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18-165 Joe's Tractor Service, Weed Mowing - McClellan Ranch PreserveCITY O F a CUPERTINO 1. PARTIES PUBLIC WORKS CONTRACT $45,000 OR LESS This public works contract ("Contract") is made and entered into on _J_u~ly_9~2_2_0_1_8 _____ _ ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and Joe's Tractor Service , a Sole Proprietorship/Individ ("Contractor") for Weed Mowing -McClellan Ranch Preserve 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 incorporated 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 12/31/2021 --------- ("Contract Time") unless terminated earlier as provided herein. 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 will based on actual costs but that will be capped so as not to exceed $18,000 .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, equipment and Public Works Project Weed Mowing -McClellan Ranch Preserve Public Works Contract $45,000/Rev. May 22, 2078 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/o r 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):N/A , 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 Ta xes. Contractor must pay income taxes on the money earned under this Contract. Upon City 's request, 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 supporting 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 p ercent (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 Weed Mowing-McClellan Ranch Preserve Public Works Contract $45 ,000/Rev. May 22, 2018 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 Cupe11ino " must be displayed in all pieces of publicity, flyers , press releases , posters , brochures , interviews , public service announcements and newspaper a11icles . No signs may be posted or displayed on or about City prope11y , except signage required by law or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perfonn all the Work with its own forces , except that Contractor may hire qualified subcontractors to perform up to 50 % 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 perfo1ming Work on the Project, if City in its sole discretion detennines that subcontractor 's Work falls sho11 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 repo11s of the Work and submit them to City upon request and at completion of Project. The reports must describe the Work and specific tasks perfotmed, the number of workers , the hours , the equipment, the weather conditions, and any circumstances affecting perfonnance. City will have ownership of the rep011s , but Contractor will be pennitted 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; HV AC systems ; utilities and utility connections; and any other components City dete1mirtes 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 Weed Mowing-McClellan Ranch Preserve Public Works Contract $45,000 /Rev. May 22, 2018 Page 3 o f 11 11. INDEMNIFICATION 11.1 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 , cau se s 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 wan-anties; (b) Perfo1mance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees , agents , servants , subcontractors or subcontractors ; ( c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work perfmmed on or off the Project Site; and ( d) Personal injury, property damage , or economic loss resulting from the work or perfo1mance of Contractor or its subcontractors or sub-subcontractors . 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-paiiy claim, in accordance with 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 constrned to give 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 endorsements 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 te1minating the Contract. Public Works Project Weed Mowing-McClellan Ranch Preserve Public Works Contract $45 ,000 !Rev. May 22, 2018 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 perfo1m. Contractor is responsible for verifying the employment status of employees p erforming 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 perfo1m 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 ce11ified 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 of Industrial 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 ce11ifies as follows: "I am aware of Labor Code Section 3700 which requires 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 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 Weed Mowing-McClellan Ranch Preserve Public Works Contract $45 ,000 /Rev. May 22, 2018 Page 5 of 11 13.4 Conflicts of Interest. Contractor, its employees, subcontractors, servants and agents, may not have , maintain or acquire a conflict of interest in relation to this Contract in violation of law , including Government Code section 1090 and Government Code section 81000 and their accompanying regulations . No officer, official, emp loyee , 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 Repre sentative or for one year thereafter. Contractor, its employees , subcontractors , servants and agents wanant 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 tenninating 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 payment bond and a performance bond, each in the penal sum of 100% of the Contract Price, using the Bond Forms attached and incorporated here as Exhibit C. Each bond must be issued by a surety admitted in California , with a financial rating from A.M. Best Company of Class A-or higher, or as otherwise acceptable to City . If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a surety 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 notice , purchase bonds at Contractor 's expense, deduct the cost from payments due Contractor, or tem1inate the Contract. City will not execute the Contract nor issue the NTP until the required bonds are submitted . 