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15-155 Hart Flooring Co. Inc., refinishing of the wood floors at Sports CenterAGREEMENT BETWEEN THE CITY OF CUPERTINO AND HART FLOORING CO. INC. FOR THE REFINISHING OF RAQUETTBALL FLOORS AT SPORT CENTER THIS AGREEMENT, for reference dated August 25TH. 2015, is by and between CITY OF CUPERTINO, a municipal corporation (hereinafter referred to as "City"), and "Hart Flooring Co. Inc.", a California corporation whose address is 60 I Virginia Ave, Campbell CA. 95008 hereinafter called the Contractor, and is made with reference to the following: RECITALS: A. City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the Constitution and the statutes of the State of California and the Cupertino Municipal Code. B. City and Contractor desire to enter into an agreement for Refinishing of Racquetball Courts at Sport Center, in accordance with the proposal dated March 23rd 2015 NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM: The Contractor shall begin wo1:k within thirty (30) calendar days after -receiving notice from the Facilities Supervisor to commence the work, and shall diligently prosecute the work to completion before the expiration of thirty (30) consecutive working days from the date of receipt of notice to begin work. 2. SERVICES TO BE PERFORMED: Contractor agrees, at its own cost and expense, to furnish all labor, tools, equipment, materials, except as otherwise specified, and to do all work strictly in accordance with the proposal dated March 23rd 2015 hereby referred to and expressly made a part hereof with the same force and effect as if the same were fully incorporated herein. 3. COMPENSATION TO CONTRACTOR: Contractor shall be compensated for services perfonned pursuant to this Agreement in the amount and manner set forth in Contractor's proposal, which is attached hereto as exhibit "A" and incorporated herein by this reference. Payment will be made in the same manner that claims of a like character are paid by the City, with checks drawn on the treasury of the City, to be taken from the general fund. 1 4. TIME IS OF THE ESSENCE: Contractor and City agree that time is of the essence regarding the perfonnance of this Agreement 5. STANDARD OF CARE: Contractor agrees to perfonn all services hereunder in a maimer commensurate with the prevailing standards of like professionals in the San Francisco Bay Area and agrees that all services shall be perfo1med by qualified and experienced personnel who are not employed by the City nor have any contractual relationship with City. 6. INDEPENDENT PARTIES: City and Contractor intend that the relationship between them created by this Agreement is that of employer-independent contractor. The mam1er and means of conducting the work are under the control of Contractor, except to the extent they are limited by statute, rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor1s services. None of the benefits provided by City to its employees, including but not limited to unemployment insurance, workers' compensation plans, vacation and sick leave are available from City to Contractor, its employees or agents. Deductions shall not be made for any state or federal taxes, FICA payments, PERS payments, or other purposes no1111ally associated with an employer-employee relationship from any fees due Contractor. Payments of the above items, if required, are the responsibility of Contractor. 7. IMMIGRATION REFORM AND CONTROL ACT (IRCA): Contractor assumes any and all responsibility for verifying the identity and employment authorization of all of its employees perfonning work hereunder, pursuant to all applicable IRCA or other federal, or state rules and r~gulations. Contractor shall indemnify and hold City harmless from and against any loss, damage, liability, costs or expenses arising from any noncompliance of this provision by Contractor. 8. NON~DISCRIMINATION: Consistent with City's policy that harassment and discrimination are unacceptable employer/employee conduct, Contractor agrees that harassment or discrimination directed toward a job applicant, a City employee, or a citizen by Contractor or Contractor's employee on the basis of race, religious creed, color, national origin, ancestry, handicap, disability, marital status, pregnancy, sex, age, or sexual orientation will not be tolerated. Contractor agrees that any and all violations of this provision shall constitute a material breach of this Agreement 9. HOLD HARMLESS: Contractor shall, to the fullest extent allowed by law, indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers against any and all liability, claims, stop notices, actions, causes of action or demands whatsoever from and against any of them, including any injury to or death of any person or damage 2 to property or other liability of any nature, arising out of, pertaining to, or related to the performance of this Agreement by Contractor or Contractor's employees, officers, officials, agents or independent contractors. Contractor shall not be obligated under this Agreement to indemnify City to the extent that the damage is caused by the sole negligence or willful misconduct of City, its agents or employees. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all other costs and fees of litigation. Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in these sections from each and every subcontractor or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this a&,1feement. If Contractor fails to obtain such indemnity obligations from others as required here, Contractor agrees to be fully responsible according to the terms of this section. 10. INSURANCE: On or before the commencement of the terms of this Agreement, Contractor shall furnish City with certificates showing the type, amount, class of operations covered, effective dates and dates of expiration of insurance coverage in compliance with paragraphs 1 OA, B, C and D. Such certificates, which do not limit Contractor's indemnification, shall also contain substantially the following statement: "Should any of the above insurance covered by this certificate be canceled or coverage reduced before the expiration date thereof, the insurer affording coverage shall provide thirty (30) days' advance written notice to the City of Cupertino by certified mail, "Attention: City Manager." It is agreed that Contractor shall maintain in force at all times during the performance of this Agreement all appropriate coverage of insurance required by this Agreement with an insurance company that is acceptable to City and licensed to do insurance business in the State of California. Endorsements naming the City as additional insured shall be submitted with the insurance ce1tificates. A. COVERAGE: Contractor shall maintain the following insurance coverage: (1) Workers' Compensation: Statutory coverage as required by the State of California. (2) Liability: Commercial general liability coverage in the following minimum limits: Bodily Injury: $1,000,000 each occun-ence $2,000,000 aggregate -all other Property Damage: $500,000 each occun-ence $1,000,000 aggregate If submitted, combined single limit policy with aggregate limits in the amounts of $2,000,000 will be considered equivalent to the required 3 minimum limits shown above. (3) Automotive: Comprehensive automobile liability coverage in the following minimum limits: Bodily injury: $500,000 each occurrence Property Damage: $500,000 each occurrence or Combined Single Limit: $1,000,000 each occurrence B. SUBROGATION WAIVER: Contractor agrees that in the event of loss due to any of the perils for which it has agreed to provide comprehensive general and automotive liability insurance, Contractor shall look solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer providing comprehensive general and automotive liability insurance to either Contractor or City with respect to the services of Contractor herein, a waiver of any right to subrogation which any such insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. C. FAILURE TO SECURE: If Contractor at any time during the term hereof should fail to secure or maintain the foregoing insurance, City shall be permitted to obtain such insurance in the Contractor's name or as an agent of the Contractor and shall be compensated by the Contractor for the costs of the insm·ance premiums at the maximum rate pennitted by law and computed from the date written notice is received that the premiums have not been paid. D. ADDITIONAL INSURED: City, its City Council, boards and commissions, officers, employees, and volunteers shall be named as an additional insured under all insurance coverages, except worker' s compensation insurance. The 11aming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy. E. SUFFICIENCY OF INSURANCE: The insurance limits required by City are not represented as being sufficient to protect Contractor. Contractor is advised to consult Contractor's insurance broker to determine adequate coverage for Contractor. 11. BONDS: Contractor is not required to provide bonds. 