10-101 SpenCon Construction, Inc., Reconstruction Sidewalks Curbs and Gutters, Project No. 2010-05 DOCUMENT: 21272893 Pages 3
RECORDING REQUESTED BY 1111 Fees .... A' No Fees
City of Cupertino Cop es
AMT PAID
WHEN RECORDED MAIL TO
REGINA ALCOMENDRAS RDE # 014
City Clerk's Office SANTA CLARA COUNTY RECORDER 8/10/2011
City of Cupertino Recorded at the request of 1 1 .36 AM
10300 Torre Avenue City
Cupertino, CA 95014 -3255
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 27383
CERTIFICATE OF COMPLETION
AND
NOTICE OF ACCEPTANCE OF COMPLETION
RECONSTRUCTION OF CURBS, GUTTERS, AND SIDEWALKS
CITY PROJECT NUMBER 2010 -05
G1 Original
O For Fast Endorsement
rirk City Hall
10300 Torre Avenue
Cupertino, CA 95014 -3255
' s (408) 777 -3354
C U P S RT I N O PUBLIC WORKS DEPARTMENT
CERTIFICATE OF COMPLETION
AND
NOTICE OF ACCEPTANCE OF COMPLETION
RECONSTRUCTION OF CURBS., GUTTERS, AND SIDEWALKS
CITY PROJECT 1N UMBER 2010 -05
NOTICE IS HEREBY GIVEN THAT I, Timm Borden, Director of Public Works and
City Engineer of the City of Cupertino, California, do hereby certify that the work and
improvements in hereinafter described in the contract which was entered into, by, and between
the City of Cupertino and Spencon Construction INC., October 4, 2010, in accordance with the
plans and specifications for said work, have been completed to the City's satisfaction and
acceptance of completion was ordered on August 2, 2011.
That said work and improvements consisted of furnishing all labor, materials, tools, and
equipment required to complete said project, all as more particularly described in the plans and
specifications for said project.
ctor of Public Works and
City Engineer of the City of Cupertino
Date: August 3, 2011
"NO FEE"
VERIFICATION
I have reviewed this Certificate of Completion and Notice of Acceptance of
Completion. To the best of my knowledge, the information contained herein is true and
complete.
I verify under penalty of perjury under the laws of the State of California, that the
foregoing is true and correct.
Executed on the 8th day of August, 2011 at Cupertino, California.
Kirsten Squarcia
City Clerk's Office
City of Cupertino
RECORDING REQUESTED BY
DOCUMENT: 21333883 Pages: 3
City of Cupertino Fees. . . . No Fees
Taxes. .
WHEN RECORDED MAIL TO Copies. .
AMT PAID
City Clerk's Office
—
City of Cupertino REGINA ALCOMENDRAS RDE # 005
10300 Torre Avenue SANTA CI_ARA COUNTY RECORDER 9/23/2011
Cupertino, CA 95014-3255 Recorded at the request of 12 03 PM
City
(SPACE ABOVE THIS LINE FOR RECORDER'S USE)
NO FEE IN ACCORDANCE
WITH GOV. CODE 27383
CERTIFICATE OF COMPLETION
AND
NOTICE OF ACCEPTANCE OF COMPLETION
RECONSTRUCTION OF CURBS, GUTTERS, AND SIDEWALKS
CITY PROJECT NUMBER 2010-05
ta'Original
O For Fast Endorsement
/� City Hall
•
�' 10300 Torre Avenue
Cupertino, CA 95014-3255
'9s:\•\ (408) 777-3354
C O P E RT I N O PUBLIC WORKS DEPARTMENT
CERTIFICATE OF COMPLETION
AN D
NOTICE OF ACCEPTANCE OF COMPLETION
RECONSTRUCTION OF CURBS, GUTTERS,AND SIDEWALKS
CITY PROJECT NUMBER 2010-05
NOTICE IS HEREBY GIVEN THAT I, Timm Borden, Director of Public Works and
City Engineer of the City of Cupertino, California, do hereby certify that the work and
improvements in hereinafter described in the contract which was entered into, by, and between
the City of Cupertino and Spencon Construction INC., October 4, 2010, in accordance with the
plans and specifications for said work, have been completed to the City's satisfaction and
acceptance of completion was ordered on August 2, 2011.
That said work and improvements consisted of furnishing all labor, materials, tools, and
equipment required to complete said project, all as more particularly described in the plans and
specifications for said project.
Thrector o Public Works and
City Engineer of the City of Cupertino
Date: September 14, 2011
"NO FEE"
VERIFICATION
I have reviewed this Certificate of Completion and Notice of Acceptance of
Completion. To the best of my knowledge, the information contained herein is true and
complete.
