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19-064 Alvernaz Construction, Concrete Pad for Bike Lockers-Sports CenterCITY OF a PUBLIC WORKS CONTRACT $60,000 OR LESS CUPERTINO 1.PARTIES This public works contract ("Contract") is made and entered into on March 29, 2019 ("Effective Date") by and between the City of Cupertino, a municipal corporation ("City"), and Alvernaz Construction , a Sole Proprietorship/lndivid ("Contractor") for Concrete Pad For Bike Lockers-Spo1is Center 2.SCOPE OF WORK Contractor will perfonn and provide all labor, materials, equipment, supplies, transportation and any other items or work necessary to perform and complete the work required for the Project ("Work"), as required in the Scope of Work, attached here and incorporated as Exhibit A, and in accordance with the terms and conditions of this Contract. 3.TIME FOR COMPLETION 3.1 Term. This Contract begins on the Effective Date and ends on September 27, 2019 ("Contract Time") unless tenninated earlier as provided herein. Contractor's Work shall begin on the date shown on a written Notice to Proceed ("NTP") and must be fully completed within the Contract Time or on the date specifically provided in the Notice to Proceed. The City Engineer will not issue a NTP until the Contract is fully executed by both parties and City has received satisfactory proof of insurance and any perfonnance and payment bonds that may be required. 3.2 Time is of the essence for Contractor's performance and completion of the Work. Contractor must have sufficient time, resources, and qualified staff to deliver the work on time. 3.3 Liquidated damages of$ 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 perfonnance of the Work an amount that will based on actual costs but that will be capped so as not to exceed $14,000.00 ("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 perfonned during the preceding month, itemizing labor, materials, equipment and Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 !Rev. Jan. 02, 2019 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 perfonning 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 wa11"ants 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): B , 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 tenns 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 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 oflaw 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 pennitted assigns Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 Cupe1iino" must be displayed in all pieces of publicity, flyers, press releases, posters, brochures, interviews, public service announcements and newspaper articles. 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 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 perfonning 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 reports 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 reports, 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 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 Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 Page 3 of 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 hannless City, its City Council, boards and cmmnissions, officers, officials, employees, agents, servants, volunteers and consultants ("Indemnitees"), tlu·ough 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 nonperfonnance 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 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 provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party 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 construed 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 tenninating the Contract. Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 perfonn. Contractor is responsible for verifying the employment status of employees perfonning the Work, as required by the Immigration Refonn 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 perfom1 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://ww w.dir.ca.gov/DLSR; (ii)Apprenticeship requirements under Labor Code Section 1777.5 for Contacts $30,000 or more; (iii)Maintain certified 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 certifies as follows: "I am aware of Labor Code Section 3 700 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 Govenunent 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 Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 Govenunent Code section 1090 and Govenunent Code section 81000 and 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 tenn 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 govenunental 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 constih1tes 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 perfonnance 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 terminate 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 Alert ("USA") 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits, City's Service Center must be called at ( 408) 777-3269. Govenunent 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 