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14-132 O'Grady Paving Inc., Pavement Maintenance Project-Phase 1 DOCUMENT: 22854894 Pages: 3 RECORDING REQUESTED BY Fees. . . . # No Fees eCopes. . City of Cupertino AMT PAID WHEN RECORDED MAIL TO REGINA ALCOMENDRAS RDE # 001 SANTA CLARA COUNTY RECORDER 2/13/2015 Recorded at the request of 11 05 AM City Clerk's Office City City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NO FEE IN ACCORDANCE WITH GOV. CODE 27283 CERTIFICATE OF COMPLETION AND NOTICE OF ACCEPTANCE OF COMPLETION 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 CITY PROJECT NUMBER 2014-01 Original 0 For Fast Endorsement "NO FEE" City of Cupertino CERTIFICATE OF COMPLETION AND NOTICE OF ACCEPTANCE 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 Certificate of Completion and Notice of Acceptance of Completion dated February 12, 2015, for 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 CITY PROJECT NUMBER 2014-01 and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on February 3, 2015 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: February 12, 2015 By: Kirsten Squarcia Deputy City Clerk. City Hall 10300 Torre Avenue Cupertino, CA 95014-3255 (408) 777-3354 C U P E RT I N O PUBLIC WORKS DEPARTMENT CERTIFICATE OF COMPLETION AND NOTICE OF ACCEPTANCE OF COMPLETION 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 CITY PROJECT NUMBER 2014-01 NOTICE IS HEREBY GIVEN THAT I, Timm Borden, Director of Public Works and City Engineer of the City of Cupertino, California, do hereby certify that the work and improvements for asphalt overlay, asphalt leveling and digout repairs performed at various locations in Cupertino, California, in hereinafter described in the contract which was entered into, by, and between the City of Cupertino and O'Grady Paving, Inc., July 21st, 2014, in accordance with the plans and specifications for said work, have been completed to the City's satisfaction and acceptance of completion was ordered on February 3, 2015. That said work and improvements consisted of furnishing all labor, materials, tools, and equipment required to complete said project, all as more particularly described in the plans and specifications for said project. Timm Bofden Director of Public Works and City Engineer of the City of Cupertino Date: February 12, 2015 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3223• FAX: (408)777-3366 C U P E RT I N O WEBSITE:www.cur)ertino.org O'Grady Paving Inc. 2513 Wyandotte Street Mountain View, CA 94043 Re: Bid Award, Project Number 2014-01201.4 Pavement Maintenance Project-Phase 1 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 OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 TELEPHONE: (408)777-3223• FAX: (408)777-3366 C U P E RT I N O W EBSITE:www.cupertino.org July 21, 2014 Graniterock 120 Granite Rock Way San Jose, CA 95136 Re: Bid Award, Project Number 2014-012014. Pavement Maintenance Project-Phase 1. 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 infonnation, please contact the Public Works Department at (408) 777-3354. Sincerely, Andrea Sanders City Clerk's Office cc: Public Works Enclosure OFFICE OF THE CITY CLERK CITY HALL 10300 TORRE AVENUE -CUPERTINO,CA 95014-3255 TELEPHONE: (408)777-3223- FAX: (408)777-3366 �T' ® W EBSITE:www.cupertino.org July 21, 2014 Teichert Construction 265 Val Dervin Parkway Stockton, CA 95206 RE: Bid Award, Project Number 2014-012014 Pavement Maintenance Project-Phase 1. 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 OFFICE OF THE CIT`(CLERK CITY HALL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 TELEPHONE:(408)777-3223• FAX: (408)777-3366 C U P E RT I N O W EBSITE:www.cupertino.org July 21, 2014 G. Bortolotto & Company, Inc. 582 Bragato Road San Carlos. CA 94070 RE: Bid Award, Project Number 2014-012014 Pavement Maintenance Project-Phase 1. 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, w� G� Andrea Sanders City Clerk's Office cc: Public Works Enclosure o. Project No.2014-01 DOCUMENT 00520 CONTRACT 64 THIS CONTRACT, dated this M1v,day of� , 2014 , by and between O'Grady Paving Inc. whose place of business is located at 2513 Wyandotte Stree, Mountain View, CA (Contractor) and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by virtue of the audhfo--rity vested in the City by the laws of the State of California. V— 1�-?Z eLA day of ��,� 201.4 awarded to Contractor the following Pro ec . WHEREAS,City,on th y �`� b j PROJECT NUMBER 2014-01 2014 PAVEMENT MAINTENANCE PROJECT- PHASE 1 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 9501.4 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 10 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 expenses(such as project management and consultant expenses), if all or City of Cupertino 00520- 1 Contract 2014 Pavement Maintenance Project—Phase 1 Project No.2014-01 any part of the Work is not completed within th(,-times 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 liquidated 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 $150.00 per day for failure to replace traffic striping as required by Document 0 10 10,Section 109-31). 3.2.4 $5,000 for each occurrence of a violation of Document 00800, Section 1.7 WORK DAYS AND HOURS. 3.2.5 Three Months Salary for each Key Personnel named in Contractor's SOQ pursuant to Article 2.G of Document 00450 (Statement of Qualifications for Construction Work) who leaves the Project and/or Contractor replaces at any point befor(: Final Completion, for any reason whatsoever, that Contractor can demonstrate to City's satisfaction i;,beyond Contractor's control. Liquidated damages shall apply cumulatively and, except as provided below, shall be presumed to be the damages suffered by City resulting from delay in completion of the Work. 3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss of public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of completion of the Work, damages resulting from defective Work, lost revenues or costs of substitute facilities, or damages suffered by others who then seek to recover their damages from City(for example, delay claims of other contractors,subcontractors,tenants,or other third-parties),and defense costs thereof n 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: Sc:e 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 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. City of Cupertino 00520-2 Contract 2014 Pavement Maintenance Project—Phase 1 a Project No.2014-01 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 th,,- results of all such observations, examinations, investigations, explorations,tests,reports and studies with the t(;rms 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 Ciity 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 54100 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 Bid Document 00430 Subcontractors List Document 00450 Statement of Qualifications Document 00481 Non-Collusion Affidavit Document 00482 Bidder Certifications 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 Requesr.Form Document 00700 General Conditions Document 00800 Special Conditions Document 00820 Traffic Control Requirements Document 00821 Insurance Document 00822 Apprenticeship Program City of Cupertino 00520-3 Contract 2014 Pavement Maintenance Project—Phase 1 Project No.2014-01 Document 00850 Technical Specifications Document 00860 General Requirements Attachment A Work Hour Restrictions 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 are the persons signing this Contract for or on behalf of City or acting as an employee, agent, or representative of City, liable on this Contract or any of the Contract Documents, or upon any warranty of authority, or otherwise, and it is further understood and agreed that liability of the City is limited and confined to such liability as authorized or imposed by the Contract Documents or applicable law. 7.3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the Contract Documents only in compliance with the Subcontractor Listing :Law, California Public Contracting Code§4100 et seq. 7.4 The Contract Sum includes all allowances(if any). 7.5 In entering into a public works contract or a subcontract to supply goods, services or materials pursuant to a public works contract, Contractor or Subcontractor offers and agrees to assign to the awarding body all rights, title and interest in and to all causes of action it may have under Section 4 of the Clayton Act(15 U.S.C. §15)or under the Cartwright Act(Chapter 2 (commencing with Section 16700)of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, services or materials pursuant to the public works contract or the subcontract. This assignment shall be made and become effective at the time City tenders final payment to Contractor,without further acknowledgment by the parties. 