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18-102 Chrisp Company, Stevens Creek Blvd Re-Striping ProjectCITY OF II CUPERTINO 1. PARTIES PUBLIC WORKS CONTRACT $45,000 OR LESS This public works contract ("Contract") is made and entered into on _M_ay~l_4~, _20_18 _____ _ ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and Chrisp Company , a Corporation ("Contractor") for Stevens Creek Blvd Re-Striping Project 2. SCOPE OF WORK Contractor will perform and provide all labor, materials , equipment, supplies, transportation and any other items or work necessary to perform and complete the work required for the Project ("Work"), as required in the Scope of Work, attached here and incorporate d as Exhibit A, and in accordance with the terms and conditions of this Contract. 3. TIME FOR COMPLETION 3.1 Term. This Contract begins on the Effective Date and ends on A ug ust 14 , 20 I 8 ("Contract Time") unless terminated earlier as provided h ere in. Contractor's Work shall begin on the date shown on a written Notice to Proceed ("NTP") and must be fully completed within the Contract Time or on the date specifically provided in the Notice to Proceed. The City Engineer will not issue a NTP until the Contract is fully executed by both parties and City has received satisfactory proof of insurance and any performance and payment bonds that may be required. 3.2 Time is of the essence for Contractor's performance and completion of the Work. Contractor must have sufficient time, resources, and qualified staff to deliver the work on time. 3.3 Liquidated damages of $200.00 will be charged for each day of unexcused delay , or City may deduct the amount from Contractor 's payments. Liquidated damages are based on reasonably foreseeable consequences of delay and may include intangible losses which the Parties agree may be difficult to ascertain , such as loss of public confidence in City and its contractors , interference or loss of use of public facilities , and extended disruption to the public. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work an amount that wi ll based on actual costs but that will be capped so as not to exceed $4190.00 ("Contract Price "), for all of Contractor 's direct and indirect costs , including all labor, materials , supplies, equipment, taxes, insurance, bonds and all overhead costs. 4.2 Invoices and Payments. Contractor must submit an invoice on the first day of each month , describing the Work performed during the preceding month , itemizing labor, materials, e quipm e nt and Public Works Project Steve ns Creek Blvd. Re-Striping Project Public Works Contract $45,000 !Rev . Nov 3, 2017 Page I of 11 any incidental costs incurred. Contractor will be paid 95% of the undisputed amounts billed within 30 days after City receives a properly submitted invoice. Any retained amounts will be included with Contractor 's final payment within 60 days of City 's acceptance of the Work as complete. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee of City. Contractor is solely responsible for the means and methods of performing the Work and for the persons under this employment. Contractor is not entitled to worker 's compensation or any other City benefits. 5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed , registered , and/or certified to perform the Work as required by law, and have procured a City Business License. Contractor shall possess a California Contractor 's License in good standing for the following classification(s):C32 , which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor 's employees are authorized to work under this Contract. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools , materials and equipment required to perform the Work under this Contract. 5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this Contract. Upon City 's requ e st, Contractor will provide proof of payment and will indemnify City for violations pursuant to the indemnification provision of this Contract. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor 's request for a change order must specify the proposed changes in the Work, Contract Price, and Contract Time. Each request must include all the suppo1iing documentation , including but not limited to plans/drawings , detailed cost estimates, and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign , hypothecate, or transfer this Contract or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval , which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs , successors and permitted assigns Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45,000 !Rev. Nov 3, 2017 Page 2 of 11 8. PUBLICITY/ SIGNS Any publicity generated by Contractor for the Project during the Contract Time, and for one year thereafter must credit City contributions to the Project. The words "City of Cupertino" must be displayed in all pieces of publicity, flyers , press releases , posters, brochures, interviews, public service announcements and newspaper aiiicles. No signs may be posted or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces , except that Contractor may hire qualified subcontractors to perform up to 25 % of the Work, provided that each subcontractor is required by contract to be bound by the provisions of this Contract. Contractor must provide City with written proof of compliance with this provision upon request. 