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15-178 HY Flooring and Gameline Painting, Inc., Agreement for Project Number 2015-10, Senior Center Exercise Room FloorDOCUMENT: 23269591 Pages: 3 1111111 11111111 I Fees . ~ No Fees RECORDING REQUESTED BY City of Cupertino WHEN RECORDED MAIL TO City Clerk's Office City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 REGINA AL COM ENDRAS SANTA CLARA COUN TY RECORDER Recorded at the req uest of ci t y Taxes Copie s . AMT PA ID ROE fl 001 4/07 /2016 2:06 PM (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NO FEE IN ACCORDANCE WITH GOV. CODE 27283 NOTICE OF COMPLETION CITY PROJECT NAME: Senior Center Exercise Room Floor Replacement (City Project No. 2015-10) D Original D For Fast Endorsement CU P ERT INO Recording Requested By: When Recorded Mail To: City of Cupertino 10300 Torre Ave . Cupertino, CA 95014 SPACE ABOVE THIS LINE IS FOR RECORDER'S USE NOTICE OF COMPLETION Civil Code§§ 8182, 8184, 9204, and 9208 NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is the agent of the owner of the project described below. 2. Owner's full name is : City of Cupertino , California . 3. Owner's address is: City Hall, 10300 Torre Ave., Cupertino, CA 95014. 4 . The nature of owner's interest in the project is: 1-_ Fee Ownership Lessee Other : __________ _ 5. Construction work on the project performed on the owner's behalf is generally described as follows: City Project Name: City Project No.: Senior Center Exercise Room Floor Replacement 2015-10 Remove existing subfloor, wood floor and base in Exercise Room and install new subfloor, resilient flooring and base. 6 . The name of the original contractor for the project is: HY Floor & Gameline Painting , Inc. 7 . The project was completed on: __ D_e_ce_m_b~e_r _1 _1 ~2_0~1_5 ______________ _ 8 . The project is located at: ____ 2_1_2_5_1 _S_t_e_ve_n_s_C_re_e_k_B_lv_d~. ,_C_u~p_e_r_tin_o~,_C_A~9_5_0_1 _4 ___ _ Verification : In signing this document, I, the undersigned , declare under penalty of perjury under the laws of the State of California that I have read this notice , and I know and understand the contents of this notice, and that the facts stated in this notice are true an~rect 4\v/1c.o ; Santa Clara County ~.-c.-+-. _-____,,,, __________ _ Date and Place ~ . Timm Borden Director of Public Works and City Engineer "NO FEE" City of Cupertino NOTICE OF COMPLETION is hereby given in order to comply with the provisions of Section 27283 of the Government Code. This is to certify that the Notice of Completion dated December 11, 2015 for CITY PROJECT NAME: Senior Center Exercise Room Floor Replacement (City Project No. 2015-10) and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on December 11, 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: By: April 6, 2016 ........ .., .. ·~..... . Laure~ ?apuda(::-. $enio1?0ffi:c::e AsSistant . ; ((_t ,,· i CUPeRTINO DATE: 1111812015 Contrnctur: H.Y. Floor 961 Commercial Stt·eet San Cal'los, CA 94070 CUPERTINO SENIOR CENTER EXERCISE ROOM FLOORING IUCPLACEMENT PROJECT PROJECT NO. 2015"10 CONTRACT CHANGE ORDER NO. 01 P.O. #2016-331 File No. 92,008.20 Acct. #420-90-943-900-905-SRCT 001-03-01 The.following changes a!'e hereby approved, notwithstandi.ng language in any attachment to the contraiy, Contractor flgrees that the rimount paid pursuant hereto Is full and complete compe1isation for the work described hereln for each and every entity involved in the . project who is being compensated hereunder and that each and every claim f01• any cost for schedule impnct such as a delay1 impact, inefficiency, acct;J!eratlon, yxtended overhead, increased supervi'slon, compress'lon and all other factol's affecting cost arising fl'om the subject oftllls Chnnge. Orde1· is hereby relensed and Wflived by all such S\lbcontrnctors nud suppliers nt nil tlers. Change City Field No. Authorization No. 01 Descl'iption W' Uni;Ierlayment rated plywood %"CDX Two layers of lwl/W' Sturdi Floor $3,272.56 ($2, 198.95) ($1)756.95) $7,228.46 Totnl C11ange Order No. -01 $ 3,272.56. Total Project: Original Contract Change Ol'der No. 1 :Revised Contract $60,010.00 $3,272.56 $3,272.56 Total Clrnnge 01'de1·s $3,272.56 Change Order 01 Page 1 v CUPERTINO SENIOR CENTER EXERCISE ROOM FLOORING REPLACEMENT PROJECT PROJECT NO. 2015·10 CONTRACT CHANGE ORDER NO. 01 Schedule Impact: 0 calendar days Project Final Completion Date: December 18, 2015 REVIEWED BY: v it of Cupe1iino lex Acenas City Project Manager Senior Project Manager Date: tJ tii f 115 APPROVED BY: r dty ofiC~ino --rod.... Titnm Borden Page 2 Director of Public Works Date: /1-?1-fJ' H.Y. Floo1' Steven Heller Project Manager Change Order 01 H.Y. Floor and Gameline Painting, Inc. 981 Comnwclaf Street San Carlos, Callfornfa 94070-4018 License# 587127 Fax (6$0} 593·7002 . Phone (650) 593-6837 Tool Free (877) HY FLOOR www.hylloor.com REQUEST FOR CHANGE ORDER #1 R Contractor: Gil bane ~~~~~~~~~~~~~ Address: 1798 Technology Drive suite 120 San Jose, CA 9511 O Phone: 408-660-4416 Attn: Dana Johnson Fax: 408-660-4402 Email: djqhnson1@gilbaneco.com Project: Cupertino Senior Center Section: Wood Floorlng Number: HY291 Requested By: Steve Heller Additional work: because subfloor is not per drawings J need to replace the 1/4" underfayment rated plywood and the 3/4" COX plywood with two layers of 1 .. 1/8" Sturdi-Flr to match the thickness of the existing floor Item# Description QTY Unit Cost Extension 1 1/4" Underlayment rated plywood 65 $ (33.83) $ (21198.95) 2 3/4" cox 65 $ (27.03) $ (1,756.95) 3 Two layers of 1~1/8" Sturdl-Floor 130 $ 52.32 $ 6,801.60 4 $ $ 5 $ $ 6 $ $ Subtotal $ .2,845.70 15% mark up $ Total Adda"' Slll~I, l>CI ltClltQif'"" lili" ......... ,. "" ••• II .......................... ,. ••••• ,. • ., ••• ~ ••••• , ........... ,. ........... , $ 426.86 3,272.56 ~£~ Steven E. Heller President Johnson, Dana From: Sent: To: Stan Woerner <swoerner@beronio.com> Wednesday, October 28, 2015 8:58 AM Steve Heller Cc: Mike Merchant Subject: RE: Cupertino Senior Center Hi Steve, Here's your pricing: 4x8x1-1/8" Sturd!Flr T&G $48 ea 4x8x1/411 Underlayment rated plywood $31.04 4x8x3/4" CD SE $24.80 On the )4" please give us 2-3 days to get it in. Thanks, Stan From: Steve Heller [mallto:Steve@hyfloor.com] Sent: Wednesday, October 28, 2015 7:59 AM To: Stan Woerner Cc: Mike Merchant subject: Cupertino Senior Center Stan, ·-··-····-··--·-····-·""''"''-"'"--•'"'""·'··--·-·------ Please give me pricing for 65 sheets each of 1-1/8" Sturd-1-floor, 14'' underlayment grade plywood and regular W' CDX plywood. I have the job and it would start next week. NO FSC or FT Thanks, Steven E. Helfer President ;EiGt~~1; H+Y+ . ~lo·or . · ....... ;-~and Gameline .·· .. ········ · · ','~.)': Painting, Inc. )\: .. ::;; QuaUty Sports floor$ Since 1969 C: 650.280.2809 F: 650.593.7002 O: 650.593.6837 Email: Steve@hyfloor.com www.hyfloor.com 1 po# 0-oi b .. 3"<E. j Project No. 2015-10 DOCUMENT 00520 CONTRACT THIS CONTRACT, dated this 13th day of October , 20 ~. by and between HY FLOORING AND GAMELINE PAINTING, INC. whose place of business is located at 961 Commercial St., San Carlos, CA 94070 ("Contractor"), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by virtue of the authority vested in the City by the laws of the State of California. WHEREAS, City, on the 12th day of October , 20~ awarded to Contractor the following Project: PROJECT NUMBER 2015-10 SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT 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 Alex Acenas 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 City has designated Prodis Associates Architects as the project Architect. City may change the identity of the Consultant at any time with notice and without liability to Contractor. 2.3 City has designated Gilbane Building Company to act as Construction Managers. City may change the identity of the Construction Manager at any time with notice and without liability to Contractor. 