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03-063 De Anza Traffic Signal System - ATMSCONTRACT FOR PUBLIC WORKS This CONTRACT made on,-~l ,, -.-'{oqly"~,J by the CITY OF CUPERTINO, a municipal corporation of the State of California, hereinafter called CITY, and Republic Electric hereinafter called CONTRACTOR. IT IS HEREBY AGREED by CITY and CONTRACTOR as follows: 1. THE CONTRACT DOCUMENTS. The complete contract consists of the following contract documents: a. Notice to Contractors, Proposal, Time of Completion, Estimated Quantities, Noncollusion Affidavit, Bidder Qualification Form, Subcontractors Form and Signature Form. b. Standard Specifications, General Provisions and Special Provisions. c. Plans and Specifications d. Faithful Performance and Labor & Material Bonds Insurance Agreement, Certificate of Insurance, Endorsement of Primary Insurance, Additional Insured Endorsement, Endorsement of Aggregate Limits of Insurance per Project, Waiver of Subrogation Endorsement Worker's Compensation Insurance and Notice of Policy Cancellation Endorsement. f. This Contract for Public Works. All of the above documents are intended to cooperate so that any work called for in one and not mentioned in the other, or vice versa, is to be executed the same as if mentioned in all of said documents. The documents comprising the complete contract are sometimes hereinafter referred to as the Contract Documents. In case of conflict between the Plans and the Specifications on the one hand, and this Contract on the other, the Plans and Specifications shall prevail. 2. THE WORK. CONTRACTOR agrees to furnish all of the tools, equipment, apparatus, facilities, labor, transportation and materials necessary to perform and complete in a good and working order, the work of furnishing and installing detector loops, detector lead in cable, detector handholes, disconnecting existing detector loops, and furnishing detector sensor units, fiber optic data transceivers, fiber optic data receivers, and a fiber optic data receiver chassis as called for, and in the manner designated in, and in strict conformity with, the Plans and Specifications prepared by the Engineer and adopted by CITY, which Plans and Specifications are entitled, respectively, DeAnza Boulevard Adaptive Traffic Signal Control System, Project No. 420-9535, and which Plans and Specifications are identified by the signatures of the parties to this Contract. It is understood and agreed that said tools, equipment, apparatus, facilities, labor, transportation and materials shall be furnished, and that said work shall be performed and completed as required in said Plans and Specifications under the sole direction of CONTRACTOR, but subject to the inspection and approval of CITY, or its representative. CITY hereby designates as its representative for the purpose of this Contract the City Engineer, Ralph A. Qualls, Jr. 3. CONTRACT PRICE. CITY agrees to pay, and CONTRACTOR agrees to accept, in full payment for the work above agreed to be done, the sum of $176,550 (one hundred seventy-six thousand five hundred fifty dollars) subject to additions and/or deductions as provided in the Contract Documents, per Exhibit A attached hereto. 4. DISPUTES PERTAINING TO PAYMENT FOR WORK. Should any dispute arise respecting the tree value of the work done, or any work omitted, or any extra work which CONTRACTOR may be required to do, or respecting the size of any payment to CONTRACTOR during the performance of this Contract, said dispute shall be determined either by reference to the Unit Prices bid, if applicable, or in accordance with agreement of prices, if applicable, or in accordance with the agreement of the parties, or in accordance with Section 6, paragraph "f" of the General Provisions. 5. PERMITS, COMPLIANCE WITH LAW. CONTRACTOR shall obtain and bear all expense for all necessary permits, licenses and easements for the construction of the project, give all necessary notices, pay all fees required by law, and comply with the laws, ordinances and regulations relating to the work and to the preservation of the public health and safety. 6. INSPECTION BY THE CITY. CONTRACTOR shall at all times maintain proper facilities and provide safe access for inspection by CITY to all parts of the work, and to the shops wherein the work is in preparation. Where the Specifications require work to be specially tested or approved, it shall not be tested or covered up without timely notice to CITY of its readiness for inspection and without the approval thereof or consent thereto by CITY. Should any such work be covered up without such notice, approval, or consent, it must, if required by CITY, be uncovered for examination at CONTRACTOR'S expense. 