I verify under penalty of perjury under the laws of the State of California, that the
foregoing is true and correct.
Executed on the 14th day of September, 2011 at Cupertino, California.
Kirsten Squarcia
City Clerk's Office
City of Cupertino
Project No. 2010 -05
DOCUMENT 00520
CONTRACT / 6° • ?-.?5i ? /4
THIS CONTRACT, dated this h day of OC)M J 2010 , by and between SPENCON CONSTRUCTION
INC., whose place of business is located at 3508 Ste. S Depot Rd, Hayward, CA 94545 ( "Contractor"), and the CITY
OF CUPERTINO, a Municipal Corporation of the State of California ( "City") acting under and by virtue of the authority
vested in the City by the laws of the State of California.
'WHEREAS, City, on the y 1f day of Oc.` o 6( , 2010 awarded to Contractor the following Project:
PROJECT NUMBER 2010 -05
RECONSTRUCTION OF CURBS, GUTTERS, AND SIDEWALKS
NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth, Contractor and City agree
as follows:
Article 1. Work
1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications,
Drawings, and all other terms and conditions of the Contract Documents.
Article 2. Agency and Notices to City
2.1 City has designated Glenn Goepfert, Assistant Public Works Director, to act as City's Authorized
Representative(s), who will represent City in performing City's duties and responsibilities and exercising City's
rights and authorities in Contract Documents. City may change the individual(s) acting as City's Authorized
Representative(s), or delegate one or more specific functions to one or more specific City's Representatives,
including without limitation engineering, architectural, inspection and general administrative functions, at any time
with notice and without liability to Contractor. Each City's Representative is the beneficiary of all Contractor
obligations to City, including without limitation, all releases and indemnities.
2.2 All notices or demands to City under the Contract Documents shall be to City's Authorized Representative at:
10300 Torre Avenue, Cupertino, California 95014 or to such other person(s) and address(es) as City shall
provide to Contractor.
Article 3. Contract Time and Liquidated Damages
3.1 Contract Time.
The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a
Notice to Proceed at any time within 30 Days after the Notice of Award. Csntractorwall not do any Work at
the Site prior to the date on which the Contract Time commences to run.
Contractor shall achieve Final Completion of the entire Work and be ready for Final Payment in accordance
with Section 00700 (General Provisions) no later than June 30, 2011 as provided in Document 00700 (General
Provisions)
3.2 Liquidated Damages.
City and Contractor recognize that time is of the essence of this Contract and that City will suffer financial Loss
in the form of contract administration expenses (such as project management and consultant expenses), if all or
City of Cupertino 00520 - 1 Contract
Reconstruction of Curbs, Gutters and Sidewallcs
Project No. 2010 -05
any part of the Work is not completed within the times specified above, plus any extensions thereof allowed in
accordance with the Contract Documents. Consistent with Document 00700 (General Provisions), Contractor
and City agree that because of the nature of the Project, it would be impractical or extremely difficult to fix the
amount of actual damages incurred by City because of a delay in completion of all or any part of the Work.
Accordingly, City and Contractor agree that as liquidated damages for delay Contractor shall pay City:
3.2.1 $75 for each Calendar Day that expires after the time specified herein for Contractor to achieve Final
Completion of the entire Work as specified above.
3.2.2 $75 per Calendar Day for failure to remove concrete from a work area within the same calendar week.
3.2.3 $75 per Calendar Day for failure to replace asphalt to finish grade within 30 calendar days.
Liquidated damages shall apply cumulatively and, except as provided below, shall be presumed to be the
damages suffered by City resulting from delay in completion of the Work.
3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss of
public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of
completion of the Work, damages resulting from defective Work, lost revenues or costs of substitute facilities,
or damages suffered by others who then seek to recover their damages from City (for example, delay claims of
other contractors, subcontractors, tenants, or other third - parties), and defense costs thereof.
Article 4. Contract Sum
4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents as
set forth in Contractor's Bid, attached hereto: See Exhibit "A" attached
Article 5. Contractor's Representations
In order to induce City to enter into this Contract, Contractor makes the following representations and warranties:
5.1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the
Contract Documents, Work, Site, locality, actual conditions, as -built conditions, and all local conditions, and
federal, state and local laws and regulations that in any manner may affect cost, progress, performance or
furnishing of Work or which relate to any aspect of the means, methods, techniques, sequences or procedures of
construction to be employed by Contractor and safety precautions and programs incident thereto.
