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19-191 CleanStreet, Inc., Contractual Street Sweeping Services, Project No. 2019-101 Contract This public works contract("Contract") is entered into by and between the City of Cupertino ("City"), a municipal corporation, and CleanStreet Inc. ("Contractor"), for work on the CONTRACTUAL STREET SWEEPING SERVICES ("Project'), Project No. 2019-101. The parties agree as follows: 1. Award of Contract. In response to the Notice Inviting Bids, Contractor has submitted a Bid Proposal and accompanying Bid Schedule, a copy of which is attached for convenience as Exhibit A, to perform the Work to construct the Project. On October 15, 2019, City authorized award of this Contract to Contractor for the amount set forth in Section 4 below. 2. Contract Documents. The Contract Documents incorporated into this Contract include and are comprised of all of the documents listed below. The definitions provided in Article 1 of the General Conditions apply to all of the Contract Documents, including this Contract: 2.1 Notice Inviting Bids; 2.2 Instructions to Bidders; 2.3 Addenda, if any; 2.4 Bid Proposal and attachments thereto; 2.5 Contract; 2.6 Performance Bond; 2.7 General Conditions; 2.8 Special Conditions; 2.9 Project Maps and Specifications; 2.10 Change Orders, if any; 2.11 Notice of Award; 2.12 Notice to Proceed; 3. Contractor's Obligations. Contractor will perform all of the Work required for the Project, as specified in the Contract Documents. Contractor must provide, furnish, and supply all things necessary and incidental for the timely performance and completion of the Work, including all necessary labor, materials, supplies, tools, equipment,transportation, onsite facilities and utilities, unless otherwise specified in the Contract Documents. Contractor must use its best efforts to diligently prosecute and complete the Work in a professional and expeditious manner and to meet or exceed the performance standards required by the Contract Documents. 4. Payment. For the performance of the services described in the Contract Documents the City shall pay Contractor the sum of$22,362.50 per month, less any deductions for work not performed and or liquidated damages payable upon submission by Contractor of an itemized billing: provided, however, that the total sum payable to Contractor shall not exceed $268,350 per year. 5. Term. The term of this contract shall be five (5)years from the start date of the contract. The City shall retain the option to extend the term of the contract for an additional one (1)to five (5) years, for a possible total of ten years. The start date of this Contract shall be November 1, 2019. Any such renewal after the first five (5) years shall be accomplished by the City providing a written notice of renewal to the Contractor at least 180 days prior to expiration of the term. Any such renewal shall contain the same provisions as the original contract, including an increase or decrease in compensation paid to the Contractor. Any increase or decrease in the previous contract price shall be based on the annual percentage change in the Consumer Price Index(CPI)as of June of the year the adjustment is being made. The CPI shall be the San Francisco/Oakland/San Jose Consumer Price Index for all urban wage earners. There will be no CPI adjustment during the first one-year term of the agreement. At the end of the initial twelve months of the contract period, and each anniversary thereafter for the duration of the contract,the unit prices on the Schedule of Bid Prices will be increased or decreased in direct proportion to the increase or decrease in the Consumer Price Index (CPI). The most recent CPI for June San Francisco/Oakland/San Jose area for all urban wage earners shall be used. 6. Liquidated Damages. The Contractor shall pay liquidated damages to the City in the sum of One Thousand Dollars ($1,000.00)for each and every day that street sweeping: services are not completed on time and/or streets are omitted. Omitted streets must be swept by the following working day. In case of breakdown by main sweeper, immediate service within one hour by a second sweeper is required to complete daily schedule. If down for more than one hour, liquidated damages will be assessed at the rate of One Hundred Dollars ($100.00) per hour for each hour above and beyond one hour and streets must be completed that day. 7. Labor Code Compliance. This section is not applicable due to the Contractor not being required to pay prevailing wages,therefor no DIR registration is required for this project 7.1 General. This Contract is subject to all applicable requirements of Chapter 1 of Part 7 of Division 2 of the Labor Code, including requirements pertaining to wages, working hours and workers'compensation insurance, as further specified in Article 9 of the General Conditions. 