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14-096 Project No. 2013-04, 2013 STP overlay project, O'Grady Paving 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 GOV. CODE 27283 DOCUMENT: 23462104 1111 111ii III I I I III 1111ii III I III Ili I I III Pages 3 Fees.... No Fees Taxes.. Copies.. AMT PAID REGINA ALCOMENDRAS RDE # 025 SANTA CLARA COUNTY RECORDER 10/13/2016 Recorded at the request of 8:17 AM City (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NOTICE OF COMPLETION CITY PROJECT NAME: 2013 STP Overlay Project (City Project No. 2013-04) HT1 Original 13 For Fast Endorsement CUPERTINO Recording Requested By: When Recorded Mail To: City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 SE NOTICE OF COMPLETION Civil Code §§ 8182, 8184, 9204, and 9208 NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is the agent of the owner of the project described below. 2. Owner's full name is: City of Cupertino, California. 3. Owner's address is: City Hall, 10300 Torre Ave., Cupertino, CA 95014. 4. The nature of owner's interest in the project is: Fee Ownership _ Lessee _X_ Other: Right of Way on various streets_ 5. Construction work on the project performed on the owner's behalf is generally described as follows: City Project Name: _2013 STP Overlay Project (City Project No.: _2013-04 ) Work and improvements for pavement maintenance at various locations in Cupertino, CA. 6. The name of the original contractor for the project is: _O'Grady Paving, Inc. 7. The project was completed on: _January 20, 2015 8. The project is located at: Various locations in Cupertino, CA Verification: In signing this document, I, the undersigned, declare under penalty of perjury under the laws of the State of California that I have read this notice, and I know and understand the contents of this notice, and that the facts stated in this notice are true and correct. Santa Clara County Date and Place Signature Timm Borden Timm of Public Works and City Engineer "NO FEE" City of Cupertino NOTICE OF COMPLETION is hereby given in order to comply with the provisions of Section 27283 of the Government Code. This is to certify that the Notice of Completion date October 5, 2016 for CITY PROJECT NAME: 2013 STP Overlay Project (City Project No. 2013-04) and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on October 5, 2016 and the grantee consents to recordation thereof by its duly authorized officer. I certify under Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct. Dated: October 5, 2016 By: Lauren Sapudar Senior Office Assistant CUPERTINO June 10, 2014 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE. • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cuperi:ino.org C.F. Archibald Paving, Inc. 3624 Haven Avenue Redwood City, CA 94064-0037 RE: Bid Award, Project Number 2013-04 2013 STP Overlay Project. Thank you for your participation in the City of Cupertino's bid process for the above -stated project. The contract was awarded to O'Grady Paving; Inc. Your bid bond and statement of qualifications envelope are enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure CUPERTINO June 10, 2014 MCK Services Inc. P.O. Box 5697 Concord, CA 94524 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertuno.org Re: Bid Award, Project Number 2013-04 2013 STP Overlay Project. Thank you for your participation in the City of Cupertino's bid process for the above -stated project. The contract was awarded to O'Grady Paving, Inc. Your bid bond and statement of qualifications envelope are enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure CUPERTINO June 10, 2014 G. Bortolotto & Company, Inc 582 Bragato Road San Carlos, CA 94070 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 77'7-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertino.org RE: Bid Award, Project Number 2013-04 2013STP Overlay Project. Thank you for your participation in the City of Cupertino's bid process for the above -stated project. The contract was awarded to O'Grady Paving, Inc. Your bid bond and statement of qualifications envelope are enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure CUPERTINO June 10, 2014 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertino.org Interstate Grading & Paving, Inc. 128 South Maple Avenue South San Francisco, CA 94080-6302 Re: Bid Award, Project Number 2013-04 2013 STP Overlay Project. Thank you for your participation in the City of Cupertino's bid process for the above -stated project. The contract was awarded to O'Grady Paving, Inc. Your bid bond and statement of qualifications envelope are enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure CUPERTINO June 10, 2014 Graniterock 120 Granite Rock Way San Jose, CA 95136 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertino.org RE: Bid Award, Project Number 2013-04 2013 STP Overlay Project. Thank you for your participation in the City of Cupertino's bid process for the above -stated project. The contract was awarded to O'Grady Paving, Inc. Your bid bond and statement of qualifications envelope are enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure CUPERTINO O'Grady Paving Inc., 2513 Wyandotte Street Mountain View, CA 94043 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223 • FAX: (408) 777-3366 WEBSITE: www.cupertino.org Re: Bid Award, Project Number 2013-04 2013 STP Overlay Project. Your bid bond and contract for the above stated project is enclosed. If you have any questions or need additional information, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure Project No. 2013-04 DOCUMENT 00520 CONTRACT THIS CONTRACT, dated this day of r�j 1(p _, 2014 , by and between O'Grady Paving, Inc. whose place of business is located at 2513 Wyandotte Street, 'Mountain View, CA 94043-2314 ("Contractor"), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by virtue of the uthority vested in the City by the laws of the State of California. V0411 WHEREAS, City, on the day of , 2014 awarded to Contractor the following Project: PROJECT NUMBER 2013-04 2013 STP OVEIRLAY PROJECT NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth, Contractor and City agree as follows: Article 1. Work 1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications, Drawings, and all other terms and conditions of the Contract Documents. Article 2. Agency and Notices to City 2.1 City has designated Roger Lee, Assistant Director, Public Works — Maintenance, 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 All notices or demands to City under the Contract Documents shall be to City's Authorized Representative at: 10300 Torre Avenue, Cupertino, California 95014 or to such other person(s) and address(es) as City shall provide to Contractor. Article 3. Contract Time and Liquidated Damages 3.1 Contract Time. The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a Notice to Proceed at any time within 30 Days after the Notice of Award. Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run. Contractor shall achieve Final Completion of the entire Work and be ready for Final Payment in accordance with Section 00700 (General Provisions) within 45 working days as provided in Document 00700 (General Provisions) 3.2 Liquidated Damages. City and Contractor recognize that time is of the essence of this Contract and that City will suffer financial loss in the form of contract administration expense:; (such as project management and consultant expenses), if all or City of Cupertino 00520-1 Contract 2013 STP Overlay Project Project No. 2013-04 any part of the Work is not completed within the rimes specified above, plus any extensions thereof allowed in accordance with the Contract Documents. Consistent with Document 00700 (General Provisions), 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 lignidated damages for delay Contractor shall pay City: 3.2.1 $1,500 for each Calendar Day that expires after the time specified herein for Contractor to achieve Substantial Completion as specified above. 3.2.2 $1,500 for each Calendar Day that expires after the time specified herein for Contractor to achieve Final Completion of the entire Work as specified above. 3.2.3 $50.00 per facility per day for failure to raise utilities to finished grade within 72 hours of completion of final paving 3.2.4 $5,000 for each occurrence of a violation of Document 00800, Section 1.7 WORK DAYS AND HOURS. 3.2.5 $5,000 per day for each street that has not received installation of temporary tab markers and traffic striping prior to opening asphalt areas to traffic. 3.2.6 $1000 per day for each street with incomplete installation of pavement markers, pavement markings and traffic striping on the 13`h calendar day following completion of surface treatment. 3.2.7 $100 per calendar day for each traffic loop that is not replaced within two weeks following damage. 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 resullt 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: See ]Exhibit "A" attached Article 5. Contractor's Representations In order to induce City to enter into this Contract, Contractor makes the following representations and warranties: 5.1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the Contract Documents, Work, Site, locality, actual conditions, as -built conditions, and all local conditions, and 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, or which may appear in the Drawings. Contractor accepts the determination set forth in these Documents and Document 00700 (General Provisions) of the limited extent of the information contained in such materials upon which Contractor may be entitled to rely. Contractor City of Cupertino 00520-2 Contract 2013 STP Overlay Project Project No. 2013-04 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 Provisions); and no additional examinations, investigations, explorations, tests, reports, studies or similar information or data are or will be required by Contractor for such purposes. 