2.4 All notices or demands to City under the Contract Documents shall be to City's Authorized Representative at: 10300 Torre Avenue, Cupertino, CA 95014 or to such other person(s) and address( es) as City shall provide to Contractor. Article 3. Contract Time and Liquidated Damages 3.1 Contract Time. The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a Notice to Proceed at any time within 30 Days after the Notice of Award. Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run. Contractor shall achieve Final Completion of the entire Work and be ready for Final Payment in accordance with Section 00700 (General Conditions) by December 18, 2015. City of Cupertino Senior Center Exercise Room Floor Replacement 00520 - 1 Contract Project No. 2015-10 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 any part of the Work is not completed within the times specified above, plus any extensions thereof allowed in accordance with the Contract Documents. Consistent with Document 00700 (General Conditions), 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 $2,000 for each Calendar Day that expires after the time specified herein for Contractor to achieve Final Completion of the entire Work as specified above. 3.2.2 $3,000 for each occurrence of a violation of Document 00800, Section 1.7 WORK DAYS AND HOURS. 3.2.3 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 before Final Completion, for any reason whatsoever, that Contractor can demonstrate to City's satisfaction is 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. Contractor should be aware that California Department of Fish and Game, and other State and Federal agencies, may also levy fines and penalties for the harming, harassing or killing of protected wildlife and endangered species. Contractor hereby agrees to become familiar with and adhere to wildlife and endangered species protection requirements. 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. Article 4. Contract Sum 4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents as set forth in Contractor's Bid, attached hereto: See Exhibit "A" attached Article 5. Contractor's Representations In order to induce City to enter into this Contract, Contractor makes the following representations and warranties: 5.1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the Contract Documents, Work, Site, locality, actual conditions, as-built conditions, and all local conditions, and federal, state and local laws and regulations that in any manner may affect cost, progress, performance or furnishing of Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of construction to be employed by Contractor and safety precautions and programs incident thereto. 5.2 Contractor has examined thoroughly and understood all reports of exploration and tests of subsurface conditions, as-built drawings, drawings, products specifications or reports, available for Bidding purposes, of physical conditions, including Underground Facilities, which are identified in Document 00320 (Geotechnical Data, Hazardous Materials Surveys and Existing Conditions), or which may appear in the Drawings. Contractor accepts the determination set forth in these Documents and Document 00700 (General Conditions) 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 Senior Center Exercise Room Floor Replacement Project No. 2015-10 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 famishing 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 Conditions); and no additional examinations, investigations, explorations, tests, reports, studies or similar information or data are or will be required by Contractor for such purposes. 5.4 Contractor has correlated its knowledge and the results of all such observations, examinations, investigations, explorations, tests, reports and studies with the terms and conditions of the Contract Documents. 5.5 Contractor has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents and as-built drawings and actual conditions and the written resolution thereof through Addenda issued by City is acceptable to Contractor. 5.6 Contractor is duly organized, existing and in good standing under applicable state law, and is duly qualified to conduct business in the State of Califomia. 5.7 Contractor has duly authorized the execution, delivery and performance of this Contract, the other Contract Documents and the Work to be performed herein. The Contract Documents do not violate or create a default under any instrument, contract, order or decree binding on Contractor. 5.8 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting Code §4100 et seq. in document 00340 (Subcontractors List) Article 6. Contract Documents 6.1 Contract Documents consist of the following documents, including all changes, addenda, and modifications thereto: City of Cupertino Document 00400 Bid Form Document 00430 Subcontractors List Document 00450 Statement of Qualifications Document 00481 Non-Collusion Affidavit Document 00482 Bidder Certifications Document 00510 Notice of Award Document 00520 Contract Document 00530 Insurance Forms Document 00550 Notice to Proceed Document 00610 Construction Performance Bond Document 00620 Construction Labor and Material Payment Bond Document 00630 Guaranty Document 00650 Agreement and Release of Any and All Claims Document 00660 Substitution Request Form Document 00680 Escrow Agreement for Security Deposit in Lieu of Retention Document 00700 General Conditions Document 00800 Special Conditions Document 00820 Special Environmental Conditions Document 00821 Insurance Document 00822 Apprenticeship Program Technical Specification/Special Provisions Addenda(s) Drawings/Plans 00520 - 3 Senior Center Exercise Room Floor Replacement Contract Project No. 2015-10 6.2 There are no Contract Documents other than those listed in this Document 00520, Article 6. Document 00320 (Geotechnical Data, Hazardous Material Surveys and Existing Conditions), and the information supplied therein, are not Contract Documents. The Contract Documents may only be amended, modified or supplemented as provided in Document 00700 (General Conditions). Article 7. Miscellaneous 7.1 Tenns used in this Contract are defined in Document 00700 (General Conditions) 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 oflndustrial 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/DLSR/PWD/Northern.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 force and effect and shall in no way be invalidated, impaired or affected thereby. If the provisions of any law 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 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 I, Division 3.6, Part 3, Chapter 5. City of Cupertino 00520 -4 Contract Senior Center Exercise Room Floor Replacement Project No. 2015-10 IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year first above written. SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT CITY: CITY OF CUPERTINO, a Municipal Corporation of the State of California Attest: c~~£t ,'J_f !o6t 1£r City Clerk: Grace Schmidt I hereby certify, under penalty of perjury, that David Brandt, City Manager of the City of Cupertino was duly authorized to execute this document on behalf of the City of Cupertino. Dated:_j 0 ·-f 5 -c S Designated Representative: Name: Timm Borden Title: Director of Public Works Address: 10300 Torre Ave., Cupertino, CA 95014 Phone: 408-777-3354 Facsimile: 408-777-3333 AMOUNT: $ 60,010 ACCOUNT NUMBER:420-90-943-900-905-SRCT 001-03-01 FILE NO.: 92,008.20 CONTRACTOR: HY Flooring and Gameline Painting, Inc. By~&;!ML [Signature] H.Y. Floor & Gameline Painting, Inc. [Please print name here] Title: President [If Corporation: Chairman, President, or Vice President] By:_~~~~~~~~~~~~~~ [Signature] [Please print name here] Title: ________________ _ [If Corporation: Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer] 587127 C-15 State Contractor's License No. Classification 01/31/2016 Expiration Date Taxpayer ID No. __ 9_4-_3_0_8_35_1_1 _______ _ Name: _________________ _ Title: ________________ _ Address: ________________ _ Phone: _________________ _ Facsimile: ________________ _ NOTARY ACKNOLEDGEMENT IS REQUIRED. IF A CORPORATION, CORPORATE SEAL AND CORPORATE NOTARY ACKNOWLEDEMENT AND FEDERAL TAX ID ARE REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY NO. IS REQUIRED See o.:11~eol 51-ieet f!tw Wofc..ri°G<L:fio'A.._ END OF DOCUMENT City of Cupertino Senior Center Exercise Room Floor Replacement 00520-5 Contract CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 • A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San fV1 a..,-/eo ) ) On Oc..fo/oe 1 13. 