7.6 Copies of the general prevailing rates of per diem wages for each craft,classification,or type of worker needed to execute the Contract,as determined by Director of the State of California Department of Industrial Relations, are deemed included in the Contract Documents and on file at City's office, or may be obtained of the State of California web site http://www.dir.ca.gov/DL,SR/PWD/Nortilem.html and shall be made available to any interested party on request. Pursuant to Section 1861 of the Labor Code, Contractor represents that it is aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that Code, and Contractor shall comply with such provisions before commencing the performance of the Work of the Contract Documents. 7.7 Should any part,term or provision of this Contract or any of the Contract Documents,or any document required herein or therein to be executed or delivered, be declared invalid, void or unenforceable, all remaining parts, terms and provisions shall remain in full forge and effect and shall in no way be invalidated, impaired or affected thereby. If the provisions of any laxv causing such invalidity, illegality or unenforceability may be waived,they are hereby waived to the end that this Contract and the Contract Documents may be deemed valid and binding contracts, enforceable in accordance with their terms to the greatest extent permitted by applicable law. In the event any provision not otherwise included in the Contract Documents is required to be included by any applicable law,that provision is deemed included herein by this reference(or, if such provision is required City of Cupertino 00520-4 Contract 2014 Pavement Maintenance Project—Phase I Project No.2014-01 to be included in any particular portion of the contract Documents, that provision is deemed included in that portion). 7.8 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa Clara, State of California, and governed in all respects by California law(excluding choice of law rules). The exclusive venue for all disputes or litigation hereunder shall be'in Santa Clara County. Both parties hereby waive their rights under California Code of Civil Procedure Section 394 to file a motion to transfer any action or proceeding arising out of the Contract Documents to another venue. Contractor accepts the Claims Procedure in Document 00700,Article 12,established under the California Government Code,Title 1,Division 3.6,Part 3,Chapter 5. City of Cupertino 00520-5 Contract 2014 Pavement Maintenance Project—Phase 1 Project No.2014-01 IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year first above wriTe-n. 2014 PAVEMENT MAINTENANCE PROJECT—Phase I CITY: CONTRACTOR: V 7 t�7 CITY OF CUPERTINO,a Municipal Corporation of the c"r �av � 1✓'C State of California By: [Signatu ] 6-Z ca Attest: _ c (If 0,% [Please qaAnt name here] City Clerk:Grace Schmidt f� Approved as to form by City Attorney: Title: " orp Von: Chai an",President,or Vice President] City Attorney: Carol Korade By: [Signat e] llno \\A I hereby certify,under penalty of perjury,that David Brandt, [Please print name here] City Manager of the City of Cupertino was duly authoriz�,d � to execute this document. Title: [If Corporation: Secretary,Assistant Secretary, Chief Financial Officer,or Assistant Treasurer] Date ? Z t ( �b t Cpl(P 1T State Contractor's License No. Classification . 12134/ l 5 David Brandt,City Manager of the City of Cupertino,a Expiration Date Municipal Corporation of the State of California Designated Representative: Taxpayer ID No. 9 tf 4936gZ Name:Roger Lee Name: CrCL-k C, Title:Assistant Director of Public Works- Title: �,f 3 Address: 10300 Torre Ave, Cupertino, CA 95014 Address: M��n �J 'f. i C et`-fir y Lk 3 Phone:408-777-3354 Phone:l.So`-�� Facsimile:408-777-3333 Facsimile: (_,so) NOTARY ACKNOWLEDGEMENT IS REQUIRED. IF A AMOUNT: $3,598,283.76 �'� y�/ CORPORATION, CORPORATE SEAL AND CORPORATE ACCOUNT NUMBER:270-8404-9325 NOTARY ACKNOWLEDEMENT AND FEDERAL TAY ID ARE REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY FILE NO.: 98,493.102 NO.IS REQUIRED END OF DOCUMENT City of Cupertino 00520-6 Contract 2014 Pavement Maintenance Project—Phase 1 ACKNOWLEDGMENT State of California _ County of nia rok, ) On Jullu 14 - UI before me, _ItEyiCa L..®aeZ Conn-Z, No+o rU I-uw iL (insert name and title of the officer) personally appeared Q'fca `40UV) o'5 M d'('y-0Hq who proved tome on the basis of satisfa y evidence to be-+e 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. WITNESS m hand and official seal. , ERICA LOPEZ 198905 y :�`.'y..�..��.•; Commission# 1989050 Notary Public-California D Santa Clara County My Comm. Expires Sep 21,2016 Signature (Seal) v Project No.2014-01 Bond#: 106084560 Premium : $17,272.00 DOCUMENT 00610 CONSTRUCTION PERFORMANCE BOND THIS CONSTRUCTION PERFORMANCE BOND ("Bond") is dated July 11, 2014 is in the penal sum of Three Million Five Hundred Ninety Eight Thousand Two Hundred Eighty Three Dollars and Seventy Six Cents [which is one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the faithful performance of the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page. Any singular reference to O'Grady Paving, Inc. ("Contractor"), Travelers Casualty and Surety Company of America ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California("City")or other party shall be considered plural where applicable. CONTRACTOR: SURETY: O'Grady Paving, Inc. Travelers Casualty and Surety Company of America Name Name 2513 Wyandotte Street 100 California Street, Suite 300 Address Principal Place of Business Mountain View, CA 94043 San Francisco, CA 94111 City/State/Zip City/State/Zip CONSTRUCTION CONTRACT: 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 PROJECT NUMBER 2014-01 at Cupertino,California. DATED July 10 ,20 14 in the Amount of$ 3,598,283.76 (the"Penal Sum") CONTRACTOR AS PRINCIPAL SURETY Travelers CasLjatty and Company: (Corp. ) O'Gr y Pavin Company S ur ty Co p ny f Amef-ica Signature: Signature: - Name and Title: i Name and Title: c M. Cli ton,Attorne`-in-fact BOND TERM'S AND CONDITIONS - 1. Contractor and Surety,jointly and severally, bind themselves,their heirs, executors, administrators, successors and assigns to City for the complete and proper performance of the Construction Contract, which is incorporated herein by reference. 2. If Contractor completely and properly performs all of its obligations under the Construction Contract, Surety and Contractor shall have no obligation under this Bond. 3. If there is no City Default, Surety's obligation under this Bond shall arise after: 3.1 City has declared a Contractor Default under the Construction Contract pursuant to the terms of the Construction Contract; and 3.2 City has agreed to pay the Balance of the Contract Sum: 3.2.1. To Surety in accordance with the terms of this Bond and the Construction Contract;or City of Cupertino Construction Performance Bond 2014 Pavement Maintenance Project—Phase 1 00610- 1 � p ACKNOWLEDGMENT State of California County of S' Y%.- On J v 4 AM before me, ?L,r i« Uooez C�,r r z . N O+rAn( Pu b (insert name and title of the officer) personally appeared C66--L-�z C'• Vou VA who proved to me on the basis of satisfa evidence to be4He 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. WITNESS my hand and official seal. ERICA LOPEZ CoRTEz M- � � Commission* 1989050 Notary Public-California z Z 4,, Santa Clara County D My Comm.Expires Sep 21,2016 Signature (Seal) Project No.2014-01 3.2.2 To a contractor selected to perform the Construction Contract in accordance with the terms'of this Bond and the Construction Contract:. -4. When City has satisfied the conditions of paragraph 3, Surety shall promptly (within 30 days) and at Surety's expense elect to take one of the following actions: 4.1 Arrange for Contractor, with consent of City, to perform and complete the Construction Contract (but City may withhold consent, in which cast; the Surety must elect an option described in paragraphs 4.2, 4.3 or 4.4,below);or 4.2 Undertake to perform and complete the Construction Contract itself, through its agents or through independent contractors; provided, that Surety may not select Contractor as its agent or independent contractor without City's consent;or 4.3 Undertake to perform and complete the Construction Contract by obtaining bids from qualified contractors acceptable to City for a contract for performance and completion of the Construction Contract, and, upon determination by Ciol of the lowest responsible bidder, arrange for a contract to be prepared for execution by City and the contractor selected with City's concurrence, to be secured with performance and_payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract; and, if Surety's obligations defined in paragraph 6, below, exceed the Balance of the Contract Sum,then Surety shall pay to City the amount of such excess;or 4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances, and, after investigation and consultation with City, determine in good faith its monetary obligation to City under paragraph 6, below, for the performance and completion of the Construction Contract and, as soon as practicable after the amount is determined, tender payment therefor to City with full explanation of the payment's calculation. If City accepts Surety's tender under this paragraph 4.4,!