15. UTILITIES, TRENCHING AND EXCAVATION 15.1 Contractor must call the Underground Service Ale11 ("USA") 811 hotline and request marking of utility locations before digging or commencing Work. For underground service ale11s for street lighting and traffic signal 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 . City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. ( a) Material believed 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 Weed Mowing-McClellan Ranch Preserve Public Works Contract $45,000 !Rev. May 22, 2018 Page 6 of 11 (c) Unknown physical conditions at the Project worksite of 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 sto1m water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is u sed 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 sto1m drains. Prior to the stai1 of the Work, Contractor will in1plement erosion and sediment controls to prevent pollution of sto1m 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 limited 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 slmTy 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 stmm 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 off site 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 Association 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 Weed Mowing -McClellan Ranch Preserve Public Works Contract $45,000 /Rev. May 22, 2018 Page 7 of l l 17. PROJECT COORDINATION City Project Manager. City assigns Brian Gathers , Public Works Supervisor 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 Joe Camarda, Owner ___________________ 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 Project 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 perfonning the Work. 18.2 City may te1minate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment 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 . P1ior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Parties elect arbitration, the arbitrator 's award must be supported 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 judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. Public Works Project Weed Mowing-McClellan Ranch Preserve Public Works Contract $45,000 /Rev . May 22, 2018 Page 8 of l l 21. SIGNS/ADVERTISEMENT No signs may be displayed on or about City 's prope1iy , 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 pa1iy 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 wan-ants 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 intiinsic in the design or materials. All Work, materials and equipment should pass to City free of claims, liens or encumbrances. Contractor wan-ants the Work and materials for one year from the date of City's acceptance of the Work as complete ("Watrnnty Period"), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Wmrnnty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor's WaITanty Work, except any wear and tear or damage resulting from improper use or maintenance . 27. ENTIRE CONTRACT This Contract and the attachments, documents , and statutes attached, referenced, or expressly 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 te1ms of this Contract, the Contract te1ms will control. 28. SEVERABILITY IP ARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal , invalid or unenforceable, the legal po11ion of said provision and all other contract provisions will remain in full force and effect. 28. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all WatTanties, indemnities, payment obligations, insurance and bonds , shall remain in full force and effect after the Work is completed or Contract ends. Public Works Project Weed Mowinq-McClellan Ranch Preserve Public Works Contract $45,000 /Rev. May 22, 2018 Page 9 o f 11 29. INSERTED PROVISIONS Each provision and clause required by law to be inse1ted in this Contract will be deemed to be included and will be inferred herein . Either paity may request an amendment to cure mistaken inse1tions 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 constrnction or interpretation of the Contract or for any other purpose . 31. COUNTERPARTS This Contract may be executed in counterpa1ts , each of which is an original and all of which taken together shall f01m 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 confomed by a reputable overnight delivery service , on the fifth calendar day after deposit in the United States Mail , postage prepaid, registered or ce1tified, or the next business day following electronic submission: To City of Cupertino: 10300 TotTe Avenue, Cupertino CA 95014 Attention: Bria n Gath e rs, Publi c work s s uperv isor Copy to: Carl Valdez , Superintendent Email : briang@ cupertino.org 30. VALIDITY OF CONTRACT To Contractor: Jo e's T rac tor Serv ice IO 193 Randy Lane, Cupertino, CA . 9 5014 Attention: Jo e C annada -------------Copy to : Email: This Contract is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupe1tino Municipal Code Chapters 3.22 and 3.23, (b) is signed by the City Manager or an authorized designee, and (c) is approved for f01m by the City Attorney's Office. 32. EXECUTION The persons signing below wainnt 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 Weed Mowing-McClellan Ranch Preserve Public Works Contract $45 ,000 /Rev. May 22, 2018 Page IO o f 11 [N WITNESS WHEREOF , the parties have caused thi s Contract to be executed as of the Execution Date first above written . CONTRACTOR Joe's Tractor Service l O 193 Randy Lane, Cupertino , CA. 95014 Sole Prooriet.720/Ind By: ~ Title: Owner ATTEST: CITY OF CUPERTINO, a Municipal Corporation Title: Director of Public Works . Signature Date: ~e--,/<--'-<---+i-+f-(_K~----- By: ~ft Pffi f GRACE SCHMIDT, City Clerk ff) ~ : J.-,\,LOJJ,~ ./5~ 101ro ~ y~ Uy\ '~ Ii . 19 , l 't '?.o + ~ .u{ Po -w r 9-N, Public Works Project Weed Mowing-McClellan Ranch Perserve Public Works Contract $45,000 /Rev. May 22, 2018 Pag e 11 o f 11 EXHIBIT 11 A11 6-21-18 To: City of Cupertino Re: Weed mowing for the City of Cupertino at McClellan Ranch Park This contract is between Joe's Tractor Service and the City of Cupertino. Joe's ·--------------------· ----------·-·----------·--- Tractor Service will provide weed mowing at McClellan Ranch Park, Cupertino, Ca. Joe's Tractor Service will weed mow the above mentioned property twice a year for $3,000.00 per time totaling $6,000.00 per year. The contract will last for 3 years unless the city determines negligent by Joe's Tractor Service then the city has the right to terminate the contract. Joe's tractor service will carry a $4,000,000 Umbrella Liability Insurance policy. Our fees will be reviewed and re negotiated if our costs increase substantially each year. Start date for first weed mowing will be the first week of April dependent upon weather and soil