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18-024 G Bortolotto & Company, 2018 Pavement Maintenance Phase 1 Project Contract This public works contract("Contract") is entered into by and between the City of Cupertino ("City"), a municipal corporation, and G Bortolotto &Company, Inc. ("Contractor"), for work on the 2018 Pavement Maintenance Phase 1 Project("Project"). The parties agree as follows: 1. Award of Contract. In response to the Notice Inviting Bids, Contractor has submitted a Bid Proposal and accompanying Bid Schedule, a copy of which is attached for convenience as Exhibit A, to perform the Work to construct the Project. On November 28, 2017, City authorized award of this Contract to Contractor for the amount of Contractor's bid. 2. Contract Documents. The Contract Documents incorporated into this Contract include and are comprised of all of the following: 2.1 Notice Inviting Bids; 2.2 Instructions to Bidders; 2.3 Addenda, if any; 2.4 Bid Proposal and attachments thereto; 2.5 Contract; 2.6 Payment Bond, Performance Bond and, if required, a Warranty Bond; 2.7 General Conditions; 2.8 Special Conditions; 2.9 Project Drawings and Specifications; 2.10 Change Orders, if any; 2.11 Notice of Award; 2.12 Notice to Proceed; 2.13 City of Cupertino Standard Details; and 2.14 The following: Typical Sections and Keycut Details, Caltrans Standard Details, Work Hour Restrictions 3. Contractor's Obligations. Contractor agrees to perform all of the Work required for the Project, as specified in the Contract Documents. Contractor must provide, furnish, and supply all things necessary and incidental for the timely performance and completion of the Work, including all necessary labor, materials, supplies, tools, equipment, transportation, and utilities, unless otherwise specified in the Contract Documents. Contractor must use its best efforts to complete the Work in a professional and expeditious manner and to meet or exceed the performance standards required by the Contract Documents. 4. Payment. As full and complete compensation for Contractor's timely performance and completion of the Work in strict accordance with the terms and conditions of the Contract Documents, City will pay Contractor$3,077,777.77(the"Contract Price")for all of Contractor's direct and indirect costs to perform the Work, including all labor, materials, supplies, equipment, taxes, insurance, bonds and all overhead costs, in accordance with the payment provisions in the General Conditions. 5. Time for Completion. Contractor will fully complete the Work for the Project within 80 Working days from the commencement date given in the Notice to Proceed ("Contract Time"). By signing below, Contractor expressly waives any claim for delayed early completion. 6. Liquidated Damages. If Contractor fails to complete the Work within the Contract Time, City will assess liquidated damages in the amount of$3000.00 per day for each day of 2018 Pavement Maintenance Phase 1 Project CONTRACT 2018-101 Page 22 unexcused delay in completion, and such liquidated damages may be deducted from City's payments due or to become due to Contractor under this Contract. 7. Labor Code Compliance. 7.1 General. This Contract is subject to all applicable requirements of Chapter 1 of Part 7 of Division 2 of the Labor Code, including requirements pertaining to wages, working hours and workers'compensation insurance. 7.2 Prevailing Wages. This Project is subject to the prevailing wage requirements applicable to the locality in which the Work is to be performed for each craft, classification or type of worker needed to perform the Work, including employer payments for health and welfare, pension, vacation, apprenticeship and similar purposes. Copies of these prevailing rates are available online at http://www.dir.ca.gov/DLSR. 7.3 DIR Registration. City will not enter into the Contract with a bidder without proof that the bidder and its Subcontractors are registered with the California Department of Industrial Relations to perform public work under Labor Code section 1725.5, subject to limited legal exceptions. 8. Workers' Compensation Certification. Under Labor Code section 1861, by signing this Contract, Contractor certifies as follows: "I am aware of the provisions of Labor Code section 3700 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 I will comply with such provisions before commencing the performance of the Work on this Contract." 9. Conflicts of Interest. Contractor, its employees, Subcontractors and agents, may not have, maintain or acquire a conflict of interest in relation to this Contract in violation of any City ordinance or policy or in violation of any California law, including under Government Code section 1090 et seq. and under the Political Reform Act as set forth in Government Code section 81000 et seq. and its accompanying regulations. No officer, official, employee, consultant, or other agent of the City("City Representative") may have, maintain, or acquire a"financial interest"in the Contract, as that term is defined under the Political Reform Act(Government Code section 81000, et seq., and regulations promulgated thereunder); or under Government Code section 1090, et seq.; or in violation of any City ordinance or policy while serving as a City Representative or for one year thereafter. Any violation of this Section constitutes a material breach of the Contract. 10. Independent Contractor. Contractor is an independent contractor under this Contract and will have control of the Work and the means and methods by which it is performed.Contractor and its Subcontractors are not employees of City and are not entitled to participate in any health, retirement, or any other employee benefits from City. 11. Notice. Any notice, billing, or payment required by or pursuant to the Contract Documents must be made in writing, signed, dated and sent to the other party by personal delivery, U.S. Mail, a reliable overnight delivery service, or by email as a PDF (or comparable)file. Notice is deemed effective upon delivery unless otherwise specified. Notice for each party must be given as follows: City: Name: City of Cupertino 2018 Pavement Maintenance Phase 1 Project CONTRACT 2018-101 Page 23 Address: 10300 Torre Avenue City/State/Zip: Cupertino, CA 95014 Phone:408-777-3354 Attn: Roger Lee Email: rogerl@cupertino.org Copy to:joannej@cupertino.org Contractor: Name: G. Bortolotto & Co. , Inc. Address: 582 Bragato Bond City/State/Zip: San Carlos. CA 94070-6227 Phone: �6�0? 545-25Q1 Attn: Robert Bortolotto Email: gbort0pacbell.net Copy to: 12. General Provisions. 12.1 Assignment and Successors. Contractor may not assign its rights or obligations under this Contract, in part or in whole, without City's written consent. This Contract is binding on Contractor's and City's lawful heirs, successors and permitted assigns. 12.2 Third Party Beneficiaries. There are no intended third party beneficiaries to this Contract except as expressly provided in the General Conditions or Special Conditions. 12.3 Governing Law and Venue. This Contract will be governed by California law and venue will be in the Superior Court of Santa Clara County, and no other place. 12.4 Amendment. No amendment or modification of this Contract will be binding unless it is in a writing duly authorized and signed by the parties to this Contract. 12.5 Integration; Severability. This Contract and the Contract Documents incorporated herein, including authorized amendments or Change Orders thereto, constitute the final, complete, and exclusive terms of the agreement between City and Contractor. If any provision of the Contract Documents, or portion of a provision, is determined to be illegal, invalid, or unenforceable,the remaining provisions of the Contract Documents will remain in full force and effect. 12.6 Authorization. Each individual signing below warrants that he or she is authorized to do so by the party that he or she represents, and that this Contract is legally binding on that party. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporation Code section 313. [Signatures are on the following page.] 2018 Pavement Maintenance Phase 1 Project CONTRACT 2018-101 Page 24 The parties agree to this Contract as witnessed by the signatures below: CONTRACTOR G. Bortolotto & cn_ ' Inc CITY OFG4FERTINO <in rt full name of Contractor above> A 7n' ipa orporatio� By BY Name Rober ortolotto David Brandt Title President City Manag _ Date Date _ 2 By _ Name Title Secretary Date February 1 -20—lid--- ED AS TO F By Name u10 City Attorney Date o�/ 2 9 �/8 ATTEST: / Grace Schmidt City Clerk -3 Date 7 Contract Amount: 01,+r �T� P.O. No. �O t Lt5 Account No. It,2sz_ END OF CONTRACT -4u L2( 46 LY&LLk Off , `� .