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor 's Work falls short of the requirements of this Contract or constitutes grounds for rejection under Public Contract Code Section 4107. If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor 's Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within 15 days after City accepts the Work if the Contract involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Project. The repo1is must describe the Work and specific tasks performed, the number of workers , the hours, the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the repo1is, but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical , electrical and plumbing work; HY AC systems ; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail , and the location of all main runs , piping, conduit, ductwork, and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles, which must be available for City review and audit, kept separate from other records , and maintained for four years from the date of City 's final payment. Public Works Project Stevens Creek Blvd. Re-Striping Project Public Work s Contract $45,000 /Rev. Nov 3, 2017 Page 3 of I I 11. INDEMNIFICATION 11.l To the fullest extent allowed by law , and except for losses caused by the sole and active negligence or willful misconduct of City personnel , Contractor shall indemnify , defend , and hold harmless City , its City Council , boards and commissions, officers, officials , employees, agents, servants, volunteers and consultants ("Indemnitees"), through legal counsel acceptable to City, from and against any and all liability , damages , claims, stop notices , actions, causes of action, demands , charges , losses and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings), of every nature arising directly or indirectly from this Contract or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees, agents, servants, subcontractors or subcontractors ; (c) Pay ment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and (d) Personal injury , property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. 11.2 Contractor must pay the costs City incurs in enforcing this provi s ion . Contractor must accept a tender of defense upon receiving notice from City of a third-party claim , in accordance w ith California Public Contract Code Section 9201. At City 's request, Contractor will assist City in the defense of a claim, dispute or lawsuit arising out of this Contract. 11.3 Contractor 's duties under this entire Section are not limited to Contract Price, Workers' Compensation or other employee benefits , or the insurance and bond coverage required in this Contract. Nothing in the Contract shall be construed to g ive rise to any implied right of indemnity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor 's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract, a purchase order or other transaction. 12. INSURANCE Contractor shall comply with the Insurance Requirements , attached and incorporated here as Exhibit B. Contractor must provide satisfactory proof of insurance and maintain it for the Contract Time or longer as required by City. City will not execute the Contract until City has approved receipt of satisfactory certificates of insurance and e ndorsements evidencing the type , amount, class of operations covered , and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance at Contractor's expense, deducting the costs from Contractor's compensation , or terminating the Contract. Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Co ntra ct $45,000 /Rev . Nov 3, 2017 Page 4 of 11 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor's ability to perform. Contractor is responsible for verifying the employment status of employees performing the Work, as required by the Immigration Reform and Control Act 13.2 Labor Laws. (a) Contracts of $1 ,000 or more are subject to the requirements of the California Labor Code, including but not limited to: (i) Prevailing wage laws under Labor Code Section 1775, which require Contractor to pay prevailing wages applicable in Santa Clara County for each craft, classification, or type of worker needed to perform the Work, including health , pension and vacation. The prevailing wage rates are on file with the City Engineer's office and are available online at http ://www.dir.ca .gov/DLSR; (ii) Apprenticeship requirements under Labor Code Section 1777.5 for Contacts $30 ,000 or more; (iii) Maintain cetiified payroll records in accordance with Labor Code Sections 1776 and 1812 , and electronically submit them to the Labor Commissioner as required by the regulations of California, Department ofindustrial Relations ("DIR"); (iv) Comply with DIR Monitoring, Enforcement and Registration requirements of Labor Code Section 1725.5. (b) Contractor must compensate workers who are paid less than prevailing wages or required to work more than a legal day 's work. Contractor will also be required to pay City a penalty of $200.00 per worker for each day of violation. ( c) As required by Labor Code Section 1861 , by signing this Contract Contractor certifies as follows: "I am aware of Labor Code Section 3700 which requires every employer to be insured against liability for workers ' compensation or to unde1iake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the Work on this Contract." 