-, City may still hold Surety liable for future damages then unknown or unliquidated resulting from the Contractor Default. If City disputes the amount of Surety's tender under this paragraph 4.4, City may exercise all remedies available to it at law to enforce Surety's liability under paragraph 6,below. 5. If Surety does not proceed as provided in paragraph 4, above, then Surety shall be deemed to be in default on this Bond ten days after receipt of an additional written notice from City to Surety demanding that Surety perform its obligations under this Bond. At all -times City shall be entitled to enforce any remedy available to City at law or under the Construction Contract including,without limitation,and by way of example only,rights to perform work, protect work, mitigate damages, advance critical work to' mitigate schedule delay, or coordinate work with other consultants or contractors. 6. Surety's monetary obligation under this Bond is limited by the Amount of this Bond identified herein as the Penal Sum. This monetary obligation shall augment the Balance of the Contract Sum. Subject to these limits, Surety's obligations under this Bond are commensurate with the obligations of Contractor under the Construction Contract. Surety's obligations shall include,but are not limited to: 6.1 The responsibilities of Contractor under the Construction Contract for completion of the Construction Contract and correction of defective work:. 6.2 The responsibilities of Contractor under the Construction Contract to pay liquidated damages, and for damages for which no liquidated damages are specified in the Construction Contract, actual damages caused by non-performance of the Construction Contract including, but not limited to, all valid and proper backcharges,offsets,payments,indemnities,or other damages; 6.3 Additional legal, design professional and delay costs resulting frorn Contractor Default or resulting from the actions or failure to act of the Surety under paragraph 4,above(but excluding attorney's fees incurred to enforce this Bond). City of Cupertino Construction Performance Bond 2014 Pavement Maintenance Project—Phase 1 00610-2 Project No.2014-01 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 Fond 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 court of competent jurisdiction in the location in which the work is located. Communications from City to Surety under paragraph 3.1 of this Bond shall be deemed to include the necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise. 10. All notices to Surety or Contractor shall be mailed or delivered(at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt 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 tl:�e cause of the asserted Contractor Default and is sufficient to justify Contractor termination of the Construction Contract. END OF DOCUMENT City of Cupertino Construction Performance Bond 2014 Pavement Maintenance Project—Phase 1 00610-3 i WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER � r T'RAVELERS POWER OF ATTORNEY 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 Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 225368 Certificate No. 005570171 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, 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 are corporations duly organized under the laws of the State of Connecticut, 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 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 undertaking's required or p � `ed`tin ancYions or-pbceedings allowed by law. v IN WITNESS WHEREOF,the Companies have caused this instruent)0be.srgn l and the corporate seals to be hereto affixed,this 22nd m day of July 2013 °' `; rr ' \Y Farmington Casualty Company , St.Paul Mercury Insurance Company Fidelity and Guaranty lns"ranc Company, Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriter,,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 GASU.1 G`�\oF1RE Wy. 1 �5 .' INSfJ`''.. LTY AN pMw�.Wp,y O Wq TY r N'0 tTy � ANp O?•°p,POq�� +LOnPp+arto aP � •RPOq 1 ,+'4JP.............9,1••s PJ SG •C/" c t�� C 1 9 8 2�''0' 'dr QP111RIMATIA _ m= !,!�O " f ARTFORD, < e J�W WOFA0 �a r 51 = ,�'SEA L;o s '�`•SEAL i 3 CON N. Oil fc 74 dD f ', C N �._ ,". / !� `:iG c:: ash �+ 896 !�s r'••.......va`t`f y.,. .• gab Via'; �� 1�AMA_�(� 9ynn mmaCu,� �r State of Connecticut By: City of Hartford ss. Robert L.Raney, e/nior Vice President On this the 22nd day of July 201.3 before me personally appeared Robert L.Raney,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•TEX In Witness Whereof,I hereunto set my hand and official seal. My Commission expires the 30th day of June,2016. # ULj ` Marie C.Tetreault,Notary Public O _ 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER t P CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sonoma On July 11, 2014 before me, K.Dixon Wright,Notary Public Date Here Insert Name and Title of the Officer ' personally appeared Stacy M. Clinton Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the person/whose name is/ e subscribed to the wi hir instrument and ack owl dged to me that w e h y executed the sa e ' e t it authorized ca city i , and that b r h i nature on the Y 9 instrument the person, or t e entity upon behalf of ,.. K. DIXON WRIGHT which the person cted, executed the instrument. rrfffr'''y_ •" Commission # 1958183 Q �' �i Z :�,�•; Notary Public -California D I certify under PENALTY OF PERJURY under the laws Marin County •'' of the State of California that the foregoing is My Comm.Expires Nov 21,2015 g 9 true and correct. WITH ESS m and.and offic' I seal. Place Notary Seal Above Signature Signature of Notary Public OPTIONAL, Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachrrrent of this form to another document. Description of Attached Document Title or Type of Document: Document Date: _ Number of Pages: Signer(s) Other Than Named Above: _ Capacity(ies) Claimed by Signer(s) Signer's Name: Stacy M. Clinton Si'gner's Name: Individual Individual Corporate Officer—Title(s): Corporate Officer—Title(s): M Partner—❑ Limited ❑ General _ _ _ r= Partner—❑ Limited ❑ General rTopof Attor ney in Fact —Attorney in Fact Top of thumb here mb here Trustee ��1 rustee Guardian or Conservator rIGuardian or Conservator Other: [10ther: Signer Is Representing: Signer Is Representing: ©2007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402-Chatsworth,CA 913,13-2402•www.NationaiNotary.org Item#5907 Reorder:Call Toll-Free 1-800-876-6827 f Project No.2014-01 Bond#: 106084560 DOCU7vIENT 00620 Premium : included in perf bond CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND THIS CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND("Bond")is dated July 11, 2014 ,is in the penal sum Three Million Five Hundred Ninety Eight Thousand Two Hundred Eighty Three Dollars&Seventy Six Cents [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:. SURETY: O'Grady Paving, Inc. Travelers Casualty and Surety Company of America Name Name 2513 Wyandotte Street 100 California Street, Suite 300 Address Principal Place of Business Mountain View, CA 94043 San Francisco, CA 94111 City/State/Zip City/State/Zip CONSTRUCTION CONTRACT: 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 PROJECT NIUMBER 2014-01 at Cupertino,California. DATED July 10 ,20 14 in the Amount of$ 3,598,283.76 (the"Penal Sum") CONTRACTOR AS PRINCIPAL SURETY Travelers Casualt nd Company: p. Seal) O'Grady ving, Inc. Company: yeal ret Compan of merica Signature:_ Signature: Name and Title: Cl Ga iC4 2CJ()UJ6; Name and Title: Stky M. CH n Attorney-in-fact BOND TERMS.AND CONDITIONS 1. 