5.2 Contractor has examined thoroughly and understood all reports of exploration and tests of subsurface
conditions, as -built drawings, drawings, products specifications or reports, available for Bidding purposes, of
physical conditions, including Underground Facilities, or which may appear in the Drawings. Contractor
accepts the determination set forth in these Documents and Document 00700 (General Provisions) of the limited
extent of the information contained in such materials upon which Contractor may be entitled to rely. Contractor
agrees that except for the information so identified, Contractor does no t and shall not rely on any other
information contained in such reports and drawings.
5.3 Contractor has conducted or obtained and has understood all such examinations, investigations, explorations,
tests, reports and studies (in addition to or to supplement those referred to in Section 5.2 of this Document
00520) that pertain to the subsurface conditions, as -built conditions, underground facilities, and all other
physical conditions at or contiguous to the Site or otherwise that may affect the cost, progress, performance or
furnishing of Work, as Contractor considers necessary for the performance or furnishing of Work at the Contract
Sum, within the Contract Time and in accordance with the other terms and conditions of the Contract
Documents, including specifically the provisions of Document 00700 (General Provisions); and no additional
examinations, investigations, explorations, tests, reports, studies or similar information or data are or will be
required by Contractor for such purposes.
City of Cupertino 00520 - 2 Contract
Reconstruction of Curbs, Gutters and Sidewalks
Project No. 2010 -05
5.4 Contractor has correlated its knowledge and the results of all such observations, examinations, investigations,
explorations, tests, reports and studies with the terms and conditions of the Contract Documents.
5.5 Contractor has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has
discovered in or among the Contract Documents and as-built drawings and actual conditions and the written
resolution thereof through Addenda issued by City is acceptable to Contractor.
5.6 Contractor is duly organized, existing and in good standing under applicable state law, and is duly qualified to
conduct business in the State of California.
5.7 Contractor has duly authorized the execution, delivery and performance of this Contract, the other Contract
Documents and the Work to be performed herein. The Contract Documents do not violate or create a default
under any instrument, contract, order or decree binding on Contractor.
5.8 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting
Code §4100 et seg. in document 00340 (Subcontractors List)
Article 6. Contract Documents
6.1 Contract Documents consist of the following docuinents, including all changes, addenda, and modifications
thereto:
Document 00002 Signature Page
Document 00003 Project Directory
Document 00012 Caltrans /City Cross - Reference Table
Document 00100 Advertisement For Bids
Document 00200 Instructions to Bidders
Document 00210 Indemnity and Release Agreement
Document 00400 Bid Form
Document 00411 Bond Accompanying B id
Document 00430 Subcontractors List
Document 00450 Statement of Qualifications
Document 00481 Non - Collusion Affidavit
Document 00482 Bidder Certifications
Document 00520 Contract
Document 00530 Insurance Forms
Document 00610 Construction Performance Bond
Document 00620 Construction Labor and Material Payment Bond
Document 00630 Guaranty
Document 00650 Agreement and Release of Any and All Claims
Document 00660 Substitution Request Form
Document 00700 General Conditions
Document 00800 Special Conditions
Document 00820 Traffic Control Requirements
Document 00821 Insurance
Document 00822 Apprenticeship Program _ <-
Technical Specifications
Addenda(s)
Drawings/Plans
6.2 There are no Contract Documents other than those listed in this Document 00520, Article 6. The Contract
Documents may only be amended, modified or supplemented as provided in Document 00700 (General
Provisions).
City of Cupertino 00520 - 3 Contract
Reconstruction of Curbs, Gutters and Sidewalks
Project No. 2010 -05
Article 7. Miscellaneous
7.1 Terms used in this Contract are defined in Document 00700 (General Provisions) and will have the meaning
indicated therein.
7.2 It is understood and agreed that in no instance are the persons signing this Contract for or on behalf of City or
acting as an employee, agent, or representative of City, liable on this Contract or any of the Contract
Documents, or upon any warranty of authority, or otherwise, and it is further understood and agreed that
liability of the City is limited and confined to such liability as authorized or imposed by the Contract
Documents or applicable law.
7.3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the
Contract Documents only in compliance with the Subcontractor Listing Law, California Public Contracting
Code §4100 et seq.
7.4 The Contract Sum includes all allowances (if any).
7.5 In entering into a public works contract or a subcontract to supply goods, services or materials pursuant to a
public works contract, Contractor or Subcontractor offers and agrees to assign to the awarding body all rights,
title and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. §15) or
under the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the Business
and Professions Code), arising from purchases of goods, services or materials pursuant to the public works
contract or the subcontract. This assignment shall be made and become effective at the time City tenders fmal
payment to Contractor, without further acknowledgment by the parties.