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed , color, ancestry , national origin , ethnicity , handicap, disability , marital status , pregnancy, age , sex, gender, sexual orientation, gender identity , Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws , including Government Code Sections 12900 and 11135 , and Labor Code Sections 1735 , 1777 and 3077.5 . Consistent with City policy prohibiting harassment and discrimination , Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors will not be tolerated . Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45,000 !Rev. Nov 3, 2017 Page 5 of 11 13.4 Conflicts oflnterest. Contractor, its employees, su bcontractors, servants and agents , may not have , maintain or acquire a conflict of interest in relation to this Contract in violation of law , includin g Government Code section 1090 and Government Code section 81000 a nd their 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 by state law, or in violation of a City ordinance or policy while serving as a City Representative or for one year thereafter. Contractor, its employees , subcontractors , servants and agents warrant they are not employees of City or have any relationship with City officials, officers or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity , as defined in section 18700 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments , requiring reimbursement, or terminating the Contract. City reserves all rights and remedies under the law and this Contract, including seeking indemnification. 14. BONDS For contracts of $25,000 or more, Contractor must obtain a pay ment bond and a performance bond , each in the penal sum of 100% of the Contract Price , usin g th e Bond Forms attached and incorporated here as Exhibit C. Each bond must be issu e d by a surety admitted in California, with a financial rating from A .M. Best Company of C lass A-or higher, or as otherwise acceptable to C it y. If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a s urety acceptable to City within seven calendar days after written notice from City. If Contractor fails to do so, City may in its sole discretion and without prior n otice, purchase bonds at Contractor's expense, deduct the cost from payments due Contractor, or terminate the Contract. City will not execute the Contract nor iss ue the NTP until the required bonds are submitted. 15. UTILITIES, TRENCHING AND EXCAVATION 15.1 Contractor must call the Underground Service Alert ("USA") 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic s ignal conduits, City 's Service Center must be called at (408) 777-3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing , and wait for instructions if one of the conditions below is found at the worksite. Ci ty will work with Contractor to amend th e Contract or issu e a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believ e d to be hazardous waste under Health and Safety Code Section 25117, and which requires removal to a Class I, Class II , or Class III disposal site pursuant to law ; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor; and Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45,000 !Rev. Nov 3, 2017 Pa ge 6 of 11 ( c) Unknown phy sical conditions at the Project worksite o f any unusual nature , materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For contracts $25,000 or higher that require excavation or involve trenches five feet or more in depth, Contractor must submit a detailed plan for City approval , per Labor Code Section 6705 prior to commencing work. The plan must show the design of shoring, bracing, sloping and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards, it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal , state and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control , Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets, gutters and storm drains . Prior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of storm drains , and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at the end of construction and completion of the Work. Such controls must include , but will not be limite d to , the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences , and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season, October 15 through June 15 , storm drain inlets impacted by construction work must be filter-protected from onsite de -watering activities and saw-cutting activities. Shovel or vacuum saw-cut slurry and remove from the Work site; (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; ( c) Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain and at the end of each work day. When the Work is completed , wash the streets , collect and dispose of the wash water offsite in lawful manner; ( d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; (e) Maintain a clean work area by removing trash , litter, and debris at the end of each work day and when Work is completed. Clean up any leaks , drips , and other spills as they occur. 