conditions and this will be determined by Joe's Tractor Service and the city. Final weed mowing will be completed by July ist. Thank you for giving us the opportunity to service the City of Cupertino. Joe Camarda -·-. --' ---· -- Owner of Joe's Tractor Service Please sign and send a copy back to Joe's Tractor Service. ~~~ Signuture ~~v City of Cupertino, Ca. Date _(t-1:>'-t-(}/_J r;;~/_· / t_· _ PUBLIC WORKS CONSTRUCTION CONTRACTS Small Projects -$45,000 Insurance Requirements: Exhibit B Contractor shall procure and maintain for the duration of the contract, and for five 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, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: vf. Commercial General Liability (CGL): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an "occurrence" basis , written on a comprehensive general liability form, and must include coverage for liability • '\')\ arising from Contractor's or Subcontractor's acts or omissions, including Contractor's protected coverage, ~ \t ,rV · blanket contractual, products and completed operations, vehicle coverage and employer 's non-ownership liability A, coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all \ \, 1 t ability for ?e:sonal_ inju?', death, property damage or_ de_struction, and personal and ad_vertis_ing injul")'.. If a general J\ · ggregate lumt apphes, either the general aggregate hm1t shall apply separately to this proJect/locat1on (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the req_uired 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 the Additional Insured and shall be (1) 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 01 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 umbrella 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. Auto obile Liability: ISO Form CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, then , 1 •. , 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 . Workers' Compensation: As required by the State of California, with Statutory Limits, and \J \[)(Employer's Liability Insurance ofno less than $1,000,000 per accident for bodily injury or disease, or as otherwise , ?f quired by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, tfl-duly authorized by the DIR. }ZQ NIA if box checked (Contractor provides written verification it has no employees). 4 . Pro~sional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. J~f N/ A if box checked (Contract is not design/build). 5. Builder's Risk. Course of Construction insurance utilizing an "All Risk" (Special Perils) coverage form, with limits ~qual to the completed value of the project and no coinsurance penalty provisions. J:8l NIA if box checked (Project does not involve construction or improvements/installations to property). Insurance Requirements 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. JZI' NIA if box checked (Project does not involve environmental hazards). 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: (1) 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 performed by or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 3 7 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 01 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 certificate of insurance 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 provided 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 insurance 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 100% 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 property damage coverage for any building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the performance of the Work, including during transit, installation, and testing at the City 's site. Insurance Requirements for Construction Contracts -$45,000 Version: Nov 2017 2 Waiver of Subrogation ~ / 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 virtue 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 performed by the Contractor, its employees , agents and subcontractors. Acceptability of Insurers Insurance must be issued by insurers acceptable to City and licensed to do business in the State of California, and each insurer must have an A.M. 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 certificates and amendatory endorsements, or copies of the applicable insurance language , effecting 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 form 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 Performance 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 l 0% 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 in 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. insurance R equirements for Construction Contracts -$45,000 Version: Nov 201 7 3 • 11 DATE IMMIODIYY¥X) ACORD CERT1IFICATE ·OF LIAB ILI TY INSURANCE ~ 06 116/201 18 I T HIS ,CERT.IFICATE IS 1JSSL1ED AS A MATIER 101: INFORMATION ONLY AND 'C'ONFERS NO 'RlG:tffS UlPON THE Cf:RJ•IFICATIE H OL'OER. THIS OEIRTIFI CAT,E DOES NOT AFFIRMATI V,El Y OR ,NEGATl ~l Y A 'ME1NI), EXTEND OR Al.TE:R TiilE COW::RAGE iillFf'OROED BY T H E POL!IOIES ..Ba.OW •. TlHISJC£R1ilF-IICAlllE.!OFJNS\!JRANCEJOOES-NOT..OONS..T!ltil.t.E.A.OON.TRA:CJ"~:tHEJSS\!lll!iGJINSllRER{~,JW.JTl:IORU\ED. R:E,PRiESENTATIIVE ,OR IPROlll!ICER, AND THE CE:RT1IF!CATE H OLD:SR. I MPORTA1NT: If t he ,cel11ficate !holder I s an AOD:rnO'NAl. lNS'l!IRED., t he ip·o'.llcy{i es) must lhav,e J&IDDmON/6!L ilNSU:RED p ~ovishm·s or lbe endorsed. llf Slil.BROGATtON IS WJIIIJVED, su~Jecl to the terms and conditions o'.fthe rpo'llcy, certain pollc'les may rsequ'l~e an endorsement. IA s'tateme·n·t on this ceJillficate does not :confer ri,ght.s t o t he :certlJJcate !holder i n l ieu ol 1&uc'h iln:rdo~sement(.s). :PRO.DUCER ~~~~c, :Petra Thom Baratto Sullivan & Co. !Insurance Agency PH'OliE (805) 68.2-8554 lr~.'N o): 1t8tl5) 5'69-37189 1"1C 'No 1Ext1: . -173-1 State St · ~Mess: -Petr-a@barattosullivan,com- INSl.lRER(S.) AFFORDING 'COVERAGE Santa Barbara CA 93101 JN&llRERA : Ubited Stal es liabifity lns1nance I INSURED United Stales Liabilily Insurance l liS\iJRERB: Joseph Camarda 1 INS\JIRERC : ' 101 ·93 Randy l n INS\!JRERD : · -lli&\!JRERE : Cupertino CA 95014 INS\lRER IF: C,OVERAG.ES ·c:ERnF,ICAT1E INUMB'ER: IGL 11851412101 REV11S10N ,NUMBER : I IBIS IS r o CERTIFY-rHATlHE POUC,lES OF INSUAA'NCE USTE'D BELOW !HAVE BEEN 'ISSUED TO THE 'INSUREO NAMED A'BOVE FOR THE POUCY !PERIOD I 11NOICAT1ED. NOTWITHSTANDING ANY RE'OUIREMENT, TERM OR CONDITION Of ANY CONTRl>/Cl OR OTHER DOCUME!NlWJiliHI RESP;Ecl 11'0 WHICH THIS CERTIACATE MAY BE ISSUED OR 'MAY !PERTAIN , THE 1NSURANCE AFFORDED 'BY T:HE POLICIES DESCRIBED HEREIN IS SUBJECT T O AU TiiE TERMS , EXCLUSJONS ANO CONDITIONS Of SUCH ,PQIJCIES. L1M1TS SHOWN 'MAY HAVE BEEN REDUCED IBY PAID CLAIMS . , 't 1ie: 1 TYPE OF llilSURANCE _ INS'D. WIID IPOLI CYIN\!JMBER lr-.u1r1i..,1 ::,r.r lt"_OL!IC~ _ICJ,,,.r ' llilllllill!IY•cn:1. INM/l!Dl\CiY¥) . LIMITS I IN~C ;# I ' I I 1 X COMMERCIAL •GENERAL :L<IM!II.JTY l>--0 CLAIMS-MADE '(g] OCCUR ,I f:,ACH OCCURRENCE , $ 1,'000,'DOO ,.......