Named whether such damage results from fire, lightning or
Insured in the Declarations. explosion or any combination of these.
SECTION III—LIMITS OF INSURANCE
7. Medical Expense Limit
1. The Most We will Pay
Subject to 5. above, the Medical Expense Limit is the
The Limits of Insurance shown in the Declarations and most we will pay under Coverage C for all medical
the rules below fix the most we will pay regardless of "bodily expenses because of bodil u
p y in j ry" sustained by any
the number of:
one person.
a. Insureds; B. How Limits Apply To Additional Insureds
b. Claims made or"suits"brought; or If you have agreed in a written contract or written
agreement that another person or organization be
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added as an additional insured on your policy, the (3) Cooperate with us in the investigation or
most we will pay on behalf of such additional insured is settlement of the claim or defense against the
the lesser of: "suit";and
a. The limits of insurance specified in the written (4) Assist us, upon our request, in the enforcement of
contract or written agreement;or any light against any person or organization which
b. The Limits of Insurance shown in the Declarations. may be liable to the insured because of injury or
Such amount shall be a part of and not in addition to damage to which this insurance may also apply.
Limits of Insurance shown in the Declarations and d. Obligations At The Insureds Own Cost
described in this Section. No insured will, except at that insured's own cost,
The Limits of Insurance of this Coverage Part apply voluntarily make a payment, assume any
separately to each consecutive annual period and to any obligation, or incur any expense, other than for first
remaining period of less than 12 months, starting with the aid,without our consent.
beginning of the policy period shown in the Declarations, e. Additional Insureds Other insurance
unless the policy period is extended after issuance for an If we cover a claim or "suit" under this Coverage
additional period of less than 12 months. In that case, the Part that may also be covered by other insurance
additional period will be deemed part of the last preceding available to an additional insured, such additional
period for purposes of determining the Limits of Insurance. insured must submit such claim or "suit" to the
SECTION IV — COMMERCIAL GENERAL LIABILITY other insurer for defense and indemnity.
CONDITIONS However, this provision does not apply to the
1. Bankruptcy extent that you have agreed in a written contract or
Bankruptcy or insolvency of the insured or of the written agreement that this insurance is primary
insured's estate will not relieve us of our obligations and non-contributory with the additional insured's
under this Coverage Part. own insurance.
2. Duties In The Event Of Occurrence, Offense, Claim f. Knowledge Of An Occurrence, Offense, Claim
Or Suit Or Suit
a. Notice Of Occurrence Or Offense Paragraphs a. and b. apply to you or to any
You or any additional insured must see to it that we additional insured only when such "occurrence",
offense,claim or"suit"is known to:
are notified as soon as practicable of an
"occurrence" or an offense which may result in a (1) You or any additional insured that is an
claim.To the extent possible, notice should include: individual;
(1) How, when and where the "occurrence" or (2) Any partner, if you or an additional insured is a
offense took place; partnership;
(2) The names and addresses of any injured (3) Any manager, if you or an additional insured is a
persons and witnesses;and limited liability company;
(3) The nature and location of any injury or damage (4) Any "executive officer" or insurance manager, if
arising out of the"occurrence"or offense. you or an additional insured is a corporation;
b. Notice Of Claim (5) Any trustee, if you or an additional insured is a
If a claim is made or "suit" is brought against any trust;or
insured,you or any additional insured must: (6) Any elected or appointed official, if you or an
(1) Immediately record the specifics of the claim or additional insured is a political subdivision or
"suit"and the date received;and public entity.
(2) Notify us as soon as practicable. This duty applies separately to you and any additional
insured.