16.2 These requirements must be used in conjunction with the California Stormwater Quality A s sociation and California Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor's failure to comply with this Section will result in the issuance of noncompliance notices , citations, Work stop orders and regulatory fines. Public Works Project Stevens Creek Blvd. Re-Striping Project Public Work s Contra ct $45 ,000 /Rev. Nov 3, 2017 Page 7 of 11 17. PROJECT COORDINATION City Project Manager. City assigns Brad Alexander as the City representative for all purposes under this Contract, with authority to require compliance with the Scope of Work. City may substitute Project Managers at any time and without prior notice to Contractor. Contractor Project Manager. Subject to City approval , Contractor assigns Danny Azcueta ___________________ as its single representative for all purposes under this Contract, with the responsibility to ensure progress with the Work. Contractor 's Project Manager is responsible for coordinating and scheduling the Work and must regularly update the City Project Manager about the status and any delays with the Work, consistent with the Scope of Work. Any substitutions must be approved in writing by City. 18. ABANDONMENT AND TERMINATION 18.1 City may abandon or postpone the Proj ect or parts therefor at any time. Contractor will be compensated for satisfactory Work performed through the date of abandonment and will be given reasonable time to close out the Work. With City's pre-approval in writing, the time spent in closing out the Work will be compensated up to 10% of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered t hrou g h the termination date and will be given reasonable time to close out the Work. 18.3 Final payme nt will not be made until Contractor delivers the Work and provides records documenting the Work, products and deliverables completed. Nothing in the Section below is intended to delay, abridge or bar City 's right under this Section. 19. GOVERNING LAW, VENUE AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public Contract Code Section 20104, incorporated here by reference, apply to this Contract and Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Pa1iies elect arbitration , the arbitrator 's award must be suppo1ied by law and substantial evidence and include detailed written findings of law and fact. 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal , or other proceedings to enforce its rights or a judg ment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45,000 /Rev. Nov 3, 2017 Page 8 of 11 21. SIGNS/ADVERTISEMENT No signs may be displayed on or about City 's property, except signage which is required by law or by the Contract, without City 's prior written approval as to size, design and location. 22. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City waiver of any breach shall not constitute waiver of another provision or breach . 26. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality , and free from defective workmanship and materials , and that the Work will be free from material defects not intrinsic in the de sign or materials. All Work, materials and equipment should pass to City free of claims, liens or encumbrances. Contractor warrants the Work and materials for one year from the date of City's acceptance of the Work as complete ("Warranty Period"), except when a longer guarantee is provided by a supp lier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or m ate rials , including damage that arises from Co ntractor 's Warranty Work, except any wear and tear or damage resultin g from improper use or maintenance. 27. ENTIRE CONTRACT This Contract and the attac hm e nts , documents, and statutes attached , referenced , or express ly incorporated herein , including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If any attachment or incorporated provisions conflict or are inconsistent with the terms of this Contract, the Contract terms will control. 28. SEVERABILITY IP ARTIAL INVALIDITY If a court find s any term or provision of this Contract to be illegal, invalid or unenforceable , the le gal portion of said provision and all other contract provisions will remain in full force and effect. 28. SURVIVAL T he contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all warranties , indemnities, pay ment obligations , in s urance and bond s , shall remain in full force and effect after the Work is completed or Contract e nds. Public Works Project Stevens Creek Blvd . Re-Striping Project Public Works Contract $45,000 /Rev. Nov 3, 2017 Page 9 of 11 29. INSERTED PROVISIONS Each provision and clause required by law to be inserted in this Contract will be deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. 