- y y 'CL 1'870.224 V ' .1 MEDEJ!P(Anyonepersoo) :S 5,:oou A I I I I ,_ ------------- --------------04115/.2018 04/15/2-01'9 1-' PERSONAL/&,ADV :lNJURY 1 :$ 1,rnm:000 •r=C..:..C."'-"'-'-"'-'-"'--="---t-=----------!I I :$ 2 ,TIOll ,'000 GEN'L AGGREGA11E LIMIT APPLIES PER : ~ D PRO-D _ POLICY , JECT LDC OTHER: ' AllTONOBILE u..m1UTY 1- ANYAUTO -OWNED ---; SCHEDULED _ ~~c5 ONLY _ ~~1~WNEO _ AUTOSONLY ,__ AUTDSONLY '1 · ~1 ·JU MBRELU tlAB" t~J ·DCCUR . B EXCESS UAB ., --I CLAIMS-MADE ' OED I I RETENT•ION s WOR~ERS :COMPENSAT,1011 , . .t.NO IE MPLO\IERS' 1.1.t.BIL!l'Y t,NYPROPRIETOR/PJ.R1'NER/EXECUTl\1E ,QFRICERIMEMBER EXCLUDED? ,(Naodator;y In ·Ntl) 1f yes, .desoo"be .under OESCRIPTION· OF OPEAAT IO~S be'low Y/H i D I I 'N .J/A '' 1 l~~) I .I ·1 XSL018M5M6. 05/.24/.2018 ' GENERAL I\GGREGI\TE ·.....- ' PRODUCTS . COMP/OP AGG J $ 2 ,00'l),'000 Employee !Bene'fils s f0MB1NED}l1NGUE: L'l'/!IT $ i ,1Ea.acddenl1 · BODILY 'INJURY (Peq per,on) :$ BODILY .INJURY (Per accident) I $ PROPERTY :D».'IAGE s I / t,-[IP~•r~e-ca~·d~e_nl~\', -----t,_.....--;::::=:::::::r",.:----1i/ I EACH OCCURRENCE { -:, $ 2,000,0IJO ~ l05/2-4/20 19 l-AGGREGATE 'is / l 'Dltl· ER ,$ · 'E .L. EACH A CClOENr , $ I E.L.'DISEASE -IEI\EMPLOY,EE ,I .$ -E.L: 'DISEASE ·'POt lCY tlll!IT · 1 1"'$ DESCRIPiiON ,OF OPERATIONS/ l:OCAT,IONS / VEHICLES I Al:O'RO 1D1, ,Addlllona l Remaric1 Schedule, may be attached 1f mo,:e •pace 11 ,n,qulred) ! ~ Certificate Holder, its City Council, officers, official, employes, agenlsd , servants anf volunteers a~e to be cove~ed as ,Additional !Insured under lhe <General 1 Liability Insurance. Waiver of Subrogation:& Primay and Non-Contribute!)' applies _ Per fom,s attached <CERTI FICATE HOl.'DER 'CAN 'CEU .ATIO'N SH OU.LO ANY OF THE ABOVE llES'CRIB'ED POUC.IES BE -CANC'ELl 'EO IB'EFORE : -rl'IE IEXPJRATION IDA~E THEREOF, NOTICE WIUL IBE ID'ELll\11:R'ED IN The City of Cupertino o&.C'COR'OA'NC,E Wlil'l'l 'tHE POUC'Y P ROVISIONS. I 1'0300 Torre Ave AUTHORIZED REPRESENTA'TJYE Cupertino CA 9501-4 ~-~ I © 19BB-2015 /A'C'ORD C'O'.R'PO'.RAil ON . /AU rl,g'htts ,r,enrv,ed . AOORD 2:5 (201 16/.03) Th e A 'CORD 11ame and logo ane r e :g'lsleTil!d mar:ks ,of AC·ORO POLICY NUMBER: COMMERC 1IAL ·GENE iRAL LIA811LITY CG 24 04 0509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST ·OTHERS TO US This endorsement modifies insurance pmvide·d under U1e following: COMMERCIAL GENERAL llAIBlllTY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART ,Nam .e of Person Or 0.rganizaUon: Eff.ective Date: 08/07 /.20118 1.2::01 AM The Ciity of Cup.erHno 10300 Torre A'\/e Cupertino, CA '95014 SCHEDULE Information required to comple~e this S·chedule, if not shown above, will be shown in the Declarations. The following 1is added to Paragraph a. Transfer Of R1ghts ,of Recov,ery A:gainst Others To Us of Sedon JV -Condmons: We waive any right of recovery we may have ,against the person or o~ganizatlon :show,n in t he Schedule abov,e because ·of payments we ma'ke for injury or damage arising out of your ongoing operations or "your work" done under a contract with that p.erson or .organizal'ion and included in t he "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above . CG24 040509 Copyright., Insurance Services Office, Inc., 2008 ENDORSEMENT #2 ~ This e ndors,.eme:nt, issued by United States Liability Insurance C ,ompany mo Joseph CamardaDB : oe•s Tractor Service forms ,a part of Po1icy Number , L 1870224 effective on 8.1712018 (MO. DAY YR) at 12:01 A.M . Add/R,emoveJAmend ·General UabHity Addiitional Insured ~n.dj).r.sement I n consideration of a f1Jat .and iu ny earned additional p:remium of $50 it is he11e'by agreed that the fo'.lllow1ing is(are) .added to th e Po!licy: CG24•04 !(!)5109 -Waiver Of Tra ·nsfer m Rights Of IRe :cov,ery A:gai 1nst Others Tio !Us Aili other terms and conditions of this Policy ,remain u nchanged. I ADD_ REM (03-01) ~. FARMERS Auto Insurance Declaration Page INSURANCE Policy Number; 18502-53-53 Eff,ective : 4/16/201812 :01 AM Expiration : 10/16/2018 12 :01 AM Named lnsured(s): Joseph Camarda Jr Joseph Camarda Ill 10193 Randyln Cupertino, CA95014-2346 joestractor82@g ma i I. com Underwritten By: Farmers Insurance Exchange 6301 Owensmouth Ave . Woodland Hills, CA91367 Household Drivers Premiums/Fees Policy Premium Fees (*also see Information on Additional Fees below) '~ Policy Premium and Fees This Is not a bill. Your bill with the amount due will be mailed separately. Information on this declaration is effective 4/16/2018. $286.00 $15.88 $301.88 All persons who drive or will occasionally be driving any o'fth·e cars on the policy should be listed .below. ,lf anyone is missing or needs to be added, such as a newly licensed driver, you should contact your agent or the company to add that person befor,e they beg ,in to drh1·e any of the cars covered on the pol icy. N,ame Joseph Camarda Jr Vehicle ,lnform.atiion Veh . # Year/Make/Model/V,IN Driver Status Covered !Drive, 'Sftaft,us J,oseph Camarda Ill Covered Coverage Deduc ti!b1:e limit 1 2000 Dodge Truck Ram 3500 Cc 4X4 Conv Cab 3B6MF3664YM201779 Comprehensive: Not Covered Collision: Not Covered Additional-fquipment: Not Covered Cove.rage Information . . Premi.VJms !by '!Jie,'hfole t 1m'1ts ............................................................................................................................................. . Coverage ( applicable to aH vehides) V1e,'hide 1 Bodily Injury Liability $250,000 each person ..v'IA / "'''°"V [' . $.24'8.20 $500,000 each accident U v-\)vv · I $/ '?J{>) -p~-;p~·rty··o~-~~g·~-ci·~·b1iity·---·-----···i;·ao·:oo·o·~~~.h-~~~ld·~~;:···········~---···~--··-····-c ·s ·y ···-······--···-···--···--·--·······--·-·················1-~~iud-~ci Permissive User Limit of Full (See Permissive User Included Liability*• Limit of Liability in your Medical Coverage Uninsured Motorist Bodily Injury Comprehensive Collision Additional Equipment policy) $250,000 each person $500,000 each accident farmers.com :Policy No. 185'02-53-53 56-6176 1st Edition 5-17 5/24/2018 Questions? Call your agentGail N Rootat(408) 244-0111 oremail gtr-oy@farmersagent.com Not Cov.e:red $33 .40 Not Cover ed otCovered otCovered Manage your accouint: Go to www. 