7.2 Prevailing Wages. This Project is subject to the prevailing wage requirements applicable to the locality in which the Work is to be performed for each craft, classification or type of worker needed to perform the Work, including employer payments for health and welfare, pension, vacation, apprenticeship and similar purposes. Copies of these prevailing rates are available online at http://www.dir.ca.gov/DLSR. 7.3 DIR Registration. City may not enter into the Contract with a bidder without proof that the bidder and its Subcontractors are registered with the California Department of Industrial Relations to perform public work pursuant to Labor Code section 1725.5, subject to limited legal exceptions. 8. Workers' Compensation Certification. Pursuant to Labor Code section 1861, by signing this Contract, Contractor certifies as follows:"I am aware of the provisions of Labor Code section 3700 which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the Work on this Contract." 9. Conflicts of Interest. Contractor, its employees, Subcontractors and agents, may not have, maintain or acquire a conflict of interest in relation to this Contract in violation of any City ordinance or requirement or in violation of any California law, including Government Code section 1090 et seq., or the Political Reform Act, as set forth in Government Code section 81000 et seq. and its accompanying regulations. No officer, official, employee, consultant, or other agent of the City("City Representative") may have, maintain, or acquire a"financial interest" in the Contract, as that term is defined under the Political Reform Act (Government Code section 81000,et seq., and regulations promulgated thereunder); or under Government Code section 1090, et seq.;or in violation of any City ordinance or requirement while serving as a City Representative or for one year thereafter. Any violation of this Section constitutes a material breach of the Contract. 10. Independent Contractor. Contractor is an independent contractor under this Contract and will have control of the Work and the means and methods by which it is performed. Contractor and its Subcontractors are not employees of City and are not entitled to participate in any health, retirement, or any other employee benefits from City. 11. Notice. Any notice, billing, or payment required by or pursuant to the Contract Documents must be made in writing, signed, dated and sent to the other party by personal delivery, U.S. Mail, a reliable overnight delivery service, or by email as a PDF file. Notice is deemed effective upon delivery, except that service by U.S. Mail is deemed effective on the second working day after deposit for delivery. Notice for each party must be given as follows: City: Name: City of Cupertino Address: 10300 Torre Avenue City/State/Zip: Cupertino, CA 95014 Phone: (408) 777-7603 Attn: Environmental Programs Email: EnvProginvoices@cupertino.org Copy to: environmental@cupertino.org Contractor: Name: OtArl S 1 ir'e'Gt Address: 1431 W• 111A ttt S - City/State/Zip:C741Y L'AA , CAR qV241 Phone: 100- 2 --13 Attn: ere' CO 21 b l G r.CO Email: Gb5 0 Ct9'15 •eefi Garv� r' �i�ld�r'501'►�c�uh ���'GbbY1 Copy to: 12. General Provisions. 12.1 Assignment and Successors. Contractor may not assign its rights or obligations under this Contract, in part or in whole, without City's written consent. This Contract is binding on Contractor's and City's lawful heirs, successors and permitted assigns. 12.2 Third Party Beneficiaries. There are no intended third party beneficiaries to this Contract. 12.3 Governing Law and Venue. This Contract will be governed by California law and venue will be in the Santa Clara County Superior Court, and no other place. Contractor waives any right it may have pursuant to Code of Civil Procedures Section 394,to file a motion to transfer any action arising from or relating to this Contract to a venue outside Santa Clara County, California. 12.4 Amendment. No amendment or modification of this Contract will be binding unless it is in a writing duly authorized and signed by the parties to this Contract. 12.6 Integration. This Contract and the Contract Documents incorporated herein, including authorized amendments or Change Orders thereto, constitute the final, complete, and exclusive terms of the agreement between City and Contractor. 12.6 Severability. If any provision of the Contract Documents, or portion of a provision, is determined to be illegal, invalid, or unenforceable,the remaining provisions of the Contract Documents will remain in full force and effect. 12.7 Iran Contracting Act. If the Contract Price exceeds$1,000,000, Contractor certifies, by signing below,that it is not identified on a list created under the Iran Contracting Act, Public Contract Code§2200 et seq. (the"Act'), as a person engaging in investment activities in Iran, as defined in the Act, or is otherwise expressly exempt under the Act. 12.8 Authorization. Each individual signing below warrants that he or she is authorized to do so by the party that he or she represents, and that this Contract is legally binding on that party. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporation Code section 313. [Signatures are on the following page.] The parties agree to this Contract as witnessed by the signatures below: CONTRACTOR CleanStreet A A i CITY OF CUPERTINO <insert fu f C r ve> A Municipal Corpor b By Sy NameTere o ello Roger Lee Title CEOMAsident Director of Pub►l 0 PCs Date 10/22 019 Date / c By NameJereLniah Costello Title Secretary Date 10/22/201.A APPROVED AS TO FORM: By '��'�� `fie Name 1�P�ttn�t r>,• :nv+� l City Attorney Date v —1 ATTEST: ce Schmidt City Clerk l Date Contract Amount: P.O. No. Account No._ END OF CONTRACT Bond No: 1009757 Performance Bond The City of Cupertino ("City")and CleanStreet, Inc. ("Contractor") have entered into a contract, authorized by the City Council October 15, 2019 ("Contract")for work on the 2019 CONTRACTUAL STREET SWEEPING SERVICES ("Project"), Project No. 2019-101. The Contract is incorporated by reference into this Performance Bond ("Bond"). 1. General. Under this Bond, Contractor as Principal and The Hanover Insurance Company, its surety("Surety'), are bound to City as obligee for an amount not less than $268,350.00 to ensure Contractor's faithful performance of its obligations under the Contract. This Bond is binding on the respective successors, assigns, owners, heirs, or executors of Surety and Contractor. 2. Surety's Obligations. Surety's obligations are co-extensive with Contractor's obligations under the Contract. If Contractor fully performs its obligations under the Contract, including its warranty obligations under the Contract, and Contractor has timely provided a warranty bond as required under the Contract. Surety's obligations under this Bond will become null and void upon City's acceptance of the Project, excluding any exceptions to acceptance, if any. Otherwise Surety's obligation will remain in full force and effect until expiration of the one year warranty period under the Contract. 3. Waiver. Surety waives any requirement to be notified of and further consents to any alterations to the Contract made under the applicable provisions of the Contract Documents, including changes to the scope of Work or extensions of time for performance of Work under the Contract. Surety waives the provisions of Civil Code sections 2819 and 2845. 4. Application of Contract Balance. Upon making a demand on this Bond, City will make the Contract Balance available to Surety for completion of the Work under the Contract. For purposes of this provision, the Contract Balance is defined as the total amount payable by City to Contractor as the Contract Price minus amounts already paid to Contractor, and minus any liquidated damages, credits, or back charges to which City is entitled under the terms of the Contract. 5. Contractor Default. Upon written notification from City of Contractor's termination for default under Article 13 of the Contract General Conditions, time being of the essence, Surety must act within the time specified in Article 13 to remedy the default through one of the following courses of action: 5.1 Arrange for completion of the Work under the Contract by Contractor, with City's consent, but only if Contractor is in default solely due to its financial inability to complete the Work; 5.2 Arrange for completion of the Work under the Contract by a qualified contractor acceptable to City, and secured by performance and payment bonds issued by an admitted surety as required by the Contract Documents, at Surety's expense; or 5.3 Waive its right to complete the Work under the Contract and reimburse City the amount of City's costs to have the remaining Work completed. 6. Surety Default. If Surety defaults on its obligations under the Bond, City will be entitled to recover all costs it incurs due to Surety's default, including legal, design professional, or delay costs. 7. Notice. Any notice to Surety may be given in the manner specified in the Contract and sent to Surety as follows: Attn: Sara J. Poplawski Address: 5 Hutton Centre Dr. Suite 1060 City/State/Zip: Santa Ana, CA 92707 Phone: 714-415-3808 Fax: 508-926-5766 Email: SPOPLAWSKI@HANOVER.COM 8. Law and Venue. This Bond will be governed by California law, and venue for any dispute pursuant to this Bond will be in the Santa Clara County Superior Court, and no other place. Surety will be responsible for City's attorneys' fees and costs in any action to enforce the provisions of this Bond. 9. Effective Date; Execution. This Bond is entered into and effective on October 23 2019 . SURETY: The Hanover In ance Company Business e s/ ZK Patrick . Moughan, Attorney-in-Fact Name/Title[print] (Acknowledgment with Notary Seal for Surety and Surety's Power of Attorney must be attached.) CONTRACT ClepnStreetfirLp. sines a s/ J e t-.e o Ste 110, GEv I pr-esi d ent Name/Title Date: s/ � ry-%ia>-i Cbsfiello Name/Title Date: �2L4 Zfl 1- END OF PERFORMANCE BON THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF ATTORNEY THIS Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. KNOW ALL PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing underthe laws of the State of Michigan,(hereinafter individually and collectively the"Company")does hereby constitute and appoint, Patrick T.Moughan,Mark D.Kiger,Alec D.Martinez,and/or Jing Guo Mason Of Global Risk,LLC of Los Angeles,CA each individually,if there be more