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 is 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 2014 Pavement Maintenance Project—Phase 1 00620- 1 ACKNOWLEDGMENT State of California County of SQY1 f-rk ctaya- On JV lv I L1 20u j before me, •'Fri ra Leai2ez �r-{-Z' NoigN RJ1011, (insert name and title of the officer) personally appeared CX61, 9. Ybupm who proved to me on the basis of satisfactory evide ce to be the a on(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. WITNESS my hand and official seal. ERICA LOPEZ CORTEZ Commission# 1989050 Notary y Public -California z ' Santa Clara County D My Comm.Expires Sep 21,2016 Signature_ (Seal) Project No.2014-01 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. 9. Suit against Surety on this Bond may be brought:by any Claimant,or its assigns,at any time after the Claimant has furnished the last of the labor or materials, or both, but,per Civil Code §3249, must be commenced before the expiration of six months after the period in which stop notices may be filed as provided in Civil Code §3184. 10. All,notices to Surety or Contractor shall be mailed 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. 1-1. This Bond has been furnished to comply with the:California Mechanic's Lien Law including,but not limited to, Civil Code §§3247, 3248, et seq. Any provision in this Bond conflicting with said statutory requirements shall be deemed deleted herefrom and provisions conforming to such statutory or other 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 is performed and(2)legal holiday and overtime work in said locality. The per diem wages shall be an amount equal to or more than the stipulated rates contained in a schedule that has been ascertained and determined by the Director 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 2014 Pavement Maintenance Project—Phase 1 00620-2 Project No.2014-01 14. Definitions. 14.1 Claimant: An individual or entity having a direct contract with Contractor or with a Subcontractor of Contractor to furnish labor, materials or equipment for use in the performance of the Contract, as further defined in California Civil Code §3181. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's Subcontractors, and all other items for which a stop notice might be asserted. The term Claimant shall also include the Unemployment Development Department as referred to in Civil Code§3248(b). 14.2 Construction Contract: The contract bdween 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 2014 Pavement Maintenance Project—Phase 1 00620-3 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER o ti 1 I ► POWER OF ATTORNEY TRAVELERS" 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 Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 225365 Certificate No. 005570172 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, 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 are corporations duly organized under the laws of the State of Connecticut, 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 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 theirbusiness off guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perrriit[edin any actions or<p"roceedings allowed by law. -�k\ IN WITNESS WHEREOF,the Companies have caused this instrurnei qto be,signhand theih�q orporate seals to be hereto affixed,this 22nd day of July 2013 ; Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insiirance•Com pan y; Travelers Casualt and Surety Y Fidelity and Guaranty Ins Y urance 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 �� N •,,.a.•...wr.. TY At,, ouww¢M G U195 ............G ! u v .9 4e•.........7v- 1982 g P S Naw 6 YY1Y.-tp s��` o` P a 3 �\o C O 19n sy m= 0 * a ' c�. ;m$ f --- n= ¢ HARTFORD,SEA' "' ?J: o: CONN. o o:£= �b P��o $EA.L.D rjf N 896 quuii�m�uCf`� �a�J s L y ' :a ....:!� `�:5,«�.+ b! a� mow.v� 1 AR State of Connecticut By: City Of Hartford SS. Robert L.Raney, enior Vice President On this the 22nd day f July 201:3 y before me personally appeared Robert L.Raney,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 b -himself as a duly authorized officer. y In Witness Whereof,I hereunto set my hand and official seal. ( (� My Commission expires the 30th day of June,2016. '°u>e�t��* Marie C.Teu'eault,Notary Public 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER f CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of Sonoma On July 11, 2014 before me, K.Dixon Wright,Notary Public Date Here Insert Name and Title of the Officer ' personally appeared Stacy M. Clinton , Name(s)of Signer(s) who ;proved to me on the basis of s tisfactory evidence to be the person ) whose name( s/ e subscribed to the wit ii instr ment and ackno edged t me that / to y executed the same 'n is e the r authorized - 'I� ca t;i (i ), and that by er t ei signatures) on the instrument the person or e entity upon behalf of ., K. DIXON WRIGHT which the person(sf- cted, executed the instrument. Commission # 1958183 , Q °�-as+ Notary Public -California z Z D I certify under PENALTY OF PERJURY under the laws Z Marin County � h of tE' State of California that the foregoing My Comm.Expires Nov 21,2015 g g paragraph is true and correct. WITNESS rvy hand a)ld off' i I seal. Signature Place Notary Seal Above �/q ignature of Notary Public OPTIONVA L 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: _ Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Stacy M. Clinton Signer's Name: Individual Q Individual Corporate Officer—Title(s): []Corporate Officer—Title(s): Partner—❑ Limited ❑ General _ 7 Partner—❑ Limited ❑ General El Attorney in Fact •- []Attorney in Fact • Q:U19 Top of thumb here Trustee EjTrustee Top of thumb here Guardian or Conservator []Guardian or Conservator 1={ Other: []Other: Signer Is Representing: Signer Is Representing: ©2007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationalNotaryorg JItem#5907 Reorder:Call Toll-Free 1-800-876-6827 t CITY qF.. Project No.2014-01 C U P S RTC N 6 INSURANCE ALGREENWNT A. Contractor is aware of the provisions of �')ection 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or undertake self- insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance of the work of this Contract. B. Contractor and all subcontractors will carry worker's compensation insurance for the protection of its employees during the progress of the work. The insurer shall waive its rights of subrogation against the City, the .City's officers, agents and employees and shall issue an endorsement to the policy evidencing same. C. Contractor shall carry at all times, on all operations hereunder, commercial general liability insurance, automobile liability insurance and builder's all risk insurance. All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a certificate in a form prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations, sub-contract work, contractual obligations, product or completed operations, all owned vehicles and non-owned vehicles. Said insurance coverage obtained by the Contractor, excepting worker's compensation coverage, shall name the City, its engineer, and each of its directors, officers, agents and employees, as determined by the City, as additional insureds on said policies. Insurers must be licensed to do business i:n the State of California. The Insurers must also have an "A"policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating or that is otherwise acceptable to the City. D. Before Contractor performs any work at, or prepares or delivers materials to, the site of construction, Contractor shall furnish certificates of insurance evidencing the foregoing insurance coverages and such certificates shall provide the name and policy number of each carrier and policy and that the insurance is in force and will not be canceled or modified without thirty (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for carrying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing, Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and having a Best's Guide Rating of A, Class VII or better or that is otherwise acceptable to the City. City of Cupertino 2014 Pavement Maintenance Project Phase I Insurance Forms 00530-2 4 Project No.2014-01 LIMITS Worker's Compensation In accordance with the Worker's Compensation &Employers' Liability Act of the State of California—Worker's comp "statutory"per CA Law; Employers' Liability $1,000,000 per occurrence. General Liability- commercial general liability; Combined single limit of$2.0 million per including provisions for contractual liability, occurrence; $4.0 million in the aggregate personal injury, independent contractors and products—completed operations hazard. Automobile Liability- comprehensive covering Combined single limit of$1.0 million per owned, non-owned and hired automobiles. occurrence. Ta\.j