16-018 Silver Cloud Tile & Marble, Inc., Re-Grout Two Bathroom FloorsCl1'Y Of' AGREEMENT
CITY OF CUPERTINO
10300 Torre Avenue
Cupertino, CA 95014
CUPERTINO 408-777-3200
THIS AGREEMENT, made and entered into this a day of, ~-{ • is by and
between the CITY OF CUPERTINO (Hereinafter "CITY") and SILVER CLOUD TILE & MARBLE,
INC. 10605 Foothill Ave. Gilroy, CA. 95020 404MJ42w2093
Hereinafter "CONTRACTOR'), in consideration of their mutual covenants, the parties agree as
follows:
CONTRACTOR shall provide or furnish the following specified services and/or materials: Re-grout
Two Bathroom Floor$).
Check box if services are further described in an Exhibit. CZ)
EXHIBITS: The following attached exhibits hereby are made part of this Agreement: Exhibit A.
TERM: The services and/or materials furnished under this Agreement shall commence on
February 10 2016 and shall be completed no laterthan April 11 2016.
COMPENSATION: For the full performance of this Agreement, CITY shall pay CONTRACTOR: i 2,975.00 __
California Labor Code, Section 1771 requires the payment of prevailing wages to all workers
employed on a Public Works contract in excess of $1,000.00.
GENERAL TERMS AND CONDITIONS
Hold H~rmless. Contractor shall, to the fullest extent allowed by law, indemnify, defend, and hold
harmless the City and its officers, officials, agents, employees and volunteers against any and all
liability, claims, stop notices, actions, causes of action or demands whatsoever from and against any
of them, including any injury to or death of any person or damage to property or other liabifity of any
nature, arising out of, pertaining to, or related to the performance of this Agreement by Contractor or
Contractor's employees, officers, officials, agents or independent contractors. Contractor shall not
be oblig~ted under this Agreement to indemnify City to the extent that the damage is caused by the
sole or active negligence or willful misconduct of City, its agents or employees. Such costs and
expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all
other costs and fees of litigation.
SaJbcontracting. Contractor has been retained due to their unique skills and Contractor may not
substitute another, assign or transfer any rights or obligations under this Agreement. Unless prior
written consent from City is obtained, only those people whose names are listed this Agreement
shall be used in the performance of this Agreement.
Assignment. Contractor may not assign or transfer this Agreement, without prior written consent
of CITY.
Page 1of3
Short Form Agreement
lnsu.m~nca. Contractor shall file with City a Certificate of Insurance consistent with the following
requirements
Coverage:
Contractor shall maintain the following insurance coverage:
(1) W2rkers' Compensation:
Statutory coverage as required by the State of California.
(2) Liability:
Commercial general liability coverage in the following minimum limits:
Bodily Injury: $1,000,000 each occurrence
$2,000,000 aggregate-all other
Property Damage: $500,000 each occurrence
$1,000,000 aggregate
If submitted, combined single limit policy with aggregate limits in the amounts of $2,000,000 will be
considered equivalent to the required minimum limits shown above.
(3) Automotive:
Comprehensive automobile Hability coverage in the following minimum limits:
Bodily injury: $500,000 each occurrence
Property Damage: $500, 000 each occurrence
or
Combined Single Limit: $1,000,000 each occurrence
Subrogation Waiver. Contractor agrees that in the event of loss due to any of the perils for which it
has agreed to provide comprehensive general and automotive liability insurance, Contractor shall
look solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer
providing comprehensive general and automotive liability insurance to either Contractor or City with
respect to the services of Contractor herein, a waiver of any right to subrogation which any such
insurer of said Contractor may acquire against City by virtue of the payment of any loss under such
insurance.
Termination of Agreement. The City reserves the right to terminate this Agreement with or
without cause with a seven (7)~day notice. The Contractor may terminate this Agreement with or
without cause with a seven (7)~day written notice.
Non-Discrimination. No discrimination shall be made in the employment of persons under this
Agreement because of the race, color, national origin, ancestry, religion, gender or sexual orientation
of such person
Interest of Contractor. It is understood and agreed that this Agreement is not a contract of
employment in the sense that the relationship of master and servant exists between City and
undersigned. At alt times, Contractor shall be deemed to be an independent contractor and
Contractor is not authorized to bind the City to any contracts or other obligations in executing this
Agreement. Contractor certifies that no one who has or will have any financial interest under this
Agreement is an officer or employee of City. City shall have no right of control as to the manner
Page 2 of3
Short Form Agreement
Contractor performs the services to be performed. Nevertheless, City may, at any time, observe the
manner in which such services are being performed by the contractor.