7.6 Copies of the general prevailing rates of per diem wages for each craft, classification, or type of worker needed
to execute the Contract, as determined by Director of the State of California Department of Industrial Relations,
are deemed included in the Contract Documents and on file at City's office, or may be obtained of the State of
California web site http:// www. dir .ca.gov/DLSR/PWD/Northern.html and shall be made available to any
interested party on request. Pursuant to Section 1861 of the Labor Code, Contractor represents that it is aware
of the provisions of Section 3700 of the Labor Code 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
Contractor shall comply with such provisions before commencing the performance of the Work of the Contract
Documents.
7.7 Should any part, term or provision of this Contract or any of the Contract Documents, or any document required
herein or therein to be executed or delivered, be declared invalid, void or unenforceable, all remaining parts,
terms and provisions shall remain in full force and effect and shall in no way be invalidated, impaired or
affected thereby. If the provisions of any law causing such invalidity, illegality or unenforceability may be
waived, they are hereby waived to the end that this Contract and the Contract Documents may be deemed valid
and binding contracts, enforceable in accordance with their terms to the greatest extent permitted by applicable
law. In the event any provision not otherwise included in the Contract Documents is required to be included by
any applicable law, that provision is deemed included herein by this reference(or, if such provision is required
to be included in any particular portion of the Contract Documents, that provision is deemed included in that
portion).
7.8 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa
Clara, State of California, and governed in all respects by California law (excluding choice of law rules). The
exclusive venue for all disputes or litigation hereunder shall be in Santa Clara County. Both parties hereby
waive their rights under California Code of Civil Procedure Section 394 to file a motion to transfer any action
or proceeding arising out of the Contract Documents to another venue. Contractor accepts the Claims
Procedure in Document 00700, Article 12, established under the California Government Code, Title 1, Division
3.6, Part 3, Chapter 5.
City of Cupertino 00520 - 4 Contract
Reconstruction of Curbs, Gutters and Sidewalks
Project No. 2010 -05
IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year first above written.
RECONSTRUCTION OF CURBS, GUTTERS AND SIDEWALKS 03 2 9 1 4
CITY: CONTRACTOR:
CITY OF CUPERTINO, a Municipal Corporation of the SPENCON CONSTRUCTION, INC.
State of California
By �
C 11--- 47 7(
[Signature]
Attest:
6 ,7v:a [Please print name here]
City Clerk: Kimberly ith
Approved as to form by City Attorney: Title: �� c:5 I ( D0 - 1
n ( [If Corporatio : Chairman , President, or Vice President]
y D ' U
kJ-
City Attorney: Carol Korade By:
[Signature]
PON,NA (_—
I hereby certify, under penalty of perjury, that Ralph A. [Please print name here]
Qualls, Jr., Director of Public Works of the City of Cupertino
was duly authorized to execute this document. Title: 5 e `(
[If Corporation: Secretary, Assistant Secretary,
Chief Financial Officer, or Assistant Treasurer]
Dated: /0 ' `T • / 0 C % % 0 A
State Contractor's License No. Classification
C� (.C. a s c : � i
Ralph A. Qualls, Jr., Director of Public of the City of Expiration Date
Cupertino, a Municipal Corporation of the to of California
Designated Representative: Taxpayer ID No. =.)S ) f ) 3 z cJ s
Name: Glenn Goepfert Name:
Title: Assistant Public Works Director Title: (), 3 iI U e■ t
Address: 10300 Torre Ave., Cupertino, CA 95014 Address: t', ()' g(J z_2_6
Phone: 408 - 777 -3254 Phone: Z . � '`(. 7,� I
c
Facsimile: 408 - 777 -3333 Facsimile: 2 1 (-t Z '
NOTARY ACKNOLEDGEMENT IS REQUIRED. IF A
AMOUNT: $589.940.00 CORPORATION, CORPORATE SEAL AND CORPORATE
ACCOUNT NUMBER: 270 - 9451 -9300 NOTARY ACKNOWLEDEMENT AND FEDERAL TAX ID ARE
REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY
FILE NO.: 50,347 NO. IS REQUIRED
END OF DOCUMENT
City of Cupertino 00520 - 5 Contract
Reconstruction of Curbs, Gutters and Sidewalks
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
State of California
County of C n
On .&p V. 210 before me, 1 l ri i 3i( a:c < �
Date Here Insert Name and Title of the Officer
personally appeared 5i ?n. V /Ctblr Sk ti arid D vUI OL SPOLA_ sin ILI
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) is /are subscribed to the
within instrument and acknowledged to me that
he /she /they executed the same in his /her/their authorized
t capacity(ies), and that by his/her /their signature(s) on the
i nstrument the person(s), or the entity upon Commission • 1715615 Y on behalf of P
• Notary Public - California which the person(s) acted, executed the instrument.
a \. p, / Contra Costa County -
M►rConxrr.6nraJar:2 •2011 I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand and official seal.