7. EXTRA OR ADDITIONAL WORK A_ND CHANGES. Should CITY at any time during the progress of the work require any alterations, deviations, additions or omissions from the Plans and Specifications or the Contract Documents, CITY shall have the right to do so, and the same shall in no way affect or make void the Contract, but the cost or value thereof will be added to, or deducted from, the amount of the Contract price, as the case may be, by a fair and reasonable valuation, which shall be determined either by reference to the Unit Prices bid, if applicable, the Standard Specifications, or in accordance with the agreement of the parties. No extra work shall be performed or change be made except by a written order from CITY, duly authorized by resolution of the City Council, and by all agencies whose approval is required by law, stating that the extra work or change is authorized, and no claim for an addition to the Contract sum shall be valid unless so ordered. 8. CHANGES TO MEET ENVIRONMENTAL REQUIREMENTS. CITY shall have the right to make changes in this Contract during the course of construction to bring the completed improvements into compliance with environmental requirements or standards established by State and Federal statutes and regulations after the Contract has been awarded or entered into. CONTRACTOR shall be paid for such changes either by reference to the Unit Prices bid, if applicable, or in accordance with the agreement of the parties. 9. TERMINATION, AMENDMENT OR MODIFICATION. This Contract may be terminated, amended or modified, with the mutual consent of the parties. The compensation payable, if any, for such termination, amendment or modification, shall be determined either by reference to the Unit Price bid, if applicable, the Standard Specifications, or in accordance with the agreement of the parties. 10. TIME FOR COMPLETION. All work under this Contract shall be completed in accordance with the Time for Completion section in the Proposal and the Specifications of this project. If CONTRACTOR shall be delayed in the work by the acts or neglect of CITY, or its employees, or those under it by contract or otherwise, or by changes ordered in the work, or by strikes, lockouts by others, fire, unusual delay in transportation, unavoidable casualties or any causes beyond CONTRACTOR'S control, or by delay authorized by CITY, or by any cause which CITY shall determine justifies the delay, then the time of completion shall be extended accordingly. This paragraph does not exclude the recovery of damages for delay by either party under other provisions in the Contract Documents. 11. INSPECTION AND TESTING OF MATERIALS. CONTRACTOR shall notify CITY a sufficient time in advance of the manufacture, production or testing of materials to be supplied under this Contract, in order that CITY may arrange for mill, factory or laboratory inspection and testing of same. 12. TERMINATION FOR BREACH OR INSOLVENCY. If CONTRACTOR should be adjudged a bankrupt, or should make a general assignment for the benefit of creditors, or if a receiver should be appointed on account of insolvency, or if CONTRACTOR or any subcontractor should violate any of the provisions of the Contract, CITY may serve written notice upon CONTRACTOR and CONTRACTOR'S surety of its intention to terminate the Contract. Such notice shall contain the reasons for CITY'S intention to terminate the Contract, and unless within ten (10) days after serving of such notice, such violation shall cease and satisfactory arrangements for corrections thereof be made, the Contract shall, upon the expiration of said ten (10) days, cease and terminate. In the event of any such termination, CITY shall immediately serve notice thereof upon CONTRACTOR'S surety and CONTRACTOR, and the surety shall have the right to take over and perform the Contract; provided, however, that, if the surety within fifteen (15) days after the serving upon it of notice of termination does not give CITY written notice of its intention to take over and perform the Contract, or does not commence performance thereof within thirty (30) days from the date of the serving of such notice, CITY may take over the work and prosecute the same to completion by contract, or by any other method it may deem advisable, for the account and at the expense of CONTRACTOR, and CONTRACTOR AND CONTRACTOR'S surety shall be liable to CITY for any excess cost occasioned by CITY thereby, and in such event CITY may, without liability for so doing, take possession of, and utilize in completing the work, such materials, appliances, plant and other property belonging to CONTRACTOR as may be on the site of the work and necessary therefor. 