5.4 Contractor has correlated its knowledge and the results of all such observations, examinations, investigations, explorations, tests, reports and studies with the terms and conditions 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 Contract, the other Contract Documents and the Work to be performed herein. The Contract Documents do not violate or create a default under any instrument, contract, order or decree 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 00002 Signature Page Document 00003 Project Directory Document 00012 Caltrans/City Cross -Reference Table Document 00100 Advertisement For Bids Document 00200 Instructions to Bidders Document 00210 Indemnity and Release! Agreement Document 00400 Bid Form Document 00411 Bond Accompanying 13 id Document 00430 Subcontractors List Document 00431 Bidder's List of Subcontractors Document 00450 Statement of Qualifications Document 00481 Non -Collusion Affidavit Document 00482 Bidder Certifications Document 00500 Federal Requirements for Federal -Aid Construction Projects Document 00501 Required Contract Provisions — Federal -Aid Construction Projects Document 00502 Equal Employment Opportunity Certification Document 00504 Debarment and Suspension Certification Document 00505 Nonlobbying Certification for Federal -Aid Contracts Document 00506 Disclosure of Lobbying Activities Document 00507 Proposal Requirements and Conditions Document 00508 Award and Execution of Contract Document 00509 Beginning of Work, Time of Completion and Liquidated Damages City of Cupertino 00520-3 Contract 2013 STP Overlay Project Project No. 2013-04 Document 00510 Subcontractor and DBE Records Document 00511 Performance of Subcontractors Document 00512 Subcontracting Document 00513 Buy America Requirements Document 00514 Local Agency Bidder -DBE Information Document 00515 Local Agency Bidder UDBE Commitment Document 00516 UDBE Information — Good Faith Efforts Document 00517 Utilization of DBE, First Tier Subcontractors Document 00518 Disadvantaged Business :Enterprise Certification Status Change Document 00519 Federal Wage Rates Document 00520 Contract Document 00530 Insurance Forms Document 00610 Construction Performance Bond Document 00620 Construction Labor and Material Payment Bond Document 00630 Guaranty Document 00650 Agreement and Release of Any and All Claims Document 00660 Substitution Request Form Document 00700 General Conditions Document 00800 Special Conditions Document 00820 Traffic Control Requirements Document 00821 Insurance Document 00822 Apprenticeship Program Technical Specifications Document 01010 Summary of Work Addenda(s) Drawings/Plans 6.2 There are no Contract Documents other than those listed in this Document 00520, Article 6. The Contract Documents may only be amended, modified or supplemented as provided in Document 00700 (General Provisions). Article 7. Miscellaneous 7.1 Terms used in this Contract are defined in Document 00700 (General Provisions) and will have the meaning indicated therein. 7.2 It is understood and agreed that in no instance ari,, the persons signing this Contract for or on behalf of City or acting as an employee, agent, or representative of City, liable on this Contract or any of the Contract Documents, or upon any warranty of authority; or otherwise, and it is further understood and agreed that liability of the City is limited and confined to such liability as authorized or imposed by the Contract Documents or applicable law. 7.3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the Contract Documents only in compliance with the Subcontractor Listing Law, California Public Contracting Code §4100 et 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. City of Cupertino 00520-4 Contract 2013 STP Overlay Project Project No. 2013-04 IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year first above written. 2013 STP OVERLAY PROJECT CITY: CONTRACTOR: CITY OF CUPERTINO, a Municipal Corporation of the State of California By: [Signatur Attest: Craig E-`�OUYlG [Pleas int name here] OrCity Clerk: Grace SchmicQ Approved as to form by City Attorney: Title: \JT 1-1) - . [If Corporat' : Chair n , President, or Vice President] City Attorney: Carol Korade 6V I hereby certify, under penalty of perjury, that Timm Borden, Director of Public Works of the City of Cupertino was duly authorized to execute this document. Dated:. � — ` I T,1 David Brandt, City Manager Cupertino, a Municipal Corporation of the State of California Designated Representative: Name: Roger Lee Title: Assistant Director, Public Works - Maintenance Address: 10555 Mary Ave, Cupertino, CA 95014 LIM T�bIN'10.5 A, 0`L-, C [Please print name here] Title: clt-l% [If Corporation: Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer] r2Sta'2-0i(.,9 co A , 0`2-- State te Contractor's License No. Classification I Z13 (11 Expiration Date Taxpayer ID No. 9 Lf — [ `4 73G' ' Z Name: Cfn IG in c,y1� Title: QQ 2513 WYgndc-Ake- Sk Address: %loLi,�fic��tn �[��e�� CA 0`fo43 Phone: 408-777-3269 Phone: (05C) �1(o(o [c12 fo Facsimile: 408-777-3399 Facsimile: 4o50-07(-4, — ['9 L'6 NOTARY ACKNOLEDGEMENT IS REQUIRED. IF A AMOUNT: $1,002,968.00 / Q/ CORPORATION, CORPORATE SEAL AND CORPORATE ACCOUNT NUMBER: 270-8404-9325 / / NOTARY ACKNOWLEDEMENT AND FEDERAL TAX ID ARE REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY FILE NO.: 98,493.99 NO. IS REQUIRED END OF DOCUMENT City of Cupertino 00520 - 6 Contract 2013 STP Overlay Project 14. Project No. 2013-04 Bond #: 105978359 Premium: $4,814.00 DOCUMENT 00610 CONSTRUCTION PERFORMANCE BOND THIS CONSTRUCTION PERFORMANCE BOND (" Ellond") is dated May 22, 2014 , is in the penal sum of One Million Two Thousand Nine Hundred Sixty Eight Dollars [which is one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the faithful performance of the Construction Contract listed below. This Bond. consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page. Any singular reference to _ O'Grady Paving, Inc. ("Contractor"), Travelers Casualty and Surety Company of America ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: O'Grady Paving Inc. Name 2513 Wyandotte Street Address Mountain View, CA 94043-2314 City/State/Zip CONSTRUCTION CONTRACT: at Cupertino, California. SURETY: Travelers Casualty and Surety Company of America Name One Tower Square Principal Place of Business Hartford, CT 06183 City/State/Zip 2013 STP OVICRLAY PROJECT PROJECT NUMBER 2013-04 DATED May 21 . , 2014 in the Amount of'$ 1,002,968.00 (the "Penal Sum") CONTRACTOR AS PRINCIPAL Company: (Corp. al) O'Grady Pa vi Inc. 611, rz Signature: Name and Title: U riel V J�1 Company:Mvers Cas ty anO Su ety Company of America Signature: Name and Title: Stac`lUL.�.Iia on, Attorney-in-fact BOND TERMS AND CONDITIONS Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to City for the complete and proper performance of the Construction Contract, which is incorporated herein by reference. If Contractor completely and properly performs all of its obligations under the Construction Contract, Surety and Contractor shall have no obligation under this Bond. If there is no City Default, Surety's obligation under this Bond shall arise after: 3.1 City has declared a Contractor Default cinder the Construction Contract pursuant to the terms of the Construction Contract; and 3.2 City has agreed to pay the Balance of the Contract Sum: 3.2.1 To Surety in accordance with the teams of this Bond and the Construction Contract; or City of Cupertino 2013 STP Overlay Project 00610- 1 Construction Performance Bond ACKNOWLEDGMENT State of California 1 County of �n{-c� On flay 21 alp ly before me, I'Yi Ccs�S byT L' (insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence tube the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ERICA LOPEZ COR TE2 { WITNESS my hand and official seal. ;c `•' Commission # 1989050 Notary Public - California iz ....... Santa Clara County D My Comm. Expires Sep 21, 2016 Signature - (Seal) Project No. 2013-04 7. No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns. 8. Surety hereby waives notice of any change, alteration or addition to the Construction Contract or to related subcontracts, purchase orders and other obligations, including changes of time. Surety consents to all terms of the Construction Contract, including provisions on changes to the Contract. No extension of time, change, alteration, modification, deletion, or addition to the Contract Documents, or of the work required thereunder, shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond. ' 9. . Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competent jurisdiction where a proceeding is pending between City and Contractor regarding the Construction Contract, or in the. courts of the County of Santa Clara, or in a coup: of competent jurisdiction in the location in which the work is located. Communications from City to Surety under paragraph 3.1 of this Bond shall be deemed to include the necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise. 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses. 11. Any provision in this Bond conflicting with any statutory or regulatory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. 12. Definitions. 12.1 Balance of the Contract Sum: The total amount payable by City to Contractor pursuant to the terms of the Construction Contract after all proper adjustments have been made under the Construction Contract, for example, deductions for progress payments made, and increases/decreases for approved modifications to the Construction Contract. 12.2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract including, but not limited to, `'default" or any other condition allowing a termination for cause as provided in Document 00700 (General Conditions). 