�� Act 2018 Pavement Maintenance Phase 1 Project CONTRACT 2018-101 Page 25 DATE(MM/DD/YYYY) A`�R,0 CERTIFICATE OF LIABILITY INSURigiWGINAL 2/2/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Pat Ellis NAME: Dorsey, Hazeltine & WynnevcNNo Ext: (650)858-2375 FAX No:(650)656-1023 License # : 0281413 E-MAIL ADDRESS:pellis@dhw-ins.com 400 Seaport Court, Suite 105 INSURER(S)AFFORDING COVERAGE NAIC# Redwood City CA 94063 INSURERA: The Travelers Indemnity Co. CT 25682 INSURED INSURERB:Travelers Prop Cas Co. of America 25674 G. Bortolotto & Co. , Inc. INSURER C: 582 Bragato Road INSURER D: INSURER E: San Carlos CA 94070 INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 All LOB Rnwl 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 I TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MM/DDY/YEFFYYY MM/ DPOLICY/YE XP LTR YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE ToRENTED A CLAIMS-MADE ❑X OCCUR PREMISES(E.occurrence) ccurnce) $ 300,000 X PPA limit applies if X Y DT22-CO-OF027488-TCT-17 8/21/2017 8/21/2018 MED EXP(Any one person) $ 5,000 required by contract PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY�JE C LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Deductible $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS�ED SCHEDAUTOSULED X Y DT 8/21/2017 8/21/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Deductible $ 1,000 X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 8,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 8,000,000 DED I X I RETENTION$ 10,000, CUP-8J389352-17-26 8/21/2017 8/21/2018 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: 2018 Pavement Maintenance Phase I Project, G Bortolotto Job #18-742 The City of Cupertino 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 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10300 Torre Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE Victoria Sunga/ C11T1TCA � —' ©1988-2014 D CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I NS025(201401) Policy No.DT22-CO-OF027488-TCT-17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED—(Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury" requiring insurance" specifically requires you "property damage"or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- ofdamage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- II. Supervisory, inspection, architectural or rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 ©2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we !I. The names and addresses of any injured cover under this endorsement. However,this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit' is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit" as person or organization as an additional in- sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage"oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit', cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit', and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit' to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 72/1/2018 (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTPRODUCER McGovern Insurance NAME: _ __ McGovern In_s_u_ra_n_ce 1625 EI Camino Real PHONE FAX Belmont, CA 94002 (AIC,No,Ext): — 650-593-8216 f AA/c NoZ 650 594-9130 E-MAIL -- - - -- _ --- ADDRESS: _ INSURERS)AFFORDING COVERAGE -! NAIC# _- - ------ - ------ - I- ------ - - www.jemins.com INSURER A: Everest National Insurance Company- A+ XV 10120 INSURED INSURER B G. Bortolotto& Company, Inc. -_- -- — — T-- 582 582 Bra ato Road INSURER C. San Carlos CA 94070 INSURER D' INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 40180983 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 LTR - -- -- --- - -- - - ----- -- IADDLISUBR ---- --- - - - - - POLICY EFF POLICY EXP TYPE OF INSURANCE _ ,INSp{yyyp+- POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ CLAIMS-MADE OCCUR DAMAGE TO RENTED ---- — -- PREMISES Ea occurrence $ !. MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I .l PRO- (-- I i ...- -- - .. _ .. -- I POLICY. ;JECT I_ LOC I I PRODUCTS COMP/OP- S__ _ OTHER: --- - --- - - S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ _(Ea accident)_ ANY AUTO I iI l I BODILY INJURY(Per person) $ -- OWNED i I SCHEDULED I - AUTOS ONLY lAUTOS I I BODILY INJURY(Per accident) S HIRED ---I NON-OWNED ' I PROPERIY DAMAGE - 1 S---------- -- AUTOS ONLY _AUTOS ONLY ; (Per accident)__ UMBRELLA LIAB I I OCCUR I EACH OCCURRENCE S EXCESS LIAB f E CLAIMS-MADI AGGREGATE I S -1--AI --- DE � i - ---- - --- DED RETENTIONS I I - - ---- A WORKERS COMPENSATION '7600018161 71 8/21/2017 i 8/21/2018 1 1 PER OTH- ;AND EMPLOYERS'LIABILITY YIN I I I L.✓-I STATUTE. ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT 51,000,000 iOFFICEH!I:dEMBER EXCLUDED? ❑ r'I/A -.... _.__.-___ __...--__._-_ -(Mandatory in NH), E.L.DISEASE-EA EMPLOYEE $1.000 000_�_- If yes,describe uner ------ DESCRIPTION OF OPERATIONS below I i E.L.DISEASE-POLICY LIMIT S 1,000,000 I i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE Work performed @ 2018 Pavement Maintenance Phase I Project Proj#2018-101/GBC#18-742 *30 day written Notice of Cancellation,except for noel-pay of premium which is 10 days. CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y P THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Hall ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Avenue Cupertino CA 95014 AUTHORIZED REPRESENTATIVE _ Sieve Suissa ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 403609d3 I 3ORT0-1 1 17/18 - 14C FIarV4 Ylorn,an I ::/1!2018 `.:15:=_' 1'M (TTI' I - _ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2%of the California workers'compensation premium otherwise due on such remuneration, SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER City of Cupertino,its directors,officers,engineers,agents and employees This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise stated. (The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective8/21/2017 Policy No6000taist �� ' Endorsement No. Insured: G.Bortolotto&Company, Inc. Premium$ INCL. Insurance Company EVEREST NATIONAL INSURANC---"-- " Countersigned By:— -1886 by the Workers'Compeneatlon Insurance Rating Bureau of California.All rights reservett. From the WCIRB's California Workers'Compensation Insurance Forms Manual-1885. 40180981 BORTO-1 1 17/18 - WC j MaryAnn Wolman 1 2/1/2018 5:15:53 PM (RST) I page 2 of 2 CITY OF WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE CUPERTINO Project Title and Number: 2018 Pavement Maintenance Phase 1, Proiect#2018-101 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 Everest National Insurance Compnay I. Insurance Company: 2, Insurance Policy Number: 7600018161 71 3, Effective Date of this Endorsement: 8/21/2017 20 4 Insured: G. Bortolotto & Company All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Tone Avenue;Cupertino, California 95014. I MaryAnn Worman (print/type name) warrant that I have authority to bind the below listed Insura ce 7T and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnish t he City) Names of Agent/Agency: McGovern Insurance Titl ; Certificate Specialist Address: 1625 El Camino Real. Telephone: 650-593-8216 Belmont, CA 94002 Facsimile: END OF DOCUMENT 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 8 ORIGINAL 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 G. Bortolotto & Company, Inc. Address. 582 Bragato Road_ San Carlos CA 94070 Description of operations/locations/products insured (show contract name and/or number, if any): 2018 Pavement Maintenance Phase 1. P. rolect Number 2018-101 ------------- WORKER'S COMPENSATION ' Statutory Min. Everest National Insurance `Employers _ Liability " (name of insurer) $ 1,000,000 $ 1,000,0.00 $1,000,000 Insurance Company's State License No. NAIC 410120 Check Policy Type: Each Occurrence COMPREHENSIVE GENERAL LIABILITY [ ] Premises/Operations General Aggregate 5 (if applicable) [ ] Owners&Contractors Protective Aggregate [ ] Contractual for Specific Contract Personal Injury S [ ] Products Liability [ ] XCU Hazards [ ] Broad Form P.D. Fire Damage(any one fire) [ ] Severability of Interest Clause If ] Personal Injury with Medical Expense Employee Exclusion Removed (any one person) or Self-Insured COMMERCIAL GENERAL LIABILITY Retention E (name of insurer) Policy No. Expiration Date 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 3 AUTOMOTIVE/VEHICLE LIABILITY BODILY INJURY PROPERTY DAMAGE Commercial Form Each Person Each Accident Liability Coverage S Each Accident (name of insurer) $ or Combined Single Limit Policy No. Expiration Date J i I BUILDER'S RISK"RLL 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. (Name of insurer) Policy No. Expiration Date Limits of Liability: Deductible: ------------------------------------------------------------------ A copy of all Endorsements to the policy(ies)which in any way ag v ia!) 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 after 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. i s IT IS HEREBY CERTIFIED that the above policy(ies)provide liability insurance as required by the Agreemen between t ity the ins'ure6d.� ay. Dated' aZ 0 120 Attach Certificate of Insurance and Additional Insured Endorsement on company forms. 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 4 Policy No. DT22-CO-OF027488-TCT-17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments 1. Blanket Additional Insured — States Or Political Subdivisions—Permits D. Incidental Medical Malpractice J. Knowledge And Notice Of Occurrence Or Offense E. Who Is An Insured— Newly Acquired Or Formed Organizations K. Unintentional Omission F. Who Is An Insured — Broadened Named Insured L. Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: The following is added to Exclusion g., Aircraft, Exclusions c, and g. through n. do not apply Auto Or Watercraft,in Paragraph 2. of SECTION to "premises damage". Exclusion f.