You or any additional insured must see to it that we 3. Legal Action Against Us
receive written notice of the claim or"suit" as soon
as practicable. No person or organization has a right under this
c. Assistance And Cooperation Of The Insured
Coverage Part:
a. To join us as a party or otherwise bring us into a
You and any other involved insured must "suit"asking for damages from an insured;or
(1) Immediately send us copies of any demands, b. To sue us on this Coverage Part unless all of its
notices, summonses or legal papers received in terms have been fully complied with.
connection with the claim or"suit";
(2) Authorize us to obtain records and other A person or organization may sue us to recover on an
agreed settlement or on a final judgment against an
information; insured; but we will not be liable for damages that are
not payable under the terms of this Coverage Part or
HG 00 01 06 05 Page 13 of 18
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that are in excess of the applicable limit of insurance. (7) When You Add Others As An Additional
An agreed settlement means a settlement and release Insured To This Insurance
of liability signed by us,the insured and the claimant or Any other insurance available to an additional
the claimant's legal representative. insured.
4. Other Insurance However, the following provisions apply to other
If other valid and collectible insurance is available to insurance available to any person or
the insured for a loss we cover under Coverages A or organization who is an additional insured under
B of this Coverage Part, our obligations are limited as this coverage part.
follows: (a) Primary Insurance When Required By
a. Primary Insurance Contract
This insurance is primary except when b. below This insurance is primary if you have agreed
applies. If other insurance is also primary, we will in a written contract or written agreement
share with all that other insurance by the method that this insurance be primary. If other
described in c. below. insurance is also primary, we will share with
b. Excess Insurance all that other insurance by the method
This insurance is excess over any of the other described in c.below.
insurance, whether primary, excess, contingent or (b) Primary And Non-Contributory To Other
on any other basis: Insurance When Required By Contract
(1) Your Work If you have agreed in a written contract,
written agreement, or permit that this
That is Fire, Extended Coverage, Builder's Risk, insurance is primary and non-contributory
Installation Risk or similar coverage for "your with the additional insured's own insurance,
work"; this insurance is primary and we will not
(2) Premises Rented To You seek contribution from that other insurance.
That is fire, lightning or explosion insurance for Paragraphs (a) and (b) do not apply to other
premises rented to you or temporarily occupied insurance to which the additional insured has
by you with permission of the owner; been added as an additional insured.
(3) Tenant Liability When this insurance is excess, we will have no
That is insurance purchased by you to cover duty under Coverages A or B to defend the insured
your liability as a tenant for "property damage" against any"suit" if any other insurer has a duty to
to premises rented to you or temporarily defend the insured against that "suit". If no other
occupied by you with permission of the owner; insurer defends, we will undertake to do so, but we
(4) Aircraft,Auto Or Watercraft will be entitled to the insured's rights against all
those other insurers.
If the loss arises out of the maintenance or use When this insurance is excess over other
of aircraft, "autos"or watercraft to the extent not insurance,we will pay only our share of the amount
subject to Exclusion g. of Section I — Coverage of the loss, if any,that exceeds the sum of:
A—Bodily Injury And Property Damage Liability;
(1) The total amount that all such other insurance
(5) Property Damage to Borrowed Equipment Or would pay for the loss in the absence of this
Use Of Elevators insurance;and
If the loss arises out of "property damage" to (2) The total of all deductible and self-insured
borrowed equipment or the use of elevators to amounts under all that other insurance.
the extent not subject to Exclusion j. of Section
- Coverage A - Bodily Injury And Property We will share the remaining loss, if any, with any
Damage Liability; other insurance that is not described in this Excess
Insurance provision and was not bought specifically
(6) When You Are Added As An Additional to apply in excess of the Limits of Insurance shown
Insured To Other Insurance in the Declarations of this Coverage Part.
Any other insurance available to you covering c. Method Of Sharing
liability for damages arising out of the premises
or operations, or products and completed If all of the other insurance permits contribution by
operations, for which you have been added as equal shares,we will follow this method also. Under
an additional insured by that insurance;or this approach each insurer contributes equal
amounts until it has paid its applicable limit of
insurance or none of the loss remains, whichever
comes first.