Govenunent 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/Perfonnance, 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 infonnation about the worksite made available to Contractor; and Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 c01mnencing 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 sh01ing 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 stonn 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. P1ior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of stonn 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 stonn 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, stonn drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum saw-cut sluny< and remove from the Work site; (b)Cover exposed piles of soil or construction mate1ial 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 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 stonnwater 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 Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 Michal Alvernaz, 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 palis therefor at any time. Contractor will be compensated for satisfactory Work perfonned 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 tenninate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the tennination 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 Couli 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 Paliies elect arbitration, the arbitrator's award must be suppolied by law and substantial evidence and include detailed written findings oflaw 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 paliy will be entitled to reasonable attorney fees and costs. Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 paiiy 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 design or mate1ials. All Work, materials and equipment should pass to City free of claims, liens or encumbrances. Contractor wairnnts the Work and materials for one year from the date of City's acceptance of the Work as complete ("Warranty Pe1iod"), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor's Warranty 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 tenns of this Contract, the Contract tenns will control. 28.SEVERABILITY /PARTIAL INVALIDITY If a court finds any tenn or provision of this Contract to be illegal, invalid or unenforceable, the legal portion 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 warranties, indemnities, payment obligations, insurance and bonds, shall remain in full force and effect after the Work is completed or Contract ends. Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 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 fonn 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: Brian Gathers, Public Works supervisor Copy to: Carl Valdez, Superintendent Email: Briang@cupe1iino.org 30.VALIDITY OF CONTRACT To Contractor: Alvernaz Construction, P.O Box 366 San Martin, CA. 95046 Attention: Michael Alvernaz Copy to: ____________ _ Email: Michaelalvernaz@alvemazconstr ution.cc 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 fonn 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 Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 !Rev. Jan. 02, 2019 Page 10 of 11 IN WITNESS WHEREOF, the pmiies have caused this Contract to be executed as of the Execution Date first above written. CONTRACTOR Alvernaz Constuction P.O. Box 366 San Martin, CA. 95046 Sole Proorietorshio/Ind By: M i (._ � �-e I /) I(; -'2-tr h Q 'L Title: Owner � d-·--3-� Signature Date: J -/ { -( f APPROVED AS TO FORM: By: HEATHER M. MINNER Cupertino City Attorney ATTEST: By: CITY OF CUPERTINO, a Municipal Corporation By � LZ.-ffi�,Z00€-IZ Lee__ AQ,119 Title:birector of Public Works Signatur e Date: -�� ,,_-L...-L,f-i£-1----;C-------- GRACE SCHMIDT, City Clerk '\. -/}{ -J. ', Public Works Project Concrete Pad For Bike Lockers-Sports Center Public Works Contract $60,000 /Rev. Jan. 02, 2019 Page 11 of I l Quote To, Brian Gathers 10300 Torre Ave. City of Cupertino Alvernaz Construction Po Box 366 San Martin CA 95046 Lie# 711435 408-595-2817 1 -Saw cut existing concrete cub approximately 10 feet 2 -Remove existing concrete slab aproxmatily 1 O'x 1 O'. 3-Remove existing soil approximately 5 yards February 26,2019 EXHIBIT A Job Name Sport Center 4 -Install forms, 3/8 steel for reinforcement for new concrete pad approximately 20'x1 O' 5-lnstall new six sack mix concrete 4-inches thick with a broom finish. 6-Clean all unnecessary materials. 