12. PROHIBITION AGAINST TRANSFERS: Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so without said consent shall be null and void, and any assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such 4 attempted assignment, hypothecation or transfer. However, claims for money by Contractor from City under this Agreement may be assigned to a bank, trnst company or other financial institution without prior written consent. Written notice of such assignment shall be promptly furnished to City by Contractor. The sale, assigrnnent, transfer or other disposition of any of the issued and outstanding capital stock of Contractor, or of the interest of any general partner or joint venturer or syndicate member or cotenant, if Contractor is a partnership or joint venture or syndicate or cotenancy, which shall result in changing the control of Contractor, shall be constrned as an assignment of this Agreement. Control means fifty percent (50%) or more of the voting power of the corporation. 13. SUBCONTRACTOR APPROVAL: Unless prior written consent from City is obtained, only those people and subcontractors whose names are listed in Contractor's bid shall be used in the performance of this Agreement. Requests for additional subcontracting shall be submitted in writing, describing the scope of work to be subcontracted and the name of the proposed subcontractor. Such request shall set forth the total price or hourly rates used in preparing estimated costs for the subcontractor's services. Approval of the subcontractor may, at the option of City, be issued in the form of a Work Order. In the event that Contractor employs subcontractors, such subcontractors shall be required to furnish proof of workers' compensation insurance and shall also be required to carry general and automobile liability insurance in reasonable confonnity to the insurance carried by Contractor. In addition, any work or services subcontracted hereunder shall be subject to each provision of this Agreement. 14. PERMITS AND LICENSES: Contractor, at its sole expense, shall obtain and maintain during the term of this Agreement, all appropriate permits, certificates and licenses, including a City Business License, that may be required in connection with the performance of services hereunder. 15. REPORTS: Each and every report, draft, work product, map, record and other document reproduced, prepared or caused to be prepared by Contractor pursuant to or in connection with this Agreement shall be the exclusive property of City. Consultant may retain a copy of any report furnished to the City pursuant to this Agreement. No report, infonnation nor other data given to or prepared or assembled by Contractor pursuant to this Agreement shall be made available to any individual or organization by Contractor without prior approval by City. Contractor shall, at such time and in such form as City may require, furnish reports concerning the status of services required under this Agreement. 16. RECORDS: 5 Contractor shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such infonnation required by City that relate to the performance of services under this Agreement. Contractor shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Contractor shall provide free access to such books and records to the representatives of City or its designees at all proper times, and gives City the right to examine and audit same, and to make transcripts there from as necessary, and to allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be kept separate from other documents and records and shall be maintained for a period of three (3) years after receipt of final payment. rf supplemental examination or audit of the records is necessary due to concerns raised by City's preliminary examination or audit of records, and the City's supplemental examination or audit of the records discloses a failure to adhere to appropriate intemal financial controls, or other breach of contract or failure to act in good faith, then Contractor shall reimburse City for all reasonable costs and expenses associated with the supplemental examination or audit. 17. NOTICES: All notices, demands, requests or approvals to be given under this Agreement shall be given in writing and conclusively shall be deemed served when delivered personally or on the second business day after the deposit thereof in the United States Mail, postage prepaid, registered or certified, addressed as hereinafter provided. All notices, demands, requests, or approvals from Contractor to City shall be addressed to City at: City of Cupertino 10555 Mary A venue Cupertino CA 95014 Attention: Chris Orr All notices, demands; requests, or approvals from City to Contractor shall be addressed to Contractor at: Hart Flooring Co. Inc. 601 Virginia Ave Campbell, CA. 95008 Attention: Kevin Hart 18. URBAN RUNOFF MANAGEMENT: The Contractor shall avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, contractor shall use as little as necessary. Contractor shall take all steps necessary to keep wash water out of the streets, gutters and st011n drains. The Contractor shall develop and implement erosion and sediment control to prevent pollution of stonn drains. Such control includes but is not limited to: 6 A. Use storm drain inlet protection devices such as sand bag bariiers, filter fabric fences, block and gravel filters. (Block storm drain inlets prior to the start of the rainy season (October 15), in site de-watering activities and saw-cutting activities; shovel or vacuum saw-cut sluny and remove from the site). B. Cover exposed piles of soil or constrnction material with plastic sheeting. All construction materials must be stored in containers. C. Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain as well as at the end of the each work day. At the completion of the project, the street shall be washed and the wash water shall be collected and disposed of offsite in an appropriate location. D. After breaking old pavement, Contractor shall remove all debris to avoid contact with rainfall or mnoff. E. Contractor shall maintain a clean work area by removing trash, litter, and debris at the end of each work day. Contractor shall also clean up any leaks, drips, and other spills as they occur. The objective is to ensure that the City and County of Santa Clara County-Wide Clean Water Program is adequately enforced. These controls should be implemented prior to the start of constmction, up~graded as required, maintained during constmction phases to provide adequate protection, and removed at the end of construction. These recommendations are intended to be used in coqjunction with the States Best Management Practices Municipal and Constrnction Handbooks, local program guidance mate1ials from municipalities, Section 7.1.01 of the Standard Specifications and any other appropriate documents on storm water quality controls for construction. Failure to comply with this program will result in the issuance of noncompliance notices, citations, project stop orders or fines. The fine for noncompliance of the above program is two hundred and fifty dollars ($250.00) per occurrence per day. The State under the Federal Clean Water Act can also impose a fine on the contractor, pursuant to Cal. Water Code '13385. 19. TERMINATION: In the event Contractor fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder, Contractor shall be deemed in default in the performance of this Agreement. If such default is not cured within a period of two (2) days after receipt by Contractor from City of written notice of default, specifying the nature of such default and the steps necessary to cure such default, City may terminate the Agreement forthwith by giving to the Contractor written notice thereof. City shall have the option, at its sole discretion and without cause, of terminating this Agreement by giving seven (7) days' prior written notice to Contractor as provided herein. Upon termination of this Agreement, each patty shall pay to the other party that portion of compensation specified in this Agreement that is earned and unpaid prior to the effective date of termination. 20. COMPLIANCES: Contractor shall comply with all laws, state or federal and all ordinances, rules and regulations enacted or issued by City. 7 21. CONFLICT OF LAW: This Agreement shall be interpreted under, and enforced by the laws of the State of California excepting any choice of law rules which may direct the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws, orders, rules, and regulations of the authorities having jurisdiction over this Agreement (or the successors of those authorities.) Any suits brought pursuant to this Agreement shall be filed with the courts of the County of Santa Clara, State of California. 12. ADVERTISEMENT: Contractor shall not post, exhibit, display or allow to be posted, exhibited, displayed any signs, adve1iising, show bills, lithographs, posters or cards of any kind petiaining to the services performed under this Agreement unless prior written approval has been secured from City to do otherwise. 23. WAIVER: A waiver by City of any breach of any tenn, covenant, or condition contained herein, shall not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant, or condition contained herein, whether of the same or a different character. 24. INTEGRATED CONTRACT: This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held .to vary the provisions hereof Any modification of this Agreement will be effective only by written execution signed by both City and Contractor. 