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If any of the other insurance does not permit insured will bring"suit" or transfer those rights to us
contribution by equal shares, we will contribute by and help us enforce them.
limits. Under this method, each insurer's share is b. Waiver Of Rights Of Recovery (Waiver Of
based on the ratio of its applicable limit of Subrogation)
insurance to the total applicable limits of insurance
of all insurers. If the insured has waived any rights of recovery
5. Premium Audit against any person or organization for all or part of
any payment, including Supplementary Payments,
a. We will compute all premiums for this Coverage we have made under this Coverage Part, we also
Part in accordance with our rules and rates. waive that right, provided the insured waived their
b. Premium shown in this Coverage Part as advance rights of recovery against such person or
premium is a deposit premium only. At the dose of organization in a contract, agreement or permit that
each audit period we will compute the earned was executed prior to the injury or damage.
premium for that period and send notice to the first 9. When We Do Not Renew
Named Insured. The due date for audit and If we decide not to renew this Coverage Part, we will
retrospective premiums is the date shown as the mail or deliver to the first Named Insured shown in the
due date on the bill. If the sum of the advance and Declarations written notice of the nonrenewal not less
audit premiums paid for the policy period is greater than 30 days before the expiration date.
than the earned premium, we will return the excess
to the first Named Insured. If notice is mailed, proof of mailing will be sufficient
c. The first Named Insured must keep records of the proof of notice.
information we need for premium computation, and SECTION V—DEFINITIONS
send us copies at such times as we may request. 1. "Advertisement" means the widespread public
6. Representations dissemination of information or images that has the
a. When You Accept This Policy purpose of inducing the sale of goods, products or
services through:
By accepting this policy,you agree: a. (1) Radio;
(1) The statements in the Declarations are accurate (2) Television;
and complete; (3) Billboard;
(2) Those statements are based upon (4) Magazine;
representations you made to us;and
(3) We have issued this policy in reliance upon your (5) Newspaper;or
representations. b. Any other publication that is given widespread
b. Unintentional Failure To Disclose Hazards public distribution.
If unintentionally you should fail to disclose all However, "advertisement"does not include:
hazards relating to the conduct of your business a. The design, printed material, information or images
that exist at the inception date of this Coverage contained in, on or upon the packaging or labeling
Part, we shall not deny coverage under this of any goods or products;or
Coverage Part because of such failure. b. An interactive conversation between or among
7. Separation Of insureds persons through a computer network.
Except with respect to the Limits of Insurance,and any 2. "Advertising idea" means any idea for an
rights or duties specifically assigned in this Coverage "advertisement".
Part to the first Named Insured,this insurance applies: 3. "Asbestos hazard" means an exposure or threat of
a. As if each Named Insured were the only Named exposure to the actual or alleged properties of
Insured;and asbestos and includes the mere presence of asbestos
b. Separately to each insured against whom claim is in any form.
made or"suit"is brought. 4. "Auto"means a land motor vehicle,trailer or semitrailer
8. Transfer Of Rights Of Recovery Against Others To designed for travel on public roads, including any
Us attached machinery or equipment. But"auto" does not
a. Transfer of Rights Of Recovery
Include"mobile equipment".
5. "Bodily injury"means physical:
If the insured has rights to recover all or part of any
payment, including Supplementary Payments, we a. Injury;
have made under this Coverage Part, those rights b. Sickness;or
are transferred to us. The insured must do nothing c. Disease
after loss to impair them. At our request, the sustained by a person and, if arising out of the above,
mental anguish or death at any time.
HG 00 01 06 05 Page 15 of 18
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:19:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 7 of 15
57UUNQY8466 COMMERCIAL AUTOMOBILE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the"insured"than other provisions of
the Coverage Form, the provisions of this endorsement apply.
1. BROAD FORM INSURED B. Employees as Insureds
A. Subsidiaries and Newly Acquired or Paragraph A.1. - WHO IS AN INSURED - of
Formed Organizations SECTION II - LIABILITY COVERAGE is
The Named Insured shown in the Declara- amended to add:
tions is amended to include: d. Any "employee" of yours while using a
(1) Any legally incorporated subsidiary in covered "auto" you don't own, hire or
which you own more than 50% of the borrow in your business or your personal
voting stock on the effective date of the affairs.