2. o I 5" before me, /v!!'ke /V/ervha.nf No16-r Date Here Insert Name and Title of the personally appeared __ 0_ft_e..=-.L._v=e.,_n.__=E.=.__._/l._,e"'--'-1 /-=e._,__v ________________ _ Name(s) of Signer{-&} who proved to me on the basis of satisfactory evidence to be the person~) whose name{aj isl.are subscribed to the within instrument and acknowledged to me that he/ahe/they executed the same in his/her/tAeir authorized capacity{ies), and that by his/.her/theif signatur~ on the instrument the person~. or the entity upon behalf of which the person{s) acted, .executed the instrument. Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~,~_A Signature of Notary Public ~--------------------------~oPTIONAL----------------------------~ Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: 2,01 s · \ o Covii f<U;t Document Date: _______ _ Number of Pages: Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) SifJner's Name: 5-teve.n e.. J/6//e.r Ejl Corporate Officer -Title(sf. f>res/cf.P.J D Partner -D Limited D General D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Other: _____________ _ Signer Is Representing: ________ _ Signer's Name: ___________ _ D Corporate Officer -Title(s): ______ _ D Partner -D Limited D General D Individual D Attorney in Fact D Trustee D Guardian or Conservator D Other: _____________ _ Signer Is Representing: ________ _ • ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 EXHIBIT A Contractor's Name: HY Floor and Gameline Painting, Inc. Project No. 2015-10 DOCUMENT 00400 BID FORM To be submitted as part of Envelope "A" by the time and date specified in Document 00200 (h1strnctions to Bidders). TO THE HONORABLE CITY COUNCIL OF THE CITY OF CUPERTINO TI·US BID IS SUBMITTED BY: HY Floor and Gameline Painting, Inc. (Finn/Company Name) Re: PROJECT NUMBER 2015·10 SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT I. The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into a contract with the City of Cupertino ("City") in the fotm included in the Contract Documents, Document 00520 (Contract), to perfonn and furnish all Work as specified or indicated in the Contract Documents for the Contract Sum and within the Contract Time indicated in this Bid and in accordance with all other tenns and conditions of the Contract Documents. All portions of this Bid Forni must be completed and signed before the bid is submitted. Failure to do so will result in the bid being rejected as non-responsive. 2. Bidder accepts all of the tenns and conditions of the Contract Documents, Document 00 I 00 (Adve1tisement for Bids}, and Document 00200 (Instructions to Bidders}, including, without limitation, those dealing with the disposition of Bid Security. This Bid will remain subiect to acceptance for 90 Days after the day of Bid opening. 3. Bidder has visited the Site and perfonned all tasks, research, investigation, reviews, examinations, and analysis and given notices, regarding the Project and the Site, as set forth in Docwnent 00520 (Contract), Article 5. 4. Bidder has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents and as-built drawings and actual conditions and the written resolution thereof through Addenda issued by City is acceptable to Contractor. 5. Bidder attended the non-mandatory Pre-Bid Meeting. YES NO _x_ 6. Subcontractors for work included in all Bid items, in accordance with the criteria in the Public Contract Code, are listed on the attached Document 00430 (Subcontractors List). 7. The undersigned Bidder understands that City reserves the right to reject this Bid. 8. If written notice of the acceptance of this Bid, hereinafter referred to as Notice of Award, is mailed or delivered to the undersigned Bidder within the time described in paragraph 2 of this Document 00400 or at any other time thereafter before it is withdrawn, the undersigned Bidder will execute and deliver the documents required by Document 00200 (Instrnctions to Bidders) within the times specified therein. These documents include, but are not limited to, Document 00520 (Contract), Document 00610 {Constmction Perfonnance Bond), and Document 00620 (Construction Labor and Material Payment Bond). 9. Notice of Award or request for additional infonnation may be addressed to the undersigned Bidder at the address set forth below on the signature page. City of Cupertino Senior Center Exercise Room Floor Replacement 00400 - l Bid Fonn Contractor's Name: HY Floor and Gameline Painting, Inc. Project No. 2015-10 10. The undersigned Bidder herewith encloses cash, a cashier's check, or certified check of or on a responsible bank in the United States, or a corporate surety bond furnished by a surety authorized to do a surety business in the State of California, in fom1 specified in Document 00200 (lnstmctions to Bidders), in the amount of ten percent (10%) of the total of Base Bid and made payable to the "City of Cupertino". 11. The undersigned Bidder agrees to commence Work under the Contract Documents on the date established in Document 00700 (General Conditions) and to complete all work within the time specified in Document 00520 (Contract). The undersigned Bidder acknowledges that City has reserved the right to delay or modify the commencement date. The undersigned Bidder furt11er acknowledges City has reserved the right to pe1for111 independent work at the Site, the extent of such work may not be detennined until after the opening of the Bids, and that the undersigned Bidder will be required to cooperate with such other work in accordance with the requirements of the Contract Documents. 12. The undersigned Bidder agrees that, in accordance with Document 00700 (General Conditions), liquidated damages for failure to complete all Work in the Contract within the time specified in Document 00520 (Contract) shall be as set forth in Document 00520 (Contract). Cily ofCupe1tino Senior Center Exercise Room Floor Replacement 00400-2 Bid Form Addendum No. 1 Contractor's Name: HY Floor and Gameline Painting, Inc. Project No. 2015-10 NOTICE Required Contractor and Subcontractor Registration City of Cupertino 1. Owner shall accept Bids only from Bidders that (along with all Subcontractors listed in Document 00430, Subcontractors List) are currently registered and qualified to perform public work pursuant to Labor Code Section 1725.5. 2. Subject to Labor Code Sections 1771.l(c) and (d), any Bid not complying with the preceding paragraph shall be returned and not considered; provided that if Bidder is a joint venture (Business & Professions Code Section 7029.1) or if federal funds are involved in the Contract (Labor Code Section 1771.l(a)), Owner may accept a non-complying Bid provided that Bidder and all listed Subcontractors are registered at the time of Contract award. 00400-3 Bid Fonn Senior Center Exercise Room Floor Replacement Addendum No. 1 Contractor's Name: HY Floor and Gameline Painting, Inc. Project No. 2015-10 SCHEDULE OF BID PRICES All Bid items, including lump sums and unit prices, must be filled in completely. Allowances and Alternative Bid items are described in Document 00800 (Special Conditions). Quote in figures only, unless words are specifically requested. Please Note that time extensions will NOT be permitted with the acceptance of any or all of the Alternative Bid Items listed below. Remove existing maple floor. Inspect existing wood stringers. Replace damaged members and nail connections as needed. Install one layer of%" CDX plywood over existing stringers. Install one layer W' finish grade plywood as recommended for resilient flooring underlayment. Provide new resilient floor, base and thresholds as shown in the plans and specifications. SCHEDULE OF ALTERNATES: (none) Unit Legend LS =Lump Sum EA=Each LF =Linear Feet TON = Ton or 2,000 Pounds CY = Cubic Yards LB =Pounds City of Cupertino Senior Center Exercise Room Floor Replacement LS AL =Allowance SF = Square Feet 00400. 