7-Protect concrete after pour. Total cost Due 100% completed materials and labor-------------$14,000.00 Thank you, Michael Alvernaz 'PUBLIC WORKS CONSTRUCTION CONTRACTS Small Projects -$60,000 I 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 prope1iy which may arise from or in connection with the perfo1mance of the work hereunder by Contractor, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE 7erage shall be at least as broad as: 1.Commercial General Liability (CGL): Insurance Services Office (ISO) Fo1m CG 00 01 covering CGL on an"occmTence" 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, blanket contractual, products and completed operations, vehicle coverage and employer's non-ownership liability coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all liability for personal injury, death, prope1iy damage or destruction, and personal and adve1iising injmy. If a generalaggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG25 03 or 25 04) or the general aggregate limit shall be twice the required occmTence limit. a.It shall be a requirement under this agreement that any available insurance proceeds broader than or in excessof the specified minimum insurance coverage requirements and/or limits shall be made available to theAdditional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broadercoverage and maximum limits of coverage of any insurance policy, whichever is greater.b.Additional Insured coverage under Contractor's policy shall be "primaiy and non-contributory," will not seekcontribution from City's insurance/self-insurance, and shall be at least as broad as ISO CG 20 01 04 13c.The limits of insurance required may be satisfied by a combination of primaiy and umbrella or excess 1insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella orexcess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on aprimaiy and non-contributory basis for the benefit of City before the City's own insurance or self-insuranceshall be called upon to protect City as a named insured. 2.Automobile Liability: ISO Fonn CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, thenhired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily· njmy and prope1iy damage. Workers' Compensation: As required by the State of California, with Statutory Limits, and Employer's Liability Insurance of no less than $1,000,000 per accident for bodily injury or disease, or as otherwise required by statute. If Contractor is self-insured, Contractor must provide a Ce1tificate of Pe1mission to Self-Insure, duly authorized by the DIR. D N/A if box checked (Contractor provides written verification it has no employees). 4.Pro�ional Liability with limits no less than $1,000,000 per occmTence or claim, and $2,000,000 aggregate.� NIA if box checked (Contract is not design/build). 5.Builder's Risk. Course of Constrnction insurance utilizing an "All Risk" (Special Pe1ils) coverage form, withlimits equal to the completed value of the project and no coinsurance penalty provisions.)3] NIA if box checked (Project does not involve construction or improvements/installations to property). Insurance Requirements for Construction Contracts -$60,000 Version: Jan. 2019 6.Contractors' Pollution Legal Liability and/or Asbestos Legal Liability and/or Eirnrs and Omissions with limits no � than $1,000,000 per occunence or claim, and $2,000,000 policy aggregate.p 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 mateiials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO F01m 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 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 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-contributo1y" 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 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 ce1tified mail and addressed to the attention of the City Manager. Builder's Risk Contractor may submit Builder's Risk insurance in the fo1m 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 occunence basis, for all-risk coverage on a 100% completed value basis on the insurable po1tion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstmction, City may elect, acting in its sole discretion, to accept an Installation Floater policy instead of Builder's Risk. For such projects, the Prope1ty Installation Floater shall include improvement, remodel, modification, alteration, conversion or adjustment to existing buildings, structures, processes, machine1y and equipment, and shall provide property damage coverage for any building, structure, machinery or equipment damaged, impaired, broken, or destroyed dming the performance of the Work, including during transit, installation, and testing at the City's site. Insurance Requirements for Construction Contracts -$60,000 Version: Jan. 2019 2 \ ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) � 04/0 3/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATI VELY 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 rh1hts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: BELL PLAZA INSURANCE f.