than one named,as its true and lawful attorney(s)-in-fact to sign,execute, seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States,any and all surety bonds,recognizances, undertakings,or other surety obligations.The execution of such surety bonds,recognizances,undertakings or surety obligations,in pursuance of these presents,shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company,in their own proper persons.Provided however,that this power of attorney limits the acts of those named herein;and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Any such obligations in the United States,not to exceed Fifty Million and Nol100($50,000,000)in any single instance That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company,and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety, any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons. RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or Vice President in conjunction with any Vice President of the Company,shall be binding on the Companyto the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 —The Hanover Insurance Company;Adopted April 14, 1982—Massachusetts Bay Insurance Company;Adopted September 7,2001—Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,this 29'h day of March,2017. The Hanover Insurance Company Massachusetts Bay Ins4ance Company The Hanover Insurance Company Citizens Insurance Company of America `"�"�"�0r Wm Massachusetts Bay Insurance Company •••� a Citizens Insurance Company of America "c �- 1_�t.L a legg r d' 14 John C.Roche,E%,T and President } Jaxnes H.Kav iecki,Vice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER )ss. On this 29"day of March,2017 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,respectively,and thatthe said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. E 1"E J. MwnA " twiOFvuo �4. Diane 1. a o.N,rnry Public Aty Commission Expim Mumh 4.2022 I,the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 23rd day of October,2019 CERTIFIED COPY Theodore G.Martinez,Vicc Presidc I CALWO NMA ALL= PURPOSE CERTWMATE OF ACKNOWLEDGI-MENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of Los Angeles } On (� �.23 -101A before me, Zipporah D. Kiger, Notary Public �^ (Here insert name ana true at e o Icer) personally appeared Patrick T. Moughan who proved to me on the basis of satisfactory evidence to be the person(s) whose name() Is re subscribed to the within instrument and acknowledged to me that �ie�. he/they executed the same in Is er/their authorized capacity(ies), and that by Is er/their signature( on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. � a ZIPPORAH D KIGER� WITNESS my hand and official seal. , : Commission No 2190589 NOTARY PUBLIC CALIFORNIA n •, LOS ANCC.LS CC JNTY �. My Comm. t rpvy;,APRIL 70 >:`t Notary Pub]i6 Sig ur (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION Th INSTRUCTIONS FOR COMPLETING THIS FORM is forth complies with current California statutes regarding notaty wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed should be completed and attached to the document.Acknotrledgments ft-ont other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document I signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document cont hued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/they is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form El Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. p Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate die title(i.e.CEO,CFO,Secretary). 2C I V,�sic n ...K yCl:: ses.cc 600-F 3-9865 • Securely attach this document to the signed document with a staple. Form se Request for Taxpayer Give Form to the (Rev.Octcber2018) Identification Number and Certification requester.Do not Departmant of the Treasury send to the IRS, Internal Revenue Ssrvfce lY Go to Www.irs.gov1FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name Is required on this fine;do not leave this line blank. CleanStreet, inc. 2 Business nameldlsregarded entity name,if different from above ro 3 Check appropriate box for federal tax classification of the person whose name is entered on fine 1.Check onry one of the 4 Exemptions(codes apply only to afoibtiving seven boxes. certain entities,not Individuals;see c Instructions on page 3): Elo IndividuaVsole proprietor or ❑ C Corporation Ov S Corporation ElPartnership ❑TrusUestate c single-member LLC Exempt payee code(if any) ❑ Umited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting N LLC If the LLC Is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code Of any) e another LLC that is not disregarded from the owner for U.S.federal tax purposes.otherwise,a single-member LLC that o Is disregarded from the owner should check the appropriate box for the tax classification of its owner. o ❑ other(see Instructions)► fAppxn ro-oa,,,n .era ncyouwue my v.s.) m N b Address(number,street,and apt.or suite no.)See Instructions. Requester's name and address(optional) c1n 1937 W.169th Street 6 City,state,and ZIP code Gardena,CA 90247 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN In the appropriate box.The