4 $60,010.00 $60,010.00 Bid Form Addendum No. 1 Contractor's Name: HY Floor and Gameline Painting, Inc. ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUMS Project No. 2015-1 O Bidder herby acknowledges receipt and examination of all Contract Docmnents and the following Addenda: Addendum No. Addendum Date 10/1/15 Bidder proposes and agrees to fully perfonn the Work within the time stated and in strict accordance with the Contract Documents for the sums of money listed in this Bid Fotm. NAME OF BIDDER: HY Floor and Gameline Painting, Inc. licensed in accordance with an act for the registration of Contractors, and with license number: __ 5_8_7_1_2_7 _____ _ Expiration Date: _11_3_1_11_6 ________________ _ DIR Registration No.: _1_00_0_0_0_1_56 ________ _ CA Where inco1porated, if applicable Steven Heller Susan Heller Principals I certify (or declare) under penalty of pe1jury under the laws of the St and correct. Signature of Bidder NOTE: If Bidder is a corporation, set forth the legal name of the corporation, state where incorporated, together with the signature of the officer or officers authorized to sign contracts on behalf of the corporation. If Bidder is a partnership, set forth the name of the finn together with the signature of the partner or partners authorized to sign contracts on behalf of the prutnership. Business Address: 961 Commercial St. HY Floor and Gameline Painting, Inc. San Carlos, CA 94070 Officers authorized to sign contracts: Telephone Number(s): (650) 593-6837 Fax Number(s): (650) 593 •7002 E-Mail Address: steve@hyfloor.com City of Cupertino Senior Center Exercise Room Floor Replacement Typed Full Name: Steven Heller END OF DOCUMENT 00400 -5 Bid Forni Project No. 2015-10 DOCUMENT 00630 GUARANTY TO THE CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City"), for construction of SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT PROJECT NUMBER 2015-10 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 111 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 written 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 oflimitation, 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. Jn 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 shall be resolved in favor of the higher level of obligation of the Contractor. H.Y. Floor & Gameline Painting, Inc. Contractor's Name 961 Commercial Street Address San Carlos, CA 94070 City/State/Zip City of Cupertino Senior Center Exercise Room Floor Replacement 10/14/2015 Date END OF DOCUMENT 00630 - 1 Guaranty DOCUMENT 00610 Project No. 2015-10 Bond No: CSB0016848 Premium: $864.00 CONSTRUCTION PERFORMANCE BOND THIS CONSTRUCTION PERFORMANCE BOND ("Bond") is dated October 13, 2015 , is in the penal sum of Sixty Thousand, Ten and no/100 Dollars ------------------------[which is one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the faithful performance of the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page. Any singular reference to H.Y. Floor and Gameline Painting ("Contractor"), Contractors Bonding and Insurance Company ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: H.Y. Floor and Gameline Painting Name 961 Commercial Street Address San Carlos, CA 94070 City/State/Zip CONSTRUCTION CONTRACT: SURETY: Contractors Bonding and Insurance Company Name 250 Montgomery St #720 Principal Place of Business San Francisco, CA 95107 City/State/Zip SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT PROJECT NUMBER 2015-10 at Cupertino, California. DATED October 13 CONTRACTOR AS PRINCIPAL Company: (Corp~~ /J// Signature:~~ £:,,, hk-~ Name and Title: s/evt't/l G' t/e/lr /Prei-4,j,f Name and Title: Timothy Hall Starbird, 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 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.l To Surety in accordance with the terms of this Bond and the Construction Contract; or City of Cupertino Senior Center Exercise Room Floor Replacement 00610 - I Construction Performance Bond Project No. 2015-10 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 case 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 City 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 from 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 Senior Center Exercise Room Floor Replacement 00610 - 2 Construction Performance Bond Project No. 2015-10 7. No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns. 8. Surety hereby waives notice of any change, alteration or addition to the Construction Contract or to related subcontracts, purchase orders and other obligations, including changes of time. Surety consents to all terms of the Construction Contract, including provisions on changes to the Contract. No extension of time, change, alteration, modification, deletion, or addition to the Contract Documents, or of the work required thereunder, shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond. 9. Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competent jurisdiction where a proceeding is pending between City and Contractor regarding the Construction Contract, or in the courts of the County of Santa Clara, or in a 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.l Balance of the Contract Sum: The total amount payable by City to Contractor pursuant to the terms of the Construction Contract after all proper adjustments have been made under the Construction Contract, for example, deductions for progress payments made, and increases/decreases for approved modifications to the Construction Contract. 12.2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract including, but not limited to, "default" or any other condition allowing a termination for cause as provided in Document 00700 (General Conditions). 12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor progress payments due under the Construction Contract or to perform other material terms of the Construction Contract, if such failure is the cause of the asserted Contractor Default and is sufficient to justify Contractor termination of the Construction Contract. City of Cupertino Senior Center Exercise Room Floor Replacement END OF DOCUMENT 00610 - 3 Construction Performance Bond POWER OF ATTORNEY RLI. dJit: nn RLI Company 9025 N. Lindbergh Dr. I Peoria, IL 61615 Phone: (800)645-2402 I Fax: (309)689-2036 RLI Insurance Company Contractors Bonding and Insurance Company Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and Insurance Company, required for the applicable bond. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each Illinois corporations (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make, constitute and appoint: Maureen Barreras, Timothy Hall Starbird, Joseph Longwello, Marko Trapani, Bill Frangieh, jointly or severally in the City of San Jose , State of California , as Attorney in Fact, with full power and authority hereby conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds, undertakings, and recognizances in an amount not to exceed Ten Million Dollars ( $10,000,000.00 ) for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation, and now in force, to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation shall be executed in the corporate name of the Corporation by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Corporation. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation. The signature of any such officer and the corporate seal may be printed by facsimile or other electronic image." IN WITNESS WHEREOF, RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 17th day of July, 2015. State of Illinois } SS County of Peoria On this 17th day of July , 2015 before me, a Notary Public, personally appeared Barton W. Davis , who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company, and acknowledged said instrument to be the voluntary act and deed of said corporation. Notary Public RLI Insurance Company Contractors Bonding and Insurance Company ~ ,{ /(/_ 5!!r" Barton W. Davis Vice President CERTIFICATE I, the undersigned officer of RLI Insurance Company, and/or Contractors Bonding and Insurance Company, each Illinois corporations, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable; and furthermore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. In testimony whereof, I have hereunto set my hand and the seal of the RLI Insurance Compa~y and/or Contractors Bonding and Insurance Company this~ day of October , --wrs-· Barton W. Davis ranee Company ' Vice President 0475281020212 A00.59115 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. ALL PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA } COUNTY OF Santa Clara } ------- On October 13, 2015 before me, __ M_a_ur_ee_n_G_h_in_a_zz_i,_A_N_o_ta_ry_P_u_b_lic ________ ~Notary Public, (here insert name and title of the officer) personally appeared __ T_im_o_th_y_H_a_ll_S_ta_rb_ird __________________ _ who proved to me on the basis of satisfactory evidence to be the person'9') whose name(.s) is/are subscribed to the within instrument and acknowledged to me that he/sh9/th'lY executed the same in his/lle:r;ltheir authorized capacity(~, and that by hisfftelf.tft~ signature~) on the instrument the personEs"), or the entity upon behalf of which the person(£-) 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. MAUfiEEN GHINAZZI -Commission # 2078708 i i • Notary Public • California ~ J Santa Clara County ~ 0 • • 0 • ,Ml g0TT-Jxf 1 ~8.8WJ·}[1 &E ' ), 11. ' Signature';'/J~LLA£tn 11~ (SoW) _________ OPTIONAL ________ _ Description of Attached Document Title or 'fype of Document: Performance Bond -CSB0016848 Number of Pages: __ _ Document Date:------- Other: _________________ _ United States Apostille Service, authentication, legalization. Sacramento Notarywww.CalifomiaApostiUe.US Tel 1-707-992·-5551 Project No. 2015-10 Bond No: CSB0016848 Premium: Included in Performance Bond DOCUMENT 00620 CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND THIS CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND ("Bond") is dated October 13, 2015 , is in the penal sum Sixty Thousand, Ten and no/100 Dollars [one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the payment of claimants under the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs I through 14, attached to this page. Any singular reference to H.Y. Floor and Gameline Painting ("Contractor"), Contractors Bonding and Insurance Company ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: H.Y. Floor and Gameline Painting Name 961 Commercial Street Address San Carlos, CA 94070 City/State/Zip CONSTRUCTION CONTRACT: SURETY: Contractors Bonding and Insurance Company Name 250 Montgomery St #720 Principal Place of Business San Francisco, CA 94107 City /State/Zip SENIOR CENTER EXERCISE ROOM FLOOR REPLACEMENT PROJECT NUMBER 2015-10 at Cupertino, California. DATED October 13, 2015 , 20~ in the Amount of$_6_0_,_0_10_._o_o ________ (the "Penal Sum") CONTRACTOR AS PRINCIPAL~ Company: ~al) Signature:~~ J. /l , Name and Title:Sfevtl'/ ;;, l/d4-/ Pr..e>fda:f' • Name and Title: Timothy Hall Starbird, 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, City of Cupertino 00620 - 1 Construction Labor and Material Payment Bond Senior Center Exercise Room Floor Replacement Project No. 2015-10 however, fail to pay any of the persons named in Section 3181 of the California Civil Code, or amounts due 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. 11. 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 Senior Center Exercise Room Floor Replacement 00620 - 2 Construction Labor and Material Payment Bond Project No. 2015-10 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 perfonnance of the Contract, as further defined in California Civil Code §3181. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's Subcontractors, and all other items for which a stop notice might be asserted. The term Claimant shall also include the Unemployment Development Department as referred to in Civil Code §3248(b). 14.2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 14.3 City Default: Material failure of City, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract, provided that failure is the cause of the failure of Contractor to pay the Claimants and is sufficient to justify termination of the Construction Contract. City of Cupertino Senior Center Exercise Room Floor Replacement END OF DOCUMENT 00620 - 3 Construction Labor and Material Payment Bond POWER OF ATTORNEY RLr cllit: an RU Company 9025 N. Lindbergh Dr. I Peoria, IL 61615 Phone: (800)645-2402 I Fax: (309)689-2036 RLI Insurance Company Contractors Bonding and Insurance Company Know All Men by These Presents: That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That this Power of Attorney may be effective and given to either or both of RLI Insurance Company and Contractors Bonding and Insurance Company, required for the applicable bond. That RLI Insurance Company and/or Contractors Bonding and Insurance Company, each Illinois corporations (as applicable), each authorized and licensed to do business in all states and the District of Columbia do hereby make, constitute and appoint: Maureen Barreras, Timothy Hall Starbird, Joseph Longwello, Marko Trapani, Bill Frangieh, jointly or severally in the City of San Jose , State of California conferred upon him/her to sign, execute, acknowledge and deliver for undertakings, and recognizances in an amount not to exceed , as Attorney in Fact, with full power and authority hereby and on its behalf as Surety, in general, any and all bonds, Ten Million Dollars ( $10,000,000.00 ) for any single obligation. The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. RLI Insurance Company and Contractors Bonding and Insurance Company, as applicable, have each further certified that the following is a true and exact copy of the Resolution adopted by the Board of Directors of each such corporation, and now in force, to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation shall be executed in the corporate name of the Corporation by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Corporation. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the Corporation. The signature of any such officer and the corporate seal may be printed by facsimile or other electronic image." IN WITNESS WHEREOF, RLI Insurance Company and/or Contractors Bonding and Insurance Company, as applicable, have caused these presents to be executed by its respective Vice President with its corporate seal affixed this 17th day of July, 2015. State of Illinois } SS County of Peoria On this 17th day of July , 2015 before me, a Notary Public, personally appeared Barton W. Davis , who being by me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of the RLI Insurance Company and/or Contractors Bonding and Insurance Company, and acknowledged said instrument to be the voluntary act and deed of said corporation. Notary Public RLI Insurance Company Contractors Bonding and Insurance Company ~,{IV. 5f!r" Barton W. Davis Vice President CERTIFICATE I, the undersigned officer of RLI Insurance Company, and/or Contractors Bonding and Insurance Company, each Illinois corporations, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable; and furthermore, that the Resolution of the Company as set forth in the Power of Attorney, is now in force. In testimony whereof, I have hereunto set my hand and the seal of the RLI Insurance Compaw and/or Contractors Bonding and Insurance Company this ---1]_ day of October, -zers-· Barton W. Davis ranee Company ' Vice President 0475281020212 AG059115 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. ALL PURPOSE ACKNOWLEDGMENT STATE OF CALIFORNIA } COUNTY OF Santa Clara } ------- On October 13, 2015 before me , __ M_a_ur_ee_n_G_h_in_a_zz_i,_A_N_o_ta_ry_P_u_b_lic ________ --'Notary Public, (here insert name and title of the officer) personally appeared __ T_im_o_th-'-y_H_a_11 _st_a_rb_ird __________________ _ who proved to me on the basis of satisfactory evidence to be the person(.9-) whose name(.s) is/are subscribed to the within instrument and acknowledged to me that he/sh9/th.ey executed the same in his/he11/tl;wir authorized capacity(~, and that by hisffte17'tfteH:. signature'8-) on the instrument the person~), 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. Signature'YJYLflJJMm Jj[1J~ (Seal) ________ OPTIONAL _______ _ Description of Attached Document Title or 'fype of Document: Payment Bond -CSB0016848 Number of Pages: __ _ Document Date:------- Other: _________________ _ United States Apostille Service .