��N,..E,, c-», (408) 288-8400 I FAX /AIC No\: (408) 246-7200 991 W Hedding St Ste 108 E-MAIL insurance@bellplaza.com ADDRESS: San Jose, CA 95126 INSURER/SJ AFFORDING COVERAGE NAIC# 0891409 INSURER A: United Specialty Insurance Company A l X. 12537 INSURED INSURER B: United Specialty Insurance Company A-I X 12537 Alvernaz Cons truction United Specialty Insurance Company A-lX 12537 INSURER C: Michael Alvernaz INSURER D: State Fund 12120 Central Ave INSURER E: San Martin, CA 95046 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A B TYPE OF INSURANCE .x COMMERCI AL GENERAL LIABILITY D CLAIMS-MADE [RJ OCCUR '--X Bl Ded $1,000 X PD Ded $1,000 GEN'L AGGREGATE LIMIT APPLIES PER: R DPRO-POLICY JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO -OWNED AUTOS ONLY X.x HIRED AUTOS ONLY X comp/coll DLOC SCHEDULED AUTOS NON-OWNED AUTOS ONLY IADDL SUBR POLICY EFF POLICY EXP '""" ""'" POLICY NUMBER IMM/DDIYYYY1 IMM/DDIYYYY1 I I y y USIC 12537040319 t 04/03/19 04/03/20 ,/ y y USIC 12537040319 04/03/19 04/03/20 v' i I I LIMITS EACH OCCURRENCE s 2,000,000 DAMAGE TO RENTED PREMISES IEa occurrence\ s 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY s 1,0 00,000 GENERAL AGGREGATE $ 4,000,000 PRODUCTS • COMP/OP AGG s 2,000,000 Hired Auto PD ACY s COMBINED SINGLE LIMIT s 1,000,000 !Ea accident! BODILY INJURY (Per person) s BODILY INJURY (Per accident) sPROPERTY DAMAGE s !Per accident! Hired Auto PD s � / 1v .x UMBRELLA LIAB f2si OCCUR I EACH OCCURRENCE s I 5,000,000 DC EXCESS LIAB CLAIMS-MADE• USIC 12537040319 Q.i/03/19 04/03120,/ AGGREGATE s ( 5,000,000 D OED I X I RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE Cr] OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below A N/A SFWC 1721281 I I $ "--./ I XI �f�TUTE I I OTH-ER 12/01/19 v' E.L. EACH ACCIDENT $ 1,000,000 I 12/01/18 I E.L. DISEASE· EA EMPLOYEE $ 1,000,000 E.L. DISEASE· POLICY LIMIT s 1,000,000 I DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Romar1<s Schedule, may be att•ched If more space Is required) City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers. Commercial Umbrella Policy extends coverage on CSL Automobile Llability underlying Polley. Rated A+ Paper I (Excellent) Bound with United Specialty Insurance Company NAIC # 12537 CERTIFICATE HOLDER City of Cupertino -Public Works 10300 Torre Avenue Cupertino, CA 95014 Attn: Brian Gathers CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1988-2015 ACORD CORPORATION. All rights reserve d. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD United Specialty Insurance Company A.M. Best#: 013105 NAIC #: 12537 FEIN#: 20-3145738 ; .. l Flna!li:1!11.Strength Rating ·¥1ew Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date: A (Excellent) p (Pooled Rating) IX ($250 Million to $500 Million) Stable Affinned December 19, 2018 May 17, 2006 !Long-Term Issuer Credit Rating .. View Definition _ '.J.: � Long-Term: Outlook: Action: Effective Date: Initial Rating Date: ( I ) Denotes Indicative Rating u Denotes Under Review Rating a+ Stable Upgraded December 19, 2018 June 20, 2007 pea Preliminary Credit Assessment Is an Independent opinion on tho relative general credit strengths and weaknesses of an Issuer, obliger, securlty, or a proposed transaction or f,iandng structuro prlmartly based on business ptana, lcrm sheets, and A.M. Bosrs expectations relative to lite llXecuticn of such business plans. A.M. Best doen not define a PCA as a Credit Rat:ng; howw,,r, tho asoeosm,mt Is expressed using the existing 88llrs Credit Rating scales. Rating Issued by: Director: Senior Director : AM. Best Rating Services, Inc. Jennifer Marshall, CPCU, ARM Michael J. Lagomarsino, CFA, FRM 2.The Version of the Procedure or Methodology used to Determine the Credit Rating as required by Paragraph (a)(1)(ii)(B) of Rule 17g-7 UNITED SPECIALTY INSURANCE COMPANY 3250 Grey Hawk Ct, Unit Z • Carlsbad, CA 92010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNITED SPECIALTY INSURANCE COM PANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-STATE OR POLITICAL SUBDIVISIONS-PERMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. State or Political Subdivision: City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers (lf no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section III -Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: I.This insurance applies only with respect to operations performed by you or on your behalf for which the stale or governmental agency or subdivision or political subdivision has issued a permit. 2.This insurance does not apply to: a."Bodily injury", '·property damage" or ;.personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b."Bodily injury" or "property damage" included within the "products-completed operations hazard". Coverage for any additional insured is governed by the terms. conditions, and exclusions of this policy and all endorsements, including the lnsuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: S1105038229877 Date: 04/18/2019 Time: 12:01 a.m. USIC AIE GOV P 00 01 0318 ,zed Representative Page 1 of 1 UNITED SPECIALTY INSURANCE COMPANY 3250 Grey Hawk Ct, Uni! Z • Carlsbad, CA 92010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNITED SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-OWNERS. LESSEES OR CONTRACTORS SCHEDULED PERSON ORORGANTZATION ONGOING OPERATIONS ONLY This endorsement modi ties insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers Designated Project/Location to which this endorsement applies: (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section III -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", "prope1ty damage" or "personal and advertising injury" caused, in whole or in part, by: I. Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of yourongoing operations performed during the policy period for the additional insured(s) at the location(s) designated above. B.This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional lnsured's status as an additional insured hereunder terminates, upon the earlier of: I.All work, including materials, parts or equipment furnished by the Named Insured 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 engaged in performing operations for a principal as part of the same project. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the propottion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the tenns, conditions and exclusions of this policy apply and remain in effect. SII0503B229877 Policy No.: 04/18/2019 Date: Time: . 12:01 a.m. USIC AIE ONO 00 01 0318 United Specialty Insurance Company 3250 Grey Hawk Ct, Ste. Z Carlsbad, 0 I 0 By: Page 1 of 1 UNITED SPECIALTY INSURANCE COMPANY 3250 Grey Hawk Ct, Unit Z • Carlsbad, CA 92010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNITED SPECIAL TY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (COMMERCIAL ONLY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Additional Insured: City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers Designated Project/Location to which this endorsement applies: If no entry appears above, the infonnation required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section III -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: I.The Named lnsured's acts or omissions; or2.The acts or omissions of those acting on the Named lnsured's behalf in the performance of"your work" for the additional insured(s) at the location(s) designated above. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Policy No.: SII0503B229877 Date: 04/18/2019 Time: 12:01 a.m. USIC AIE COM 00 01 0318 United Specialty Insurance Company 3250 Grey Hawk Ct, Ste. Z Carlsbad;�O I 0 By: /lhf' Page 1 of 1 UNITED SPECIAL TY INSURANCE COMP ANY 3250 Grey Hnwk Ct, Unit Z • Cnrlsbnd, CA 92010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNITED SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABIUTY POLICY ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION INCLUDTNG PRIMARY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers Designated Project/Location to which this endorsement applies: (lfno entry appears above, the infonnation required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section III -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; or2.The acts or omissions of those acting on your behalf; in the perfom1ance of your ongoing operations performed during the policy period for the additional insured(s) at the localion(s) designated above. B.This insurance does not apply to "bodily injury" or "property damage" that takes place after, and theAdditional lnsured's status as an additional insured tenninates, upon the earlier of when: 1.All work, including materials, parts or equipment furnished by the Named Insured in connection withsuch 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 useby any person or organization other than another contractor engaged in perfom1ing operations for a principal as part of the same project. C.If expressly required by a written and legally enforceable contract entered into by the Named Insured priorlo commencement of work by the Named Insured for the Additional Insured, the insurance afforded by the policy to the Additional lnsured(s) listed in the Schedule for the described location(s) is primary insurance. Any other insurance or self-insurance maintained directly by the Additional lnsured(s) is excess of this insurance and shall not contribute to it. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the tem1s, conditions and exclusions of this policy apply and remain in effect. Policy No.: S110503B229877 Date: 04/18/2019 Time: 12:01 a.rn. USIC AIE OOP 00 01 0318 United Specialty Insurance Company 3250 Grey Hawk Ct, Ste. Z Carlsbad�O 10 By: /7//;f"'zed Representative Page 1 of 1 UNITED SPECIAL TY INSURANCE COMP ANY 3250 Grey Hawk Ct, Unit Z • Curlsbad, CA 92010 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. UNITED SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION INCLUDING WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Additional Insured: City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers Designated Project/Location to which this endorsement applies: lfno entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A.Section III -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: I.