30. CAPTIONS The captions, titles, and headings in this Contract are for convenience only and may not be used in the construction or interpretation of the Contract or for any other purpose. 31. COUNTERPARTS This Contract may be executed in counterparts, each of which is an original and all of which taken together shall form one single document. 20. NOTICES All notices, requests, and approvals must be sent in writing to the persons below and will be considered effective on the date of personal delivery, the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: 10300 Torre Avenue, Cupertino CA 95014 Attention: Brad Alexander Copy to: Carl Valdez Email: brada@cupertino.org 30. VALIDITY OF CONTRACT To Contractor: Chrisp Company Attention: Danny Azcueta Copy to: _oa_v_id_M_o_rr_is _________ _ Email: dazcueta@chrispco.com This Contract is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, (b) is signed by the City Manager or an authorized designee, and (c) is approved for form by the City Attorney's Office. 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45,000 /Rev . Nov 3, 2017 Page lO of ll IN WITNESS WHEREOF , the partie s have caused thi s Contract to be executed as of the Execution Date first above written . CONTRACTOR Chrisp Company Corooration '/lh. By:~ Title: Vice President CITY OF CUPERTINO, a Municipal Corporation By:·~ f~~ Title: Director of Public Works S ignature Date: __ S~\.-1--------.-\ ~\ )S'" ___ _ Signature Date: ____,,~__,_A..,,z '----l-~-l-l '------1-"'~'--------- APPROVED AS TO FORM: B y : AT T EST : By ~ ii & .('2-· /J oRAC SCHMIDT, City Clerk Public Works Project Stevens Creek Blvd. Re-Striping Project Public Works Contract $45 ,000 /Rev. Nov 3, 2017 Page 11 of 11 ~p &tmpam; Fremont Office 43650 Osgood Rd EXH I BIT 11 A11 Contractors Li ce nse No . 374600 DIR Registration No. 1000000306 A General Engineering Fremont CA 94539 Phone : (510) 656-2840 Fa x: (510) 656-2397 Quotation TO: CUPERTINO, CITY OF 10300 TORRE AVENUE CUPERTINO Phone : (408) 777-3354 Contact: Brad Alexander email : BradA@cupertino.org Fax: CA ( ) - ITEM NO. DESCRIPTION 95014-0255 REMOVE EXISTING STRIPING AND REPLACE IN NEW ALIGNMENT Written Authorization is Required Prior to Proceeding With Work ACCEPTED BY: P.O. Number TITLE: Job Number This quote includes all stipulations found on page 3 Page 1 of 3 C-13 Fence, Wire, wood C-32 Highway Improvement Union Contractor/ No minority Status Current Date : BidDate : JobName : Location: Contract#: Working Days : 2/23/2018 2/26/2018 STEVENS CREEK AT FOOTHILL CUPERTINO Bid#: 39342 Job#: Liquidated Damages QUANTITY UNIT UNIT PRICE LS Subtotal Bond Rate 1.2% 4190.000 TOTAL Addendu QUOTE PREPARED BY Danny Azcueta 0 TOTAL / $4,190 .0 0 $4 ,190 .00 $4 ,190 .0 0 (650) 224-1115 dazcueta@chrispco.com CHRISP COMPANY ~P~a!Uf Fremont Office 43650 Osgood Rd Fremont CA 94539 Phone : (510) 656-2840 Fax : (510) 656-2397 Quotation Con tracto rs License No . 374600 DIR Registration No. 1000000306 A General En gi neering C-13 Fen ce, Wire, wood C-32 Highway Improvement Union Contractor/ No minority Status COMMENTS, EXCLUSIONS, AND STIPULATIONS The following stipulations are hereby incorporated into and made part of the quotation from Chrisp co. dated February 23, 2018 for the following project STEVENS CREEK AT FOOTHILL • NO RETENTION TO BE TAKEN ON CONTRACTS LESS THAN $5 ,000.00 • Chrisp Company reserves the right to withdraw proposal if written acceptance Is not received within 30 days of bid date • Clean, clear and unobstructed access required for Chrisp Co. work • Final PAY QTYS presented by owner MUST be agreed by Chrisp Co . • Changeable Message board if required to be provided by General Contractor for Chrisp Co. Use at no Charge to Chrisp Co. • EXCLUDE: Traffic Control Plan • EXCLUDE: Seal Coat • EXCLUDE: Removal of Concrete Curing Material prior to PAINT I THERMOPLASTIC/ PAVEMENT MARKER • EXCLUDE : Red -Lined As-Built Drawings • Traffic Control INCLUDED for Chrisp Company work ONLY • After receiving contract 10 working days written notice required prior to scheduling of work • Chrisp Co. will remove contractors short term temporary markers (Floppys) placed for lanelines and centerlines only (no edgelines or shoulders). No Tape removal. Short Term Temporary markers are to be placed so that striping may be placed before removal of temporary markers. • This quotation excludes Primary Liability Insurance greater than $2,000,000. • This quotation excludes all work associated with the project SWPP and WPCP. • EXCLUDE: Encroachment Permit (If required to be provided at No Cost to Chrisp Company) • EXCLUDE: ALL Safety Training, Badging, Drug Testing and Orientation (To be paid at time and material Cal -Trans • Access/ and or Access i bility by 1 Ton Vehicle required for Chrisp Company work • EXCLUDE: Advanced posting of "No Parking" signs • This quotation EXCLUDES removal of Yellow stripe and markings treated as hazardous. • EXCLUDE: Lead Compliance Plan • Retainage percentage on monthly progress payments to be no greater than the percentage retained by the Owner on its payment to the Contractor. If Owner reduces the retainage percentages on payments to the Contractor, the Contractor shall likewise reduce the retainage percentage on payment to Chrisp Company. Full retention to be released no later than thirty, (30) Days after completion of Chrisp Companys work. Excessive or delinquent retainage will be subject to the highest interest rate allowed by law. • Chrisp Company shall be reimbursed the full amount for bonds upon submission to General Contractor. Retention shall not be held from bond reimbursement. • THIS QUOTATION IS BASED ON A STANDARD MONDAY THROUGH FRIDAY WORK WEEK . ADDITIONAL COSTS WILL OCCUR FOR WORK PERFORMED ON WEEKENDS Page 2 of 3 e/vti.,p &mfJantJ Fremont Office 43650 Osgood Rd Fremont CA 94539 Phone : (510) 656-2840 Fax : (510) 656-2397 Quotation Contractors License No . 