• authentication, legalization. Sa(..'l'amento Notary www.CalifomiaApostille.US Tel 1-707-992-555 l CITY OF a Project No. 2015-10 CUPERTINO CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO This certifies to the City of Cupertino that the following described policies have been issued to the insured named below and are in force at this time. Insured: H.Y. Floor & Gameline Painting, Inc. Address: 961 Commercial Street San Carlos, CA 94070 Description of operations/locations/products insured (show contract name and/or number, if any): Project No. 2015-10 Senior Center Exercise Floor Replacement ===================================================================== WORKER'S COMPENSATION State Compensation Ins. Fund (name of insurer) *Statutory Min. * Employer's Liability $ 1,000,000 $ 1,000,000 $ $1,000,000 Insurance Company's State License No. __ 5_8_71_2_7 ________________ _ ===================================================================== Check Policy Type: Each Occurrence $ 1,000,000 COMPREHENSIVE GENERAL LIABILITY [ ] Premises/Operations General Aggregate $ 2,000,000 (if applicable) [ ] Owners & Contractors Protective Aggregate $ [ ] Contractual for Specific Contract Personal Injury $ 1,000,000 $ [ ] Products Liability [ ] XCUHazards [ ] Broad Form P.D. Fire Damage (any one fire) $ 500,000 [ ] Severability of Interest Clause [ ] Personal Injury with Medical Expense $ 10,000 Employee Exclusion Removed (any one person) or Self-Insured COMMERCIAL GENERAL LIABILITY Retention $ West American Insurance Company (name of insurer) Policy No. BKW56220333 Expiration Date 11-10-2015 ===================================================================== City of Cupertino Senior Center Exercise Room Floor Replacement 00530 - 4 Insurance Forms AUTOMOTIVE/VEHICLE LIABILITY Commercial Form Liability Coverage American Fire and Casualty (name of insurer) BODILY INJURY Each Person $ ______ _ Each Accident $ ------- Project No. 2015-10 PROPERTY DAMAGE Each Accident or Combined Single Limit $ 1.000.000 Policy No. BAA56220333 Expiration Date __ 1_1 _-1_0_-2_0_15 __ BUILDER'S RISK "ALL RISK" This is to certify that the following policy has been issued by the below-stated company in conformance with the requirements of the project documents and is in force at this time. NIA (Name of insurer) Policy No. --~------Expiration Date _______ _ Limits of Liability: Deductible: ---------= = = = = =yt= == = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = J l _n_' 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 Agre:=:!__enthe City and the insured. By: ~ ~ Dated: / () .~ I =/ 20 l S-- Attach Certificate of Insurance and Additional Insured Endorsement on company forms. City of Cupertino Senior Center Exercise Room Floor Replacement 00530 - 5 Insurance Forms 11/10/14 ~Liberry ~Mutual. INSURANCE Named Insured Coverage Is Provided In: West American Insurance Company - a stock company Common Policy Declarations Agent Policy Number: BKW (15) 56 22 03 33 Policy Period: From 11/10/2014To11/10/2015 12:01 am Standard Time at Insured Mailing Location HY FLOOR & GAMELINE PAINTING (866) 966-8928 ASERO INSURANCE SERVICES, INC. SUMMARY OF LOCATIONS This policy provides coverage for the following under one or more coverage parts. Please refer to the individual Coverage Declarations Schedules, or, the individual Coverage Forms for locations or territory definition for that specific Coverage Part. 000 I 961 Commercial St, San Carlos, CA 94070-403 I POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER CG 00 01 04 13 CG 20 10 04 13 CG 20 37 04 13 CG 21 47 12 07 CG 21 65 12 04 CG 21 67 12 04 CG 21 70 01 08 CG 21 76 01 08 CG 21 86 12 04 CG 21 88 01 07 CG 22 79 04 13 CG 24 04 05 09 CG 24 26 04 13 TITLE Commercial General Liability Coverage Form -Occurrence Additional Insured -Owners, Lessees or Contractors -Scheduled Person or Organization Additional Insured -Owners, Lessees or Contractors -Completed Operations Employment-Related Practices Exclusion Total Pollution Exclusion with a Building Heating, Cooling and Dehumidifying Equipment Exception and a Hostile Fire Exception Fungi or Bacteria Exclusion Cap on Losses From Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion -Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism In lving Nuclear, Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) Exclusion -Contractors -Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition In witness whereof, we have caused this policy to be signed by our authorized officers. Dexter Legg Secreta1y To report a claim, call your Agent or 1-800-362-0000 DS 70 21 01 08 56220333 N0141462 270 Paul Condrin President GGAOPPNO INSURED COPY 003951 PAGE 58 OF 292 -~- 11/10/14 ~Libert): \P) Mutual. Coverage Is Provided In: West American Insurance Company - a stock company INSURANCE Common Policy Declarations Named Insured Agent Policy Number: BKW (15) 56 22 03 33 Policy Period: From 11/10/2014To11/10/2015 12:01 am Standard Time at Insured Mailing Location H Y FLOOR & GAMELINE PAINTING (866) 966-8928 ASERO INSURANCE SERVICES, INC. POLICY FORMS AND ENDORSEMENTS -CONTINUED This section lists all of the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER CG 25 03 05 09 CG 32 34 01 05 CG 70 02 01 01 CG 80 08 10 09 CG 84 94 12 08 CG 84 99 01 12 CG 88 10 04 13 CG 88 60 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 89 58 09 10 CG 89 98 04 12 CG 90 40 01 13 CG 90 41 01 13 CL 01 00 03 99 CL 01 62 08 06 CL 06 00 0 I 08 CL 07 00 10 06 CL 16 60 06 06 CM 76 13 07 13 CP 00 10 04 02 CP 00 30 04 02 CP 00 90 07 88 CP 01 40 07 06 CP 04 49 12 05 CP I 0 30 04 02 CPl0320808 CP 10 45 08 99 TITLE Designated Construction Project(s) General Aggregate Limit California Changes General Endorsement Employee Benefits Liability Coverage Form Exclusion -Consolidated Insurance Programs Wrap-Up Non-Cumulation Of Liability Limits Same Occurrence Commercial General Liability Extension Each Location General Aggregate Limit Exclusion -Earth Movement Medical Expense At Your Request Etidorsement Exclusion -Asbestos Liability Cyber Liability-Amendment of Coverage B--Personal Injury and Advertising Injury Amendment of Other Insurance Condition California Exclusion -Residential Construction Operations Amendment Of Coverage B Personal And Advertising Injury Common Policy Conditions Amendato1y Endorsement -California Certified Terrorism Loss Virus or Bacteria Exclusion Conditional Nuclear, Biological, And Chemical Terrorism Exclusion -(With Limited Exception) Waiver of Theft Deductible Building and Personal Property Coverage Form Business Income (a ) Coverage Form Commercial Property Conditions Exclusion of Loss Due to Virus or Bacteria California Changes -Replacement Cost Causes of Loss -Special Form Water Exclusion Endorsement Earthquake and Volcanic Emption Endorsement (Sub-Limit Form) To report a claim, call your Agent or 1-800-362-0000 OS 70 21 01 08 56220333 N0141462 270 GCAOPPNO INSURED COPY 003951 PAGE 59 OF 292 11/10/14 ~LiberlJ. \:P) Mutual INSURANCE Named Insured Coverage Is Provided In: West American Insurance Company - a stock company Common Policy Declarations Agent Policy Number: BKW (15) 56 22 03 33 Policy Period: From 11/10/2014To11/10/2015 12:01 am Standard Time at Insured Mailing Location HY FLOOR & GAMELINE PAINTING (866) 966-8928 ASERO INSURANCE SERVICES, INC. POLICY FORMS AND ENDORSEMENTS -CONTINUED This section lists all of the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER CP 72 97 04 02 CP 88 04 03 10 CP 89 00 12 12 CP 90 58 12 12 CP 90 59 12 12 CP 90 65 12 12 IL 00 03 09 08 IL 00 17 11 98 IL 00 21 09 08 IL 01 02 05 05 IL 01 04 09 07 IL 02 70 09 12 IL 09 35 07 02 IL 09 52 03 08 IL 09 96 01 07 IL 88 15 07 12 IM 20 09 12 04 IM 22 00 06 04 IM 70 00 04 04 IM 70 34 06 04 IM 71 00 06 04 LC 87 10 05 00 TITLE Equipment Breakdown Enhancement Endorsement -Special Form Removal Permit Property Extension Plus For Constrnction California Changes -Increased