TIN provided must match the name given on line 1 to avoid social security number backup withholding.For individuals,this is generally your social security number(SSN).However,fora s I I m resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it Is your employer identification number(EIN).If you do not have a number,see Now to get a OT TIN,later. or Note:If the account is In more than one name,see the Instructions for line 1.Also see What Name and Employer Identification number Number To Give the Requester for guidelines on whose number to enter. M95 JjM Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am wafting for a number to be Issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)i have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S,citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form Of any)indicating that I am exempt from FATCA reporting Is correct, Certification instructions.You must crass out item 2 above If you have been notified by the iRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,Item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than Interest and dividends,you are not required to sign the ce 'ication,but you must provide your correct TIN,See the instructions for Part 11,later. Sign I Signature of =dl Here U.S.person► D General Instructions •Form 1099-DiV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise noted .Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) Future developments,For the latest information about developments .Form i099(3(stock or mutual fund sales and certain ocher relates!to Form W-9 and its instructions,such as legislation enacted transactions B brokers) after they were published,go to www.lrs.gov1FormW9. •Form 1099-S(proceeds from real estate transactions) PUCE]OS$of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage Interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) Identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption taxpayer Identification number(ATIN),or employer identification number •Form 1099-A(acquisition or abandonment of secured property) (EIN),to report on an information return the amount pald to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. if you do not return Form W-9 to the requester with a TiN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat,No.10231X Form W-9(Rev.10-2018) CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 05/09/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: _ Marron Insurance Services/Global Risk,LLC PHONE AAIC o Ext 310-514-8425 FAX c Not:310-514-8688 1891 N. Gaffey Street, Suite 203 E-MAIL becky@marronins.com y@m arronins.com San Pedro, CA90731 INSURER(S)AFFORDING COVERAGE NAIC# License#OE63455 _ INSURERA: United States Fire Insurance Com an 1 1113 INSURED INSURERB:Alaska National Insurance Company 38733 CleanStreet, Inc. INSURERC: DBA: California Street Maintenance INSURERD: 1937 W 169th Street Gardena, CA 90247 INSURER E. 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 ADDL SUER - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICYNUMBER MM/DDIYYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X 506-896201-8 1; 04/01/19 04/01/M,'EACHOCCURRENCE $ ;/ 1,000,000 CLAIMS-MADE XI OCCUR DAMAGE T RENTEO PREMISES(Ea occurrence) $ 1,000,000 Contractual Liability MEDEXP(Any one person) $ 10,000 -- PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ✓ 2,000,000 'V POLICY JECTPRO- u LOC PRODUCTS.COMP/OP AGG $ 2,000,000 i OTHER: $ A AUTOMOBILE LIABILITY X 506-896201-8 I/ 04/01/19 04/01/20,j Eaaociderri)SINGLE LIMIT $ �/ 1,000,000 Ix ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURYAUTOS ONLY AUTOS (Per accident) $ HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB 1 X OCCUR 523-809816-3 04/01/19 04/01/20 EACH OCCURRENCE _ $. 5,000,000-� EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ � B WORKERS COMPENSATION X 19DWS08875 04/01/19 04/01/20 X STATUTE "AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ i' 1,000,000 OFFICER/MEMBEREXCLUDED7 Y❑ NIA — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) City of Cupertino, its City Council, Officers, Officials, Employees, Agents, Servants and Volunteers are named as Additional Insured per attached endorsements. **10 Day notice will apply for non payment of premium.** CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,?� I Il R �_,-:IL•iA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I POLICY NUMBER`. 