Ion, Leic By:-- (Contrac is Name) U U Dated: U 20A City of Cupertino 2014 Pavement Maintenance Project Phase 1 Insurance Forms 00530-3 1 - A S OO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) AC CERTI 7/11/2014 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 Ipolicy(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 CONTACT Luiza Watkins NAME: ABD Insurance & Financial Services PHONE (650)488-8565 FAX (650)488-8566 A/C No): E-MAIL ADDRESS:luiza @theabdteam.com 3 Waters Park Dr. , Ste 100 INSURERS AFFORDING COVERAGE NAIC# San Mateo CA 94403 INSURER A:Liberty Mutual Fire Insurance 23035 INSURED INSURER B:Zurich American Insurance 16535 O'Grady Paving Inc. INSURERC:Starr Indemnity and Liability 38318 2513 Wyandotte Street INSURERD:Illinols Union Insurance 27960 INSURER E: Mountain View CA 94043 INSURER F: COVERAGES CERTIFICATE NUMBERNaster 20:14 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DY LTR /YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 r X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE X❑OCCUR X B2-Z91-459513-044 7/1/2014 /1/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY X PRO LOC _ $ AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED X AP 0173639-00 /1/2014 /1/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS Ix AUTOS Per accident Hired Auto Physical Dama e $ 1,000 C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED RETENTION$ X 1000020165 _ /1/2014 /1/2015 Products Completed Agg $ 10,000,000 B WORKERS COMPENSATION y X WC STATURY E AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 ❑ OFFICER/MEMBER EXCLUDED? C 0173640-00 /1/2014 /1/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEq$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Pollution Liability CPY G2454039A 004 /1/2014 /1/2015 Per Pollution Condition $1,000,000 Retention: $25,000 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job #14077, City of Cupertino 2014 Pavement Maintenance Project - Phase 1 Project No. 2014-01. The City of Cupertino, its engineer, and each of its directors, officers, agents and employees are named as additional insureds as respects Liability for all California operations performed by our insured at all locations under contract with certificate holder. For Waiver of Subrogation see attached WC040306 for WC. For Additional Insured see CA20480299 for Auto; LC04430512, CG20100413 & CG20370413 for GL. Primary Insurance is included. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Cupertino 10300 Torre Ave. Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE ' Rod Sockolov/JMB dd ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 tgnlnnril ni Thn Arr Pr)name anti Innn sire rnnicfnrnrl manta of Arr1Rr) CITY OF Project No.2014-01 • ' ADDITIONAL INSURED ENDORSEMENT and CUPERTINO ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION!ENDORSEMENT Project Title and Number: 2014 Pavement Maintenance Project - Phase 1; Project #2014-01 In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows: The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies from whom permits will tie obtained and their directors, officers, engineers,. agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additional insureds under the terms of this policy, but.only with respect to the operations of the Contractor at or upon any of the premises of the City in connection with the Contract with the City, or acts or omissions of the additional insureds in connection with, but limited to its general supervision or inspection of said operations. The insurance afforded by this policy is primary insurance, and no additional insurance held or owned by the designated additional insured(s) shall be called upon to cover a loss under said i additional policy. Cancellation Notice. The insurance afforded by this policy shall not be suspended,voided, canceled, reduced in coverage or in limits, or mal;erially altered, except after thirty(30) days' prior written notice by certified mail, return receipt requested, has been given to the City of Cupertino ("City"). Stich notice shall be addressed to the Cil:y as indicated below. POLICY INFORMATION General Liability - Liberty Mutual Fire Insurance Company Auto Liability - Zurich American Insurance Company 1. Insurance Company: General Liability Pol# TB2-Z91-459513-044 2. Insurance Policy Number: Auto Liability Pol# BAP017363900 3. Effective Date of this Endorsement: July 1 20 14 4. Insured: O'Grady Paving, Inc. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and these Endorsements, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95014. Luiza Watkins I, _ (print/type name) City of Cupertino 2014 Pavemeent Maintenance Project Phase 1 Insurance Forms 00530-6 Project ho.2014-01 warrant that I-have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: � (Original signature required on all Endors�ements fair fished o the District) Names of ABD Insurance & Financial Services, Inc. Agent/Agency: Title: SVP 3 Waters Park Drive, Bldg 3, Suite 100 Address: Telephone: 650-488-8565 San Mateo, CA 94403 650-488-8566 Facsimile: City of Cupertino 2014 Pavement Maintenance Project—Phase 1 Insurance Forms 00530-7 1 1 ,� CITY OF Project No.2014-01 COMPREHENSIVE C"ENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF A(3GREGATE LIMITS OF CUPERTINO INSURANCE:PER PROJECT Project Title and Number: 2014 Pavement Maintenance Project - Phase 1; Project #2014-01 In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance. The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as 2014 Pavement Maintenance Project - Phase 1; Project #2014-01 POLICY INFORMATION Liberty Mutual Fire Insurance Company 1. Insurance Company: 2. Insurance Policy Number: TB2-Z91-459513-044 3. Effective Date of this Endorsement: July 1 20 14 O'Grady Paving, Inc. 4. Insured: 5. Additional hisured: City of Cupertino, its directors,officers,agents and employees, All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino,California 95014. I Luiza Watkins (printltype name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: GJc" i (Original signature required on all Endorsements urnished to the District) Names of Agent/Agency: ABD Insurance & Financial Services, Inc. s" Title: Address: 3 Waters Park Drive, Bldg 3, Suite 100 Telephone: 650-488-8565 San Mateo, CA 94403 Facsimile: 65.0-488-8566 City of Cupertino 2014 Pavement Maintenance Project—Phase I Insurance Forms 00530-8 T - CITY OF Project No.2014-01 WAIVER OF SUBROGATION ENDORSEMENT CUPERTINO WORKER'S COMPENSATION INSURANCE Project Title and Number: 2014 Pavement Maintenance Project - Phase 1; Project #2014-01 In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other JP:ndorsement attached thereto, it is agreed as follows: It is agreed that with respect to such insurance as is afforded by the policy, the Insurance Company waives any right of subrogation against the City of Cupertino, and each of its directors, officers, agents, consultants and employees by reason of any payment made on account of injury, including death resulting therefrom, sustained by any employee of the insured, arising out of the performance of the above-referenced Contract. POLICY INFORMATION Zurich American Insurance Company 1. Insurance Company: 2. Insurance Policy Number: WC0173b4000 3. Effective Date of this Endorsement: July 1 _ 20 14 4. Insured: O'Grady Paving, Inc. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino,Califoniia 9501.4. I Luiza Watkins (print/type name) warrant that I have authority to bind the below listed Tnsuratice Company and by my signature Hereon do so bind this Company. Signature of Authorized Representative: Q (Original signature required on all Endorsements f rnished to the District) Names of All Insurance & Financial Services, Inc. Agent/Agency: SVP Title: 3 Waters Park Drive, Bldg 3, Suite 100 s Telephone: "0-488-8565 San Mateo, CA 94403 Facsimile: 650-488-8566 City of Cupertino 2014 Pavement Maintenance Project—Phase 1 Insurance Firms 00530-9 _ 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-$4) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 07/01/14 at 12:01 A.M. standard time,forms a part of (DATE) Policy No. WC 0.173640 Endorsement No. of the Zurich American Insurance Co. (NAME OF INSURANCE COMPANY) issued to O'Grady Paving, Inc. , Premium (if any)$ Authori ed Represen alive We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the,remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED,,.EXECUTED PRIOR TO THE.ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION WC 252(4-84) WC 04 03.06(Ed. -84) Page 1 of 1 r POLICY NUMBER: BAP 0173639 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED 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, i'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 Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 07/01/14 Named Insured: O'Grady Paving, Inc. X uthorized Representative) SCHEDULE Name of Person(s)or Organization(s): -Any person or organization to whom or which you are required to provide additional insured status or additional insured status on a primary,non-contributory basis,in a written contract or written agreement executed prior to loss,except where such contract or agreement is prohibited by law. (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" under the Who Is An Insured Provision contained in Section II of the Coverage Form. Copyright, Hawaii Insurance Bureau, Inc., 1999 Includes copyrighted material of the Insurance Services Office, Inc., with its permission CA 1028 (2-99) CA 20 48 02 99 Copyright, Insurance Servi(-es Office, Inc., 1999 Page 1 of 1 _ r , POLICY NUMBER: TB2-Z91-459513-044 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under thE! following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) _ Locations Of Covered Operations City of Cupertino, its engineer, and each of its Job#14077, City of Cupertino 2014 Pavement directors, officers, agents and employees are Maintenance Project- Phase 1 Project No. named as additional insureds as respects Liability 2014-01 for all California operations performed by our insured at all locations under contract with certificate holder. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © ISO Properl:ies, Inc., 2012 Page 1 of 2 ❑ C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©ISO Properties, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: TB2-Z91-459513-044 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FART PRODUCTS/COMPLETED OPERATIONS LIABILITI(COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of Cupertino, its engineer, and each of its Job#14077, City of Cupertino 2014 Pavement directors, officers, agents and employees are Maintenance Project- Phase 1 Project No. 2014-01 named as additional insureds as respects Liability for all California operations performed by our insured at all locations under contract with certificate holder. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured will with respect to liability for "bodily injury" or not be broader than that which you are required "property damage" caused, in whole or in part, by by the contract or agreement to provide for such "your work" at the location designated and additional insured. described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 37 04 13 ❑ 199201300030800135 !Policy No. : TB2-Z91-4595 THIS ENDORSEWNT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. CONVIEERCIAL GENERAL LIABILITY ENHANCEWENT FOR CONTRACTORS This endorsement modifies insurance provided under this following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Index of modified kerns* Rem 1. Reasonable Force Item 2. Non-Owned Watercraft Extension kern 3. Damage To Premises Rented To You-Expanded Coverage Rem 4. Bodily Injury To Co-Employees Rem 5. Health Care Professlonals As Insureds Item 6. Knowledge Of Occurrence Item 7. Notice Of Occurrence Kern S. Unintentional Errors And Omissions Kern 9. Bodily Injury Redefinition Rem 10. Supplementary Payments-=Increased Limits Item 11. Properly In Your Care,Custody Or Control Item 12. N bblle Equipment Redefinition Rem 13. Newly Formed Or Acqulmd 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 15. Blanket Additional Insured—Grantors Of Pcrmits Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement Item 17. Other Insurance Amendment item 18. Contractual Liability-Railroads Rem 1. Reasonable Force Exclusion a.of Section I-Coverage A-Bodily Injury And Property Damage Liabilfty is replaced by the following: a. Expected Or Intended lijury °bodily irgtmy° or "property damage" expected or I111ended 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 Liabilky is replaced by the following: (2) A watercraft you do not own that is: LC 04 43 05 12 0 2012 Liberty Mutual Insurance.All rights reserved. Page 1 of 9 Includes copyrighted material of Insurance Services Office.Inc..with fts permission. 1492 01300030900126 (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 1-Coverage A -Bodily Injury And Property Damage Liability is replaced by the following. Exclusions c.through n.do not apply to damage by fire,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 III-Limks Of Insurance, B. Paragraph C.of Section III—LimAs Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above. the Damage To Premises Rented To You Llmt is the most we will pay under Coverage A for damages because of"property 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 defrnkion of"insured contract°in Section 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 indemnifies 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 Liabilky is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to `property damage' (other than damage by fete, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage) to premises. including the contents of sucli premises, rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance appiie:;to Damage To Premises Rented To You as described in Section III—Limits of Insurance. Rem 4. Bodily Injury To Co-Employees A. Paragraph 2.of Section 11-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 limited liability company) or your managers (if you are a lkn'ked tiabilly company)) are insureds while in the course of their employment or whie performing duties related to the conduct of your business with respect to"bodily ir�ury': (1) To you; (2) To your partners or members (f you are a partnership or joint venture); LC 04 43 0512 0 2012 Liberty Mutual Insurance.All rights reserved_ Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc.,with Is permi!;slon. 199201300030800127 (3) To your members(if you area 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 byyou). Your semployees° (other than either your "executive offers" (if you are an organization other than a partnership,joint venture or limited liabilty company) or your managers (if you are a limited liaNky company)) or`volunteer workers' are insureds while in the course of their employment or while performing duties related to the conduct of your business for a Good Samaritan,Aet 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 liiablity company);or (4) To a cc°employees 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 acfivitiies sponsored by you). A Good Samardan 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 memployees" (including supervisory or management 'employees") or "volunteer workers"are insureds for the providing or failure to provide professional health care services. 13. The insurance provided by this Item 4. will not apply if the injured person's sole remedy for such injury is provided under a workem'compensation law or any similar law. C. Other insurance The insurance provided by this Rem 4. is excess over any other valid and collectible insurance available to the insured, whether primary,excess, contingent or on any other basis. Rem 5: Health Care Pr+afessionals As Insumds A. Paragraphs 2.a.(1)(a) and(d) of Section 11-Who Is An Insured 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 Famed Insured who is a°designated health care provider' Wthe"bodily injury" or°personal and advertising injury` occurs in the course and scope of the "designated health care prov'ider's' employment by the Named Insured. B. VVth respect to"employees" and 'volunteer workeri" providing professional heath care services,the following exclusions are added to Paragraph 2. Exclusions of Section I — Coverage A — Bodily injury And Property Damage Liablty 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 contract or agreement; (2) Liability arising out of the providing of professional heath care services in violation of law; (3) Liabik arising out of the providing of any professional health care services whsle 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®S 12 ®2012 Liberty Mutual Insurance.All rights reserved. Page 3 of 9 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 199301300030800128 (5) Punitive or exemplary damages,fines or penalties. C. The following defir ,n is added to Section V-Definitions: 'Designated health care provider means any 'employee` or 'volunteer worker"of the Named Insured whose duties include providing professional health care services. Including but not limited to doctors, nurses, emergency medical technicians or designated first aid personnel. D. Other Insurance The insurance provided by this gem 5.is excess over any other valid and collectible insurance available to the insured. whether primary, excess. contingent or on any pother 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 `employee' or other third Marty 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 ft!