374600 DIR Registration No. 1000000306 A General Engineering C-13 Fence, Wire, wood C-32 Highway Improvement Union Contractor/ No minority Status • CHRISP COMPANY WILL USE EXISTING EMPLOYEE POOL TO PERFORM ALL WORK ON THIS PROJECT. IF THERE ARE ANY HIRING GOALS FOR THIS PROJECT THIS WILL BE EXCLUDED Page 3 of 3 t RE-STRIPE TRAVEL LANES N Stevens Creek Blvd at Foothill Blvd DETAIL 22 <:::= 24 '-0" ll.'..:Q" ~ ~ ~ .. ~=q~ Wo.-k H t>'-'-,,.f : IOIJM .,. 2 :30 Pr1 M ~,.. -FR.r. DETAIL 32 I <:::= ""' M ~ ~ 96'-0" I 24 '-0" 2 4 '-0" 2 4'-0 " I 24 '-0 " I I 000 !!ill l!i'!l l'il!I ~cec:~ ~ l1il! ~" ~ i!1i : : :,c:c:a@§@@@f§§ffl Bllil B!!I I 96'-0" PUBLIC WORKS CONSTRUCTION CONTRACTS Small Projects -$45,000 Insurance Requirements: E~hibit B Contractor shall procure and maintain for the duration of the contract, and for jive years following the completion of the Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representati ves, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an "occurrence" basis, written on a comprehensive general liabili ty form, and must include coverage for liability arising from Contractor's or Subcontractor's acts or omissions, including Contractor's protected coverage, blanket contractual, products and completed operations, ve hicle coverage and employer's non-o wnership liability coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all liabili ty for personal injwy, death , property damage or destruction, and personal and advertising injury. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to th e Additional Insured and shall be (I) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO CG 20 0 I 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrell a or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City 's own insurance or self-insurance shall be called upon to protect City as a named insured. 2 . Automobile Liability: ISO Form CA 0001 covering any auto (Code 1), or if Contractor has no owned autos, then ./ hired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: As required by the State of California, with Statutory Limits , and / Employer's Liability Insurance ofno less than $1,000,000 per accident for bodily injury or disease, or as otherwise V required by statute. If Contractor is self-insured, Contractor must provide a Certificate of Pem1ission to Self-Insure, duly authorized by the DIR. D N/A if box checked (Contractor provides written verification it has no emp lo yees). 4. Professional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. [81 N IA if box checked (Contract is not design/build). 5. Builder's Risk. Course of Construction insurance utilizing an "All Risk" (Special Perils) coverage fonn, with limits equal to the completed value of the project and no coinsurance penalty provisions. @ NI A if box checked (Project does not involve construction or improvements/installations to property). Insurance Req uirem ents for Construction Contracts -$45,000 Version: Nov 2017 6. Contractors' Pollution Legal Liability and/or Asbestos Legal Liability and /or Errors and Omissions with limits no less than $1,000,000 per occurrence or claim , and $2,000,000 policy aggregate . .[8J N I A if box checked (Project does not involve environmental hazard.1). If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City . Self-Insured Retentions. Self-insured retentions must be declared to and approved by City. At City's option, either: ( l) Contractor shall cause the insurer to reduce or eliminate self-insured retentions as respects City, its officers, officials, employees, and volunteers; or (2) Contractor shall provide a financial guarantee satisfactory to City guaranteeing payment of losses and related investigations, claim administration, and defense expenses. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or the City. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino , its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of the Services perfonned by or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Fann CG 20 l O 11 85 or if not available, through the addition of both CG 20 l 0, CG 20 26 , CG 20 33 , or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Project, Contractor's insurance coverage shall be "primary and non-contributory" and at least as broad as ISO CG 20 0 I 04 13 with respect to City, its officers, officials, employees and volunteers, and shall not seek contribution from City's insurance. If the limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a "primary and non-contributory" basis for the benefit of City . Notice of Cancellation Each insurance policy required shall provide that coverage shall not be canceled, except with notice to the City. Each ce1tificate of insmance must state that the coverage afforded by the policy is in force and will not be reduced, cancelled or allowed to expire without at least 30 days advance written notice to City, unless due to non-payment of premiums, in which case ten days advance written notice must be prnvided to City. Such notice must be sent to City via certified mail and addressed to the attention of the City Manager. Builder's Risk Contractor may submit Builder's Risk insmance in the form of Course of Construction coverage, which shall name the City as a loss payee, as its interest may appear. The Builder's Risk policy must be issued on an occurrence basis, for all-risk coverage on a I 00% completed value basis on the insurable portion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstruction, City may elect, acting in its sole discretion, to accept an Installation Floater policy instead of Builder's Risk. For such projects, the Property Installation Floater shall include improvement, remodel, modification, alteration, conversion or adjustment to existing buildings, structures, processes, machinery and equipment , and shall provide prope1ty damage coverage for any building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the perfo1mance of the Work, including during transit, installation, and testing at the City's site . lnsurance Requirem ents for Con s truction Contra c ts -$45 ,000 Version: No v 2017 2 Waiver of Subrogation V Each required policy must include an endorsement providing that the carrier agrees to waive any right of subrogation it may have against City. Contractor agrees to waive rights of subrogation which any insurer of Contractor may acquire from Contractor by vi.t1ue of the payment of any loss. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation. The Workers' Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work perfom1ed by the Contractor, its employees , agents and subcontractors. Acceptability of Insurers Insurance must be issued by insurers acceptable to City and licensed to do busmess in the State of California , and each insurer must have an AM . Best's financial strength rating of"A" or better and a financial size rating of "VII " or better. Verification of Coverage Contractor shall furnish the City with original ce11ificates and amendatory endorsements, or copies of the applicable insurance language, effectmg coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences . The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a fonn at least as broad as CG 20 38 04 13. Surety Bonds As required by Contract and described in the Contract Documents . The Payment and Performance Bonds shall be in a sum equal to the Contract Price. If the Perfonnance Bond provides for a one-year warranty a separate Maintenance Bond is not necessary. If the warranty period specified in the Contract is for longer than one year a Maintenance Bond equal to 10% of the Contract Price is required. Bonds shall be duly executed by a responsible corporate surety, authorized to issue such bonds in the State of California and secured through an authorized agent with an office m California. Special Risks or Circumstances City reserves the right to modify these requirements, based on the nature of the risk, prior experience, insurer, coverage, or other circumstances . In s uran ce Requirements.for Con s tru ction Contra cts -$45 ,000 Vers ion : No v 201 7 3 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 5/16/2018 THIS CERTIFICATE IS ISSUED AS A MATIER 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Certificate Deoartment NAME : Arthur J . Gallagher & Co . p~~N,,Tn ~-"· 925-299-1112 I r~ .. ~,. 925-953-6210 Insurance Brokers of CA, Inc. LIC #0726293 ~~~A~~~~-CertRequests@ajg .com 3697 Mt. Diablo Blvd ., Suite 300 Lafayette CA 94549 INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A ,Zurich American Insurance Company 16535 INSURED INSURER B ,American Guarantee and Liability Ins Co 26247 Chrisp Company INSURER C: 43650 Osgood Road INSURER D : .. Fremont, CA 94539 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER· 1450001791 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: INDIGATED. 