Cost of Construction Identity Theft Incident Administrative Services and Expense Coverage Earthquake Sprinkler Leakage Coverage Schedule -Location Sublimit Calculation of Premium Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement (Broad Form) California Changes -Actual Cash Value California Cha_nges California Changes -Cancellation and NonRenewal Exclusion of Certain Computer-Related Losses Cap on Losses From Certified Acts of Terrorism Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical Terrorism (Relating to Dispostion of Federal Terrorism Risk Insurance Act) Conditional Exclusion of Terrorism -Involving Nuclear, Biological or Chemical Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) Amendatory Endorsement -California Amendato1y Endorsement -Fungus Exclusion And Limited Coverage Deleted Contractors' Equipment Coverage Tools Endorsement Installation Floater Coverage Punitive or Exemplmy Damages Exclusion To report a claim, call your Agent or 1-800-362-0000 DS 70 21 01 08 56220333 N0141462 270 GCAOPPNO INSURED COPY 003951 PAGE 60 OF 292 N 00 0 11/10/14 ~Liberfy \Pl Mutual. INSURANCE Named Insured Coverage Is Provided In: American Fire and Casualty Company - a stock company Common Policy Declarations Agent HY FLOOR & GAMELINE PAINTING (866) 966-8928 Policy Number: BAA (15) 56 22 03 33 Policy Period: From 11/10/2014To11/10/2015 12:01 am Standard Time at Insured Mailing Location ASERO INSURANCE SERVICES, INC. POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER AC 00 31 01 14 CA 00 Ol 03 06 CA 01 43 05 07 CA 03 05 02 97 CA 04 24 04 06 CA 21 54 09 09 CA 23 84 01 06 TITLE Changes in Your Policy Business Auto Coverage Form California Changes California Changes -Waiver of Collision Deductible California Medical Payments California Uninsured Motorists Coverage -Bodily Injury Exclusion of Terrorism CA 23 94 03 06 CA 70 02 11 02 Silica or Silica-Related Dust Exclusion for Covered Autos Exposure General Endorsement CA 85 47 12 93 CA 85 53 12 93 CA 87 57 08 13 CA 88 10 01 13 CA 99 44 12 93 IL 00 03 09 08 IL 00 17 11 98 IL 00 21 09 08 IL 02 70 09 12 Temporary Substitute Auto -Physical Damage Insurance Recreational Trailers and Boat Trailers Punitive or Exemplary Damages Exclusion Busine.ss Auto Coverage Enhancement Endorsement Loss Payable Clause Calculation of Premium Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement (Broad Form) California Changes -Cancellation and NonRenewal In witness whereof, we have caused this policy to be signed by our authorized officers. Dexter Legg Secretaiy To report a claim, call your Agent or 1-800-362-0000 DS 70 21 01 08 56220333 N0141462 270 GCAOPPNO Paul Condrin President INSURED COPY 003952 PAGE 14 OF 82 CITY OF a CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project No. 2015-10 Project Title and Number: Senior Center Exercise Room Floor Replacement Project No. 2015-10 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, 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 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 1. Insurance Company: West American Insurance Company /American Fire and Casualty 2. Insurance Policy Number: __ B_K_W_56_2_2_0_33_3_/B_A_A_56_2_2_03_3_3 _________ _ 3. Effective Date of this Endorsement: October 14 20 15 ------------------- 4. Insured: H.Y. Floor & Gameline Painting, 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. I, Lisa Koo (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. City of Cupertino Senior Center Exercise Room Floor Replacement 00530 - 6 Insurance Forms Names of Agent/ Agency: Asero Insurance Services 200 N. Almaden Blvd. 3rd Floor San Jose, CA 95110 City of Cupertino Senior Center Exercise Room Floor Replacement 00530 - 7 Project No. 2015-10 Title: Account Executive Telephone: 408 ~ 2300 Facsimile: 408 271 1802 -------- Insurance Forms CITY OF Project No. 2015-10 fl CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT Project Title and Number: Senior Center Exercise Room Floor Replacement Project No. 2015-10 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 Project No. 2015-10 Senior Center Exercise Floor Replacement POLICY INFORMATION West American Insurance Company 1. Insurance Company: _________________________ _ 2. Insurance Policy Number:_B_KW_5_6_22_0_3_3_3 ________________ _ 3. Effective Date of this Endorsement: October 14 20 15 ------------------ 4. Insured: H.Y. Floor & Gameline Painting, Inc. ------------------------------ 5. Additional Insured: City of Cupertino, its directors, officers, agents and employees. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95014. I, Lisa Koo (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: ~b, ~ (Original signature required on all Endorsements furnished to the District) Names of Title: Account Executive Agent/ Agency: Asero Insurance Services Address: 200 N. Almaden Blvd. 3rd Floor Telephone: 408 ~ 2300 San Jose, CA 95110 City of Cupertino Senior Center Exercise Room Floor Replacement Facsimile: 408 -21.i 1802 00530 - 8 Insurance Forms CITY OF a Project No. 2015-10 CUPERTINO WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: Senior Center Exercise Room Floor Replacement Project No. 2015-10 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: State Compensation Insurance Fund 2. Insurance Policy Number: __ 9_0_8_4_22_0_-_15 _________________ _ 3. Effective Date of this Endorsement: October 14 20 15 ------------------ 4. Insured: H.Y. Floor & Gameline Painting, 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, California 95014. I, Lisa Koo (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. 1 . Y Signature of Authorized Representative: ~ (Original signature required on all Endorsements furnishJd to the District) Names of Agent/ Agency: __ A_s_e_ro_ln_s_u_ra_n_c_e_S_e_rv_ic_e_s ___ _ Title: Account Executive Address: ------------------ 200 N. Almaden Blvd. 3rd Floor Telephone: 408 __E_!_ 2300 San Jose, CA 95110 Facsimile: 408 ____ni 1802 END OF DOCUMENT City of Cupertino Senior Center Exercise Room Floor Replacement 00530 - 9 Insurance Forms ........ ~.9.9~~ ...... 9.~RT~.F.!_gf.\Tt.; .. 9.F ... ~.~.A~·'·~·~.TX.J.N.~.ld.f~.A~G..~ ..................................... ~/ _D1~-~~~-~;o_D~;_i _ 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 certificale does not confer rights to the certificate holder in lieu of such endorsement(s). Producer License Number: OA91339 CONTACT NAME: Lisa Koo l-------------~-------------PHONE (NC, No, Ext): 866-966-8928 / FAX (NC, No): 408-271-1802 Asero Insurance Services, Inc. 200 N. Almaden Blvd., 3rd Floor San Jose, CA 95110 E-MAIL certs@aseroins.com ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC# INSURED H.Y. Floor & Gameline Painting, Inc. 961 Commercial Street San Carlos, CA 94070 COVERAGES CERTIFICATE NUMBER· INSURER A: West American Insurance Company 44393 INSURER B; American Fire and Cas. 24066 INSURER C: State Compensation Ins. Fund. 35076 INSURER D: Travelers Prop. Cas. Co. of America 25674 INSURERE; 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DDIYYYYl IMM/DDIYYYYl EACH OCCURRENCE $ 1,000,000 181 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 0 0 CLAIMS-MADE 181 OCCUR PREMISES (Ea occurrence) D x BKW56220333 11-10·2014 11-10-2015 MED EXP (Any on person) $ 10,000 A D PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 0 POLICY 181 PROJECT 0 LOG $ OOTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 181 ANY AUTO (Ea accident) 0 ALL OWNED AUTOS BODILY INJURY (Per Person) $ 0 SCHEDULED AUTOS BAA56220333 11-10-2014 11-10-2015 BODILY INJURY (Per Accident) $ B 181 HIRED AUTOS PROPERTY DAMAGE $ 181 NON-OWNED AUTOS (Per accident) D 181 UMBRELLA LIAB 181 OCCUR EACH OCCURRENCE $ 7,000,000 0 EXCESS LIAB 0 CLAIMS-MADE ZUP·81M37853·15-NF AGGREGATE $ 7,000,000 D 07-24-2015 11-10-2016 0 DEDUCTIBLE 181 RETENTION $ 10,000 WORKERS COMPENSATION IOI PER STATUTE UOTH- AND EMPLOYERS' LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ 1,000,000 c OFFICER/MEMBER/EXCLUDED? D NIA 9084220-15 01-01-2015 01·01-2016 (Mandatory In NH) E.L DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF E.L. DISEASE -POLICY LIMIT $ 1,000,000 OPERATION below DESCRIPTION OF OPERA