13. THE CITY'S RIGHT TO WITHHOLD CERTAIN AMOUNTS AND MAKE APPLICATION THEREOF. In addition to amounts which CITY may retain under other provisions of the Specifications until final completion and acceptance of all work covered by the Contract, CITY may withhold from payment to CONTRACTOR such an amount or amounts as in its judgment may be necessary to pay just claims against CONTRACTOR or subcontractors for labor and services rendered and materials furnished in and about the work. City may apply such withheld amount or amounts to the payment of such claims in its discretion. In doing so, CITY shall be deemed the agent of CONTRACTOR, and any payment so made by CITY shall be considered as a payment made under the Contract by CITY to CONTRACTOR, and CITY shall not be liable to CONTRACTOR for any payment made in good faith. Such payment may be made without prior judicial determination of the claim or claims. With respect to any retention of payment by CITY to ensure performance of the Contract, CONTRACTOR will be entitled to substitute securities as provided in Section 4590 of the California Government Code as more fully described in CITY'S Notice to Contractors. 14. NOTICE AND SERVICE THEREOF. Any notice from one party to the other under this Contract shall be in writing, and shall be dated and signed either by the party giving such notice, or by a duly authorized representative of such party. Any such notice shall not be effective for any purpose whatsoever unless served in the following manner: (a) if the notice is given to CITY, either by personal delivery thereof to the Engineer of CITY, or by depositing same in the United States mails, enclosed in a sealed envelope, addressed to CITY OF CUPERTINO; 10300 TORRE AVENUE; CUPERTINO, CA 95014; postage prepaid and certified; (b) if the notice is given to CONTRACTOR, either by personal delivery thereof to CONTRACTOR, or to CONTRACTOR'S duly authorized representative at the site of the project, or by depositing same in the United States mails enclosed in a sealed envelope, addressed to, Republic Electric, 7120 Redwood Boulevard, Novato, CA 94945-4114 postage prepaid and certified; and (c) if notice is given to CONTRACTOR'S surety or any other person, either by personal delivery thereof to CONTRACTOR'S surety or other person, or by depositing same in the United States mails, enclosed in a sealed envelope, addressed to CONTRACTOR'S surety or person, as the case may be, at the address of CONTRACTOR'S surety or the address of the person last communicated by such person to the party giving the notice, postage prepaid and certified. 15. ASSIGNMENT OF CONTRACT. Neither the Contract, nor any part thereof, nor moneys due or to become due thereunder, shall be assigned by CONTRACTOR without the prior written approval of CITY. 16. COMPLIANCE WITH SPECIFICATIONS OF MATERIALS. Whenever in the Specifications, any material or process is indicated or specified by patent or proprietary name, or by name of manufacturer, such Specifications must be met by CONTRACTOR, unless CITY agrees in writing to some other material, process or article offered by CONTRACTOR which is equal in all respects to the one specified. It shall be CONTRACTOR'S responsibility to prove equality of any such material, process or article offered as a substitution to the one(s) specified. 17. WORKER'S COMPENSATION INSURANCE AND EMPLOYER'S LIABILITY INSURANCE. CONTRACTOR shall take out and maintain during the life of this Contract Worker's Compensation Insurance and Employer's Liability Insurance for all of CONTRACTOR'S employees employed at the site of the project. In case any work is sublet, CONTRACTOR shall require any and all subcontractors similarly to provide Worker's Compensation and Employer's Liability Insurance for all of the latter's employees unless such employees are covered by the protection afforded to the CONTRACTOR. In signing this Contract CONTRACTOR makes the following certification, required by Section 1861 of the Labor Code: "I am aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for worker's compensation or to tmdertake self insurance in accordance with the provisions of the Labor Code, and I will comply with such provisions before commencing the performance of the work of this Contract." 18. ACCIDENT PREVENTION. Precaution shall be exercised at all times for the protection of persons (including employees) and property. The safety provisions of applicable laws, building codes and construction codes shall be observed. Machinery, equipment and other hazards shall be guarded or eliminated in accordance with the safety provisions of the Construction and Safety Orders issued by the Industrial Accident Commission of the State of California. 