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed during the policy period for the additional insured(s) at the location(s) designated above. B.This insurance does not apply to "bodily injury" or "property damage" that takes place after, and the Additional lnsured's status as an additional insured terminates, upon the earlier of when: I.All work, including materials, parts or equipment furnished by the Named Insured 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.Thal 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 engaged in performing operations for a principal as part of the same project. C.If expressly required by a written and legally enforceable contract entered into by the Named Insured prior to commencement of work by the Named Insured for the Additional Insured, then we waive any right of subrogation we may have against an entity that is an Additional Insured per the terms of this endorsement because of payments we make for injury or damage arising out of''your work" performed under such written and legally enforceable contract with that Additional Insured. Coverage for any additional insured is governed by the terms, conditions, and exclusions of this policy and all endorsements, including the Insuring Agreement. The coverage provided for any additional insured is only to the extent of and in the proportion the additional Insured is held liable for the negligence or strict liability/conduct/acts of the Named Insured. No coverage is provided for liability based upon the acts, errors or omissions of the Additional Insured. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. Policy No.: Sl105038229877 Date: 04/18/2019 Time: 12:01 a.m. zed Representative USIC AIE OOPWOS 00 01 0318 Page 1 of 1 STATE COMPENSATION INSURANCE FUND HOME OFFICE SAN FRANCISCO ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1721281-18 RENEWAL NA 3-36-79-98PAGE 1 EFFECTIVE MARCH 18, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME AND EXPIRING DECEMBER 1, 2019 AT 12.01 A.M. ALVERNAZ CONSTRUCTION PO BOX 366 SAN MARTIN, CA 95046 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF CUPERTINO WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, ALVERNAZ CONSTRUCTION IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 20, 2019 2570 �!.,q, PRESIDENT AND CEO SCIF FORM 10217 IREV.4-2018) OLD DP 217 STATE COMPENSATION INSURANCE FUND HOME OFFICE SAN FRANCISCO ENDORSEMENT AGREEMENT ADDITIONAL INSURED EMPLOYER 1721281-18 RENEWAL NA 3-36-79-98PAGE 1 EFFECTIVE MARCH 18, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ALVERNAZ CONSTRUCTION PO BOX 366 SAN MARTIN, CA 95046 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE CITY OF CUPERTINO IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF ALVERNAZ CONSTRUCTION (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: MARCH 20, 2019 �!,,q, PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 0015 OLO DP 217 STATE COMPENSATION INSURANCE FUND ISSUE DATE: 03-18-2019 THE CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014-3202 CERTHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROUP: NA POLICY NUMBER: 1721281-2018 CERTIFJCA TE ID: 4 CERTIFICATE EXPIRES: 12-01-2019 12-01-201 8/12-01-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. �t!q IL�� xll�� Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-03-18 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: THE CITY OF CUPERTINO ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-03-18 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: THE CITY OF CUPERTINO EMPLOYER ALVERNAZ, MICHAEL A PO BOX 366 SAN MARTIN CA 95046 (REV.7-2014) NA PRINTED [KMC,VL] 03-18-2019 NA STATE COMPE;NSATION INSURANCE FUND ISSUE DATE: 03-18-2019 THE CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014-3202 POLICYHOLDER COPY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROUP: NA POLICY NUMBER: 1721281-2018 CERTIFICATE JD: 4 CERTIFICATE EXPIRES: 12-01-2019 12-01-2018/12-01-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 1 O days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not .;imend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. �ti ,6£/ 1:L_ .fl� Authorized Representative President and CEO UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-03-18 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: THE CITY OF CUPERTINO ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2019-03-18 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: THE CITY OF CUPERTINO EMPLOYER ALVERNAZ, MICHAEL A PO BOX 366 SAN MARTIN CA 95046 (REV.7-2014) NA PRINTED [KMC,VL] 03-18-2019 NA WAIVER OF SUBROGATION NOTICE Enclosed is your copy of a certificate of insurance on which the certificate holder required a waiver of subrogation: 1.Please be advised that a waiver of subrogation requires that a 3% surchargewill be applied by State Fund ONLY to the premium assessed on the payrollof your employees earned while engaged in work for that certificate holderwho requested the waiver. (Note: if you have no employee payroll on that job,then there is no charge.) 2.To apply the 3% surcharge, you must also agree to maintain accuratelysegregated payroll records for employees engaged in work on job/s for thecertificate holder who has the waiver. The payroll records are subject toverification by an auditor. Example: Payroll for job: Sample Rate: Regular Premium equals: Surcharge: $5,000.00 13.30% $ 665.00 3.00% Additional Waiver charge: $ 19.95 Total premium equals $ 684.95 (665.00 + 19.95)