Coverage Form. However, the Named C. Lessors as Insureds
Insured does not include any subsidiary Paragraph A.1. - WHO IS AN INSURED - of
that is an "insured" under any other Section II - Liability Coverage is amended to
automobile policy or would be an add:
"insured" under such a policy but for its
termination or the exhaustion of its Limit e. The lessor of a covered "auto" while the
of Insurance. "auto" is leased to you under a written
agreement if:
(2) Any organization that is acquired or
formed by you and over which you (1) The agreement requires you to
maintain majority ownership. However, provide direct primary insurance for
the Named Insured does not include any the lessor and
newly formed or acquired organization: (2) The"auto"is leased without a driver.
(a) That is a partnership, joint venture or Such a leased "auto" will be considered a
limited liability company covered "auto" you own and not a covered
(b) That is an "insured" under any other "auto"you hire.
policy, 2. AUTOS RENTED BY EMPLOYEES
(c) That has exhausted its Limit of Any "auto" hired or rented by your "employee" on
Insurance under any other policy, or your behalf and at your direction will be
(d) 180 days or more after its acquisition considered an "auto"you hire.
or formation by you, unless you have The OTHER INSURANCE Condition is amended
given us notice of the acquisition or by adding the following:
formation. If an "employee's" personal insurance also
Coverage does not apply to"bodily injury" applies on an excess basis to a covered "auto"
or"property damage"that results from an hired or rented by your"employee" on your behalf
"accident" that occurred before you and at your direction, this insurance will be
formed or acquired the organization. primary to the"employee's" personal insurance.
Form HA 99 16 03 02 Page 1 of 3
©2001,The Hartford(Includes copyrighted material
of ISO Properties,Inc.,with its permission.)
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 8 of 15
3. AMENDED FELLOW EMPLOYEE EXCLUSION 6. LEASE GAP COVERAGE
EXCLUSION 5. - FELLOW EMPLOYEE - of Under SECTION III - PHYSICAL DAMAGE
SECTION II - LIABILITY COVERAGE does not COVERAGE, if a long-term leased "auto" is a
apply if you have workers' compensation covered "auto" and the lessor is named in the
insurance in-force covering all of your policy as a Loss Payee, we will pay in the event
"employees". of a total "loss" your additional legal obligation to
Coverage is excess over any other collectible the lessor for any difference between the actual
insurance. cash value of the "auto" at the time of the "loss"
and the"outstanding balance"of the lease.
4. HIRED AUTO PHYSICAL DAMAGE COVERAGE
"Outstanding balance" means the amount you
If hired "autos" are covered "autos" for Liability owe on the lease at the time of "loss" less any
Coverage and if Comprehensive, Specified amounts representing taxes; overdue payments;
Causes of Loss, or Collision coverages are
penalties, interest or charges resulting from
provided under this Coverage Form for any "auto" overdue payments; additional mileage charges;
you own, then the Physical Damage Coverages excess wear and tear charges; lease termination
provided are extended to "autos" you hire or
fees.
borrow, subject to the following limit. AIRBAG COVERAGE
7.The most we will pay for"loss"to any hired "auto"
is: Under Paragraph B. EXCLUSIONS- of SECTION
(1) $50,000; III - PHYSICAL DAMAGE COVERAGE, the
following is added:
(2) The actual cash value of the damaged or The exclusion relating to mechanical breakdown
stolen property at the time of the"loss"; or does not apply to the accidental discharge of an
(3) The cost of repairing or replacing the airbag.