12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor progress payments due under the Construction Contract or to perform other material terms of the Construction Contract, if such failure is the cause of the asserted Contractor Default and is sufficient to justify Contractor termination of the Construction Contract. City of Cupertino 2013 STP Overlay Project IV►U • D 6 /1TIWUI 00610-3 Construction .Performance Bond WARNING: THIS POWER OF ATTORNEYIS INVALID WITHOUT THE RED BORDER .A► POWER OF ATTORNEY TRAVELERS.1 Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Compaqy United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 225368 Certificate No. 004976296 KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Fannington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Catherine A. Pinney, Nancy L. Wallis, K. Dixon Wright, Stacy M. Clinton, Donnalyn Revis, Venetia G. Johnson, Kandace L. Reeves, Natalie Ann Horder, and Mark A. Mallonee of the City of petalurA2 , State of S`allft»a3 , their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or per idcdiin any�,a ons otrproceedings allowed by law. `11 IN WITNESS WHEREOF, the Companies have caused this instrument the signed nd t_heir'� rporate seals to be hereto affixed, this 23rd day of July 2012 Farmington Casualty Company \'I St. Paul Mercury Insurance Company Fidelity and Guaranty Insur nee company,. Travelers Casualty and Surety Company Fidelity and Guaranty`Insuisance Underw ,,.itelrs, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company 2 pI.5MU,�Y� ea.a,� v"FiRslna +,'� \*N SRI` r�"+' INgUq ... Jp�TY ANO NW Sl1A() CrtORRORgj � � � � IHC6RRDRATED �' m � f � F• r �w: �A e'; ., J � i SEAI.r911 aF: ne HARTFOnD, s•+wrtTroRa 1e°0�'+an �y�er�'�D � 1 s -.i°•' �a.,�SEAL °: ;.01 �q AHI o.. State of Connecticut City of Hartford ss. 13y: Georg Thompson, enior ice President On this the 23rd day of JU1y 201:2 before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United.States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the,corporations by himself as a duly authorized officer. G.T�P In Witness Whereof, I hereunto set my hand and official seal.!r * - * My Commission expires the 30th day of June, 2016. * Marie C. Tetreault, Notary Public 58440-6-11 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sonoma On May -22, 2014 before me, Naucy L. Wallis, Notary Public Date Here Insert Name and Title of the Officer personally appeared Stacy M. Clinton NANCY L. WALLIS 3 a comm. # 1986855 N y, NOTARY PUBLIC -CALIFORNIA SONOMA COUNTY MY COMM. EXPIRES AUG. 2B, 2016 Place Notary Seal Above who proved to me on the basis of i factory evidence to be the person whose name is re subscribed to the wit In instrument and acit gentty to me that { �e y executed the samh r authorized capp�cit (�Ss'j, and that by ' /bture� on the instrument the person, orpon' behalf of whichthe personli-4 6cted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m, hand and official seal. Signa"lure A Signature of NotarT Pub OPTION A I 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 Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Stacy M. Clinton E] Individual 13 Corporate Officer —Title (s): Partner — ❑ Limited ❑ General El Attorney in Fact El Trustee El Guardian or Conservator M Other: Signer Is Representing: RIGHTTHUMBPRINT. DF SIGNER,;:, •• of thumb here Number of Pages: Signer's Name: Fl Individual rlCorporate Officer—Title(s): F1 Partner — ❑ Limited [-]General [.Attorney in Fact r–I rustee r_71 Guardian or Conservator r-1 Other: Signer Is Representing RIGHTTHUMBPRINT. OF SIGNER ©2007 National Notary Association • 9350 De Soto Ave.,^PO. Box 2402 • Chatsworth, CA 91313-2402 www.NaticnalNotary.org Item #5907 Reorder: Call Toll -Free 1-800-876-6827 Project No. 2013-04 Bond #: 1'05978359 Premium : included in pert bond DOCUMENT 00620 CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND THIS CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND ("Bond") is dated May 22, 2014 , is in the penal sum One Million Two Thousand Nine Hundred Sixty Eight Dollars [one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the payment of claimants under the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, • paragraphs 1 through 14, attached to this page. Any singular reference to O'Grady Paving Inc. ("Contractor"), Travelers Casualty and Surety Company of America ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: O'Grady Paving, Inc. Name 2513 Wyandotte Street Address Mountain View, CA 944043-2314 City/State/Zip CONSTRUCTION CONTRACT: at Cupertino, California. SURETY: Travelers Casualty and Surety Company of America Name One Tower Square Principal Place of Business Hartford, CT 06183 City/State/Zip 2013 STP OVERLAY PROJECT PROJECT NUMBER 2013-04 DATED May 21 , 20 14 in the Amount of $ 1,002,968.00(the "Penal Sum") CONTRACTOR AS PRINCIPAL Company: Zrp.) O'Grad aving, Inc. Signature:Name and Title: SURETY Company:a r vel rs Cas 1ty and Surety Company of /ica Signature: V Ilk_ Amer Name and Title: Sta4 M. Citon Atforney-in-fact- BOND TERMS AND CONDITIONS Contractor and Surety, jointly and severally, bind. themselves, their heirs, executors, administrators, successors and assigns. to City and to Claimants, to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which its incorporated herein by reference. 2. With respect to City, this obligation shall be null and void if Contractor: 2.1 Promptly makes payment, directly or indirectly, for all sums due Claimants; and 2.2 Defends, indemnifies and holds harmless City from all claims, demands, liens or suits by any person or entity who furnished labor, materials or equipment for use in the performance of the Construction Contact, provided City has promptly notified Contractor and Surety (at the address set forth on the signature page of this Bond) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to Contractor and Surety, and provided there is no City Default. 3. With respect to Claimants, this obligation shall be null and void if Contractor promptly makes payment, directly or indirectly through its Subcontractors, for all sums due Claimants. If Contractor or its Subcontractors, however, fail to pay any of the persons named in Section 3181 of the California Civil Code, or amounts due City of Cupertino Construction Labor and Material Payment Bond 2013 STP Overlay Project 00620- 1 Project No. 2013-04 under the Unemployment Insurance Code with respect to Work or labor performed under the Contract, or for any amounts required to be deducted, withheld, and paid over to the. Employment Development Department from the wages of employees of Contractor or Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to such Work and labor, then Surety shall pay for the same, and also, in case suit is brought upon this Bond, a reasonable attorney's fee, to be fixed by the court. 4. Consistent with the California Mechanic's Lien Law, Civil Code §3082, et seq., Surety shall have no obligation to Claimants under this Bond unless the Claimant: has satisfied all applicable notice requirements. . 5. Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited for any payments made in good faith by Surety under this Bond. 6. Amounts due Contractor under the Construction Contract shall be applied first to satisfy claims, if any, under any Construction Performance Bond and second, to satisfy obligations of Contractor and Surety under this Bond. 7. City shall not be liable for payment of any costs, expenses, or attorney's fees of any Claimant under this Bond, and shall have under this Bond no obligations to make payments to, give notices on behalf of, or otherwise have obligations to Claimants under this Bond. 8. Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. Surety further hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Construction Contract, or to the Work to be performed thereunder, or materials or equipment to be furnished thereunder or the Specifications accompanying the same, shall in any way affect its obligations under this Bond, and it does hereby waive any requirement of notice or any such change, extension of time,. alteration or addition to the terms of the Construction Contract or to the Work or to the Specifications or any other changes. Suit against Surety on this Bond may be brought by any Claimant, or its assigns, at any time after the Claimant has furnished the last of the labor or materials, oir both, but, per Civil Code §3249, must be commenced before the expiration of six months after the period in which stop notices may be filed as provided.in Civil Code §3184. 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses. IL This Bond has been furnished to comply with the California Mechanic's Lien Law including, but not limited to, Civil Code §§3247, 3248, et seg. Any provision in this Bond conflicting with said statutory requirements shall be deemed deleted herefrom and provisions cont:orming to such statutory or other legal requirements shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a common law bond. 12. Upon request by any person or entity appearing; to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 13. Contractor shall pay to persons performing labor in and about Work provided for in the Contract Documents an amount equal to or more than the general prevailing rate of per diem wages for (1) work of a similar character in the locality in which the Work i's performed and (2) legal holiday and overtime work in said locality. The per diem wages shall be an amountequal to or.more than the stipulated rates contained in a schedule that has been ascertained and determined by the Director of the State Department of Industrial Relations and City to be the general prevailing rate of per diem wages for each craft or type of workman or mechanic needed to execute this Contract. Contractor shall also cause a copy of this determination of the prevailing rate of per diem wages to be posted at each Site. City of Cupertino Construction Labor and Material Payment Bond 2013 STP Overlay Project 00620-2 Project No. 2013-04 1.4. Definitions. 14.1 Claimant: An individual or entity having a direct contract with Contractor or with a Subcontractor of Contractor to furnish labor, materials or equipment for use in the performance of the Contract, as further defined in California Civil Code §3181. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's Subcontractors, and all other items for which a stop notice might be asserted. The term Claimant shall also include the Unemployment Development Department as referred to in Civil Code §3248(b). 