The Contractor shall comply with all applicable Federal, State, and local laws and ordinances
including, but not limited to, unemployment insurance benefits, FICA laws, and the City business
license ordinance.
Changes. No changes or variations of any kind are authorized without the written consent of the
City.
CONTRACT co .. oRDINATOR and representative for CITY shall be:
NAME: __ ,...C ...... hr;.,;;,.is........,,.O""""rr __________ DEPARTMENT: Public Works
This Agreement shall become effective upon its execution by CITY, in witness thereof, the parties
have executed this Agreement the day and year first written above.
CITY OF CUPERTINO:
By,~~
1tl Tit!e: .S vfe../'VcSo....-
oc. Sec. #orTax l.D .:t <O) --Coo -s 3:r:z Co r qLr c<.. ·-f <c; :,,,
EXPENDITURE DISTRIB-'-U_T.;_;;IO_N_~--,-__,.,.~,..,,,,.........., APPROVALS
DEl?.AR+M~ . D
,,,.. ~ --PATE
:5' I (p $2,975
Page 3 of3
Short Fonn Agreement
i>HOOUCT 118
Jlrnponal No. of
Exhibit "A'
Wa hereby submit sp11eif1,catl1ons estimates for:
2
lilt> {arnµn)l~ hereby to 1urnish material and labor -complete in accordance with above specifications, for the sum of:
, ________ ,,,, ___ _ _ dollars{$ ---------___ ).
All malarial Is guaranteed to be as specified. All work 10 be oompleted in a workmanlike
manner acc:ording to standard practices. Any alteration or deviation from above specltlcalions
Involving extra costs will be exec~rtad only upon writter\ orders, and will llacome an extra
charge over and above tha estimate, All agreements con!lt\gent upon sWkes, accldenls or
delays beyond our control. Owoar to carry lite, tornado Md other necessary lnsvmntt!. Our
workers ar,; fully covered by Worl<mun's Componsalion Insurance,
!if f.~ f flptl!Ud ·-The abow. prices, speclficatlons
'"'""'"'~ ~--~-.. Signature~-· _._ .... ~ .... ---....... ,. ... ~ ..
/ te: This proposal may be withd~awf\ by us if not accepted within ---·~-.. -~--.. -~--
Pro er ( 4 0 8 ) 2 9 5 -119 5
Sanfilippo & Sons Insurance Services LLC P.O. Box 471, S.J. 95103
Insured SCLOUOl-XXX
Silver Cloud Tile And Marble Inc.
19605 Foothill Ave
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
Company State Compensation Insurance Fund A
Company
B
Company
c
Company
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
THIS CERTIFICATE MAY BE: ISSUED DR 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.
co
LTR TYPE OF INSURANCE
GENERAL LIABILITY
Commercial General Uabllity
Clair11s Made Ooccur
Owner's & Contractor's Protective
Umbrella Form
Other Than Umbrella Form
POLICY POLICY
POLICY NUMBER EFFECTIVE EXPIRATION
DATE DATE LIMITS
General Aggregate
Products-Com lated Ops A g
Personal & Advertising Injury
Each Occurrence
Fire Damage (any 1 fire)
Medical Ex ense {any one erson)
Combined Single Limit
Bodily Injury
(per person)
Bodily Injury
(per accident)
Property Damage
Auto Only -Eacg Accident
Other Than Auto Only
Eaoh Accident
A re ate
Each Occurrence
Aggre ate
Statutory limit
A
WORKERS' COMPENSATION
EMPLOYERS' LIABILITY
The Proprietor/ Partners/Executive Officers are:
9025032-15 10/01/15
OTHER
Incl
Exel
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
11 California Operations
City Of Cupertino 10555 Mary Ave Cupertino, CA. 95014
EL Disease-Ea Em lo ee
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
__Jj}• DAYS WRITTEN NOTlCE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIAS 'rrr OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE-
SENTAt E~.