damaged or stolen property, 8. SOUND RECEIVING AND TRANSMITTING
whichever is smallest, minus a deductible. The EQUIPMENT-BROADENED COVERAGE
deductible will be equal to the largest deductible Paragraphs B.4.c. & d. - EXCLUSIONS - of
applicable to any owned "auto" for that coverage. SECTION III - PHYSICAL DAMAGE COVERAGE
No deductible applies to "loss" caused by fire or do not apply to equipment designed solely for
lightning. Hired Auto Physical Damage coverage receiving or transmitting sound and accessories
is excess over any other collectible insurance. used with such equipment, provided such
Subject to the above limit, deductible and excess equipment is permanently installed in the covered
provisions, we will provide coverage equal to the "auto" at the time of the "loss" or such equipment
broadest coverage applicable to any covered is removable from a housing unit which is
"auto"you own. permanently installed in the covered "auto" at the
We will also cover loss of use of the hired "auto" if time of the "loss", and such equipment is
it results from an "accident", you are legally liable designed to be solely operated by use of the
and the lessor incurs an actual financial loss, power from the "auto's" electrical system, in or
subject to a maximum of$1000 per"accident". upon the covered "auto".
This extension of coverage does not apply to any 9. EXTRA EXPENSE-BROADENED COVERAGE
"auto" you hire or borrow from any of your Under Paragraph A. - COVERAGE - of SECTION
"employees", partners (if you are a partnership), III - PHYSICAL DAMAGE COVERAGE, we will
members (if you are a limited liability company), pay for the expense of retuming a stolen covered
or members of their households. "auto"to you.
5. PHYSICAL DAMAGE -ADDITIONAL 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE
TEMPORARY TRANSPORTATION EXPENSE
COVERAGE Under Paragraph D. -DEDUCTIBLE-of SECTION
III - PHYSICAL DAMAGE COVERAGE, the
Paragraph A.4.a. of SECTION III - PHYSICAL following is added:
DAMAGE COVERAGE is amended to provided a
limit of $50 per day and a maximum limit of No deductible applies to glass damage if the
$1,000. glass is repaired rather than replaced.
Form HA 99 16 03 02 Page 2 of 3
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 9 of 15
11. TWO OR MORE DEDUCTIBLES 14. HIRED AUTO-COVERAGE TERRITORY
Under Paragraph D.-DEDUCTIBLE- of SECTION Paragraph e. of GENERAL CONDITIONS 7. -
III - PHYSICAL DAMAGE COVERAGE, the POLICY PERIOD, COVERAGE TERRITORY - of
following is added: SECTION IV-BUSINESS AUTO CONDITIONS is
If another Hartford Financial Services Group, Inc. replaced by the following:
company policy or coverage form that is not an e. For short-term hired "autos", the coverage
automobile policy or coverage form applies to the territory with respect to Liability Coverage is
same"accident", the following applies: anywhere in the world provided that if the
(1) If the deductible under this Business Auto "insured's" responsibility to pay damages for
Coverage Form is the smaller (or smallest) "bodily injury" or "property damage" is
deductible, it will be waived; determined in a "suit," the "suit" is brought in
the United States of America, the territories
(2) If the deductible under this Business Auto
Coverage Form is not the smaller (or and possessions of the United States of
America, Puerto Rico or Canada or in a
smallest) deductible, it will be reduced by the settlement we agree to.
amount of the smaller (or smallest)
deductible. 15. WAIVER OF SUBROGATION
12. AMENDED DUTIES IN THE EVENT OF TRANSFER OF RIGHTS OF RECOVERY
ACCIDENT, CLAIM, SUIT OR LOSS AGAINST OTHERS TO US - of SECTION IV -
BUSINESS AUTO CONDITIONS is amended by
The requirement in LOSS CONDITIONS 2.a. - adding the following:
DUTIES IN THE EVENT OF ACCIDENT, CLAIM,
SUIT OR LOSS - of SECTION IV - BUSINESS We waive any right of recovery we may have
AUTO CONDITIONS that you must notify us of an against any person or organization with whom
"accident" applies only when the "accident" is you have a written contract that requires such
known to: waiver because of payments we make for
(1) You, if you are an individual;
damages under this Coverage Form.