506-896201-8 COMMERCIAL GENERAL LIABILITY CLEANSTREET, iNC. CG 20 37 07 04 DBA: CALIFORNIA STREET MAINTENANCE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION WHOM ANY LOCATION WHERE YOU ARE YOU ARE REQUIRED BY A WRITTEN REQUIRED BY A WRITTEN CONTRACT TO CONTRACT TO ADD AS AN ADDITIONAL ADD A PERSON OR ORGANIZATION AS INSURED AN ADDITONAL INSURED 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' or"property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". SUCH COVERAGE AS IS AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ADDITIONAL INSURED SHALL BE PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED SHALL BE NON-CONTRIBUTING WITH THE COVERAGE PROVIDED UNDER THIS POLICY. CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER' 506-896201-8/ COMMERCIAL GENERAL LIABILITY CLEANSTREET,'INC. / CG2010 07 04 DBA: CALIFORNIA STREETJVIAINTENANCE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 Organ ization s : Locations Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU ANY LOCATION WHERE YOU ARE ARE REQUIRED BY A WRITTEN CONTRACT TO REQUIRED BY A WRITTEN CONTRACT TO ADD AS AN ADDITIONAL INSURED ADD A PERSON OR ORGANIZATION AS AN ADDITONAL INSURED 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 1.AI1 work, including materials, parts or equipment include as an additional insured the person(s) or furnished in connection with such work, on the organization(s) shown in the Schedule, but only project (other than service, maintenance or re- with respect to liability for "bodily injury", "property pairs)to be performed by or on behalf of the addi- damage" or "personal and advertising injury" tional insured(s) at the location of the covered op- caused, in whole or in part, by: erations has been completed; or 1. Your acts or omissions; or 2.That portion of"your work"out of which the injury or 2. The acts or omissions of those acting on your damage arises has been put to its intended use by behalf; any person or organization other than another con- in the performance of your ongoing operations for tractor or subcontractor engaged in performing opera- the additional insured(s) at the location(s) desig- tions for a principal as a part of the same project. nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage"occurring after: CG 20 10 07 04 C ISO Properties, Inc., 2004 POLICY NUMBER: 506-896201-6 COMMERCIAL GENERAL LIABILITY CLEANSTREET, INC. ! CG 24 04 05 09 DBA: CALIFORNIA` THE T-6AINTENANCE WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION FOR WHOM THE INSURED IS REQUIRED TO WAIVE RIGHT TO RECOVERY UNDER A CONTRACT AS DESCRIBED BELOW. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Alaska National INSURANCE COMPANY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from You must maintain payroll records accurately anyone liable for an injury covered by this policy. We segregating the remuneration of your employees while will not enforce our right against the person or engaged in the work described in the Schedule. organization named in the Schedule. (This agreement applies only to the extent that you perform The additional premium for this endorsement shall be work under a written contract that requires you to 2 % of the California workers' compensation obtain this agreement from us.) premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Blanket Waiver: Any person or organization for whom the insured has agreed, by written contract, to furnish this waiver. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective 04/01/19-04/01/20 Policy 19D WS 08875'- Insured Cleanstreet, Inc. Endorsement No. 5 Countersigned By WC 04 03 06 (04 84) All Docs Copy THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL PURPOSE ENDORSEMENT Named Insured* CLEANSTREET, INC. Policy No. 5238098163 Company* United States Fire Insurance Company Endorsement No. 002 Producer* MARRON INSURANCE SERVICES Effective Date 10/29/2019 *This information is completed only when this endorsement is issued subsequent to preparation of policy. POLICY CHANGES ARE INDICATED BY A X l Named Insured amended to read as shown below. Address of Named Insured amended to read as shown below. _ Premium or rates amended as shown below. Policy Period amended to read as shown below. Premium Basis is amended to read as shown below. Limit(s)of insurance is amended to read as shown below. Total Advance Premium amended to read as shown Policy conditions amended as shown below. below. Business Description of Insured is amended to read as Description or location of property amended to read as shown below. _ shown below Location(s shown below added to olic . Location (s)shown below deleted from policy. Other as shown below. X Forms and Endorsements shown below made part of this policy. — Item(s)listed below added to schedule. Item (s)listed below deleted from schedule. Total of schedule increased by Total of schedule reduced by To a total of To a total of Additional Premium Return Premium Premium Payable at Endorsement Effective Date Tax/Surcharge Tax/Surcharge Premium Adjustment to Payment Schedule Dates Due Previous Installment Increase Decrease Revised Installment Total Endorsement Premium to Policy Expiration All other terms and conditions remain unchanged. Aufhorzed Representative FM 101.0.1403 (10/93) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULED ADDITIONAL INSURED ENDORSEMENT Section III, WHO IS AN INSURED, is amended by adding the following paragraph C.: Each of the persons and/or entities scheduled below qualifies as an additional insured, but only to the extent that insurance is provided to such persons and/or entities, for the full scheduled limit, by "Underlying Insurance": Additional Insured Mailing Address City of Cupertino, Its City Council, Officers Officials, Employees, Agents, Servants and Volunteers. FM 101.0.920 08 05