19. CONTRACTOR'S RESPONSIBILITY FOR THE WORK. CONTRACTOR shall not be responsible for the cost of repairing or restoring damage to the work caused by Acts of God. NEVERTHELESS, CONTRACTOR shall, if the insurance premium is a separate bid item, obtain the insurance to indemnify CITY for any damage to the work caused by Acts of God. "Acts of God" shall include only the following occurrences or conditions and effects: earthquakes and tidal waves, when such occurrences or conditions and effects have been proclaimed a disaster or state of emergency by the President of the United States or by the Govemor of the State of California, or were of a magnitude at the site of the work sufficient to have caused a proclamation of disaster or state of emergency having occurred in a populated area. Subject to the foregoing, CITY shall not, in any way or manner, be answerable or suffer loss, damage, expense or liability for any loss or damage that may happen to said building, work, or equipment or any part thereof, or in, on, or about the same during its construction and before acceptance. 20. CONTRACTOR'S GUARANTEE. CONTRACTOR unqualifiedly guarantees the first-class quality of all work and of all materials, apparatus and equipment used or installed by CONTRACTOR or by any subcontractor or supplier in the project which is the subject of this Contract, unless a lesser quality is expressly authorized in the Plans and Specifications, in which event CONTRACTOR unqualifiedly guarantees such lesser quality; and that the work as performed by CONTRACTOR will conform with the Plans and Specifications or any written authorized deviations therefrom. In case of any defect in the work, materials, apparatus or equipment, whether latent or patent, revealed to CITY within one (1) year of the date of acceptance of completion of this Contract by CITY, CONTRACTOR will forthwith remedy such defects without cost to CITY. P.O. No. 21. DEFERRED ALTERNATE SELECTION. The City reserves the right for the term of the Contract, the deferred selection of none, any or all alternate bid items at the bid price. The alternates chosen would be For any sites currently under construction or to be constructed in the future. IN WITNESS WHEREOF, the parties have executed this Contract, in duplicate, the day and year first hereinabove written. CITY~ CUPERTINO~/~ Attest: ~d~d~4 ~ City Clel~ ' Date: ,~_~,t~7~ 2g .2003 APPROVED AS TO FORM' City Atto~'r~e~ CONTRACTOR: Notary ac~ledgment is re, hired. Ifa*' corporation, corporate seal and corporate notary acknowledgment and Federal Tax I.D. are required, lfnot a corporation, a Social Security No. is required. Social Security # Federal Tax I.D. # Contractor's LicenseNo. ~ PROJECT NAME & NUMBER: DeAnza Boulevard Adaptive Traffic Signal Control System, Project No. 420-9535 CONTRACTOR'S NAME & ADDRESS: Republic Electric, 7120 Redwood Boulevard, Novato, CA 94945-4114 CONTRACT AMOUNT: $1 76,550 ACCOUNT NUMBER: 420-9535 FILE NO: 74,001.29 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California coun, of On personally appeared r[~l~ll~ known to me [] proved to me on the basis of satisfacto,7 evidence Commission # 1331537 z Notary Public - Cali[ornia Marin Count~ to be the person j)0 whose nameO[O is/~J~'e subscribed to the within instrument ~nd acknowledged to me that he/s~/t~y executed the same in his/i~e'r/t h.,~l r authorized capacity(i~), and that by his/~l~r/tl~ir signature(.1K) on the instrument the pers~h~', or the entity upon behalf of which the person,~0 acted, executed the instrument. ~.IT~ (,~SS my hand and~official seal..--. OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer Signer's Name: [] Individual [] Corporate Officer--Title(s): F~ Partner-- [] Limited [] General [] Attorney-in-Fact [] Trustee ~ Guardian or Conservator [] Other: Signer Is Representing: Top of thumb here © 1999 National Notary Association · 9350 De Soto Ave P O Box 2402 · Chatsworth. CA 91313 2402 · w'*w natio nalnot ar7 or g prod NO 5907 Reolder: Call Tolt Free 1 800 876 6827 INSURANCE FORMS INSTRUCTIONS FOR ITEMS 3, 4 AND 5, THE FORMS PROVIDED BY THE CITY OF CUPERTINO MUST BE USED. FORMS OTHER THAN THESE WILL NOT BE ACCEPTED. ALL DOCUMENTS MUST BE ORIGINALS - SUBMIT IN TRIPLICATE 1. Insurance Agreement - Must be signed by Contractor. 2. Certificate of Insurance to the City of Cupertino - must be completed by the insurance agent or must provide a certificate on the company's form. They must contain the same information. 3. Endorsement of Additional Insured and Primary Insurance and Notice of Cancellation - must be signed by the insurance agent for general liability and automobile liability only. 4. Comprehensive general liability/commercial general liability endorsement of aggregate limits of insurance per project - must be signed by the insurance agent for general liability only. 5. Waiver of subrogation endorsement worker's compensation insurance - must be signed by the insurance agent for worker's compensation only. CUPERTINO INSURANCE AGREEMENT A. Contractor is aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or undertake self-insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance 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 in the State of California. The Insurers must also have an "A" policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating. 