'farmers. coni to access your account any time! Page 1 of3 Oedaratl,on Page (continued) Coverage Uninsured Motorist Property Damage Without Collision Uninsured Motorist Property Damage With Collision Towing and Road Servioe Tota l Premium Per Vehicle ..... ·Policy Prem'lum 1FeeDetalf Limits ----------------------------------------------------------·-·--------·---------------------------------Premiums ,by Vehkle ( applicable to a// vellicles) Veh io!e "I Not Cover ed Not Cover ed $286.00 :$286.00 Vehicle 1 Total ~~~(~~-~~~-~'.~~~--------·----·-··-------·-······--------·--·---··-·-··-·--·--···---·---·--·---·--·----------·---·····-···---·-··-·-·-·-·-·-···------····-·--------·-··----··------·---·-·--·-·-···-·J .~:~_?. ________________ :~-~:-~-~ FeesPerVehicle $15 .00 $15 .00 '~f.ees $15 . .SS ~ .Polley Premium and Fees $301.88 Disc,o:unts Disco,Unt Type Applies to Vehicle(s) Discount Type Applies to Vehicle(s) Auto/Home Persistency Sa fe Driver losses .and Convictions Dri ver Joseph Camarda Ill Rating lnformat,iton De t ails Garaging Z i p Current Annual Mileage Vehicle Usage Years of Driving Experience Type Conviction Conviction farmers.com Policy No. 18502-53-53 56-6176 1stEdition 5-17 Date 2/12/2018 4/24/2017 Multiple Car Good Driver Questions? Call your agent Gail N Root at (408) 2 44-0111 or email gtroy@farmersagent.com Manage your account: Vehicle 1 95014 10,000 Other Use N/A Go to www.fanners .com to access your account any time ! Page2 of 3 ------------------- Dedaration Page (continued) Policy and Endorsements This section lists the policy form number and any applicable endorsements that make up your insurance contract. Any endorsements that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document: 56-5684 1st ed .; 25-8531 10-12; CA 125 1st ed. Other Information .. *YOUR POUCY INCLUDES TH 1E fUU .. PEIRM1SSfVf USER U.MIT OF l:IAB1UTY. PLEASE Sff PERM!JSS'1VE USER LIMIT OF UAB1UTY IN YOUR POLICY fOlll f,U/RTH /f:R ,JNfOIRMATION. You may be eligible for a different rate but with differ.ent coverage from Farmers Specialty Insurance Company. Please contact your FarmersG· agent to discuss your options. Go Green by Jogging onto Farmers.com or contacting your Farmers Agent. Farmers Friendly Reviews are a great way to make sure you are receiving all the discounts for which you qualify, and identify any potential gaps in coverage . Contact your agent to learn more about the policy discounts, coverage options, and ot her product offerings that may be available to you. *Information on Additional Fees The ''Fees" stated in the "Premium/Fees" section on the front apply on a per-policy, not an account basis. The following additional fees a'lsoapply: 1 .. Service Charge per ,installment (In consideration of our agreement to allow you to pay in installments): -For Recurring Electron ic Funds Transfer (EFT) and fully enrolled on line billing (paperless): '$0.00 (applied per account) -For other Recurring EFT p.lans : $2.00 (applied per account) -For all other payment plans : $5.'00 (applied per account) If this account is for more than one policy, changes in these fees are not effective until the revised fee information is provided for each policy. Countersignature Au t horized Representative 2. Late Fee: $10.00 (applied per account) 3. Returned Payment Charge: $25.00 (applied per check, electronic transaction , or other remittance which is not honored by your financial institution for any reason including but not limited to insufficient funds or a closed account) 4 . Reinstatement Fee: $18.40 (applied per vehicle, 20% discount will apply for Good Drivers) One or more of the fees or charges described above may be deemed a part of premium under applicable state law . farmers.com Policy No. 18502-53-53 Questlons? Manage your account: 56-6176 1st Edition 5-17 Call your agent Gail N Root at ( 408) 244-0111 or email gtroy@farmersagent.com Go to www.farmers .com to access your account any time ! Page3 of 3 8-2-18 To: City of Cupertino Re: Weed mowing for the City of Cupertino at McClellan Ranch Park Dear Sir, ---fnis letteT is regarding-workman's-comp insurance. Joe's-Tractor Seotice does not have any employees and therefore I'm not required to carry workman's comp. If I ever choose to hire someone then I will purchase workman's comp Insurance and provide the City of Cupertino with a copy for their records. Thank you for giving us the opportunity to service the City of Cupertino. Joe Camarda, Owner of Joe's Tractor Service PUBLIC WORKS CONSTRUCTION CONTRACTS Small Projects -$45,000 Insurance Requirements: Exhibit B Contractor shall procure and maintain for the duration of the contract, andforfive yearsfolfowing th e completion of th e Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the perform a nce of the work hereund er by Co ntractor, it s agents , repre sentatives, employees or s ubcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: vf. Commercial General Liability (CGL): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an "occurrence" basis, written on a comprehensive general liability }arm, and must include coverage jar liability x,\ arising jiwn Contractor's or Subcontractor's acts or omissions, including Con tractor's protected coverage, 1// blanket contractual, products and completed operations, vehicle coverage and e mployer ·s non-ownership liability cove rage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all \.;, t\ liability for personal injury, death, properly damage or destruction, and personal and advertising injury. If a general · ~~~ggregate limit applies, either the general aggregate limit shall apply separately to this project/location (TSO CG 'iJ 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a require ment under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be ( l) the minimum coverage/I imits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b . Additional In sured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/se lf-insurance, and shall be at least as broad as ISO CG 20 01 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance , provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. V2.