Aut or e epresen ve _.,,
~/-~.r<:
~Rd CERTIFICATE OF LIABILITY INSURANCE I l.lAT~'MIDriVY) 0 19 16
THIS CERTlflCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE ooes NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFfORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE ooes NOT CONSllTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlflcar. holdet Is an ADDITIONAL INSURED, the pollcy(iel'I) must be ttndor'Sed. If SUBROGATION IS WAIVED, subject to
the tenns and eondltlons of the policy, certain polh;:IOB may req1,1lri;1 an endorsem11;mt. A statement on this certificate does not confer rights to tile
certificate holdet in Heu of such endorsement(s),
PROUUCl!A ~Xi~7 .. ' WALT FIRSTSROOR
WALT ~IRSTSROOK INSui:tANCK AGBNC)"' _r.&N:ct '41.)' 408-817-9408 I ~ .. ~w 4oa-3oo-9423
1155 MERIDIAN AVE STK 112 e.i,IAIL _A@FlliSS; ·-SAN JOSE, CA. 9S12S 1Ns,l,IRE8($) Al'~OltDING <;C'IERl\.Ge NAIC_~-
~ ,-"
-~NSUREiFI. p.: LIBBR'l'Y MO'l'UAL INSURUCE .. -
INSURi;o INSURER l!I: ·-srLVER CLOUD TILK AND WUl.BLE, INC -
!N$1,1R!R C: .. 10605 FOOTHILL A'l/BN'UE INSURERD: _ .. ··-GILltOY, 95020 CA. INSUR!RI!: ·" ,. .. _
INSUR!!R ~:
COVERAGES CERTIFICATE NUMBER· i:!EVISION NUMBER·
THIS IS TO CEmlFY THAT THE POLICIES Of INSURANCE LISTED SELDW HAVS BEEN ISSUED TO '!'HE INSURED NAMED AflOVE FOR THE POLICY PERIOD
INDICATED. NQTWllHSTANOtNG ANY f'l.EOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENi WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN. THE INSURANCE AFFORDED SY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAIO CLAIMS. w:~ ..;ooi.SUBR ,.':Slr!%'/ri~1 1,oLICYEXP -
TYPI! OF IN5URAlllCI! ........... ,~ !'DLICY NUMllER LIMITS
GENERAL L.IAl!llLITY i;ACH OCCURRENCE $ l,000,000 ...__....
COMMERCIAL GENE!'w. LIABILITY D""""'~-JQ_n.o; .. 'cu _s l,000,00Q. -,_Ef.:I;t.!l~E!i (lil 2!l!;umin""l ~ Cl,AIMS·MADE D OCCVR MEO li!CPIANone parson) $ 10,000
F'EJ'l.S.ONAL & ADV INJURY s 1 000 000 ---· ·--•'
GENER.Ill.AGGREGATE s 2,000.000 -nL AGGRE~E !.IMIT nS PER; PRODUCTS -0'!MF>/OP AGG $
POLICY I ~~9,: LOC $
AUT0M(JBILI! LIAlllLITY :SAS{l7)56339089 01/31/16 Ol/31/:t. 7 )f.~~Jll~llNGLE Ll~l·l· ~ -~ ·-
Mf'f AUTO EIOOIL Y INJVRY (~r poo!OnJ s --ALL OWNED ~l_ SCHEDULED
.. _
OOC>I!. y INJVRY (Per accident) s -AUTOS AUTOS .--
H1,.,;DAUTOS NON-OWNIOD ~ERTY OAMl'ite s --AUTOS -~i9'1nt) -$
UMl'.JRE!~!.A LIA.II I -I OCCUR EA~H OCCURRENCE s -·-
i;xcESSUAl!I CLAIMS·MADE ~(>~RI;GATE -~" -·
DED I I AETENTION it s
WQll:KERS COMPEN!l.'TIQtl ~srn1~~/ jOJ~· ANO !MPLOYl!"S" LIAllll.J'J'V' 'l'/N tl.l.Y.
ANY PROPRIETQl'IJj:>ARTNERl~XECIJTIVE D NIA E,L, EACH ACCIDENT s OFFICERIMEMEll:R ~l(CLl)DEM (M~lnNH) E.L. O!Sl'ASE • i;:A !'MPLOYEE $
~lfc~~~ ~~PERA'riONS b.Jow E.L. DISEASE -POLICY ~IMIT $
D!SCIUl'TION OF oPIOMTION$/ LOCATIONS I VEHICLl!S (Atl.otih ACORD 101, AddldQll•l ftmn~tka 9che4uto, Jf lllQill •p""o I• li!IQull'$dl
CERTIFICATE HOLDER
CI~Y OP CUPBRTINO
ACORD 25 (2010/05)
CANCELLATION
SHOULD ANY OF THE AB0'¥'E 0£$C::RIBl!.D POLICIES SE CANCELLED BEf"O~E
THE EXPIRATION DATIS THEREOF', NOTICI: WILL BE 01;1.,IV~RED IN ACCOROAHCE WITH THE POLICY PROVISIONS.
111-010 CORO CORPORAllON. All tights reserved.