(1)(a) I — COVERAGES — COVERAGE A BODILY IN- does not apply to "premises damage" caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured; and d. Smoke resulting from such fire,explosion, (c) Not being used to carry any person or prop- or lightning;or erty for a charge. e. Water,- B. ater;B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f. of Section i—Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion —All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 O 2011 The Travelers Indemnity company.All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE: 1, The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same 'occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies.We do not have to fur- fire;explosion;lightning;smoke resulting from nish these bonds. such fire, explosion, or lightning; or water, or any combination of any of these causes. 2. The following replaces Paragraph 1.d, of SUPPLEMENTARY PAYMENTS — COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part;or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the 1. The following is added to the definition of"oc- definition of'insured contract' in the DEFINI- currence"in the DEFINITIONS Section: TIONS Section: "Occurrence"also means an act or omission a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services', first aid or lease of premises that indemnifies any "Good Samaritan services"to a person. person or organization for "premises 2. The following is added to Paragraph 2.a.(1)of damage"is not an"insured contract"; SECTION II—WHO IS AN INSURED: 5. The following is added to the DEFINITIONS paragraph (1)(d) above does not apply to Section: "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age"to: a. Any premises while rented to you or tem- (i) "Incidental medical services" by any of porarily occupied by you with permission Your employees who is a nurse practi- af the owner;or tioner, registered nurse,licensed practical nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic;or premises is rented to you,if you rent such (ii) First aid or"Good Samaritan services" by premises for a period of seven or fewer any of your "employees" or "volunteer consecutive days. workers", other than an employed or vol- 6. The following replaces Paragraph 4.b.(1)(b) unteer doctor_ Any such "employees" or of SECTION IV—COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or "Good Samaritan ser- (b) That is insurance for"premises damage"; vices" during their work hours for you will or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 ©2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE: other than a partnership, joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that Or- son will be deemed to be one"occurrence". ganization. However. 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I— COV- only: ERAGES—COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of, the insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form a. Medical, surgical, dental, laboratory, x-ray it, and we agree in writing that it will Con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages; or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization;and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization. 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED—BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- TIONS: The following Is added to SECTION if—WHO IS AN INSURED: The insurance is excess over any valid and collectible other insurance available to the in- Any of your subsidiaries,other than a partnership, sured, whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices",first aid or "Good Samaritan services" No such subsidiary is an insured for"bodily injury" to any person to the extent not subject to or "property damage" that occurred, or"personal Paragraph 2.a.(1) of Section 11 —Who Is An injury" or "advertising injury" caused by an of- insured. fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- The following replaces Paragraph 4. of SECTION sidiary. li—WHO IS AN INSURED. CG D3 16 11 11 @ 2011 The Traverers Indemnity Company.All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED—OWNERS, H. BLANKET ADDITIONAL INSURED—LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION 11 —WHO IS The following is added to SECTION It—WHO IS AN INSURED; AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for"bodily injury", "property dam- for "bodily injury", "property damage", "personal age","personal injury"or"advertising injury"that: injury"or"advertising injury"that: a. Is "bodily injury" or "property damage" that $• Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement;and or agreement;and b. Is caused, in whole or in part, by your acts or b. Arises out of the ownership, maintenance or omissions in the maintenance, operation or use of that part of any premises leased to you. use of equipment leased to you by such equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement,or the limits shown on vide in the written contract or agreement, or the Declarations,whichever are less. the limits shown on the Declarations, which- ever are less. b. The insurance provided to such equipment lessor does not apply to any"bodily injury"or b. The insurance provided to such premises property damage" that occurs, or owner,manager or lessor does not apply to: personal injury or advertising injury"caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs,or"personal injury"or"adver- lease expires. tising injury" caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises;or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager, that this insurance must be primary to, or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on 1. BLANKET ADDITIONAL INSURED -- STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS—PERMITS the written contract or agreement that this in- The following is added to SECTION II—WHO IS surance must be primary to, or non- AN INSURED: contributory with, such other insurance, in which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 X12011 The Travelers Indemnity Company.All rights reserved. CG D3 16 1111 COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company; or an insured, but only with respect to liability for (iii)An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury" or "advertising injury" arising out of such op- that is your partner, joint venture erations. member or manager; or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury" or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision; or (3) Notice to us of such"occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the"occurrence" or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. (1) or (2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or Z. However, if this Coverage Part includes an en- of Section If—Who Is An Insured: dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of"pollutants"which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you(if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual(if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- cers"or directors (if you are an organiza- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS; ployee" authorized by you to give notice The unintentional omission of, or unintentional of an"occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company, and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence" or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence"or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph S., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership orjoint venture; of SECTION IV— COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 111 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury,shock,fright,disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of. of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. "Personal injury" or "advertising injury" definition of"insured contract"in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- The following replaces the definition of "bodily leted. injury"in the DEFINITIONS Section: Page 6 of 6 0 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY POLICY NUMBER DT22-CO-OF027488-TCT-17 ISSUE DATE: 08/21/16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN GENERAL AGGREGATE A WRITTEN CONTRACT WHICH IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS. GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated"project"shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- Aggregate Limit for any other designated ject", and that limit is equal to the amount of "project"shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of "bodily injury" or "prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds: der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated"project"shown in the Schedule above: c. Persons or organizations making claims or bringing"suits". CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit,whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2.of SECTION III—LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1)which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated"project"shown in the considered a single"project". SCHEDULE above. F. The provisions of SECTION III — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. 