-. Auto~obile Liability: ISO Form CA 00 01 covering any auto (Code 1 ), or if Contractor has no owned autos, then .1$' h ·1eo autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily Q}. :v-"l\i~injury and property damage . ~ vJ . Workers' Compensation: As required by the State of California, with Statutory Limits, and \ I)< Employer's Liability Insurance ofno less than $1,000,000 per accident for bodily injrny or disease, or as otherwise ·~l equired by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, &~ duly authorized by the DIR. ,n N/ A if bo x checked ( Contractor provides written verification it has no emp !oyee.s). 4. Professional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate . J2Sf N/ A if box checked (Contract is not design/build). 5. Builder's Risk. Course of Construction insurance utili z ing an "A ll Risk " (Special Perils) coverage form, with limits ~qua! to the completed value of the project and no coinsurance penalty provisions . JZ] N/A if box checked (P roje ct do es not involve construction or improvements/installations to property). In surance Requirements.fo r Co nstrue/i on Con tracts -$45,000 Version: Nov 2017 6. Contractors' Pollution Legal Liability a nd /or Asbestos Legal Liab ili ty and/or Errors a nd Omi ss io n s w ith limits no less than $1,000,000 per occu rr e nce or c la im , and $2,000,000 policy aggregate. JZf N IA if box c hecked (P roject does not involve environmental hazards). If Con tractor ma int a in s broader coverage and/or higher limi ts tha n t h e minimums shown above, City requires a nd shal I be e nti t led to the b roa d er coverage an d/or hi ghe r I im it s m ai nt ained by the contractor. Any ava il a bl e in s urance pro ceeds in excess of the spec ifi e d minimum limits of in surance a nd coverage sh a ll be avai lab le to the C ity . Self-Insured Retentions. Se lf-in s ure d retentions must be declared to and ap pro ved by C ity. At City 's option , e ith e r : (l) C o ntracto r shall cause the insurer to reduc e or eli minate se lf -insured retentions as re spects C ity , its officers, officials , e mplo yees, and volunteers; or (2) Contractor shall provid e a financial guarantee sat isfactory t o C ity g uarantee in g pay m e nt of losses and re late d in vestigat io ns , c laim administration , a nd defense expenses . The po li cy lan g uage s hall provide, o r be endorsed to provide, th at the se lf-ins ure d retention may be satisfied by e ith er the na me d in sured or th e City . OTHER INSURANCE PROVISIONS T he in sura nce policies are to contain, or be endorsed to cont a in , the fo llo w in g provisio ns: I Additional Insured Status V The C ity of C up e rtin o, it s C ity Co un c il , officers , officials, e mployees , age nts , servant s and volunteers a re to be covered as additional in s ured s on th e CGL policy with respect to liability arising out of the Serv ice s pe rfo rmed by or on behalf of Contractor including materia ls, parts, or equipment furnished. E n dorseme nt of CGL coverage shall b e at least as broad as lSO Form CG 20 IO I! 85 or if not available, through the a ddition of both CG 20 I 0 , CG 2 0 26, CG 20 33 , or CG 20 38 ; and CG 20 37 if a later edition is used. Prima,y Coverage For any claims related to this Project, Contractor's in s u rance coverage shall be "primary and non-contributory" a nd at least as broad as ISO CG 20 0 I 04 13 with respect t o C ity , it s officers, officials, emp loyee s a nd vo luntee rs, and sha ll no t see k contribution from City's insurance. If th e limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess IJ1sur ance shall co nt ai n or be e nd o rsed to contain a provision that s uch coverage sha ll also apply o n a "prim a ty and non-contributo1y" b as is for the be nefit of City . Notice of Ca11cellatio11 Each in surance policy req uire d sha ll prov ide th at coverage shall not be canceled, exce pt with noti ce to the C ity . Each certifi cate of insurance mu st state that the coverage afforded by the po lic y is in force and wil I not be re du ced, cancelled or a llow e d to expire without at least 30 days advance written notice to C ity , unl ess du e to non-payment of premiums, in w hi c h case ten clays advance written notice mu st be provid ed to City. Such noti ce must be se nt to C ity via certified mail and ad dressed to th e attention of the C ity Manager. Builder's Risk Co ntractor may s ubmit Builder's Risk in surance in th e form of Co urse of Co nstru ction coverage, which shall name the City as a loss payee , as it s int e rest may appear. The Builder's Ri sk policy must be iss ued on an occurrence basis, fo r a ll-ri sk coverage o n a I 00% comp l eted value bas is on th e in surabl e porti o n of the Proj ect , w ith no co in s urance pe nalti es, and fo r the benefit of C ity . If the Project does not in vo lve new or m ajor reconstruction , C ity may e lect , acting in its so le di sc re ti o n, to accept an Install at io n Floater policy in stea d of Builder's Risk. For suc h p rojects, the P roperty In stall at ion Floater shall in c lud e impro vement, remodel , modificati on , alteration , conversion or adjustment to ex isting buildings, st ru ctures, processes, machinery a nd equipment, and s h a ll provide property damage coverage for any building, structure, mac hinery or equipment damage d , impaire d , bro ke n , o r destro ye d durin g th e performance of th e Work, including during tran s it , in st a ll at ion , and testing at th e C ity 's s it e . In s urance Requirements fo r Con stru ction Contracts -$45,000 Version : Nov 20 17 2 l Waiver of Subrogation ~ac h required p.o li cy ~nu st in c lud e an endorseme.nt p1:ov idin g that th e .carr ier.agrees ~o wa ive any ri g ht of sub rogat ion r\Y m~y ha ve aga rn st City. Co ntractor agr -ees to wa