14.2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 14.3 City Default: Material failure of City;, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract, provided that failure is the cause of the failure of Contractor to pay the Claimants and is sufficient to justify termination of the Construction Contract. END OF :DOCUMENT City of Cupertino Construction Labor and Material Payment Bond 2013 STP Overlay Project 60620-3 WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER TRAVELERS J� POWER OF ATTORNEY Farmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company P y Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and'Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 225368 Certificate No. 004976297 KNOW ALL MEN BY THESE PRESENTS: That St. Paul Fire and Marine Insunrnc:e Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Catherine A. Pinney, Nancy L. Wallis, K. Dixon Wright, Stacy M. Clinton, Donnalyn Revis, Venetia G. Johnson, Kandace L. Reeves, Natalie Ann Horder, and Mark A. Mallonee of the City of - Petaluma State of California , their true alawfuleach in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, re ognizancesncondit onalttunderorneytakings and other writings obligatory in the nature thereof on behalf of the Companies in their busyness of guaranteeing the fidelity of persons,. guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permideddin any aciions opproceedings allowed by law. y ,0 IN WITNESS WHEREOF, the Companies have caused this instrumenkt6`4be sign eirgrporate seals to be hereto affixed, this 23rd co day of July 2012 lipIV Farmington Casualty Company ) St. Paul Mercury Insurance Company s a <o <, . Fidelity and Guaranty�Insuranae{'Coin pan t}`? Travelers Casualty and Surety Company Fidelity and Guaranty "InsuranceUnderwrlters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Compan St. Paul Guardian Insurance Company y �Asu� o��FiRE °u�iuynx.' r'rr. O? �0.PW{,) L +oR`n° q J 6 '•i \�'µ PMSG •' j °MSUq`"r p lY gry0 CC% 2_''`�, of � •.. , �.(Go a.;;'a;SHAL' State of Connecticut City of Hartford ss. By: Georg Thompson, enior ice President On this the 23rd day of July 2012 before me personally appeared George W. Thompson, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2016. ,g. vplMarie C. Tetreault, Notary Public 55440-6-11 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER c ` Y CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sonoma On May 22, 2014 before me, Nancy L. Wallis, Notary Public Date Here Insert Name and Title of the Officer ' personally appeared Stacy M. Clinton �lANCY L. WALLIS COMM•#1986855 kA m NOTARY PUBLIC CALIFORNIA r� >, SONOMA COUNTY MY COMM. EXPIRES AUG. 28,,2016 who proved to m on the basis of satisfactory evidence to be the person( whose name Is/ e subscribed to the within instrument and ac� ed g to me that / E y executed the same e th1r authorized Capje�), and that by �/ r/ nature;(-b� on the instrument the erson OR entity y upon behalf of which the person) kted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS y hand and official S I. Signature � Place Notary Seal Above Signature of Notary Public OPTIONAI. 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 Title or Type of Document: Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Stacy M. Clinton O Individual Corporate Officer — Title(s): — Partner — ❑ Limited ❑ General O Attorney in Fact E' Trustee O Guardian or Conservator n Other: Signer Is Representing: RIGHTTHUMBPRINT OFSIGNER ,_ •• of • here Number of Pages: Signer's Name O Individual OGorporate Officer — Title(s): [3Partner —❑ Limited ❑ General OAttorney in Fact OThlstee FIGuardian or Conservator n_1 Other: Signer Is Representing: RIGHTTHUMBPRIN: OF SIGNER .• of thumb here 02007 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 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 5/20/2014 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 ABD Insurance & Financial Services 3 Waters Park Dr., Ste 100 San Mateo CA 94403 NAME: Luiza Watkins PHONE . (650) 488-8565 FAX (650)JIC.488-8566 A!C No I' -MAIL r1 D RESS:luiza@theabdteam.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Wausau Underwriters Insurance 26042 INSURED O r Grady Paving Inc. 2513 Wyandotte Street Mountain View CA 94043 IINSURERB:Starr Indemnity and Liability 38318 IINSURER C: INSURER D: INSURER E: INSURER F: V V Y G!\/1V LJ 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 OF 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 LTR TYPE OF INSURANCE A DL POLICY NUMBER _ POLICY EFF MM/DD/YYYY POLICY EXP MM)DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 5,000 A CLAIMS -MADE Fx_] OCCUR rviz91459513023 /23/2013 /1/2014 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 $ POLICYFXJ PRO LOC AUTOMOBILE LIABILITY _ ND COaa acccidentSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED siz91459513013 /23/2013 7/1/2014 BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ Peraccident X HIRED AUTOS X AUTOS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A 11 EXCESS LIAB CLAIMS -MADE $ 1000020165 /23/2013 /1/2014 DED I I RETENTION$ WC STATU- OTH- WORKERS COMPENSATION LIM ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE F N E.L. EACH ACCIDENT $ _ E.L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) A E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Job #14051 - 2013 STP Overland Project Number 2013-04 The City of Cupertino, its engineer and each of its directors, officers, agents and employees, as determined by the City of Cupertino are named Additional Insured on General Liability and Auto Liability per the attached endorsements. L:t_K I WIL A City Of Cupertino Roger Lee 10555 Mary Avenue Cupertino, CA 95014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sockolov/LUIZA ..A ACORD 25 (2010105) w.... INS025rgmnnsim Thn ARl1Rr%nnmo anti Innn nim rnniefarnrl marker of A( npn Policy Number YVJ'Z91459513023 Issued by Wausau underwriters insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY ENHANCEMENT FOR CONTRACTORS This endorsement modifies Insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART Index of modified items: item 1. Reasonable Force Item 2. Non -Owned Watercraft Extension Item 3. Damage To Premises Rented To You - Expanded Coverage Item 4. Bodily Injury To Co -Employees Item 5. Health Care Professionals As Insureds Item 8. Knowledge Of Occurrence Item 7. Notice Of Occurrence Item 8. Unintentional Errors And Omiselone Item 9. Bodily injury Redefinition Item i0. Supplementary Payments — increased Limits Item 11. Property In Your Care, Custody Or Control Item 12. Mobile Equipment Redefinition Item 13. Newly Formed Or Acquired Entitles Item 14. Blanket Additional Insured Where Required By Written Contract Lessors of Leased Equipment Managers or Lessors of Premises Mortgagees, Assignees or Receivers Owners, Lessees or Contractors Architects, Engineers or Surveyors Any Person or Organization Item 16. Blanket Additional Insured — Grantors Of Permitc Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement item 17. Other Insurance Amendment item 18. Contractual Liability - Railroads Item 1. Reasonable Force Exclusion a. of Section I - Coverage A - Bodily Injury And Propsoty Damage Liability is replaced by the following: a. Expected Or Intended Injury "Bodily Injury" or "property damage" expected or Intended from the standpoint of the Insured. This exclusion does not apply to "bodily Injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Item 2. Non -Owned Watercraft Extension Paragraph (2) of Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability Is replaced by the following: (2) A watercraft you do not own that Is: LC 04 43 0612 O 2012 Liberty Mutual Insurance. All rights reserved. Page 1 of 9 Includes copyrighted material of Insurance Services Off lee, Inc., with Its permission. (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge; Item 3. Damage To Premises Rented To You - Expanded Coverage A. The final paragraph of 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by 17re, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion Including water damage to premises while rented to you or temporarily occupied by you with permission of the owner, A separate limit of insurance applies to this coverage as described in Section Ili - Limits Of insurance. B. Paragraph 6. of Section IIf — Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "propert}i damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion Including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You Limit Is the greater of: a. $300,000; or b. The damage To Premises Rented To You Limit shown on the Declarations. C. Paragraph 9.a. of the definition of "Insured contract" in Se,ation V — Definitions is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that Indemnifles any person or organization for damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion Including water damage to premises while rented to you or temporarily occupied by you with permission of the owner Is not an "insured contract". D. The paragraph immediately following Paragraph (6) of exclusion j. of Section i — Coverage A -- Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage) to premises, including the contents of such premises, rented to you for a period of 7 or fewer consecutive days_ A separate limit of Insurance applies to Damage To Premises Rented To You as described in Section III -- Limits of Insurance. Item 4. Bodily Injury To Co -Employees A. Paragraph 2. of Section II - Who Is An Insured Is amended to Include: Each of the following Is also an Insured: Your supervisory or management "employees" (other than either your "executive officers" (if you are an organization other than a partnership, joint venture or Ilmhed liability cornpany) or your managers (if you are a limited liability company)) are Insureds while in the course of their employment or while performing duties related to the conduct of your business with respect to "bordity injury": (1) To you; (2) To your partners or members (if you are a partnership or joint venture); LC 04 43 05 12 © 2012 Liberty Mutual insuranw. All rights reserved. Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. (3) To your members (if you are a limited liability compa(iy); or (4) To a co"employee" or "volunteer worker" while that co -"employee" or "volunteer worker" is either in the course of his or her employment by you or while performing duties related to the conduct of your business (including participation In any recreational activities sponsored by you). Your "employees" (other than either your "executive officers" (If you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company)) or "volunteer workers" are Insureds while in the course of their empio"ent or while performing duties related to the conduct of your business for a Good Samaritan Act that results In "bodily injury": (1) To you; (2) To your partners or members (If you are a partnership or joint venture); (3) To your members (if you are a limited liability company); or (4) To a co -"employee" or "volunteer worker" while that co -"employee" or "volunteer worker" is either in the course of his or her employment by you or while performing duties related to the conduct of your business (Including participation In any recreational activities sponsored by you). A Good Samaritan Act means an attempt to rescue or aid a person In Imminent or serious peril, provided the attempt is not recklessly made. However, none of these "employees" (Including supervisory or management "employees") or "volunteer workers" are Insureds for the providing or failure to provide professional health care services. B. The Insurance provided by this Item 4. will not apply if the Injured person's sole remedy for such Injury Is provided under a workers' compensation law or any similar law. C. Other Insurance The insurance provided by this Item 4. is excess over any other valid and collectible Insurance available to the insured, whether primary, excess, contingent or on any other basis. Item 5. Health Care Professionals As Insureds A. Paragraphs 2.a.(1)(a) and (d) of Section 11 - Who Is An Ensured do not apply to 'bodily Injury" or "personal and advertising Injury" arising out of the providing of or failure to provide professional health care services by any "employee" or "volunteer" of the Named Insured who is a "designated health care provider" If the "bodily injury" or "personal and advertising injury" occurs In the course and scope of the "designated health care provider's" employment by the Named Insured. B. With respect to "employees" and "volunteer workers" providing professional health care services, the following excluslons are added to Paragraph 2. Exclusions of Suction i — Coverage A -- Bodily injury And Property Damage Liability and Paragraph 2. Exclusions of Section 1 — Coverage B — Personal And Advertising Injury Liability: This Insurance does not apply to: (1) Liability assumed under an "Insured contract" or any other contractor agreement; (2) Liability arising out of the providing of professional heelth care services in violation of law; (3) Liability arlsing out of the providing of any professloneil health care services while in any degree under the influence of intoxicants or narcotics; (4) Liability arising out of any dishonest, fraudulent, malicious or knowingly wrongful act or failure to act; or LC 04 43 06 12 @ 2012 Liberty Mutual insurance. All rights reserved. Page 3 of 8 Includes copyrighted material of insurance Services Office, Inc., with its permission. (5) Punitive or exemplary damages, fines or penalties. C. The following definition is added to Section V - Definitions: "Designated health care provider" means any "employei3' or "volunteer vrorker" of the Named Insured whose duties include providing professional health care seances, including but not limited to doctors, nurses, emergency medical technicians or designated first aid personnel. D. Other insurance The Insurance provided by this Item 5. is excess over any other valid and collectible Insurance available to the Insured, whether primary, excess, contingent or on any other basis. Item 6. Knowledge of Occurrence Knowledge of an "occurrence" by your agent, servant or "employee" will not in itself constitute knowledge by you unless your "executive officer" or "employes" or other third party designated by you to notify us of "occurrences" has knowledge of the "occurrence". item 7. Notice of occurrence For purposes of Paragraph 2.a. of Section IV - Condltlons, you refers to an "executive officer' of the Named Insured or to the "employee" designated by the Insured to give us notice. Item 8. Unintentional Errors And bmisslons Unintentional failure of the Named Insured to disclose all hsizards existing at the inception of this policy shall not be a basis for denial of any coverage afforded by this policy. However, you must report such an error or omission to us as soon as practicable after Its discovery. This provision does not affect our right to collect additional 'premium or exercise our right of cancellation or non- renewal. Item 9. Bodily Injury Redefinition The definition of "bodily injury" in Section V - Definitions is replaced by the following: "Bodily Injury" means_ a. Bodily Injury, sickness or disease sustained by a person, Including death resulting from any of these at any time; and b. Mental anguish, shock or humiliation arising out of injuiy as defined In Paragraph a. above. Mental anguish means any type of mental or emotional Illness or dlstrem. item 1o. supplementary Payments - Increased Limits Paragraphs 1.10, and 1.d. of Section I - Supplementary Payments - Coverages A And B, are replaced by the following: b. Up to $3,000 for cost of ball bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverag 3 applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the Insured at our irequest to assist us in the investigation or defense of the claim or "suit" including substantiated loss of earninga up to $500 a day because of time off from work. LO 04 43 OB 12 © 2012 Liberty Mutual Insurance. All rights reserved. Page 4 of 9 Includes copyrighted material of insurance Services Office, Inc., with its permission. Harrill. Property in Your Care, Custody Or Control A. Paragraphs (3) and (4) of exclusion J. of Section I — Coveirage A — Bodily Injury and Property Damage Liability only apply to; 1. "Property damage" to borrowed equipment, or 2. "Property damage" to property in your care, custody and control while in transit. B. This insurance does not apply to any portion of a loss for which the insured has available any other valid and collectible insurance, whether primary, excess, contingent, or on any other basis, unless such other insurance was specifically purchased by the Insured to apply in excess of this polby. C. Limits of Insurance Subject to Paragraphs 2., 3., and 5. of Section III — Limits Of Insurance, the most we will pay for insurance provided by Paragraph A., above is. $10,000 Each Occurrence Limit $25,000 Aggregate Limit The Each Occurrence Limit for this coverage applies to all damages as a result of any one "occurrence" regardless of the number of persons or organizations who sustain damage because of that "occurrance". The Aggregate Limit is the most we will pay for the sum of all damages under this Item 11. Item 12. Montle Equipment Redefinition The definition of "Mobile Equipment" in Section V — Definitions is amended to Include self-propelled vehicles with permanently attached equipment less than 1000 pounds gross vehicleweight 1hatare primarily designed for: (1) Snow removal; (2) Road Maintenance, but not construction or resurfacing; or (3) Street cleaning. Item 13. Newly Formed Or Acquired Entities Paragraph 3. of Section It — Who Is An Insured is replaced by the following. 3. Any organization, other than a partnership or Joint venture, you newly acquire or form and over which you maintain majority ownership or majority Interest will qualify as a Named Insured if there Is no other similar insurance available to that organization. a. Coverage under this provision Is afforded only until: (1) The 180th day after you acquire or form the organization; (2) Separate coverage Is purchased for the organization; or (3) The and of the policy period, whichever is earlier. b. Coverage A does not apply to "bodily injury" or "propady damage" that occurred before you acquired or formed the organization; and LC 04 43 05 12 ® 2012 Liberty Mutual Insurance. All rights reserved. Page 5 of 9 Includes copyrighted material of insurance Services Office, Inc., with its perms: sion. c. Coverage s does not apply to "personal and advertising injury" arising cut of an offense committed before you acquired or formed the organization. Item 14. Blanket Additional Insured Where Required By Written Contract Paragraph 2. of Section Ii - Who Is An insured is amended to add the following: e. Additional Insured by Written Contract or Written Agreemont The following are Insureds under the policy when you have agreed in awritten contract or written agreement to provide them coverage as additional insureds under your 130licy; (1) Lessors of leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, In whole or In part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). (2) Managers or Lessors of Premises: Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure additional Insured coverage. The coverage afforded to the additional Insured is ilmited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, In whole or In part, by some negligent acts or omissions of you, your "employees", your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional Insured or those acting on behalf of the addltional Insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional Insured shall conform to the agreement, but only If the applicable law would allow you to Indemnify the additional insured for liability arising out the additional Insured's sole negligence. This Insurance does not apply to: (a) Any "occurrence" which takes place after you copse to be a tenant In that premises or to lease that land; or (b) Any premises for which coverage is excluded by endorsement. (3) Mortgagees, Assignees or Receivers: Any person(s) or orgenization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This Insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4) Owners, Lessees or Contractors: any person(s) or organtzation(s) to whom you are obligated by a written agreement to procure additional Insured cov3rage, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertlsinii Injury" caused, in whole or in part, by your acts or omissions or the acts or omisslons of your "employees", your agents, or your subcontractors, In the performance of your ongoing operations. - This insurance does not apply to "bodily injury", "propesty damage", or "personal and advertising Injury" arising out of "your worst" Included In the "products-corrspleted operations hazard" unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for Ila,bllity caused, In whole or in part, by your acts or omissions or the acts or omissions of your "employees", your agents, oryour subcontractors. There is no