(2) A partner, if you are a partnership; 16. RESULTANT MENTAL ANGUISH COVERAGE
The definition of "bodily injury" in SECTION V-
(3) A member, if you are a limited liability DEFINITIONS is replaced by the following:
company; or
"Bodily injury" means bodily injury, sickness or
(4) An executive officer or insurance manager, if disease sustained by any person, including
you are a corporation. mental anguish or death resulting from any of
13. UNINTENTIONAL FAILURE TO DISCLOSE these.
HAZARDS 17. EXTENDED CANCELLATION CONDITION
If you unintentionally fail to disclose any hazards Paragraph 2. of the COMMON POLICY
existing at the inception date of your policy, we CONDITIONS - CANCELLATION - applies except
will not deny coverage under this Coverage Form as follows:
because of such failure.
If we cancel for any reason other than
nonpayment of premium, we will mail or deliver to
the first Named Insured written notice of
cancellation at least 60 days before the effective
date of cancellation.
Form HA 99 16 03 02 Page 3 of 3
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:19:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 10 of 15
57UUNQY8466 5/24/2013
Bill's Tree Care and Landscape, Inc.
POLICY NUMBER: 57 WiN QY8466
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PER PROJECT- AMENDMENT OF GENERAL AGGREGATE
SUBJECT TO MAXIMUM ANNUAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
LIMITS OF INSURANCE:
The Limits of Insurance shown in the Declarations are amended by the following:
The Limits of Insurance,subject to all the terms of this policy that apply,are:
Each Occurrence Limit $ See Declarations Page
Personal and Advertising Injury Limit $ See Declarations Page
Damage to Premises Rented to You—Any One Premises $ See Declarations Page
Medical Expense Limit-Any One Person $ See Declarations Page
General Aggregate Limit $ 2,000,000
Project General Aggregate Limit $ 2,000,000
Maximum Annual Aggregate Limit $ 10,000,000
Products-Completed Operations Aggregate Limit $ See Declarations Page
In return for the payment of the premium when due and subject to all the terms of the Commercial General Liability
Coverage Part not expressly modified herein,we agree with you as follows:
A. The LIMITS OF INSURANCE (SECTION III) is b. Damages under any one or more Project
deleted in its entirety and replaced with the General Aggregate Limit(s), as
following: described in paragraph 4.below.
1. The Most We Will Pay 3. General Aggregate Limit
The Limits of Insurance shown in the above Subject to 2. above, the General Aggregate
Schedule and the rules below fix the most Limit is the most we will pay for the sum of:
we will pay regardless of the number of: a. Damages under Coverage B Personal
a. Insureds; and Advertising Injury Liability;and
b. Claims made or"suits"brought;or b. Damages under Coverage C Medical
c. Persons or organizations making claims Payments, and Coverage A Bodily
or bringing"suits". Injury and Property Damage Liability,
2. Maximum Annual Aggregate
with the following exceptions:
The Maximum Annual Aggregate Limit is the (1) "Bodily injury" or"property damage"
included in the "products-completed
most we will pay for the sum of: operations hazard";or
a. Damages under the General Aggregate
Limit and
Form HS 25 41 06 08 Page 1 of 3
©2008,The Hartford
(Includes copyrighted material of Insurance Services Office, Inc.with its permission.)
CERT NO.: 16469440 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 10:12:46 AM Page 11 of 15
f '
(2) "Bodily injury" or"property damage" 5. Products-Completed Operations
attributed solely to ongoing Aggregate Limit
operations at a single"project"; The Products-Completed Operations
c. "Property damage"included as Damage Aggregate Limit is the most we will pay for
to Premises Rented to You. damages under Coverage A-Bodily Injury
4. Project General Aggregate Limit and Property Damage Uability because of
Subject to 2.above: "bodily injury" and "property damage"
included in the "products-completed
a. A separate Project General Aggregate operations hazard".