6 Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 Policy No. DT-810-OF027488-TCT-17 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE—INCREASED LtMIT B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D. EMPLOYEES AS INSURED K. AIRBAGS E. SUPPLEMENTARY PAYMENTS — INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO — LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE—INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED executed by you before the "bodily injury" or The following is added to Paragraph A.1., Who Is "property damage" occurs and that is in effect An Insured, of SECTION II — LIABILITY COV- during the policy period, to be named as an addi- ERAGE: tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance Any organization you newly acquire or form dur- applies and only to the extent that person or or- ing the policy period over which you maintain ganization qualifies as an "insured" under the 50% or more ownership interest and that is not Who Is An Insured provision contained in Section separately insured for Business Auto Coverage. II Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- 1. The following is added to Paragraph A.1., ever is earlier. Who Is An Insured, of SECTION 11 — LI- B. BLANKET ADDITIONAL INSURED ABILITY COVERAGE.- The OVERAGE:The following is added to Paragraph c. in A.1., An "employee" of yours is an "insured" while Who Is An Insured, of SECTION II — LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" name, with your permission, while performing Any person or organization who is required under duties related to the conduct of your busi- a written contract or agreement between you and ness. that person or organization, that is signed and CA T3 53 03 10 ©2010 The Travelers Indemnity Company. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., within such country or jurisdiction, for Liability Other Insurance, of SECTION IV — BUSI- Coverage for any covered "auto" that you NESS AUTO CONDITIONS: lease, hire, rent or borrow without a driver for b. For Hired Auto Physical Damage Cover- a period of 30 days or less and that is not an age, the following are deemed to be cov- "auto" you lease, hire, rent or borrow from ered "autos"you own: any of your "employees", partners (if you are a partnership), members (if you are a limited (1) Any covered "auto" you lease, hire, liability company) or members of their house- rent or borrow; and holds. (2) Any covered "auto" hired or rented by (a) With respect to any claim made or "suit" your "employee" under a contract in brought outside the United States of that individual "employee's" name, America, the territories and possessions with your permission, while perform- of the United States of America, Puerto ing duties related to the conduct of Rico and Canada: your business. (i) You must arrange to defend the "in- However, any "auto"that is leased, hired, sured"against, and investigate or set- rented or borrowed with a driver is not a tle any such claim or "suit" and keep covered "auto". us advised of all proceedings and ac- D. EMPLOYEES AS INSURED tions. The following is added to Paragraph A.1., Who Is (ii) Neither you nor any other involved An Insured, of SECTION II — LIABILITY COV- "insured" will make any settlement ERAGE: without our consent. Any "employee" of yours is an "insured"while us- (iii) We may, at our discretion, participate ing a covered "auto"you don't own, hire or borrow in defending the "insured" against, or in your business or your personal affairs. in the settlement of, any claim or E. SUPPLEMENTARY PAYMENTS — INCREASED "suit". LIMITS (iv) We will reimburse the "insured" for 1. The following replaces Paragraph A.2.a.(2), sums that the "insured" legally must of SECTION 11—LIABILITY COVERAGE: pay as damages because of "bodily Injury" or"property damage" to which (2) Up to $3,000 for cost of bail bonds (in- this insurance applies, that the "in- cluding bonds for related traffic law viola- sured" pays with our consent, but tions) required because of an "accident" only up to the limit described in Para- we cover. We do not have to furnish graph C., Limit Of Insurance, of SEC- these bonds. TION 11—LIABILITY COVERAGE. 2. The following replaces Paragraph A.2.a.(4), (v) We will reimburse the "insured" for of SECTION II—LIABILITY COVERAGE: the reasonable expenses incurred (4) All reasonable expenses incurred by the with our consent for your investiga- "insured" at our request, including actual tion of such claims and your defense loss of earnings up to $500 a day be- of the "insured" against any such cause of time off from work. "suit', but only up to and included F. HIRED AUTO — LIMITED WORLDWIDE COV- within the limit described in Para- graph C., Limit Of Insurance, of SECTION 11 — LIABILITY COVER- The following replaces Subparagraph (5) in Para- AGE, and not in addition to such limit. graph B.7., Policy Period, Coverage Territory, Our duty to make such payments of SECTION IV — BUSINESS AUTO CONDI- ends when we have used up the ap- TIONS: plicable limit of insurance in pay- (5) Anywhere in the world, except any country or ments for damages, settlements or jurisdiction while any trade sanction, em- defense expenses. bargo, or similar regulation imposed by the (b) This insurance is excess over any valid United States of America applies to and pro- and collectible other insurance available hibits the transaction of business with or Page 2 of 4 ©2010 The Travelers Indemnity Company. CA T3 53 03 10 Includes copyrighted material of Insurance Services Office,Inc.with Its permission. COMMERCIAL AUTO to the "insured" whether primary, excess J. PERSONAL EFFECTS contingent or on any other basis. The following is added to Paragraph AA., Cover- (c) This insurance is not a substitute for re- age Extensions, of SECTION III — PHYSICAL quired or compulsory insurance in any DAMAGE COVERAGE: country outside the United States, its ter- Personal Effects ritories and possessions, Puerto Rico and Canada. We will pay up to $400 for "loss" to wearing ap- You agree to maintain all required or parel and other personal effects which are: compulsory insurance in any such coun- (1) Owned by an"insured"; and try up to the minimum limits required by (2) In or on your covered"auto". local law. Your failure to comply with This coverage applies only in the event of a total compulsory insurance requirements will theft of your covered"auto". not invalidate the coverage afforded by this policy, but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage. had you complied with the compulsory in- K. AIRBAGS surance requirements. The following is added to Paragraph B.3., Exclu- (d) It is understood that we are not an admit- sions, of SECTION III — PHYSICAL DAMAGE ted or authorized insurer outside the COVERAGE: United States of America, its territories Exclusion 3.a. does not apply to "loss" to one or and possessions, Puerto Rico and Can- more airbags in a covered "auto"you own that in- ada. We assume no responsibility for the flate due to a cause other than a cause of"loss" furnishing of certificates of insurance, or set forth in Paragraphs A.1.b. and A.1.c., but for compliance in any way with the laws of other countries relating to insurance. only: G. WAIVER OF DEDUCTIBLE—GLASS a. If that"auto" is a covered "auto"for Compre- hensive Coverage under this policy; The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE b. The airbags are not covered under any war- COVERAGE: ranty; and No deductible for a covered "auto" will apply to c. The airbags were not intentionally inflated. glass damage if the glass is repaired rather than We will pay up to a maximum of $1,000 for any replaced. one"loss". H. HIRED AUTO PHYSICAL DAMAGE— LOSS OF L. NOTICE AND KNOWLEDGE OF ACCIDENT OR USE—INCREASED LIMIT LOSS The following replaces the last sentence of Para- The following is added to Paragraph A.2.a., of graph AA.b., Loss Of Use Expenses, of SEC- SECTION IV—BUSINESS AUTO CONDITIONS: TION III—PHYSICAL DAMAGE COVERAGE: Your duty to give us or our authorized representa- However, the most we will pay for any expenses tive prompt notice of the "accident" or "loss" ap- for loss of use is $65 per day, to a maximum of plies only when the "accident" or "loss" is known $750 for any one"accident". to: I. PHYSICAL DAMAGE — TRANSPORTATION (a) You (if you are an individual); EXPENSES—INCREASED LIMIT (b) A partner(if you are a partnership); The following replaces the first sentence in Para- (c) A member (if you are a limited liability com- graph A.4.a., Transportation Expenses, of pany); SECTION 111 — PHYSICAL DAMAGE COVER- (d) An executive officer, director or insurance AGE: manager(if you are a corporation or other or- We will pay up to $50 per day to a maximum of ganization); or $1,500 for temporary transportation expense in- (e) Any"employee" authorized by you to give no- curred by you because of the total theft of a cov- tice of the"accident" or"loss". ered auto of the private passenger type. CA T3 53 03 10 ©2010 The Travelers Indemnity Company. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION such contract. The waiver applies only to the The following replaces Paragraph A.5., Transfer person or organization designated in such Of Rights Of Recovery Against Others To Us, contract. of SECTION IV — BUSINESS AUTO CONDI- N. UNINTENTIONAL ERRORS OR OMISSIONS TIONS: The following is added to Paragraph B.2., Con- 5. Transfer Of Rights Of Recovery Against cealment, Misrepresentation, Or Fraud, of Others To Us SECTION IV—BUSINESS AUTO CONDITIONS: We waive any right of recovery we may have The unintentional omission of, or unintentional against any person or organization to the ex- error in, any information given by you shall not tent required of you by a written contract prejudice your rights under this insurance. How- signed and executed prior to any "accident" ever this provision does not affect our right to col- or"loss", provided that the"accident'or"loss" lect additional premium or exercise our right of arises out of operations contemplated by cancellation or non-renewal. Page 4 of 4 ©2010 The Travelers Indemnity Company. CA T3 53 03 10 Includes copyrighted material of Insurance Services Office,Inc.with its permission. Policy# DT-810-OF027488-TCT-17 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. PROVISIONS B. The following is added to Paragraph 5., Other A. The following is added to Paragraph c. in A. 1., Insurance, in B. General Conditions of SEC- Who Is An Insured, of SECTION II — LIABILITY TION IV—BUSINESS AUTO CONDITIONS: COVERAGE: Regardless of the provisions of paragraph a. and Any person or organization who is required under paragraph d. of this part 5. Other Insurance, this a written contract or agreement between you and insurance is primary to and non-contributory with that person or organization, that is signed and applicable other insurance under which an addi- executed by you before the "bodily injury" or namedonal insuredtired de son rth organization c s the first "property damage occurs and that is in effect or during the policy period, to be named as an addi- agreement between you and that person or or- tional insured is an "insured" for Liability Cover- ganization, that is signed and executed by you age, but only for damages to which this insurance before the "bodily injury" or "property damage" applies and only to the extent that person or or- occurs and that is in effect during the policy pe- ganization qualifies as an "insured" under the riod, requires this insurance to be primary and Who Is An Insured provision contained in non-contributory. Section II. Vh CA T4 74 02 12 ©2012 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. Policy No. DT22-CO-OF027488-TCT-17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: RAILROAD PROTECTIVE LIABILITY COVERAGE PART A. Paragraph 3.b. of Section IV — Conditions is (b) Discovery of fraud or material replaced by the following: misrepresentation by: 3. Cancellation (i) Any insured or his or her rep- b. All Policies In Effect For 60 Days Or resentative in obtaining this Less insurance;or If this policy has been in effect for 60 (ii) You, your representative or days or less, and is not a renewal of a the "contractor" in pursuing a policy we have previously issued,we may claim under this policy. cancel this policy by mailing or delivering (c) A judgment by a court or an ad- to you, the producer of record, the "con- ministrative tribunal that you or tractor" and any involved governmental the "contractor" have violated a authority, or any other contracting party California or Federal law, having designated in the Declarations, advance as one of its necessary elements written notice of cancellation, stating the an act which materially increases reason for cancellation, at least: any of the risks insured against. (1) 10 days before the effective date of (d) Discovery of willful or grossly cancellation if we cancel for: negligent acts or omissions, or of (a) Nonpayment of premium;or any violations of state laws or regulations establishing safety (b) Discovery of fraud by: standards,by you,your represen- (i) Any insured or his or her rep- tative, or the 'contractor" which resentative in obtaining this materially increase any of the insurance;or risks insured against. (ii) You or your representative in (e) Failure by you, your representa- pursuing a claim under this tive or the 'contractor" to imple- policy. ment reasonable loss control re- (2) 60 days before the effective date of quirements, agreed to by you as cancellation if we cancel for any other a condition of policy issuance, or reason. which were conditions precedent to our use of a particular rate or B. The following is added to the Cancellation Con- rating plan, if that failure materi- dition of Section IV—Conditions: ally increases any of the risks in- __ _ _ _f. _Policies In Effect For-More Than 60 __ _._ _ ___ suredagainst Days (f) A determination by the Commis- (1) If this policy has been in effect for sioner of Insurance that the: more than 60 days, or is a renewal of (i) Loss of, or changes in, our a policy we issued, we may cancel reinsurance covering all or this policy only upon the occurrence, part of the risk would threaten after the effective date of the policy, our financial integrity or sol- of one or more of the following: vency;or (a) Nonpayment of premium, includ- (ii) Continuation of the policy ing payment due on a prior policy coverage would place us in we issued and due during the violation of California law or current policy term covering the the laws of the state where same risks. CG 29 11 09 12 ©Insurance Services Office, Inc.,2012 Page 1 of 2 COMMERCIAL GENERAL LIABILITY we are domiciled; or threaten b. If the policy has been extended for 90 our solvency. days or less, provided that notice has (g) A change by you, your represen- been given in accordance with Paragraph tative or the "contractor" in the C.1. activities or property of the com- c. If you have obtained replacement cover- mercial or industrial enterprise, age, or if you and the "contractor" have which results in a materially agreed, in writing, within 60 days of the added, increased or changed termination of the policy, to obtain that risk, unless the added, increased coverage. or changed risk is included in the d. If the policy is for a period of no more policy. than 60 days and you and the "contrac- (2) We will mail or deliver advance writ- tor" are notified at the time of issuance ten notice of cancellation, stating the that it will not be renewed. reason for cancellation, to: e. If you and the "contractor" request a (a) You; change in the terms or conditions or risks (b) The producer of record; covered by the policy within 60 days of (c) The"contractor"; the end of the policy period. f. If we have made a written offer to you (d) Any involved governmental au- and the "contractor", in accordance with thority; and the timeframes shown in Paragraph C.1., (e) Any other contracting party des- to renew the policy under changed terms ignated in the Declarations. or conditions or at an increased premium (3) If we cancel, we will give notice at rate, when the increase exceeds 25%. least: D. Paragraph CA.Appraisal of Section IV—Condi- (a) 10 days before the effective date tions is replaced by the following: of cancellation if we cancel for C. The following conditions apply to Coverage B nonpayment of premium or dis- only: covery of fraud; or 1. Appraisal (b) 60 days before the effective date If we and you fail to agree on the value of of cancellation if we cancel for the property, or the amount of loss, either any other reason listed in Para- may make written request for an ap- graph f.(1). praisal of the loss. If the request is ac- C. The following is added and supersedes any pro- cepted, each party will select a competent visions to the contrary: and impartial appraiser. Each party shall Nonrenewal notify the other of the appraiser selected within 20 days of the request. The two 1. If we decide not to renew this policy, we will appraisers will select an umpire. If they mail or deliver written notice, stating the rea- cannot agree within 15 days, either may son for nonrenewal, to you, the producer of request that selection be made by a judge record, the "contractor", any involved gov- of a court having jurisdiction. The ap- ernmental authority, and any other contract- praisers will state separately the value of ing party designated in the Declarations, at the property and the amount of loss. If the respective mailing addresses last known they fail to agree, they will submit their to us, at least 60 days, but not more than 120 differences to the umpire. A decision days, before the expiration or anniversary agreed to by any two will be binding. date. Each party will: 2. We are not required to send notice of nonre- a. Pay its chosen appraiser; and newal in the following situations: b. Bear the other expenses of the ap- a. If the transfer or renewal of a policy, with- praisal and umpire equally. out any changes in terms, conditions or If there is an appraisal, we will retain our rates, is between us and a member of our right to deny the claim. insurance group. Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 29 11 09 12 Bidder's Name: G. Bortolotto & Co. , Inc. Bid Schedule This Bid Schedule must be completed in ink and included with the sealed Bid Proposal. Pricing must be provided for each Bid Item as indicated. Items marked "(SW)" are Specialty Work that must be performed by a qualified Subcontractor.The lump sum or unit cost for each item must be inclusive of all costs,whether direct or indirect, including profit and overhead. The sum of all amounts entered in the "Extended Total Amount" column must be identical to the Base Bid price entered in Section 1 of the Bid Proposal Form. LS = Lump Sum EA = Each LF= Linear Foot CY=Cubic Yard SY=Square Yard SF= Square Feet LB = Pounds TON =Ton (2000 lbs) AL=Allowance BID EST. UNIT EXTENDED TOTAL ITEM ITEM DESCRIPTION QTY UNIT COST AMOUNT NO, 8 1`S 1 $ lift Control 1 LS $ ' o $ l t 03 ` 2 Leveling Course-No.4 Hot Mix Asphalt Type 4,107 TON $ 'O yr $ 4 3 4 ` ` w 3 Hot Mix Asphalt,1/2"Maximum Type A 17'694 TON $ $ J,_1 16 31 4 Pavement Fabric 151,575 SY $ `• S3 $2's I, qC:' .1 S e� v l 5 Ke cutA 71'018 LF $ 6� u= $ 142, o3b•cju 6 ke cut B 5,750 LF $ S�•�= $ 2 �' $O '= 7 Dig Out 6"AC 841 Sy $ ,O.10 $ 8 Adjust Survey Monument Cover to Finish 155G 43 L �+ "`• Grade EA $ 3 r $ 6 0, 1 L 5 2 o_ 9 Lower Manhole Covers Prior to Cold Planing51 EA $ 3 O 1 0_ $ 15, 3 S( 10 Lower Cleanout/Water/Gas Valve Cover 26 $ `� ' 2' $ Prior to Cold PlaningEA 11 Adjust Manhole Covers to Finish Grade 200 EA $ 435 `= $ (SS, 1 g00•u� 12 Adjust Cleanout/Water/Gas Valve Cover 29 $ 39 3 �� $ 11 39 }• to Finish Grade EA I � c W� 13 Install Blue RPM's Fire Hydrant 48 EA $ (�• —V C$ J 2 O 14 6"White Lines Thermo 210 LF $ 3 $ [3 O -- 15 12"White Hatch(Thermo) 140 LF $ 4 c•c_ $ J v O 16 12"White Crosswalk/Limit Line(Thermo) 1,540 LF $ 3-'O" $ 4 6 20 `- 17 12"Yellow Crosswalk Thermo 300 LF $ 4– '�`= $ 2 Od'�'=• a� 98 24"White Thermo 410 LF $ , •U_ $ tJ' 1924"Yellow(Thermo) 210 LF $ ,-�� $ 14"�C) a= 20 Striping Detail#22 Thermo&Markers 5,550 LF $ I 'SV $ 3 2!, 21 Striping Detail 38 Thermo&Markers 40 LF $ 3 $$ 6' 4- 2 O. $ 22 Striping Detail#40A(Thermo) 40 LF U = $ 12 O 23 "Ahead Legend"Yellow(Pre-formed thermo $ 4 3 EA GOU' U 24 "STOP"Legend Pre-formed Thermo) 39 EA $ 3 l 0 u $ S 2 tO 2018 Pavement Maintenance Phase 1 Project BID SCHEDULE Project Number 2018-101 Addendum 1 Page 11 Bidder's Name: G. Bortolotto & Co. , Inc. BID EST. UNIT EXTENDED TOTAL ITEM ITEM DESCRIPTION QTY UNIT NO. COST AMOUNT 9 q 25 "SLOW"Legend Pre-formed Thermo 1 EA $ � o- $ ilU v 26 "SCHOOL"Legend Pre-formed Thermo 1 EA $ 3cio W $ 3 V v� 27 "XING"Le ned Pre-formed Thermo 1 EA $ 14�q•�•—• $ p C`� l 28 "25"Legend Pre-formed Thermo 11 EA $ 2 3 ( `— $ 'C 6?- l �� 29 "YIELD"Legend Pre-formed Thermo 2 EA $ 2J l0 a— $ o 0 u 30 "BUMP"Legend(Pre-formed Thermo) 12 EA $ J 0 0 o $ 3 160 a 31 Pre-formed Therm mo) SIF $ .. 6 $.� G .�IsC) Green Bike Lane F 32 Bike Rider Symbol Left Facing (Pre-formed 1 $ -� ,�= $ ••1 v_ white on gre en) EA `1 33 Bike Rider Arrow Pre-Formed white on $ green) 1 EA � �� • 34 Arrow Type III Pre-formed Thermo 1 EA 35 Arrow Type IV Pre-formed Thermo 8 EA $ 00 r $ G 400 36 Replace Traffic Signal Loos 28 EA $ G 1 O' $ (o 9 2 O ' Remove/Install Speed Bump (Modified City 7 $1� 17 $ 54,444 9 37 detail 17-A 12'section EA 38 Tye D HMA Dike 150 LF $ S ` $ 2, 39 Type E HMA Dike 780 LF $ -- $ " 5 $o. 40 HMA Remove Esixing 4"Shoulder/Replace with 4" 3984 SF $ L`. $ 19, Q cZ 0 41 Regrade Shoulder to Drain 300 SF $ $ J a,. 1, 3 O U'`- 42 Shoulder Backing 1200 SF $ S'a' $ 6,o o o•a=— TOTAL BASE BID: Items 1 through 42 inclusive: $ r I '77 Note: The amount entered as the "Total Base Bid"should be identical to the Base Bid amount entered in Section 1 of the Bid Proposal form. BIDDER NAME: U JZT. UT T L� END OF BID SCHEDULE 2018 Pavement Maintenance Phase 1 Project BID SCHEDULE Project Number 2018-101 Addendum 1 Page 12 Bidder's Name: G_ Rnrtolotto & Co. , Inc Subcontractor List For each Subcontractor that will perform a portion of the Work in an amount in excess of one-half of 1%of the Bidder's total Contract Price,' the bidder must list a description of the Work,the name of the Subcontractor, its California contractor license number, the location of its place of business, its DIR registration number, and the portion of the Work that the Subcontractor is performing based on a percentage of the Base Bid price. Bidder may not list more than one Subcontractor for each such portion of the Work listed by Bidder below. DESCRIPTION SUBCONTRACTOR CALIFORNIA LOCATION OF DIR REG. NO. PERCENT OF WORK NAME CONTRACTOR BUSINESS OF LICENSE NO. WORK 5Tr.ff,` 15S317 Rosc�[iI1C loboab2l $ 3 1 I �. T_1t144 Ll-f5 134. (00 3N 11 ler,J 1000f.17-7 u$ . O 5 J&,-1 AWI-A,1 900 38S ,gac000002a`12 0 fwc ..�,� �� �<< N S2 l S�o�l�t • 000004os `1 ✓ 0 abYi C. � t•- �- END OF SUBCONTRACTOR LIST For street or highway construction this requirement applies to any subcontract of$10,000 or more. 2018 Pavement Maintenance Phase 1 Project SUBCONTRACTOR LIST 2018-101 Page 13 Bidder's Name: G- Borto_lotto & Co. Iric Noncollusion Declaration TO BE EXECUTED BY BIDDER AND SUBMITTED WITH BID The undersigned declares: am the_��"E_�c d{-,�,i i [title]of <,C; ��l lG-t-tom n [business name], the party making the foregoing bid. The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or to refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder.All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, to effectuate a collusive or sham bid, and has not paid and will not pay, any person or entity for such purpose. This declaration is intended to comply with California Public Contract Code section 7106 and Title 23 U.S.0 section 112. 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on ;1 1 -T [date], at aN C Ar l Cs [city], C.A [state]. s!- C Q-1k Name[print] END OF NONCOLLUSION DECLARATION 2018 Pavement Maintenance Phase 1 Project NONCOLLUSION DECLARATION Project Number 2018-101 Page 14 Bidder's Name: G. Bortolotto & Co. , Inc. Bid Proposal 2018 Pavement Maintenance Phase 1 Project .ti L - > ("Bidder") hereby submits this Bid Proposal to the City of Cupertino("City")for the above-referenced project("Project") in response to the Notice Inviting Bids and in accordance with the Contract Documents referenced therein. 1. Base Bid. Bidder proposes to perform and fully complete the Work for the Project as specified in the Contract Documents,within the time required for full completion of the Work, including all labor, materials, supplies, and equipment and all other direct or indirect costs including, but not limited to, taxes, insurance and all overhead for the following price("Base Bid"): 2. Addenda. Bidder agrees that it has confirmed receipt of or access to, and reviewed, all addenda issued for this Bid. Bidder specifically acknowledges receipt of the following addenda: Addendum: Date Received: T55 cteJ Addendum: Date Received: #01 /6--ao17 t1/1q) #05 #02 I - -a U 1 #06 #03 #07 #04 #08 3. Bidder's Warranties. By signing and submitting this Bid Proposal, Bidder warrants the following: 3.1 Examination of Contract Documents. Bidder has thoroughly examined the Contract Documents and represents that, to the best of Bidder's knowledge, there are no errors, omissions, or discrepancies in the Contract Documents, subject to the limitations of Public Contract Code section 1104. 3.2 Examination of Worksite. Bidder has had the opportunity to examine the Worksite and local conditions at the Project location. 3.3 Bidder is Qualified. Bidder is fully qualified to perform the Work. 3.4 Responsibility for Bid. Bidder has carefully reviewed this Bid Proposal and is solely responsible for any errors or omissions contained in its completed Bid. 4. Award of Contract. By signing and submitting this Bid Proposal, Bidder agrees that if Bidder is awarded the Contract for the Project,within ten days following issuance of the notice of award to Bidder, Bidder will do all of the following: 4.1 Execute Contract. Enter into the Contract with City in accordance with the terms of this Bid Proposal, by signing and submitting to City the Contract prepared by City using the form included with the Contract Documents; 4.2 Submit Required Bonds. Submit to City a payment bond and a performance bond, each for 100% of the Contract Price, using the bond forms provided and in accordance with the requirements of the Contract Documents; and 4.3 Insurance Requirements. Submit to City the insurance certificate(s) and endorsement(s) as required by the Contract Documents. 2018 Pavement Maintenance Phase 1 BID PROPOSAL 2018-101 Page 9 Bidder's Name: G. Bortolotto & Co. , Inc. 5. Bid Security. As a guarantee that, if awarded the Contract, Bidder will perform its obligations under Section 4 above, Bidder is enclosing bid security in the amount of ten percent of its maximum bid amount in one of the following forms(check one): A cashier's check or certified check payable to City and issued by [Bank name] in the amount of X A bid bond, using the Bid Bond form included with the Contract Documents, payable to City and executed by a surety licensed to do business in the State of California. This Bid Proposal is hereby submitted on November 28 , 20_12. B rt lotto & Co. Inc. 4vvembe 2017 B der Business Al me t 5- Signature Sig ature ' RnbPrt Rnrtnlottn/Presi_-dent Gary Bortolotto/Secretary Name/Title (If Corporation: Chairman, President or Vice Name/Title(If Corporation: Secretary, Assistant President) Secretary, Chief Financial Officer or Assistant Treasurer) 397341 A Tanury 31} 2019 1000002795 License#, Expiration Date, and Classification DIR Registration# 582 Bragato Road 650-595-2591 Address Phone San Carlos, CA 94070-6227 Robert Bortolotto/President City, State, Zip Contact Name/Title 650-595-2591 gbort@pacbell.net Contact Phone Contact Email END OF BID PROPOSAL 2018 Pavement Maintenance Phase 1 BID PROPOSAL 2018-101 Page 10 Premium: $16,100.00 Bond No: 12157811 Performance Bond The City of Cupertino("City")and G Bortolotto&Company, Inc. ('Contractor)have entered into a contract. dated February 6 ,2018 ("Contract")for work on the 2018 Pavement Maintenance Phase 1 Project("Project"). The Contract is incorporated by reference into this Performance Bond ("Bond"). 