The ACORD nama and logo are regi&t(lrad marks of CORD
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12/17/15
~Libertx ~ Mutuat
INSURANCli
ITEM ONE:
Named Insured
Coverage Is Provide~ lt1:
Ohio Sec1,1rity Insurance Company • a stock company
Business Automobile
Polley Declarations
~gant
SILVf:!{ CLOUD TILE AND MARBLf.I, INC (707} 773-360 I
AGENCY S8RVTCE BUREAU
ITEM TWO: SCHEDULE OF COVERAGES AND COVERED AUTOS
Polley Number:
BAS (17} 56 33 90 89
Policy Period:
From 01/31/2016 To 01/31/2017
12:01 am Standard Tima
at Insured Malling Location
This policy provides only those coverages where a charge is shown in the premium column below. Each of these
coverages will apply onty to those "autos" ~hown as covered "autos". "Autos" arc shown as covered "autos'' for a
particular coverage by the entry of one or more or the symbols from the COVERED AU·ro Section of thi; Husincss
Auto Co~erage Form next tt; the name of the coverage.
*See Business Auto Coverage Form CA 00 01 for Cove1·ed Auto Symbol Descriptions
COVERAGES LIMIT
Liability Insurance $1,000,000 each 11ccident
Covered Auto Symbol(s) 01 111
Medical Payments $5,000 per person
Covered Auto Symbol(~) 07*
Uninsured Motorists $500,000 each accident
Califomia California Uninsured Motorists Coverage • Bodily lnjuey
Covered Auto Symbol(s) 07*
Physical Damage Refer to Item Three
Comprehensive
Covered A11t() Symbol(s) 07*
Collision
Covered Auto Symbol(~) 07-r.
Mi!Cellaneous Coverages
Business Auto Enhancement Endorsement
Terrorism Coverage
Total Provisional Charges:
n.111JPQl't a tJlalm, call your Ag1mt or 1-IW0-362-1)(}1)()
DS 70 43 01 US
56338088 POLSVC:S 270 INSUHEIJ COP\'
PREMIUM
$1,975.00
$252.00
$279.00
$258.00
$510.00
$50.00
$17.00
$3,341.00
NQtet Thi,f iJ not a bJl/
001258 PAGt 15 OF 62
12/17/15
~Libcrtr. ~Mutual
INS URA NC!
Named Insured
C<>verage 111 Provide~ In:
Ohio Security 1m:urnnce Company • a stock company
Buslnes$ Automobile
Policy Declarations
Agent
SILVER CLOUD TILE AND MARBLE, INC (707) 773-3601
Policy N1,11nber: ·
BA$ (17) 56 3:i 90 89
Policy Period; From 01/31/2016 Tn 01/31/2017
12:01 am Standard Time
at Insured Mailing Location
AGENCY SERVICE BUREAU
!l-JMMARY QF COVERE£l VEHICLES
UNIT YEAR MAKEJMODEL
001 2001 DODGE 3500
002 2001 DODGE 3500
003 2006 DODGE 3500
To report ff c/fl/m, call your Agent or 1·800-362-0000
OS 70 43 01 08
56339089 POl,$VCS 270
VIN TERR ST CLASS ZIP SYM/COST
3B6MC3661 IMS24833 074 04 21189 95020 $26,880
3B6MC366 71 M542432 074 04 21189 95020 $33,000
3D7MX48C I 6G 156609 074 04 211S9 95020 $39,900
GCA~PPNlJ INSURl:D COPY PNii:. 10 or s~
en :::J" -6'
-I 0
CUPER'T'INO
City of Cupertino
Service Center
10555 Mary Avenue
CUPERTINO, CA 95014
www.Cupertino.org
VENDOR 320 -Silver Cloud Tile and Marble, Inc.
Silver Cloud Tile and Marble, Inc.
10605 Foothill Drive
GILROY, CA 95020
REFERENCE#
QUANTITY HJSll& DESCRIPTION
1.0000 Each
City of Cupertino
Service Center
10555 Mary Avenue
CUPERTINO, CA 95014
www.Cupertino.org
Purchase Order
No. 2016-00000446
DATE 02/18/2016
PURCHASE ORDER NUMBER MUST APPEAR ON
ALL INVOICES, SHIPPERS, BILL OF LADING AND
CORRESPONDENCE
DELIVER BY
SHIP VIA
FREIGHT TERMS
PAGE 1 of1
ORIGINATOR: Chylene Osborne
DESCRIPTION: Re-grout two bathroom floors
UNIT COST TOTAL COST
2,975.0000 $2,975.00
100-87-832 900-990 -Capital Outlay Special Projects -PW 2,975.00
~ TOTAL DUE $2,975.00 •
DATE 02/18/2016
Authorized Signature
Special Instructions