ive nghts of subrogation whi c h any msure r of Contractor may ac quire ~ ~-"from ntractor by vir t ue of the paym ent of a ny loss . Co ntractor agrees to obta in any endorse me nt th at may be -~-.... M'Y to affect thi s waiv e r of subr ogat io n. T he Workers ' Comp e nsation policy sha ll be en dorse d with a wa iver of sub rogat io n in favor of t he C ity for a ll wo rk performed by the Co ntractor, it s e mploye es, age nt s a nd s ub co ntrac tors. Acceptability of Insurers In suranc e mu st be iss ued by in sur ers acceptab le to C ity and li censed to do busin ess in th e State of Ca li forn ia, and eac h in sur er mu st have a n A.M. Bes t 's financial strength rat in g of "A " or better a nd a financial s ize rating of"Vl l" or better. Verification of Coverage Co ntractor sha ll furni sh th e City with origina l certificates a nd amendatory endorse ments, or copies of th e app li cab le in suran ce la ngua ge , effect in g coverage requ ir ed by th is co ntract. A ll ce rtifi cates a nd end o rseme nt s a re to be rece iv ed a nd approv e d by the C ity befo re work com mences. The C ity rese rv es th e ri ght to require co mpl ete , certified cop ies of all require d insurance po li c ies , in c lu d in g e ndorse ments , req uired by these s pec ifications , at any time. S ubconlractors Co ntractor sha ll require and verify that a ll subco ntracto rs m ain tai n insurance meeting all th e requireme nts stated herein , and C ontractor s ha ll ens ur e th at City is an add iti ona l insured on in suran ce required from subcontractors. For CG L coverage sub contractors shall provid e coverage with a form at least as broad as CG 20 38 04 13. Surety Bonds As re quired by Co ntra ct a nd described i n the Contract Documents. The Payment and Performance Bonds sha ll be in a sum e qu a l to the Co ntrac t Price . lf the Performance Bond pr ov id es for a one-year warranty a separate Maintenance Bond is not neces sary. If th e warra nty p e riod spec ifi ed in the Co ntra ct is for longe r than one year a Maintenance Bond equal to l 0% of th e Co ntr ac t Price is required . Bonds s hall be duly exec ut ed by a responsible corporate sur ety, a uth orized to iss ue such bond s in the S tate of Ca lifornia and sec ur ed through an authorized age nt with an office in Ca li fo rni a. Special Risks or Circumstances C ity reserv es the ri ght to mod ify these req ui rements , based o n the nature of the ri sk, prior experience , insure r, coverage, or ot her circumstances. Insurance Req uiremenlsfor Co ns/ru ction Con lra cts -$45,000 Version: Nov 20 17 3 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM /DDNYYY) ~ 10/01 /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 have ADDITIONAL INSURED provisions or be endorsed. II 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 '-V'"M'-Monica Carrillo NAME: Baratto Sullivan & Co. Insurance A gency ritJgNJ0 Exll : (805) 682-8554 I CAIC, Nol : (805) 569-3789 1731 State St :il"~bs: sales@baratlosu/livan.com INSURER(S) AFFORDING COVERAGE NAIC# Santa Barbara CA 93101 INSURER A : Ubiled Slates Liability Insurance INSURED INSURER B : United States Liability Insurance Joseph Camarda INSURER C : United Financial Cas Co 10193 Randy Ln INSURER D : INSURER E: Cupertino CA 95014 INSURER F: COVERAGES CERTIFICATE NUMBER: Cl1851412101 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF IN SURANCE 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 CERTIFI CATE MAY BE ISSU ED OR MAY PERTAIN , THE IN S URANCE AFFORDED BY THE POLICIES DESCR IBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF S UCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'L¥11 TYPE OF INSURANCE INSD WVD POLICY NUMBER l~~LJ5iYYYYl 1~~'biTYvvv1 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 V -~ CLAIMS -MADE [8] OCCUR l.lMIYIMUL.. I U --i1..."1 I t:.U PREMISES !Ea occurrence\ $ 100,000 f-- CL 1870224 / MED EXP (Any one person) $ 5,000 -y 04/15/20 191, A y 04/15/2018 PERSONAL & ADV INJURY $ 1,000,000 -VJ ' GEN'L AGGR EG ATE LIMIT APP LIE S PER: GENERAL AGG REGATE $ 2,000,000 H DPRO-DLOC PRODU CTS -CO MP/OP AGG 2,000,000 POLI CY JECT $ OTHER: Employee Be nefits $ AUTOMOBILE LIABILITY COMB INED SINGL ~ LIMI T $ 1 ,000,000 IEa accidenll -ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED 08223791-0 ./ 10/01/2019 t C AUTOS ONLY X AUTOS 10/01 /20 18 BODILY INJURY (Per accidenl) $ f--HIRED -NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ON LY !Pe r accidenll $ 3,500 j f---/ $ ........ -X UMBRELLA LIAB ~ OCCUR E;ACH OCCU RREN CE $ 2,000,000 _y f-- XS L018A45M6. 05/24/2018 05/24/2019 , ',.GGREGATE ~ _/ B EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION I ~-ffTuTE I I OTH- AND EMPLOYERS' LIABILITY ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D N /A t\ \ ~ E.L. EACH ACC IDENT $ OFFIC ER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCR IPTION OF OP ER ATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) Certificate Holder , its City Council, officers, official, e mployes, agentsd , servants ant volunteers are to b e covered as Additional Insured under the General Liability Insurance. Waiver of Subrogation & Primay and Non-Contributory a pplies . Per forms allached CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The C ity of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS . 10300 Torre Av e AUTHORIZED REPRESENTATIVE Cupertino CA 95014 1~~ c~ I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 32 93 09 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Effective Date : 06/19/2018 12:01 AM The City of Cupertino 10300 Torre Ave Cupertino, CA 95014 Location(s) Of Covered Operations: 10193 Randy Lane Cupertino, CA 95014 Information required to complete this Schedule, if not shown above , will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal 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 for the additional insured(s) at the location(s) designated above . However: 1. If an additional insured(s) shown in the Schedule is a builder, general contractor or contractor not affiliated with the builder; and 2. You have entered into a residential construction contract subject to the requirements of California Civil Code Section 2782(c) with such builder or contractor; then such builder or contractor is an additional insured under this endorsement but only to the extent of the liability for "bodily injury", "property damage" or "personal and advertising injury" that you have assumed in the residential construction contract with that party. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person .or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 32 93 09 09 Copyright, Insurance Services Office, Inc ., 2008 This endorsement morufies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE FORM Primary And Non-Contributory-Written Contract Schedule: Effective Date: 06/19/2018 12 :01 AM Name of Person or Organization: The City of Cupertino 10300 Torre Ave Cupertino, CA 95014 (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. OTHER INSURANCE, a. Primary Insurance is amended with the addition of the following: The coverage afforded by this policy to the person(s) or organization(s) listed above is primary and non- contributory if: 1. This insurance is required to be primary and non-contributory under a written contract; and 2. The loss to be covered occurs on or after the effective date of the written contract; and 3. The loss to be covered resulted solely and exclusively from your ongoing acts or omissions or the ongoing acts or omissions of those acting on your behalf in performing "your work" under a written contract referred to above. 4 . The person(s) or organization(s) is an additional insured under this policy. However, the coverage provided by this endorsement does not apply to any coverage provided for an "auto" on a "non-owned auto", "hired auto", uninsured motorists coverage, underinsured motorists coverage, personal injury protection, property protection or similar no-fault coverage by whatever name called and/or an "auto" coverage of any type. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy unless another effective date is shown. L 776 (04-15) Page 1 of 1 BARATIO SULLIVAN 1731 STATE ST SANTA BARBARA, CA 93101 JOE CAMARDA Ill JOE'S TRACTOR SERVICE 10193 RANDY LN CUPERTINO, CA 95014 Additional insured endorsement Name of Person or Organization CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO, CA 95014 PROGREIIIVE . COMMERCIAL Policy numb~ Underwritt~ United Financial Cas Co Insured: JOE CAMARDA Ill October 6, 2018 Policy Period: Oct 1, 2018 -Oct 1, 2019 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1-800-444-4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability Bodily Injury Property Damage Combined Liability All other terms, limits and provisions · policy remain unchanged. This endorsement applies to Policy Number: 08223791-0 Issued to (Name of lnsured):JOE CAMARDA Ill JOE'S TRACTOR SERVICE Effective date of endorsement: 10/01/2018 Form 1198 (01/04) Policy expiration date: 10/01/2019 IV. WHO IS AN INSURED 1. Except as limited in 2. below, each person or organization who is an insured in the "underlying insurance" is an insured under This policy. 2. Each person or organization who is a Named Insured on any underlying policy but is not a Named Insured on this policy is not an insured under this policy. Nor are any of the following an insured under this policy: a. "Employees"; b. "Volunteer workers"; or c. Any person or organization acting as real estate manager of a Named Insured on any underlying policy who is not a Named Insured on this policy. 3 . No person or organization is an Insured with respect to the operations or conduct of any current or past partnership, joint venture, or limited liability company that is not shown as a Named Insured in the Declarations of this policy. V. EXCLUSIONS This policy incorporates by reference all exclusions now or hereafter contained in the "underlying insurance" as though fully set forth in this policy. Where a common exclusion exists, in this policy and the "underlying insurance", the exclusion that is more restrictive of coverage will apply. In addition, this policy does not apply to: 1. Any "damage" not covered by the "underlying insurance". 2. Liability imposed on the Insured under any of the following laws: a. Employee's Retirement Income Security Act (E.R.I.S.A.) of 1974; b. Jones Act (vessels and seaman exposures); c. Federal Employers Liability Act (railroad workers); d . Migrant and Seasonal Agricultural Workers Protection Act (migrant farm workers); e. "Damages" awarded under the provisions of the Racketeer Influenced and Corrupt Organization Act 18 U.S.C Sections 1961-68 (1970) (RICO); f . Any other federal or state employers liability, workers compensation, unemployment compensation, disability benefits law or any other similar law. and amendments thereto. 3. Any obligation of an insured under any employee benefit program, including but not limited to group life insurance, group accident or health insurance, pension plans, employee stock subscription plans, workers compensation, unemployment insurance, social security and disability benefits, and any other similar employee benefits programs. 4. "Damages" which an insured is obligated to pay by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for "damages": a. That an insured would have in the absence of the contract or agreement; or b. Assumed in a contract or agreement that is an "insured contract", provided the "damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes ofliability assumed in an "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be "damages", provided: (1) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (2) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 5. Any: a. "Bodily injury", "property damage", or "personal and advertising injury"; b. "Damages" for devaluation of property or for the taking, use or acquisition or interference with the rights of others in property or air space; XLP (7/05) -3 - Includes copyrighted material oflnsurance Services Office, Inc., with its p ermission State of California County of Santa Clara City of Cupertino Contractor/Consultant Affidavit of No Employees I, the undersigned, declare as follows: I am an independent contractor and the owner of 006'G S tt<!/J:C-1D>R_ :fez_v/~ I wish to enter into a services contract with the City of Cupertino. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this l7 day of OC.:tlltle!< 2018, a t C,upef!?:[)µ 0 J , California. Revised 1.05 .18