25. SAFETY REQUIREMENT All work perfonned under this Agreement shall be perfonned in such a manner as to provide safety to the public and to meet or exceed the safety standards outlined by CAL-OSHA. City reserves the right to issue restraints or cease and desist orders to Contractor when unsafe or ham1ful acts or conditions are observed or reported relative to the perf01mance of the work under this Agreement. Contractor shall maintain the work sites free of hazards to persons and/or property resulting from his or her operations. Any hazardous condition noted by Contractor, which is not a result of his or her operations, shall immediately be reported to City. 26. HOURS OF OPERATION Contractor shall be allowed to operate only for the hours of 7:00 a.m. to 3:30 p.m. unless prior written approval has been secured from City to do otherwise. 8 27. REQUIREMENT TO PAY PREVAILING WAGES Consistent with the City's policy to pay prevailing wage rates, Contractor shall comply with the City's Labor Compliance Program and all other requirements set forth in Labor Code section 1770 et seq. The City shall require payment of the general rate of per diem wages or the general rate of per diem wages for holiday and overtime work. Contractor will submit (monthly or biweekly) certified payroll records to the City for all employees and subcontractors in a preapproved format or a City provided fo1m. Any delay in remitting certified payroll repotis to the City upon request from the City will result in either delay and/or forfeit of outstanding payment to Contractor. 28. INSERTED PROVISIONS: Each provision and clause required by law to be inserted into the Agreement shall be deemed to be enacted herein, and the Agreement shall be read and enforced as though each were included herein. If through mistake or otherwise, any such provision is not inserted or is not correctly inserted, the Agreement shall be amended to make such inse1tion on application by either party. 9 29. CAPTIONS: The captions in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the te1ms or provisions of this Agreement. IN WITNESS WHEREOF, the patiies have caused the Agreement to be executed on the day and year first above written. CONTRACTOR "Hart Flooring Co. Inc." I By au~- Title Owner Date 8-25-15 CITY OF CUPERTINO A Municipal Corporation Soc. Sec.# or Tax I.D. 93 0959958 . APP~ ~Attorney ATTEST: AL: City_ Clerk 1'. 11 Ir s"' 57 o -63 -61 ( -~o& ., ?o'-{ 4Wlovl/\+· fl; S1 ).oo 10 I ' lf iu b1 I . f1 . HAR. T FLOOR.ING CO. INC. R.ECREA TIONAL & HAR.0\i\/000 FLOOR. DESIGN 601 YfRGlNJA AVE. CAMPBELL, CALIF. 9008 PHONE# ( 408) 3782182 FAX4F ( 408) 3782182 LISCENSE # 389744 hai:tfloors@yahoo.com _ City Of Cupertino !O~ -·~~~~~~~--~~~~~~~ 3-23-15 DATE·: _ __,_ ____ ....,_;;_..... P.O.#: _____ .,--__ _ Atten: Coleen Joi> Deser!pt~o~ Quote For: Cupertino Sports Center Sand and Refinish 2 Raquettball Courts Sand floor to bare wood Screen floor with 120 grit screens for a smooth surf ace Seal floor with Gym Floor Seal Apply Raguettball Lines Apply 3 coats of Gym Floor Finiah ,screening between coats Quote Amount $2600.00 Each Thank You Kevin Hart Amount- $5200.00 Total . ··--•.. -----·----·· -·---- OP ID: AA ·ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 08117/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl. PRODUCER CONTACT NAME: Orr and Associates Ins. Serv. PHONE I FAX CALIC#OE63493 PH,95~506-5859 IAIC No Ext\: (AIC Nol: 28780 Single Oak Dr ve 255 E-MAIL Temecula, CA 92590 ADDRESS: Jim Henderson ~~~vg~~~ ID#: HARTF-1 INSURER(S) AFFORDING COVERAGE NAIC# INSURED Hart Flooring Company, Inc. INSURERA:COLONY INS co 39993 601 Virginia Avenue INSURERS: Campbell, CA 95008 INSURERC: INSURERD: INSURERE: I INSURER F: COVERAGES CERTIFICATE NUMBER· 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 ~DDL SUBR POLICY EFF POLICY EXP LIMITS LTR fl .. ~D f,.n1n POLICY NUMBER llMM/DD/YYYYl 'IMM/DD/YYYY\ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <-----DAMAl;t: TO KENTED A x COMMERCIAL GENERAL LIABILITY x X GL4156218 12/21/2014 12/21/2015 PREMISES IEa occurrence) $ 100,000 ~ D CLAIMS-MADE []] OCCUR 5,00C MED EXP (Any one person) $ >--PERSONAL & ADV INJURY $ 1,000,00( >--GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 1,000,000 fXl POLICY n ~~,Q,: n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ '--(Ea accident) ,_ ANY AUTO BODILY INJURY (Per person} $ ~ ALL OWNED AUTOS BODILY INJURY (Per accident) $ '-- SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) '-- NON-OWNED AUTOS $ ~ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ '-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ '--DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION /WCSTATU-I /OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH} E.L DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ~ttach ACORD 101NAddltlonal Remarks Schedule, if more space Is required) CE~TIFICATE HOLDER kSJiAM~D AS A DITIONAL I SURED gr1=11U$.f~J~%<§ ~'R~~k BL ~T R UPERTINO, CA 95014 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF CUPERTINO ACCORDANCE WITH THE POLICY PROVISIONS. 