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 , EXCL USIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . -· INSR TYPE OF INSURANCE l"UUL l~UHK ~ POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMl)ER IMM/DD/YYYYl IMM/DD/YYYYl A X COMMERCIAL GENERAL LIABILITY y ( GLO 02177 30-02 ~ 12/1/2017 12/1/2018 EACH OCCURRENCE $1,000 ,00 0 V 1 CLAIMS-MAD E 0 OCCUR DAMAGE TO RENTED PREMI S ES /Ea occu rren ce) $50,000 X Bl/PD: $10 000 MED EX P (Any one person) $5,000 ,__ X DED/OCC PERSONAL & ADV INJURY $1,000,000 ,,. GEN 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREG ATE $2,000 ,00 0 vr , Fl 0 PRO-D LO C $2 ,000,000 ' POLICY JECT PR OD UCTS -COMP/OP AGG OTHER : $ A AUTOMOBILE LIABILITY BAP 0217729-02 12/1/2017 12 /1/2018 COMBINED SINGLE LI MIT $1,000.000 v (Ea accident) -X ANY AUTO BODILY INJURY (Per pe rson) $ -· I -OWN ED -SCHEDULED ·,·/ AUTOS ONLY AUTOS BOD ILY INJURY (Per accident) $ -HIRED NON-OWNED PROPERTY DAMAGE I X AUTOS ONLY X AUTOS ONLY (P er accident) $ --_v-----/: B X UMBRELLA LIAB M OCCUR AUC 0217902-02 12/1/2017 12 /1/2018 EACH OCCURRENCE I $5,000,000 V -l $5,000,000 r) EXCESS LIAB CLAIMS-MADE -~ AGGREGATE OED IX I RETENTION $10 ,000 / ' _,..,., ~ A WORKERS COMPENSATION ~ ~217 ~ 12/1/2017 12/1/2018 I PER I I OTH - AND EMPLOYERS' LIABILITY X STATUTE ER Y/N v ANY PROP RI ETO R/PARTN ER/EXECUTIVE D E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXC LUDED? N/A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes , describe under DESCR IPTION OF OPERATIONS below E.L. DISE AS E -POLICY LIMIT $1,00 0,000 .. DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) -'•·· Chrisp Job#: 10C .18 .024 RE : Stevens Creek Blvd Re-Striping Project, Cupertino , CA. ADDITIONAL INSURED{S): The City of Cupertino, its City Council, officers , officials , employees , agents, servants and volunteers. --· 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 10555 Mary Ave . ACCORDANCE WITH THE POLICY PROVISIONS. Cupertino CA 95014 AUTHORIZED REPRESENTATIVE ),~ ' I © 1988-2015 ACORD CORPORAT ION . All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ~ Additional Insured -Automatic -Owners, Lessees Or Contractors ZURICH __fleliCV No. -E-fl Date of Pol. Exp. Date of Pol. Eff. Date of End . Producer No. Add'I. Prem Return Prem. V GLO 0217730-02 : µ1 1/2017 "12/1/2018 · 121112017 ----- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Address (including ZIP Code): This endorsement modifies insurance provided under the : Commercial General Liability Coverage Part A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personai and advertising injury" caused, in whole or in part, by: 1 . Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, the insurance afforded to such add itional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide fa( such additional insured . B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: .!' This insurance does not apply to: :I "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including : a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions , reports, surveys , field orders, change orders or drawings and specifications: or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision , hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved th~ rendering of or the failure to render any professional architectural, engineering or surveying services . · Includes copyrighted material of Insurance Services Office, Inc .. with its permission . U-GL-11 75-F CW (04/13 ) Page 1 of 2 C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV - Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV -Commercial General Liability Conditions: Primary and Noncontributory insurance This Insurance Is primary to and will not seek contribution from any other Insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. . , 2. The following paragraph is added to Paragraph 4.b . of the Other Insurance Condition of Section IV -Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and nori l contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. · · F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added tq Section Ill -Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or -.! •:1 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. Includes copyrighted material of Insurance Services Office, Inc., with its permission . . I U -GL-1175-F CW (04/13) Page 2 of 2 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed . 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 12/1/2017 at 12:01 A.M. standard time, forms a part of (DATE) Policy N of the issued to Premium (if any) $ Endorsement No. (NAME OF INSURANCE COMPANY) Authorized Representative 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 mium otherwise due on such remuneration. Schedule Person or Organization % of the California workers' compensation pre- Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION. WC 252 (4 -84) WC 04 03 06 (Ed . 4-84) Page 1 of 1 AGENCY CUSTOMER ID:------------------- LOC #: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED POLICY NUMBER CARRIER I NAIC CODE EFFECTIVE DATE : ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM , FORM NUMBER: FORM TITLE: Additional Information GENERAL LIABILITY : 'Additional Insured if required by written contract per attached Form U-GL-1175-F CW ( O 4 / 13) • Coverage is Pr imary/Non-Contributory if required by written contract per attached U-GL-1175-F CW ( 04/13) WORKERS' COMPENSATION : ' Covered States: California , Nevada . Oregon *WaiverofSubrogationifrequiredbywrittencontractperattachedFormwc 04 03 06 (Ed. 4-84) and WC 252 (4-84) UMBRELLA LIABILITY : ' Underlying : General Liabil ity , Automobile Liability and Employer's Liability ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved . The ACORD name and logo are registered marks of ACORD