coverage for the additional Insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional Insured, except as provided below. LC 04 43 0612 0 2012 Liberty Mutual insurance. All rights reserved. Page 6 of 8 Includes copyrighted material of insurance Services Office, Inc., with Its permission. If the written agreement obligates you to procure additional insured coverage for the addition€ insured's sole negligence, then the coverage for the additional Insured shall conform to the agreement, but only if the applicable law would allow you to Indemnify the addltlonal Insured for liability arising out the additional Insured's sole negligence. This Insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury' arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or falling to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specificallons; or (b) Supervisory, Inspection, architectural or engineering activities. (5) Architects, Enginears or Surveyors: any architect, engineer, orsurveyor engaged by you but only with respect to (lability for "bodily injury", "property damage" or "personal and advertising Injury' caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) in connection with your premises; or (b) In the performance of your ongoing operations. This Insurance does not apply to "bodily Injury", "property damage" or 'personal and advertising Injury" arising out of the rendering of or the failure to render any professional services by or for you, Including: (a) The preparing, approving, or falling to prepare or eipprove, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, Inspection, architectural or engineering activities. (6) Any Person or Organization Other Than a Joint Venture: Any person or organization (other than a joint venture of which you are a member) for whom your are obilgeted by a written agreement to procure additional insured coverage, but only with respect to liability for 'bodily Injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (a) In the performance of your ongoing operations; or (b) In connection with premises owned by you. This Insurance does not apply to: 1. Any construction, renovation, demolition or installation operations performed by or on behalf of you, or those operating on your behalf; 2, Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs, specification or the performance of any other professional services by such person or organization; or 3. Any person or organization more specifically coven;d In Paragraphs e.(1) through (6) above. The insurance afforded to any person or organization as an Insured under this Paragraph 2'.e.: (1) Applies only to coverage and minimum limits of Insurance required by the written agreement or written contract, but In no event exceeds either the scope of coverage or the limits of Insurance provided by this policy; LC 04 43 0612 © 2012 Liberty Mutual Insurance. All rights reserved. Page 7 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. (2) Does not apply to any person or organization for any "bodily injury°, "property damage" or "personal and advertising Injury" If any other additional Insured endorsement attached to this policy applies to that person or organization with regard to the "bodily Injury", "property damage' or"personal and advert)sing injury (3) Applies only If the "bodily Injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed, subsequent to the execution of the Nvdtten agreement; and (4) Applies only if the written agreement is In effect at tho time the "bodily Injury" or "property damage" occurs, or at the time the offense giving rise to the "personal and advertising injury" Is committed. Item 1S. Blanket Additional Insured -- Grantors Of Permits Paragraph 2, of Section 11- Who Is An Insured Is amended to add the following: Any state, municipality or political subdivision with respect to Piny operations performed by you or on your behalf, or In connection with premises you own, rent or control and to which this insurance applies, for which the state, municipailty or political subdivision has issued a permit. However, this Insurance does not apply to: 1. "Bodily Injury", "property damage" or "personal and advertising injury"orising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury' or "property damage" Included within 4he "products -completed operations hazard", except when required by written contract or agreement Initiated prior to loss; or 3. "Bodily injury", "property damage" or "personal and advertising Injury", unless negligently caused, in whole or in part, by you or those acting on your behalf. item 18. Waiver Of Right Of Recovery By Written Contract Or Agreement The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV Conditions: We waive any right of recovery because of payments we mako under this policy for injury or damage arising out of your ongoing operations or "your work" Included in the "produ+:ts-completed operations hazard" that we may have against any person or organization with whom you have agreed In a written contract or agreement to waive your rights of recovery but only if the "bodily Injury" or "property damage" occurs, or offense giving rise to "personal and advertising Injury" Is committed subsequent to the execution of the written contract or agreement. item 17. Other Insurance Amendment If you are obligated under a written agreement to provide liability Insurance on a primary, excess, contingent, or any other basis for any person or organization that quallfYes ea an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV -- Conditions will not apply. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions will govern. However, this Insurance Is excess over any other insurance available to the additional Insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit". Item 18. Contractual Liability — Railroads Paragraph a. of Section V - Definitions is replaced by the following: 9. "Insured Contract" means: LC 04 43 OS 12 4 2012 Liberty Mutual insurance. All rights reserved. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. a. A contract for a lease of premises. However, that ;portion of the contract for a lease of premises that Indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner Is not an "insured contracl'; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to Indemnify a municipal�ty, except In connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (Including an Indemnification of a municipality In connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily Injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law In the absence of any contract or agreement. Paragraph f. does not Include that part of any contract or agreement: (1) That Indemnlfles an architect, engineer or surveyor for Injury ordemage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or Instructions, or failing to glue them, if that is the primary cause of the injury or damage; or (2) Under which the Insured, If an architect, engineer or surveyor, assumes liability for an Injury or damage arising out of the insured's rendering nr failing to render professional services, including those listed In Paragraph (1) above and supervisory, Inspection, architectural or engineering activities. LC 04 43 0512 ® 2042 Liberty Mutual Insurance. All rights reserved. Page 0 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE lame of Person(s) or Organization(s): Any person or organization where the named insured has agreed by written contract to include such person or organization as a designated insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" funder the Who Is An Insured Provision contained in Section 11 of the Coverage Form. Policy No: ASJ-Z91-459513-013 Effective Date: 07/01/2013 Expiration Date: 07/01/2014 Sales Office: 0600 Issued By: Wausau Underwriters Insurance Company CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Couipany THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Auto Enhancement Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Newly Acquired or Formed Organizations I1. Employees as Insureds III. Lessor - Additional Insured and Loss Payee IV. Supplementary Payments - Increased Limits V. Fellow Employee Coverage VI. Personal Property of Others VII. Additional Transportation Expense and Cost to Recover Stolen Auto VIII. Airbag Coverage IX. Tapes, Records and Discs Coverage X. Physical Damage Deductible - Single Deductible XI. Physical Damage Deductible - Glass XII. Physical Damage Deductible -Vehicle Tracking System XIII. Duties in Event of Accident, Claim, Suit or Lass XIV. Unintentional Failure to Disclose Hazards XV. Worldwide Liability Coverage - Hired and Notnowned Autos XVI. Hired Auto Physical Damage XVI. Auto Medical Payments Coverage Increased Limits XVIII. Drive Other Car Coverage - Broadened Covet -age for Designated Individuals XIX. Rental Reimbursement Coverage XX. Notice of Cancellation or Nonrenewal XXI. Loan/Lease Payoff Coverage XXII. Limited Mexico Coverage XXIII Waiver of Subrogation NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words you and your also refer to any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership of more than 50 percent interest, provided: A. There is no similar insurance available to that organization: B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until: 1. The 90th day after you acquire or form the organization, or 2. The end of the policy period, whichever is earlier; and C. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 11 Includes copyrighted material of Insurance Services Office, Inc., with, its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau underwriters Insurance Company II. EMPLOYEES AS INSUREDS Paragraph A. 1. Who Is An Insured of SECTION II - LIABILITY COVERAGE is amended to add: Your "employee" is an insured while using with your permission a covered "auto" you do not own, hire or borrow in your business or your personal affairs. 111. LESSOR - ADDITIONAL INSURED AND LOSS PAYEE A. Any 'leased auto" will be considered an "auto" you own and not an "auto" you hire or borrow. The coverages provided under this section apply to ;any 'leased auto" until the expiration date of this policy or until the lessor or his or her agent takes possession of the 'leased auto" whichever occurs first. B. For any "leased auto" that is a covered "auto" under SECTION II - LIABILITY COVERAGE, subparagraph A.1., Who Is An Insured provision is changed to include as an insured the lessor of the 'leased auto." However, the lessor is an "im;ured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You. 