-Conditions, you refers to an 6executive officer" of the Named Insured or to the.`'employee" designated by the insured to give us notice. Rem 8. Unintentional Errors And Omissions Unintentional Wure of the Named Insured to disclose all h:nxards existing at the inception of this policy shall not be a basis for derdal 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-Definkions is replaced by the following: 'Bodily injure®means: a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any tune:and b. Mental anguisK shock or humiliaWn arising out of anjuvy as defined in Paragraph a. above. Mental anguish means any type of mental or emotional illness or distress. item 10. Supplementary Payments-Increased Limits Paragraphs '.b. and U. of Section I - Supplementary Payments - Coverages A And S. are replaced by the follovhg: b. Up to$3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us In the investigation or defense of the claim or`suit° including substantiated loss of earnings up to $500 a day because of time off from work. LC 04 43 05 12 0 2012 Liberty Mutual Insurance.All rights reserved. Page 4 of 9 Includes copyrighted material of Insurance Services Office, Inc.,with is permissiom 1992 0130003080012 9 Item 11_ Property In Your Care,Custody Or Control A. Paragraphs (3) and (4) of exclusion j. of Section I--Coverage A—Bodily Injury and Property Damage Liability ordy apply to: 1. "Property damageo 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 policy. C. Limits of Insurance Subject to Paragraphs 2.. 3., and 5. of Section Ill-® Limits Of Insurance, the most we will pay for insurance prodded by Paragraph A.,above is: $10.000 Each Occurrence Limit 5.0100 Aggregate Limit The Each Occurrence Umk for this coverage applies to all damages as a result of any one "occurrence regardless of the number of persons or organ'rzatiops who sustain damage because of that°occurrence% The Aggregate limit is the most we will pay for the :sum of all damages under this Item 11. Rem 12. Wblle Equipment Redefinition The definition of wMcbHe Equipment®in Section V--Definitions is amended to include self-propelled vehicles with permanently attached equipment less than 1000 pounds gross vehicle weight that are primarily designed for (1) Snow removal. (2) Road Mahtenance, but not construction or resurfacing:or (3) Street cleaning. Resit 13. Newly Formed Or Acquired Entities Paragraph 3.of Section n—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 MI 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 thi. organizations (2) Separate coverage is purchased for the organization, or (3) The end of the policy period. whichever is earlier. b. Coverage A does not apply to Bbodily irjury® or °property damage° that occurred before you acquired or formed the organizations and LC 04 43 05 12 0 2012 Liberty kkitual Insurance.All rights reserved. Page 5 of 9 Includes copyrighted material of Insurance Services Office, Inc.,with its permission 1992 0130003 090013 0 C. Coverage B does not apply to'personal and advefting injury`arising out of an offense committed before you acquired or formed the organization. Item 14. Blanket Additional Insured Where Required 18y Written Contract Paragraph 2. of Section 11-Me is An Insured is amended to add the following: e. Additional Insured by Written Contract or Written Agreement The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only with respect to liabRity 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) Nbriagers or Lessors of Premises:Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure adcftionial insured coverage. The coverage afforded to the additional Insured) Is limited to liablity 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 agennts or your subcontractors. There Is no coverage for the additional insured for i'sabilly arising out of the sole negligence of the additional insured or those acting on behalf of the additional 'assured, 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 of the addkional insured"s sole negligence. This insurance does not apply to: (a)Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land;or (b)Any premises for which coverage is excluded by endorsement. (3) l rtgagees, Assignees or Receivers: Any persons) or organization(s) with respect to their liabilky 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 organization(s) to whom you are obligated by a written agreement to procure additional Insured coverage, but only with respect to liablily for°bodily injury', `property damage' or `personal and advertising UVUFy• caused. in whole or in part, by your acts or omissions or the acts or omissions of your °employees°, your agents, or your subcontractors, in the performance of your ongoing operations. 'this insurance does not apply to 'bodily injury', "property damage'. or "personal and advertising irtjurym arising out of"'your work' included in the 'products-completed 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 liabirky caused. in whole or in part, by your acts or omissions or the acts or omissions of 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 addiional insured,except as provided below. LC 04 43 OS 12 0 2012 Liberty Mutual Insurance.All rights reserved. Page 6 of 9 Includes copyrighted material of Insurance Services Office.Inc.,with its permission. 199301300030800131 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 of the additional hsuredas sole negligence. This insurance does not apply to `bodiy injurf`, "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 failing to prepare or approve, maps, shop drawings, opinions, reports, surveys.field orders,change orders or drawings and specifications; or (b) Supervisory,inspection,architectural or engineering activities. (5) Architects, Engineers or Surveycrs: any architect, engineer, or surveyor engaged by you but only wbh 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 connection with your premises;or (b) In the performance of your ongoing operations. This insurance does not apply to 'bodly injure", "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 failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications; or (b) Supervisory. inspection.architectural or engineering activi'ti'es. (f) Any Person®r Organization Other Than a Joint Venture:Any person or organization (other than a joint venture of which you are a member) for whom you are obligated by a written agreement to procure addRional insured coverage, but only with respect to Iiabilky 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!hose acting on your behalf: (a) Its 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 covered in Paragraphs e.(1)through(5)above. The insurance afforded to any person or organization as an insured under this Paragraph 2.e.:. (1) Applies only to coverage and minimum limns of insurance required by the wren 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 0512 C 2012 Liberty Mutual Insurance.All rights reserved. Page 7 of 9 Includes,copyrighted material of Insurance Services Office. inc.,with Us permission. 199301300030500132 (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 advertising 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 written agreement;and (4) Applies only if the written agreement is in effect at the 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 15. Blanket Additional Insured—Grantors Of Perrn its Paragraph 2_ of Section 11-Who Is An Insured is amended to add the following: Any state. municipals or political subdivision with respect to any operations performed by you or on your behalf. or in connection wfth premises you own. rent or control and to which this insurance applies, for which the state, municipality or polifical subdivision has issued a permit However.thus insurance does not apply to: 1. "Bodily injury "property damage" or"personal and advertising injury" arising out of operations performed for the state,mum alky or polkical subdMsson; 2. Any "bodly injury" or "property damage` included wbiln the "products-completed operations hazardm. except when required by wrtien contract or agreement initiated prior to loss; or 3_ `Bodily ihjury"."property damage" or"personal and advertising Injury". unless negligently caused, in whole or in part.by you or those acting on your behalf. Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement The following is added to Paragraph 6. Transfer Of Rights Of Recovery Against Others To Us of Section IV Conditions: We waive any right of recovery because of payments we make under this policy for injury or damage arising out of your ongoing operations or"your works included in the "products-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 subsequentto the execution of the written contract or agreement. Item. 17. Other Insurance Amendment if you are obligated under a written agreement to provide IkMityy insurance on a primary, excess. contingent, or any other basis for any person or organization that qualifies as an additional insured on this policy.this policy will apply solely on the basis required by such wri ten agreement and Paragraph 4.Other Insurance of Section IV--Conditions will not apply. Where the applicable wrkten agreement elves 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 assurance is excess over any other insurance avagable to the additional insured for Mich i1 is also covered as an additional insured by attachment of an endorsement to another policy proving coverage for the same "occurrence".claim or`sun`. Item M ContractualL.lability—Railroads Paragraph 9. of Section V-Definitions is replaced by the following: 9. "insured Contract"means: LC 04 43 OS 12 0 2012 Liberty idlutual Insurance-All rights reserved. Page 8 of 9 Includes copyrighted material of Insurance Services Office, inc..with its permkcsion. 194201300030800133 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 contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality. except in connection wkh work for a municipalkyy; 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 Ifor 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 indemnifies an architect,engineer or surveyor for injury or damage 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 give them, if that is the primary cause of the injury or damage: or (2) tinder which the insured, if an architect, engineer or surveyor,assumes liability for an injury or damage arising out of the insureds rendering or failing to render professional services, including those listed in Paragraph(1) above and supervisory, inspecition,architectural or engineering activities. LC 04 433 QS 12 0 2012 Liberty Mutual Insurance.All rights reserved. Page g of g Includes copyrighted material of Insurance Services Office, Inc.,who its permission. Project No.2014-01 DOCUFMENT 00630 GUARANTY TO THE CITY OF CUPERTINO,a Municipal Corporation of the State of California("City"),for construction of 2014 PAVEMENT MAINTENANCE PROJECT—PHASE 1 CUPERTINO,CALIFORNIA The undersigned guarantees all construction performed on this Project and also guarantees all material and equipment incorporated therein. Contractor hereby grants to City for a period of one year; following the date of Final Acceptance, or such longer period specified in the Contract Documents, its unconditional warranty of the quality and adequacy of all of the Work including, without limitation, all labor, materials and equipment provided by Contractor and its Subcontractors of all tiers in connection with the Work. Neither final payment nor use or occupancy of the Work:performed by the Contractor shall constitute an acceptance of Work not done in accordance with this Guaranty or relieve Contractor of liability in respect to any express warranties or responsibilities for faulty materials or workmanship. Contractor shall.remedy any defects in the Work and pay for any damage resulting therefrom, which shall appear within one year, or longer if specified, from the date of Final Acceptance. If within one year after the date of Final Acceptance, or such longer period of time as may be prescribed by laws or regulations, or by the terms of Contract Documents, any Work is found to be defective, Contractor shall promptly, without cost to City and in accordance with City's writt(m instructions, correct such defective Work. Contractor shall remove any defective Work rejected by City and replace it with Work that is not defective, and satisfactorily correct or remove and replace any damage to other Work or the work of others resulting therefrom. If Contractor fails to promptly comply with the terms of such instructions,or in an emergency where delay would cause serious risk of loss or damage, City may have the defective Work corrected or the rejected Work removed and replaced. Contractor shall pay for all claims,costs, losses and damages caused by or resulting from such removal and replacement. Where Contractor fails to correct defective Work, or defects are discovered outside the correction period, City shall have all rights and remedies granted by law. Inspection of the Work shall not relieve Contractor of any of its obligations under the Contract Documents. Even though equipment,materials,or Work required to be provided under the Contract Documents have been inspected,accepted,and estimated for payment, Contractor shall, at its own expense, replace or repair any such equipment, material, or Work found to be defective or otherwise not to comply with the:requirements of the Contract Documents up to the end of the guaranty period. All abbreviations and definitions of terms used in this Agreement shall have the meanings set forth in the Contract Documents, including,without means of limitation, Section 00700(General Conditions). The foregoing Guaranty is in addition to any other warranties of Contractor contained in the Contract Documents, and not in lieu of, any and all other liability imposed on Contractor under the Contract Documents and at law with respect to Contractor's duties, obligations, and performance under the Contract Documents. In the event of any conflict or inconsistency between the terms of this Guaranty and any warranty or obligation of the Contractor under-the Contract Documents or at law, such inconsistency or conflict shall1 be resolved in favor of the higher level of obligation of the Contractor. Contractor's N e 251 � WtlQ S�-. Address Mown'-ain City/State/Zip Date END OF DOCUMENT City of Cupertino 00630- 1 Guaranty 2014 Pavement Maintenance Project—Phase 1 Form W'9 Request for Taxpayer Give Form to the (Rev.December Tre& I send to the Identification Number and Certification requester. not Department rreasury RS. Internal Revenue Sw" Name(as shown on your Income tax return) O'Grady Paving,Inc. C\i Business name/disregarded entity name,if different from above a, rn W rz Check appropriate box for federal tax classification: c m c ❑individua!/sole proprietor ❑✓ C Corporation ❑S Cor poratlon ❑ Partnership ❑Trust/estate 0 Limited liability company.Enter the tax classification C=C corporation,S=S corporation, El Exempt payee ❑ Y { po poration,P=parinetship)► o �- ------------------------------ c � IL ❑ Other(see instructions) Address(number,street,and apt.or suite no.) Requester's name and address(optional) CL 2513 Wyandotte Street City,state,and ZIP code 'Mountain View,CA 94043 List account number(s)here(optiona) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the nanie given on the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,safe proprietor,or disregarded entity,see the Part I Instructions on page 3.For other entities,It is your employer identification number(EIN).If you do not have a number,see How to get a TIM on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. M94 -- 1 1 4 1 9 1 3 6 1 9 2 Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a)I am exempt from bai.kup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement ORA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign S' Date! i General I ructlo S Note/it a r uester gives you a form other than Form W-9 to request your TIN,you must use the requester's form If it Is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must •An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage Interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation .An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident ;pecial alien),to provide your correct TIN to the person requesting it(the rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding 1.Certify that the TIN you are giving is correct(or you are waiting for a tax on any foreign partners'share of income from such business.Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, e 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a:U.S.person that is a 3.Claim exemption from backup withholding.if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.if applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.-10231X Form w-g(Rev.12-2011)