1. General. Under this Bond, Contractor as Principal and The Guarantee Company of North America USA its surety("Surety"),are bound to City as obligee for an amount not less than s 3,077,777.77 1 By executing this Bond, Contractor and Surety bind themselves and their respective heirs, executors,administrators, successors and assigns,jointly and severally,to the provisions of this Bond. 2. Surety's Obligations,Waiver. If Contractor fully performs its obligations under the Contract, including its warranty obligations under the Contract, Surety's obligations under this Bond will become null and void upon recordation of the notice of completion, provided Contractor has timely provided a warranty bond as required under the Contract. Surety waives any requirement to be notified of and further consents to any alterations to the Contract made under the applicable provisions of the Contract Documents, including changes to the scope of Work or extensions of time for performance of Work under the Contract. Surety waives the provisions of Civil Code sections 2818 and 2845. 3. Application of Contract Balance.Upon making a demand on this Bond, City will make the Contract Balance available to Surety for completion of the Work under the Contract. For purposes of this provision, the Contract Balance is defined as the total amount payable by City to Contractor as the Contract Price minus amounts already paid to Contractor, and minus any liquidated damages,credits, or backcharges to which City is entitled under the terms of the Contract. 4. Contractor Default Upon written notification from City that Contractor is in default under Article 13 of the Contract General Conditions, time being of the essence, Surety must act within the time specified in Article 13 to remedy the default through one of the following courses of action: 4.1 Arrange for completion of the Work under the Contract by Contractor,with City's consent, but only if Contractor is in default solely due to its financial inability to complete the Work; 4.2 Arrange for completion of the Work under the Contract by a qualified contractor acceptable to City, and secured by performance and payment bonds issued by an admitted surety as required by the Contract Documents, at Surety's expense; or 4.3 Waive its right to complete the Work under the Contract and reimburse City the amount of City's costs to have the remaining Work completed. 5. Surety Default If Surety defaults on its obligations under the Bond, City will be entitled to recover all costs it incurs due to Surety's default, including legal, design professional, or delay costs. 6. Notice. Any notice to Surety may be given in the manner specified in the Contract and delivered or transmitted to Surety as follows: Attn: Kevin Chambers Address: 1800 Sutter St., Ste 880 2018 Pavement Maintenance Phase 1 Project PERFORMANCE BOND Project Number 2018-101 Page 3 City/State/Zip: Concord CA 94520 Phone: 925 566-6040 Fax: 925 566-6045 Email: kchambersnr gcna.com 7. Law and Venue. This Bond will be governed by California law,and any dispute pursuant to this Bond will be venued in the Superior Court for Santa Clara County in which the Project is located,and no other place. Surety will be responsible for City's attomeys'fees and costs in any action to enforce the provisions of this Bond. 8. Effective Bate; Execution.This Bond is entered into and effective on FebnAU 6__, 20118_. SURETY: The Guarantee Company of North America USA Business Dame si Mary Baez, Attorney -Fact Name/Title[print) (Acknowledgment with Notary Seal for Surety and Surety's Power of Attorney must be attached.) CONTRACTOR- G. Bortolotto & Company, Inc. Business Name s / � Robert BortolQtto / President Name/T'it] S/7 Gary Bortolotto Secretary Namd,t7itle APPROVED BY CITY OF CUPERTINO: st Name/Title END OF PERFORMANCE BOND 2018 Pavement Maintenance Phase 1 Project PERFORMANCE BOND Project Number 20.18-101 Page 4 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 Mateo ) On February 6, 2018 before me, Deborah M. Knipp, Notary Public Date Here Insert Name and Title of the Officer personally appeared Mary Baez Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the personx whose nameN is/XX subscribed to the within instrument and acknowledged to me that A'g)(she/XXXexecuted the same in )(iX/her/XXXauthorized capacity(NA, and that by XXher/)WXsignature(4 on the instrument the person)0, or the entity upon behalf of which the personX 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. DEBORAH M. KNIPP WITNESS my hand and official seal. COMM. #2151035 z °�@_MX Notary Public California o Signature Z, San Mateo County g Comm.Expires MaX 26,2020 Signature of tarlPublk Place Notary Seal Above 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): 0 Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑General ❑ Partner — ❑Limited -1 General ❑Individual E)�Attorney in Fact ❑ Individual ❑Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association • www.NationaiNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 Premium: Included Bond No: 12157811 PAYMENIT BOND The City of Cupertino ("City")and G. Bortolotto&Company,Inc.("Contractor")have entered into a contract. dated February 6 , 2018 ("Contract")for work on the 2018 Pavement Maintenance Phase 1 Project("Project"). The Contract is incorporated by reference into this Payment Bond ("Bond"). 1. General. Under this Bond, Contractor as principal and The Guarantee Company of North America USA its surety("Surety"), are bound to City as obligee in an amount not less than 63,077,777.77 , under California Civil Code sections 9550, et seq. 2. Surety's Obligation. If Contractor or any of its Subcontractors fails to pay any of the persons named in California Civil Code section 9100 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 and its Subcontractors, under California Unemployment Insurance Code section 13020,with respect to the work and labor, then Surety will pay for the same. 3. Beneficiaries. This Bond inures to the benefit of any of the persons named in California Civil Code section 9100, so as to give a right of action to those persons or their assigns in any suit brought upon this Bond. Contractor must promptly provide a copy of this Bond upon request by any person with legal rights under this Bond. 4. Duration. If Contractor promptly makes payment of all sums for all labor, materials. and equipment furnished for use in the performance of the Work required by the Contract, in conformance with the time requirements set forth in the Contract and as required by California law, Surety's obligations under this Bond will be null and void. Otherwise, Surety's obligations will remain in full force and effect. 5. Waivers. Surety waives any requirement to be notified of alterations to the Contract or extensions of time for performance of the Work under the Contract_ Surety waives the provisions of Civil Code sections 2819 and 2845. City waives requirement of a new bond for any supplemental contract under Civil Code section 9550. Any notice to Surety may be given in the manner specified in the Contract and delivered or transmitted to Surety as follows: Attn: Kevin Chambers Address: 1900 Sulter St . ti, 90 CitylStatelZip. Concord CA 94520 Phone: (925)566-6040 Fax: (925) 566-6045 Email: kchamher4gcnn rom 6. Law and Venue, This Bond will be governed by California law, and any dispute pursuant to this Bond will be venued in the Superior Court of Santa Clara County in which the Project is located, and no other place. Surety will be responsible for City's attorneys'fees and costs in any action to enforce the provisions of this Bond: 2018 Pavement Maintenance Phase 1 Project PAYMENT BOND Project Number 2018-101 Page 1 7. Effective Date; Execution. This Bond is entered into and is effective on February 61 2018, SURETY: The Guarantee Company of North America USA Business Name sl Mary Baez, Attorney-in-Fact Name/Title (Acknowledgment with Surety's Notary Seal and Surety's Power of Attorney must be attached.) CO RACTOR: G. Bortolotto & Company, Inc. Business Name s1 Roberzt Bortolotto President Name/Ti Gary Bortolotto / Secretary Namefritle APPROVED BY CITY OF CUPERTIN07 sl NamefTitle END OF PAYMENT BOND 2018 Pavement Maintenance Phase 1 Project PAYMENT BOND Project Number 2018-101 Page 2 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 rMr�rr cr ct cs r r�rr is£sem{c ......... essy c�r �c� c�a r�r�crcr�c c �r 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 Mateo ) On February 6, 2018 before me, Deborah M. Knipp, Notary Public Date Here Insert Name and Title of the Officer personally appeared Mary Baez Name(s)of Signer(s) who proved to me on the basis of satisfactory evidence to be the persona whose nameN is/'XX subscribed to the within instrument and acknowledged to me that p((she/(executed the same in XiX/her/ Xauthorized capacity(XX, and that by XXher/)MXsignature(g on the instrument the person%, 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. QDEBORAH M. KNIPP WITNESS my hand and official seal. COMM. #2151035 z Notary Public• California ozSan Mateo County My Comm.Expires May 26,2020! Signature LkyLcA $2 Signature of fVotar7 Publ Place Notary Seal Above 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: Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: ❑Corporate Officer — Title(s): El Corporate Officer — Title(s): ❑Partner — ❑ Limited ❑General ❑Partner — ❑ Limited D General ❑Individual N Attorney in Fact ❑ Individual f..:]Attorney in Fact ❑Trustee ❑Guardian or Conservator ❑Trustee ❑Guardian or Conservator ❑Other: ❑ Other: Signer Is Representing: Signer Is Representing: 02014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 TME THE GUARANTEE COMPANY OF NORTH AMERICA USA GUARANTEE Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS:That THE GUARANTEE COMPANY OF NORTH AMERICA USA,a corporation organized and existing under the laws of the State of Michigan,having its principal office in Southfield,Michigan,does hereby constitute and appoint Gregory McCartney, Steve Suissa, Mary Baez James E. McGovern, Inc. its true and lawful attomey(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof,which are or may be allowed,required or permitted by law,statute,rule,regulation,contract or otherwise. The execution of such instrument(s)in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so,and may be revoked,pursuant to and by authority of Article IX,Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31s`day of December,2003. The President,or any Vice President,acting with any Secretary or Assistant Secretary,shall have power and authority: 1. To appoint Attomey(s)-in-fact,and to authorize them to execute on behalf of the Company,and attach the Seal of the Company thereto,bonds and undertakings,contracts of indemnity and other writings obligatory in the nature thereof;and 2. To revoke,at any time,any such Attomey-in-fact and revoke the authority given,except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. 4. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner— Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. Further,this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011,of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. o��v+*eE�oa IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and F� its corporate seal to be affixed by its authorized officer,this 23rd day of February,2012. �< THE GUARANTEE COMPANY OF NORTH AMERICA USA STATE OF MICHIGAN Stephen C.Ruschak,Vice President Randall Musselman,Secretary County of Oakland On this 23rd day of February,2012 before me came the individuals who executed the preceding instrument,to me personally known, and being by me duly sworn,said that each is the herein described and authorized officer of The Guarantee Company of North America USA;that the seal affixed to said instrument is the Corporate Seal of said Company;that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Takai IN WITNESS WHEREOF,I have hereunto set my hand at The Guarantee 4,�>? ..%,•., Notary Public, State of Michigan Company of North America USA offices the day and year above written. County of Oakland My Commission Expires February 27, 2018 Acting in Oakland County I,Randall Musselman,Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA,which is still in full force and effect. 1p,WTEEC IN WITNESS WHEREOF,I have thereunto set my hand and attached the seal of said Company this 6th day of February 2018 a Randall Musselman,Secretary Form W-9 Request for Taxpayer Give Form to the (Rev.December 2014) requester. Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. G.Bortolotto&Co.,Inc. N2 Business name/disregarded entity name,if different from above a) CO C- 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to rz certain entities,not individuals;see O F1ElIndividual/sole proprietor or C Corporation ❑� S Corporation ❑ Partnership Trust/estate instructions on page 3): m H E]c single-member LLC C' G ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee code(if any) Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting m the tax classification of the single-member owner. code(if any) L C a o ❑Other(see instructions)► (Applies to accounts maintained outside the US.) w 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) v 582 Bragato Road Ns City,state,and ZIP code City of Cupertino a) 10300 Torre Avenue rn San Carlos,CA 94070 Cupertino,CA 95014 7 List account number(s)here(optional) JA Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number( g).However,for a pa -m - resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer identification number guidelines on whose number to enter. 9 4 - 2 7 1 1 2 0 6 9 EMMU Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. 1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign Signature of �. /�/ y�/ Here U.S.person► �9 L ItiGQ� Date► L� - �� - L General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.Irs.gov1fw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) 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 na d b a ar in Jprce at thisJm�e. Insured: �4 if �s� Address: I'�f a C.L/'lil� Coo 9 y Description of operations/locations/products insured (show contract name and/or number, if any): 2018 Pavement Maintenance Phase 1, Proiect Number 2018-101 --------------------------------------------------------------------- --------------------------------------------------------------------- WORKER'S COMPENSATION . Statutory Min. 5 " Employer's /V Liability (name of i urer) Insurance Company's State License No. --------------------------------------------------------------------- --------------------------------------------------------------------- Check Policy Type: Each Occurrence $ �/ me ddl COMPREHENSIVE GENERAL LIABILITY [ ] Premises/Operations General Aggregate $ 2e 00C/000 (f applicable) [ j Owners&Contractors Protective Aggregate [ ] Contractual for Specific Contract Personal Injury [ ] Products Liability [ ] XCU Hazards [ ] Broad Form P.D. Fire Damage (any one fire) $ � 000 [ ] Severability of Interest Clause [ ] Personal Injury with Medical Expense $ >; 000 Employee Exclusion Removed (any one person) or Self-Insured COMMERCIAL GENERAL LIABILITY Retention e ins er Policy No. — � � lJ� Expiration Date 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 3 AUTO MOTIVENEHICLE LIABILITY BODILY INJURY PROPERTY DAMAGE Commercial Form Each Person Each Accident Liability Coverage 5 Each Accident (name of insurer) or 4 Combined Single Limit $ 4/00,919 000 Policy No., I 0 —OFOZ 711,foo Expiration Date1�- --------------------------------------------------------------------- --------------------------------------------------------------------- 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. x/14 (Name of insurer) Policy No. Expiration Date Limits of Liability: Deductible: A copy of all Endorsements to the policy(ies)which in any way (agent's initial) limit the above-listed types of coverage are attached to this Certificate of Insurance. This Certificate of Insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term,or condition of any contract or any other document with respect to which this Certificate of Insurance may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. IT IS HEREBY CERTIFIED that the above policy(ies)provide liability insurance as required by the Agreement between the City and the insured. By: ,/t e",elo S't�al fes_ Dated: -2, 20 Attach Certificate of Insurance and Additional Insured Endorsement on company forms. Umbrella Policy -Term period:8 21 17-.8 21 18 Each Occurence/Aggregate- 8 Million 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 4 CITY OF [I ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE CUPERTINO and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project Title and Number: 2018 Pavement Maintenance Phase 1, Project#2018-101 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 A 1. Insurance Company::�thL '/cif(&/crr _7hd(tJh44� jy, 2. Insurance Policy Number: �T2 Z — 4-0 `0,60 .2 7`14f --7'77' f'7 3. Effective Date of this Endorsement: R/f��� /7 20 4. Insured: �_ #Y_# 110 4v R,p±A j j5Lc. 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. [Signature on following page.] 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 5 I. P/e-P C/q SuV 6--m (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsements furnished to the City) Names of kc 1 /,t AgentJAgency: #W —�n FUrX h C( brTitle: �`IL //7 r' Address: f/ -. n f G'1. VIP 105- Telephone: i�S�—J.r('— �3-h- Ld[JUD� CA qtJ6� Facsimile: Zap a " DZ 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 6 CITY OF COMPREHENSIVE GENERAL LIABILITY 12 COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT CUPERTINO Project Title and Number: 2018 Pavement Maintenance Phase 1, Prosect#2018-101 In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance. The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: bfza ` CD 060Z 741d'F— TzT-- f7 3. Effective Date of this Endorsement:��Z I I/Z _20- 4. Insured: �� R/YlS td-&'7 �j h.o�.•� _;the_ 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, IllC'ft L/A S-WAJ" (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: (Original signature required on all Endorsem u-mished to the City) Names ofL Agent/Agency: � A) �,4,(kYsf Ke. pJrd/c{� Title: f / Address: 0 Telephone�o" IF Z II Facsimile: _ _ If 2018 Pavement Maintenance Phase 1 INSURANCE FORMS Project Number 2018-101 Page 7 COMMENTS/REMARKS or inspection of said operations with respects to General Liability and Auto. Primary and non-contributory wording applies. Waiver of subrogation for General Liability and Auto are included. General aggregate limit per project applies. 30 day notice of cancellation provided by the named insured. OFREMARK COPYRIGHT 2000, AMS SERVICES INC.