Limit applies to each single "project", in 6. personal And Advertising Injury Limit
lieu of and not in addition to,the General
Aggregate. Such Project General Subject to 3. above, the Personal and
Aggregate is the most we will pay for all Advertising Injury Limit is the most we will
damages under Coverage A Bodily pay under Coverage B Personal and
injury and Property Damage Liability, Advertising Injury Liability for the sum of
or Coverage C Medical Payments,with all damages because of all "personal and
the following exceptions: advertising injury" sustained by any one
(1) "Bodily injury"or"property damage" person or organization.
included in the "products-completed 7. Occurrence Limit
operations hazard";or Subject to 3., 4., or 5. above, whichever
(2) "Property damage" included in the applies, the Each Occurrence Limit is the
Damage to Premises Rented to You most we will pay for damages under
coverage;or Coverage A - Bodily injury and Property
(3) "Bodily injury", "property damage", Damage Liability because of "bodily injury"
or medical expenses under or"property damage" arising out of any one
Coverage C, which cannot be "occurrence".
attributed solely to the ongoing 8. Damages To Premises Rented To You
operations at a single "project". Limit
Such damages will erode the
General Aggregate Limit as Subject to 7. above, the Damage to
provided in paragraph 3.above. Premises Rented to You Limit is the most
b. The Project General Aggregate we will pay for damages because of
ggregate Limit:
"property damage" to any one premises,
(1) Applies only to "occurrences" while rented to you, or in the case of
attributed solely to ongoing damage by fire, lightning or explosion,while
operations at a single"project";and rented to you or temporarily occupied by you
(2) Does not include damages for with permission of the owner.
Coverage B Personal and In the case of damage by fire, lightning or
Advertising injury Liability, no explosion, the Damage to Premises Rented
matter where or in how many to You Limit applies to all damage
"projects" the offense or offenses proximately caused by the same event,
may be committed. Such damages whether such damage results from fire,
will erode the General Aggregate lightning or explosion or any combination of
Limit as provided in paragraph 3. these.
above.
The Damage to Premises Rented to You
c. Any payments made under this Coverage is not subject to any Project
paragraph 4., for damages for "bodily General Aggregate Limit, but will erode the
injury", "property damage", or medical General Aggregate Limit.
expenses under Coverage C, shall
reduce the Maximum Annual Aggregate 9. Medical Expense Limit
Limit and the Project General Aggregate Subject to 3. or 4.above,whichever applies,
for that "project". Such payments shall the Medical Expense Any One Person Limit
not reduce the General Aggregate Limit is the most we will pay under Coverage C
or the Products-Completed Operations Medical Payments for all medical expenses
Aggregate Limit nor shall they reduce any because of"bodiy injury" sustained by any
other Project General Aggregate Limit. one person.
Form HS 25 41 06 08 Page 2 of 3
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 12 of 15
Such Medical Payments Coverage Is subject The Limits of Insurance of this Coverage Part apply
to either the Project General Aggregate Limit separately to each consecutive annual period and to
or the General Aggregate Limit as provided any remaining period of less than 12 months,
in paragraphs 3.or 4.above. starting with the beginning of the policy period shown
10. How Limits Apply To Additional Insureds in the Declarations, unless the policy period is
extended after issuance for an additional period of
If you have agreed in a written contract or
written agreement that another person or less than 12 months. In that case, the additional
organization be added as an additional period will be deemed part of the last preceding
insured on your policy, the most we will pay period for purposes of determining the Limits of
on behalf of such additional insured is the Insurance.
lesser of: B. For the purposes of this endorsement, the
(1) Definitions Section is amended by the addition of
( ) The limits of insurance specified in the the following definition:
written contract or written agreement;or
(2) "Project" means a jobsite including premises
( ) The Limits of Insurance shown in the involving the same or connecting lots, or
Declarations. premises whose connection is interrupted only
Such amount shall be a part of and not in by a street, roadway,waterway or right of way of
addition to Limits of Insurance shown in the a railroad.