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee" or agent of the lessor, operating a leased "auto" with the permission of any of the above. C. Loss Payee Clause 1. We will pay, as interests may appear, you and the lessor of the 'leased auto" for 'loss" to the covered "leased auto." 2. The insurance covers the interest of the lessor of the 'leased auto" unless the "loss" results from fraudulent acts or omissions on your part. 3. If we make any payment to the lessor of a "'leased auto," we will obtain his or her rights against any other party. D. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. E. The lessor is not liable for payment of your premiums. F. For purposes of this endorsement, the following definitions apply: "Leased auto" means an "auto" which you leases for a period of six months or longer for use in your business, including any "temporary substitute" of such 'leased auto." "Temporary substitute" means an "auto" that is furnished as a substitute for a covered "auto" when the covered "auto" is out of service because of its breakdown, repair, servicing, "loss" or destruction. AC 84 07 11 11 O 2011, Liberty Mutual Group of Companies. All rights reserved. Page 2 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company IV. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS Subparagraph A.2.a. (2) and A.2.a.(4) of SECTION II - LIABILITY COVERAGE are deleted and replaced by the following: (2) Up to $3,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not Inave to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including the actual loss of earnings up to $500 a day because of time off from work. V. FELLOW EMPLOYEE COVERAGE A. Exclusion B. 5. of SECTION II - LIABILITY COVERAGE does not apply: B. For the purpose of Fellow Employee Coverage only, paragraph B.5. of BUSINESS AUTO CONDITIONS is changed as follows: This Fellow Employee Coverage is excess over any other collectible insurance. VI. PERSONAL PROPERTY OF OTHERS Exclusion 6. in SECTION II - LIABILITY COVERAGE for a covered "auto" is amended to add: This exclusion does not apply to "property damage" or "covered pollution cost or expense" involving "personal property" of your employees or others while such property is carried by the covered "auto." The Limit of Insurance for this coverage is $5,000 per accident. Payment under this coverage does not increase the Limit of Insurance. For the purpose of this section of this endorsement, "personal property" is defined as any property that is not used in the individual's trade or business or held for the production or collection of income. VII. ADDITIONAL TRANSPORTATION EXPENSE AND COST TO RECOVER STOLEN AUTO A. Paragraph AA.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: The amount we will pay is increased to $50 per day and to a maximum limit of $1,000. B. Paragraph AA.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is amended to add the following: If your business is shown in the Declarations as something other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered auto from the place where it is recovered to its usual garaging location. Vlll. AIRBAG COVERAGE Exclusion B.3.a.in SECTION III - PHYSICAL DAMAGE COVERAGE is amended to add: This exclusion does not apply to the accidental discharge of an airbag. IX. TAPES, RECORDS AND DISCS COVERAGE Exclusion B.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 3 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company a. Tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment except when the tapes, records, discs or other similar audio, visual or data electronic devices; 1) Are your property or that of a family member, and 2) Are in a covered "auto" at the time of "loss." The most we will pay for "loss" is $200. No Physical Damage Coverage deductible applies to this coverage. X. PHYSICAL DAMAGE DEDUCTIBLE - SINGLE DEDUCTIBLE Paragraph D. in SECTION III - PHYSICAL DAMAGE= COVERAGE is deleted and replaced by the following: D. DEDUCTIBLE For each covered "auto," our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in 'the Declarations does not apply to "loss" caused by fire or lightning. When two or more covered "autos" sustain "loss" in the same collision, the total of all the "loss" for all the involved covered "autos" will be reduced by a single deductible, which will be the largest of all the deductibles applying to all such covered "autos." XI. PHYSICAL DAMAGE DEDUCTIBLE - GLASS Paragraph D. in SECTION III - PHYSICAL DAMAGE= COVERAGE is amended to add: No deductible applies to "loss" to glass if you elect to patch or repair it rather than replace it. Xli. PHYSICAL DAMAGE DEDUCTIBLE- VEHICLE TRACKING SYSTEM Paragraph D. in SECTION III - PHYSICAL DAMAGI:- COVERAGE is amended to add: Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped withi a vehicle tracking device such as a radio tracking device or a global positioning device and that device was the method of recovery of the vehicle. XIII. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Subparagraphs A.2.a. and A.2.b. of SECTION IV- BUSINESS AUTO CONDITIONS are changed to: a. In the event of "accident," claim, "suit" or "loss," your insurance manager or any other person you designate must notify us as soon as reasonably possible of such "accident," claim, "suit" or "loss." Such notice must include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 4 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Con.ipany Knowledge of an "accident," claim, "suit" or "loss" by your agent, servant or "employee" shall not be considered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "accident," claim, "suit" or "loss" from your agent, servant, or "employee." b. Additionally, you and any other involved "insured" must: (1) Assume no obligation, make no payment or incur no expense without our consent, except at the "insured's" own cost. (2) Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit." (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit." (4) Authorize us to obtain medical records or other pertinent information. (5) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. XIV. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. in SECTION IV - BUSINESS AUTO CONDITIONS is amended to add the following: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business Auto Coverage Form or at any time during the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. XV. WORLDWIDE LIABILITY COVERAGE - HIRED AND NONOWNED AUTOS Condition B.7. in SECTION IV - BUSINESS AUTO CONDITIONS is amended to include the following: For "accidents" resulting from the use or operation of covered "autos" you do not own, the coverage territory means all parts of the world subject to the following provisions: a. If claim is made or "suit" is brought against an "insured" outside of the United States of America, its territories and possessions, Puerto Rico and Canada, we shall have the right, but not the duty to investigate, negotiate, and settle or defisnd such claim or "suit." If we do not exercise that right, the "insured" shall have the duty to investigate, negotiate, and settle or defend the claim or "suit" and we will reimburse the "insured" for the expenses reasonably incurred in connection with the investigation, settlement or defense. Reimbursement will be paid in the currency of the United States of America at the rate of exchange prevailing on the date of reimbursement. The "insured" shall provide us with such information we shall reasonably request regarding such claim or "suit" and its investigation, negotiation, and settlement or defense. The "insured" shall not agree to any settlement: of the claim or "suit" without our consent. We shall not unreasonably withhold consent. AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 5 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company We are not licensed to write insurance outside of the United States of America, its territories or possessions, Puerto Rico and Canada. We will not furnish certificates of insurance or other evidence of insurance you may need for the purpose of complying with the laws of other countries relating to auto insurance. Failure to comply with the auto insurance laws of other countries may result in fines or penalties. This insurance does not apply to such fines or penalties. XVI. HIRED AUTO PHYSICAL DAMAGE If no deductibles are shown in the Declarations for Physical Damage Coverage for Hired or Borrowed Autos, the following will apply: A. We will pay for 'loss" under Comprehensive and: Collision coverages to a covered "auto' of the private passenger type hired without an operator for use in your business: 1. The most we will pay for coverage afforded) by this endorsement is the lesser of: a. The actual cost to repair or replace such covered "auto" with other property of like kind and quality, or b. The actual cash value of such covered "auto" at the time of the 'loss". 2. An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total 'loss." 3. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. B. For each covered "auto," our obligation to pay ior, repair, return or replace the covered "auto' will be reduced by any deductible shown in the Declarations that applies to private passengel- autos that you own. If no applicable deductible is shown in the Declarations, the deductible will be $250. If the Declarations show other deductibles for Physical Damage Coverages for Hired or Borrowed Autos, this Section XVII of this endorsement does not apply. C. Paragraph A.4.11b. of the Physical Damage Coverage is replaced by: b. Loss of Use Expenses For Hired Auto Physical Damage provided) by this endorsement, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a private passenger vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto," (2) Specified Causes of -Loss only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto," or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto." AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 6 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company However, the most we will pay under this coverage is $30 per day, subject to a maximum of $900. XVII. AUTO MEDICAL PAYMENTS COVERAGE - INCREASED LIMITS For any covered "loss," the Limit of Insurance for .Auto Medical Payments will be double the limit shown in the Declarations if the "insured" was wearing a seat belt at the time of the "accident." This is the maximum amount we will pay for all covered medical expenses, regardless of the number of covered "autos," "insureds," premiums paid, claims made, or vehicles involved in the "accident," If no limit of insurance for Auto Medical Payments is shown on the Declarations, this paragraph Section XVIII of this endorsement does not apply. XVIII. DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR DESIGNATED INDIVIDUALS A. This endorsement amends only those coverages indicated with an "X" in the Drive Other Car section of the Schedule to this endorsemenl:. B. SECTION II - LIABILITY COVERAGE is amended as follows: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by any individual named in the Drive Other Car section of the Schedule to this endorsement or by his or her spouse while a resident of the same household except: a. Any "auto" owned by that individual or by any member of his or her household, or b. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos." 2. The following is added to Who Is An Insured: Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her spouse, while a resident of the same household, are "insureds" while using any covered "auto" described in paragraph B.1. of this endorsement. C. Auto Medical Payments, Uninsured Motorise;, and Underinsured Motorist Coverages are amended as follows: The following is added to Who Is An Insured: Any individual named in the Drive Other Cara section of the Schedule to this endorsement and his or her "family members" are "insured" while "occupying" or while a pedestrian when struck by any "auto" you don't own except: Any "auto" owned by that individual or by any "family member." D. SECTION III - PHYSICAL DAMAGE COVERAGE is changed as follows: Any private passenger type "auto" you don't: own, hire or borrow is a covered "auto" while in the care, custody or control of any individual named in the Drive Other Car section of the Schedule to this endorsement or his or her spouse while a resident of the same household except: 1. Any "auto" owned by that individual or by any member of his or her household, or AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 7 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 ` Issued By Wausau Underwriters Insurance Company 2. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos." E. For purposes of this endorsement, SECTION V - DEFINITIONS is amended to add the following: "Family member" means a person related to the individual named in the Drive Other Car section of the Schedule to this endorsement: by blood, marriage or adoption who is a resident of the individual's household, including a ward or foster child. XIX. RENTAL REIMBURSEMENT COVERAGE A. For any owned "covered auto" for which Collision and Comprehensive Coverages are provided, we will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of a covered physical damage "loss" to an owned covered "auto." Such payment applies in addition to the otherwise applicable amount of physical damage coverage you have on a covered "auto." No deductibles apply to this coverage. B. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending with the earlier of the return or repair of the covered "auto," or the exhaustion of the coverage limit. C. Our payment is limited to the lesser of the following amounts: 1. Necessary and actual expenses incurred, or 2. $30 per day with a maximum of $900 in any one period. D. This coverage does not apply: 1. While there are spare or reserve "autos" available to you for your operations: or 2. If coverage is provided by another endorsement attached to this policy. E. If a covered "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under paragraph 4 ,overage Extension of SECTION III — PHYSICAL DAMAGE COVERAGE of the Business Auto Coverage Form or Section VII of this endorsement. XX. NOTICE OF CANCELLATION OR NONRENEWAP_ A. Paragraph A. 2. of the COMMON POLICY CONDITIONS is changed to: 2. We may cancel or non -renew this policy, by mailing written notice of cancellation or non -renewal to the Named Insured, and to any name(s) and address(es) shown in the Cancellation and Non -renewal Schedule: a. for reasons of non-payment, the greater of: (1) 10 days, or (2) the number of days specified in ,any other Cancellation Condition attached to this policy; or AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 8 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number AST -Z91-459513-013 Issued By Wausau underwriters Insurance Company b_ for reasons other than non-payment, the greater of: (1) 60 days, (2) the number of days shown in the Cancellation and Non -renewal Schedule, or (3) the number of days specified in any oliher Cancellation Condition attached to this policy. prior to the effective date of the cancellation or non -renewal. B. All other terms of Paragraph A., of the COMMON POLICY CONDITIONS, and any amendments thereto, remain in full force and effect. XXL LOAN/LEASE PAYOFF COVERAGE The following is added to Limit of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE: In the event of a "total loss" to a covered "auto" of the "private passenger type" shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," less; 1. The amount paid under the PHYSICAL DAMAGE COVERAGE SECTION of the policy, and 2. Any; a. Overdue lease/loan payments at the time of the 'loss," b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. C. Security deposits not returned by the lesser; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. This coverage is limited to a maximum of $15001or each covered "auto." AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 9 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company XXII. LIMITED MEXICO COVERAGE WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD (CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES FROM THE BOUNDARY OF THE UNITED STKI F -S OF AMERICA_ A. Coverage 1. Paragraph B. 7 of SECTION IV - BUSINESS AUTO CONDITIONS is amended by the addition of the following: The coverage territory is extended to include Mexico but only if all of the following criteria are met: a. The "accidents" or "loss" occurs within 25 miles of the United States border; and b. While on a trip into Mexico for 10 days or less_ 2. For coverage provided by this Section of the endorsement, Paragraph B.5. Other Insurance in SECTION IV - BUSINESS AUTO CONDITIONS is replaced by the following: The insurance provided by this endorsement willl be excess over any other collectible insurance. B. Physical Damage Coverage is amended by the addition of the following: If a 'loss" to a covered "auto" occurs in Mexico, we will pay for such "loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value, of such 'loss" at the nearest United States point where the repairs can be made. C. Additional Exclusions The following additional exclusions are added: This insurance does not apply: 1. If the covered "auto" is not principally garaged and principally used in the United States. 2. To any "insured" who is not a resident of the United States. XXIII. WAIVER OF SUBROGATION Paragraph A.5. in SECTION IV- BUSINESS AUTO CONDITIONS does not apply to any person or organization where the Named Insured has agreed, by written contract executed prior to the date of accident, to waive rights of recovery against such person or organization. AC 84 07 11 11 © 2011, Liberty Mutual Group of Companies. All rights reserved. Page 10 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number ASJ-Z91-459513-013 Issued By Wausau Underwriters Insurance Company Schedule Premium Liability Included Physical Damage Included Total Premium Included V. Fellow Employee Schedule of Employees: Your "employee," but only for acts within the scope of their employment by you. XVIII. Drive Other Car LIAB MIP UM Ulm COMP COLL Name of Individual Thomas O'Grady X X X X X X XX. Notice of Cancellation or Nonrenewal Name and Address This endorsement does not apply in: FL, KS, HI, NY, VA, GU, PR, VI Numbers of Days 30 AC 84 07 11 11 © 2011, Liberty Mutual Group, of Companies. All rights reserved. Page 11 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 13 X51 A Human Resource Management Company May 20, 2014 O'GRADY PAVING INC 2513 WYANDOTTE ST MOUNTAIN VIEW, CA 94043-2314 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self -Insurance for Workers' Compensation Coverage For O'GRADY PAVING INC, CSLB license number 201696, 601144 As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self -Insured Workers' Compensation Plan. As a party to a co -employment contract with BBSI, which is effective from 7/1/2013 until 6/30/2014, California Labor Code §3602 allows O'GRADY PAVING INC to obtain its workers' compensation coverage from BBSI. BBSI's California customers can also verify BBSI's state certification at http://www.dir.ca.gov/osip/PrivateRoster.pdf; then scroll down to Barrett (the list is alphabetical by company name). Additional information is as follows: State: California Workers' Compensation Limits: Employer Liability Limits: Self Insurance Certification #: 2246 Statutory $5,000,000.0 Each Accident $5,000,000.0 Disease Coverage Limit by Client $5,000,000.0 Disease; Each Employee Notice of Termination: In the event the contract between BBSI and O'GRADY PAVING INC is terminated, BBSI must provide notice of the termination within seven (7) days to the California Contractors State License Board ("CSLB"). Other Comments (place an "X" if applicable): FX Named "Letter Holder": City of Cupertino 10300 Torre Ave Cupertino, Ca 95014 ® Other: Job #14051 2013 STP Overlay Project number 2013-04 Additionally, BBSI's self-insured program is further supported by an excess workers' compensation insurance policy with ACE American Insurance Co. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: SAN JOSE (408)321-9901 Very truly yours, 11OL4& Michael L. Elich President and Chief Executive Officer doc: LOSI-3