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 issued by a company admitted in California and having a Best's Guide Rating of A, Class VII or better. Worker's Compensation & Employers' Liability LIMITS In accordance with the Worker's Compensation Act of the State of Califomia- Worker's comp - "statutory" per CA Law; Employers' Liability - $1,000,000 per occurrence. Insurance Agreement Page 1 of 2 General Liability - commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products - completed operations hazard. Automobile Liability - comprehensive covering owned, non-owned and hired automobiles. Combined single limit of $1.0 million per occurrence; $2.0 million in the aggregate. Combined single limit of $1.0 million per occurrence. Consultants only: Errors and Omissions liability. $1.0 million per occurrence. x (C~ntractor's Name) 20 ~ Insurance Agreement Page 2 of 2 CUPEP~TINO CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO This certifies to the City of Cupertino that the following described policies have been issued to the insured named below and are in force at this time. Insured: Address: Description of operations/locations/products insured (show contract name and/or number, if any): WORKER'S COMPENSATION (name of insurer) * Statutory Min. * Employer's Liability $ Insurance Company's State License No. $ $ Check Policy Type: COMPREHENSIVE GENERAL LIABILITY ] Premises/Operations Owners & Contractors Protective Contractual for Specific Contract $ Products Liability XCU Hazards Broad Form P.D. Severability of Interest Clause Personal Injury with Employee Exclusion Removed or 2OMMERCIAL GENERAL LIABILITY Each Occurrence General Aggregate (if applicable) Aggregate Personal Injury Fire Damage (any one fire) Medical Expense (any one person) Self-Insured Retention $ $ $ Policy No. (name of insurer) Expiration Date Certificate of Insurance Agreement Page 1 of 2 AUTOMOTIVE/VEHICLE LIABILITY Commercial Form Liability Coverage BODILY INJURY Each Person PROPERTY DAMAGE Each Accident $ $ (name of insurer) Each Accident Policy No. Combined Single Limit Expiration Date or A copy of all Endorsements to the policy(ies) which in any way (agent's initial) limit the above-listed types of coverage are attached to this Certificate of Insurance. This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or any other document with respect to which this Certificate of Insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. IT IS HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by the Agreement between the City and the insured. By:. Dated: 20 Attach Certificate of Insurance and Additional Insured Endorsement on company forms. Certificate of Insurance Agreement Page 2 of 2 CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project Title and Number: In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows: The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies from whom permits will be obtained and their directors, officers, engineers, 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 additional policy. Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided, canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City of Cupertino ("City"). Such notice shall be addressed to the City as indicated below. POLICY INFORMATION l. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 2O 4. Insured: Additional Insured and Primary Insurance and Notice of Cancellation Endorsement Page 1 of 2 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. I, _(prim/type 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: (Original signature required on all Endorsements fumished to the District) Names of Agent/Agency: Title: Address: Telephone: __ Facsimile: Additional Insured and Primary Insurance and Notice of Cancellation Endorsement Page 2 of 2 CUPEILTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT Project Title and Number: 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 POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 4. Insured: 20 5. Additional Insured: City of Cupertino, its directors, officers, agents and employees. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Tone Avenue; Cupertino, California 95014. I, (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of Agent/Agency: Address: Title: Telephone: __ Facsimile: Aggregate Limits Endorsement Page 1 of 1 CUPI:~INO WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: 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: 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 1. Insurance Company: 2. Insurance Policy Number: 3. Effective Date of this Endorsement: 20 4. Insured: 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, (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the District) Names of Agent/Agency: Address: Title: Telephone: __ Facsimile: Subrogation Endorsement Page 1 of 1 FAITHFUL PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENT: THAT WE, Principal, (contractor's name) and as , as Surety, (bonding company's name) are held and firmly bound unto the City of Cupertino, State of California, in the sum of lawful money of the United States, for the payment of which will and truly to be made, we bind ourselves, our heirs, executors, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION of the foregoing obligation is such that, WHEREAS, the Principal has entered into a contract with the City 20 dated __ with the obligee to do and perform the following work to-wit: NOW, THEREFORE, if the said principal shall well and truly perform the work contracted to be performed under said contract, then this obligation shall be void; otherwise to remain in full force and effect. this IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety day of ,20 (To be signed by Principal and Surety, Notary acknowledgment required) CONTRACTOR Principal Surety Street Address: City, State, Zip. By:_ Attorney-In-Fact The above bond is accepted and approved this day of _, 20 Faithful Performance Bond Page 1 of 1 PAYMENT BOND KNOW ALL MEN BY THESE PRESENT: WHEREAS, the City o£ Cupertino, State of California, and hereinafter designated as "Principal" have entered into or are about to enter into a contract providing for the installation, construction, and erection by Principal of more pa~'lcularly described in said contract; and incorporated herein by reference. WHEREAS, said principal is required to furnish a bond in connection with said contract, providing that if said Principal, or any of his or its subcontractors, shall fail to pay for materials, provisions, provender or other supplies or teams used in, upon, for or about the performance of work contracted to be done, or for any work or labor done thereon of any kind, the Surety on said bond shall pay the same to the extent hereinafter set forth; NOW, THEREFORE, WE, (contractor's name) as Principal, as Surety, and (bonding company's name) firmly bind ourselves, our executors, administrators, successors and assigns, jointly and severally, unto the City of Cupertino, and any and all materialmen, persons, companies, or corporations fumishing materials, provisions, provender or other supplies used in, upon, for or about the performance of the aforesaid work contracted to be executed or performed under the contract hereinabove mentioned, and incorporated herein by reference, and all persons, companies or corporations lending or hiring teams, implements or machinery, for or contributing to said work to be done, and all persons who perform work or labor upon the same, and all persons who supply both work and materials, whose claim has not been paid by Principal or by any other person, in the just and full sum of THE CONDITION OF THIS OBLIGATION IS SUCH THAT if said principal, his or its subcontractors, heirs, executors, administrators, successors or assigns, shall fail to pay for any materials, provisions, provender or other supplies or teams used in, upon, for or about the performance of the work contracted to be done, or for any work or labor thereon of any kind, or for amounts due under the Unemployment Insurance Act with respect to such work or labor, or any and all damages arising under the original contract, then said Surety will pay the same and also will pay in case suit is brought upon this bond, such reasonable attorney's fee as shall be fixed by the court. This bond shall insure to the benefit of any and all persons, companies, and corporations entitled to file claims under Section 1184.1 of the Code of Civil Procedure, so as to give a right of action to them or their assigns in any suit brought upon this bond. Subrogation Endorsement Page 1 of 1 And the said Surety, for value received, hereby stipulates, and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall in any wise affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications. IN WITNESS WHEREOF, this instrument has been duly executed by Principal and Surety this day of ., 20 (To be signed by Principal and Surety. Notary acknowledgments required.) CONTRACTOR Principal Surety Street Address: City, State, Zip_ By: Attorney-In-Fact The above bond is accepted and approved this __ .day of ,20 Subrogation Endorsement Page 2 of I