10300 TORRO A VE CUPERTINO, CA 95014 AUTHORIZED REPRESENTATIVE df oVv ~ I © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 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) (Additional Insured): Location(s) of Covered Operations: ALL PERSONS OR ORGANIZATIONS AS REQUIRED RE: OPERATIONS OF THE NAM ED BY WRITTEN CONTRACT WITH THE INSURED. INSURED. A. SECTION II -WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" casued, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "Bodily injury" or "property darryage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE FDLICY REMAIN UNCHANGED. U156-0310 Includes copyrighted material of ISO Properties, Inc., with its permission. Insured Page 1 of 1 IL 00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Decla- rations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of can- cellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of can- cellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named lnsured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time dur- ing the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspec- tions, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, ad- visory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or re- commendations we may make relative to cer- tification, under state or municipal statutes, ordinances or regulations, of boilers, pres- sure vessels or elevators. E. Premiums The first Named Insured shown in the Decla- rations: 1. Is responsible for the payment of all pre- miums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an ind iv id ual Named Insured. If you die, your rights and duties will be tran- sferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. lLOO 1711 98 Copyright, Insurance Services Office, Inc., 1998 Insured GU 519 ( 11-98) Page 1 of 1 Policy Change N umber_O_l __ _ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IL 120111 85 POLICY CHANGES POLICY NO. GL4156218 NAMED INSURED POLICY CHANGES EFFECTIVE 12/21/2014 HART FLOORING COMPANY, INC. COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY CHANGES COMPANY COLONY INSURANCE COMPANY AUTHORIZED REPRESENTATIVE Monarch E & S Insurance Services PRIMARY AND NON-CONTRIBUTORY WORDING -INCLUDED AS APPLICABLE TO BLANKET ADDITIONAL INSURED PER FORM Ul56(3-10): " IT IS FURTHER AGREED THAT THIS INSURANCE SHALL BE PRIMARY AND NON- CONTRIBUTORY BUT ONLY IN THE EVENT OF A NAMED INSURED'S SOLE NEGLIGENCE". ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. GU 269 (11-85) IL12011185 Authorized Representative Signature Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983 Insured Page 1of1 WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1. Please be advised that a waiver of subrogation requires that a 3% surcharge will be applied by State Fund ONLY to the premium assessed on the payroll of your employees earned while engaged in work for that certificate holder who requested the waiver. (Note: if you have no employee payroll on that job, then there is no charge.) 2. To apply the 3% surcharge, you must also agree to maintain accurately segregated payroll records for employees engaged in work on job/s for the certificate holder who has the waiver. The payroll records are subject to verification by an auditor. Example: Payroll for job: Sample Rate: Regular Premium equals: Surcharge: $5,000.00 13.30% $ 665.00 3.00% Additional Waiver charge: $ 19.95 Total premium equals $ 684.95 (665.00 + 19.95) POLICYHOLDER COPY 'sirAi·&~.~ ,: COMPE"l!iA\TION~: P.O. BOX 8 192, PLEASANTON, CA 94588 INSIJRANS::E" :~·~-N~f CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-19-2015 GROUP: POLICY NUMBER: 9105711-2015 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 07-09-2016 07-09-2015/07-09-2016 CITY OF CUPERTINO NA JOB:CUPERTINO SPORTS CENTER BLDG INSPT DEPT 10300 TORRE AVE CUPERTINO CA 95014-3202 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form appr·dved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by lhe Fund except upon 10 days advance writlen notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiratron. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. ~~~ d~~~ .Jl:.~ Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -HART, KEVIN JOSHUA TREASURER -EXCLUDED. ENDORSEMENT #1600 -HART, ALLEN CHARLES VICEPRES -EXCLUDED. ENDORSEMENT #1600 -HART, ANITA JOANNE PRESIDENT -EXCLUDED. ENDORSEMENT #1600 -HART, BENJAMIN SCOTT SECRETARY -EXCLUDED. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015-08-19 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF CUPERTINO EMPLOYER HART FLOORING CO. INC. 601 VIRGINIA AVE CAMPBELL CA 95008 (AEV.7-20141 NA PRINTED [MBQ,CSJ 08-19-2015 NA