Declarations and described in this Section. If a "project" has been abandoned, delayed, or
11. if More Than One Limit of Insurance abandoned and then restarted, or if the
Applies authorized contracting parties deviate from
If more than one limit of insurance under this plans, blueprints, designs, specifications or
Coverage Part and any endorsements timetables,the project will still be deemed as the
attached thereto applies to any claim or same project.
"suit", the most we will pay under this
Coverage Part and such endorsements is
the single highest limit of liability of all
coverages applicable to such claim or"suit".
However, this paragraph 11. does not apply
to the Medical Expense Limit for Coverage
C.
Form HS 25 41 06 08 Page 3 of 3
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/20".3 9:28:12 AM Page 13 of 15
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION REP 06
STATE 9017821-12
NEW
NF
FUND 4-17-84-44
PAGE 1
HOME OFFICE
SAN FRANCISCO EFFECTIVE MAY 23, 2013 AT 12.01 A.M.
ALL EFFECTIVE DATES ARE AND EXPIRING JULY 1, 2013 AT 12.01 A.M.
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
BILL'S TREE CARE AND LANDSCAPE,
PO BOX 24950
SAN JOSE, CA 95154
ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING,
IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND
WAIVES ANY RIGHT OF SUBROGATION AGAINST,
CITY OF CUPERTINO
WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS
POLICY IN CONNECTION WITH WORK PERFORMED BY,
BILL'S TREE CARE AND LANDSCAPE,
IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN
PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION
OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE
EMPLOYER.
IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH
EMPLOYEES SHALL BE INCREASED BY 03%.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MAY 28, 2013 2570
/t; -,eZe61 /r wymia.
CERT NO.: 16968669 CLIENT 4941-li9'BL°84Q6'13':1 MK^ Wessa Gilbert 5/24/2013 9:28:12 AM PagR SIQEiNT AND CEO
SCIF FORM 10217 IREV.1-2012) OLD DP 217
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S)
This policy is subject to the following additional If notice is mailed, proof of mailing to the last known
Conditions: mailing address of the certificate holder(s) on file with
A. If this policy is cancelled by the Company, other the agent of record or the Company will be sufficient
than for nonpayment of premium, notice of such proof of notice.
cancellation will be provided at least thirty (30) Any notification rights provided by this endorsement
days in advance of the cancellation effective date apply only to active certificate holder(s) who were
to the certificate holder(s) with mailing addresses issued a certificate of insurance applicable to this
on file with the agent of record or the Company. policy's term.
B. If this policy is cancelled by the Company for Failure to provide such notice to the certificate
nonpayment of premium, or by the insured, notice holder(s) will not amend or extend the date the
of such cancellation will be provided within (10) cancellation becomes effective, nor will it negate
days of the cancellation effective date to the cancellation of the policy. Failure to send notice shall
certificate holder(s) with mailing addresses on file impose no liability of any kind upon the Company or its
with the agent of record or the Company. agents or representatives.
Form IH 03 13 06 11 Page 1 of 1
© 2011,The Hartford
CERT NO.: 16468669 CLIENT CODE: 2002-09-06 13:14:05.607 Vanessa Gilbert 5/24/2013 9:28:12 AM Page 15 of 15
\rip/
OFFICE OF THE CITY CLERK
CITY HALL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
�S
-c.19„. TELEPHONE:(408)777-3223•FAX: (408)777-3366
WEBSITE:www.cupertino.org
CUPERTINO
June 12, 2013
Bill's Tree Care &Landscape, Inc
P.O. Box 24950
San Jose, CA 95154
Re: Removal of dead pine trees along Baxter Avenue right-of-way pathway
Enclosed for your records is a fully executed original copy of the agreement with the City
of Cupertino. If you have any questions, please contact the Public Works Department at
(408) 777-3354.
Sincerely,
/Ge..t.,L-t.., _..,,d t2,--e.---,—c----..--'
Kirsten Squarcia
Deputy City Clerk
Enclosure
cc: Public Works