TIONS/LOCATIONSNEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Project No. 2015-10 Senior Center Exercise Floor Replacement 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, and the State of California, and its officers, agents and employees are named as additional insureds per endorsement attached. Waiver of Subrogation applies to Workers Compensation per attached. Insurance is Primary and Non-Contributory when required by written contract. NOTE: 30 DAYS NOTICE OF CANCELLATION WILL BE GNEN EXCEPT 10 DAYS FOR NON-PAYMENT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH City of Cupertino THE POLICY PROVISIONS 10300 Torre Ave. AUTHORIZED REPRESENTATIVE Cupertino, CA 95014-3202 Jibl~fh\- ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. Insured: H.Y. Floor & Gameline Painting, Inc. Policy No: BKW56220333 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SUBJECT PAGE ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1-3 PRIMARY AND NON-CONTRIBUTORY -ADDITIONAL INSURED EXTENSION 3 ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 3-4 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU 4 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. G. 1 b. c. d. CG 88100413 ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT Paragraph 2. under Section 11 _ Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: a Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or Premises or facilities rented by you or used by you; or The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury'', "property damage", or "personal and advertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury'' or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. (b) The construction, erection, or removal of elevators; or ( c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: ( 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury'' or "property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suif' by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV_ Commercial General liability Conditions. 2 With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I -Coverage A • Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury'' or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury" or "property damage" occurs. c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury" or "property damage" 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 (1) 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 other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED. OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy. 3 With respect to the insurance afforded to these additional insureds, the following is added to Section Ill . 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: a. Required by the contract or agreement; or b. 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. H PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. b The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ADDITIONAL INSUREDS -EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1 The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suif' to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2 The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section Ill -Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. P. WANER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US_ WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV. Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or ''your work" done under a contract with that person or organization and included in the "products-completed operations hazard" provided: 1 . You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. POLICY NUMBER: BKW56220333 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations BLANKET ADDITIONAL INSURED AGREED WORK DESCRIBED IN VVRfflNG IN THE CONTRACT, WRITTEN CONTRACT, AGREEMENT, PERMIT AGREEMENT OR PERMIT. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and 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 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -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. CG20370413 ©Insurance Services Office, Inc., 2012 Page 1of1 POLICY NUMBER: BKW56220333 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Description of Construction Project ALL NAMED INSURED'S PROJECTS. Location of Construction Project ALL NAMED INSURED'S PROJECTS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes le- gally obligated to pay as damages caused by "occurrences" under Section I -Coverage A, and for all medical expenses caused by ac- cidents under Section I -Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" in- cluded in the "products completed oper- ations hazard", and for medical expenses under Coverage C regardless of the num- ber of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Des- ignated Construction Project General Ag- gregate Limit for that designated con- struction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construc- tion Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense con- tinue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Desig- nated Construction Project General Ag- gregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1of2 B. For all sums which the insured becomes le- gally obligated to pay as damages caused by "occurrences" under Section I -Coverage A, and for all medical expenses caused by ac- cidents under Section I -Coverage C, which cannot be attributed only to ongoing oper- ations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Ag- gregate Limit or the Products-completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Des- ignated Construction Project General Ag- gregate Limit. C. When coverage for liability ans1ng out of the "products-completed operations hazard" is provided, any payments for damages be- cause of "bodily injury" or "property dam- age" included in the "products-completed op- erations hazard" will reduce the Products-completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the au- thorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section Ill -Limits Of Insur- ance not otherwise modified by this endorse- ment shall continue to apply as stipulated. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 2 of 2 COMMERCIAL AUTO CA 8810 0113 Policy No: BAA56220333 Insured: H.Y. Floor & Gameline Painting, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGE INDEX SUBJECT PROVISION NUMBER ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT AMENDED FELLOW EMPLOYEE EXCLUSION EXTENDED CANCELLATION CONDITION WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION II -LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: ( 1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: 3 5 23 20 (1) If there is similar insurance or a self-insured retention plan available to that organization; (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II -LIABILITY COVERAGE, paragraph A.1. -WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II -LIABILITY, exclusion 8.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV -BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION CA 8810 0113 COMMON POLICY CONDITIONS, paragraph A.-CANCELLATION condition applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancellation. © 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. ENDORSEMENT AGREEMENT l• STATE COIV!Pi=NSATION INSURANCE FUND WAIVER OF SUBROGATION BLANKET BASIS REP 31 9084220-15 RENEWAL HOME OFFICE SAN FRANCISCO EFFECTIVE JANUARY 1, 2015 AT 12. 01 A.M. NA 2-25-86-00 PAGE 1 OF ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC AND EXPIRING JANUARY 1, 2016 AT 12.01 A.M. ST AND ARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME HY FLOOR AND GAMELINE PAINTING, 961 COMMERCIAL STREET SAN CARLOS, CA 94070 WE HAVE 1HE 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 1HE SCHEDULE. 1HIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN 1HIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF 1HE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR 'WHOM 1HE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AN~;;,ANCISCO, DECEMBER AUTHORIZED REPRES~ 31, 2014 IL~ .dl~~ PRESIDENT AND CEO 2572 1