Signature
•= 4 I& �' 6 ' f��.
Place Notary Seal Above Signature of Notary P blic
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: CArl bl _( tw YYt( a'a 6052.0
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Individual ❑ Individual
❑ Corporate Officer — Title(s): ❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General RIGHTTHUMBPRINT ❑ Partner — ❑ Limited ❑ General RIGHTTHUMBPRINT
❑ Attorney in Fact OF SIGNER ❑ Attorney in Fact OF SIGNER
❑ Trustee Top of thumb here ❑Trustee Top of thumb here
❑ Guardian or Conservator ❑ Guardian or Conservator
❑ Other: ❑ Other:
Signer Is Representing: Signer Is Representing:
✓i� ✓,G \�!i` %,i \'!� \'!� \`_%i \!ice i\'! i\✓_, S\!<\'.. �i\' i4� !i \?!i�'!i \� \�i \ ✓i \ ✓ %S� ✓, i\ rte. \.��. rte. \�..�. \., r`, \_,. .' , . \- r�..�.. \�!.�.i�..�.� ✓.�..�.
'2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 •Chatsworth, CA 91313 -2402• www.NationalNotary.org Item #5907 Reorder: Call Toll -Free 1-800-876-6827
EST Spencon
ITEM DESCRIPTION QTY Unit Price Total
A.
ONE CU. YD. CONC. OR LESS (81 S.F. Sdwlk, OR 18 L.F. Std. Curb & Gutter)
1. Remove and Replace 4" Sidewalk (1 -19) 725 10.00 $7,250.00
2. Remove and Replace 5" Sidewalk (1 -19)
2.1 Driveway Detail - Detached Sidewalk (1 -20) 11 l 10.00 $1,110.00
2.2 Driveway Detail - Monolithic Sidewalk (1 -21) 222 10.00 $2,220.00
3. Remove and Replace Curb & Gutter (1 -16 Type A2 -6) 111 40.00 $4,440.00
4. Remove and Replace Rolled Curb & Gutter (1 -16 Type E) 55 40.00 $2,200.00
5. Doweling (1 -23) 44 4.00 $176.00
B V V LK VINE ( l) l.U. YU. 1...V1NL. 1V JIA CO) l,U. YL. k25 I-480 J.t'.4 SOWIK, 15 -1Vb
L.F. std. Curb & Gutter)
1. Remove and Replace 4" Sidewalk (1 -19) 3,386 10.00 $33,860.00
2. Remove and Replace 5" Sidewalk (1 -19)
2.1 Driveway Detail - Detached Sidewalk (1 -20) 399 10.00 $3,990.00
2.2 Driveway Detail - Monolithic Sidewalk (1 -21) 256 10.00 $2,560.00
3. Remove and Replace Curb & Gutter (1 -16 Type A2 -6) 456 40.00 $18,240.00
4. Remove and Replace Rolled Curb & Gutter (1 -16 Type E) 114 40.00 $4,560.00
5. Doweling (1 -23) 285 4.00 $1,140.00
C.
OVER SIX CU. YD. CONC.
1. Remove and Replace 4" Sidewalk (1 -19) 9,500 9.00 $85,500.00
2. Remove and Replace 5" Sidewalk (1 -19)
2.1 Driveway Detail - Detached Sidewalk (1 -20) 1,050 10.00 $10,500.00
2.2 Driveway Detail - Monolithic Sidewalk (1 -21) 1,050 10.00 $10,500.00
3. Remove and Replace Curb & Gutter (1 -16 Type A2 -6) 2,500 38.75 $96,875.00
4. Remove and Replace Rolled Curb & Gutter (1 -16, Type E) 1500 38.75 $58,125.00
5. Doweling (1 -23) 1,400 4.00 $5,600.00
D. ALL CATEGORIES AND LOCATIONS
1. Remove Park Strip Improvements 4,000 1.65 $6,600.00
2. Valley Gutter 1,600 16.50 $26,400.00
3. Depressed Curb Ramps (1 -24) 52 1997.00 $103,844.00
4. Upgrade Existing Curb Ramps 62 495.00 $30,690.00
5. Root Barriers 200 12.00 $2,400.00
6. Median Island Curb (1 -16, Type A1-8) 750 27.00 $20,250.00
7. Reconstruction of Catch Basin Tops (3 -2) 30 685.00 $20,550.00
8. Asphalt Replacement (6" Placement) 220 138.00 $30,360.00
$589,940.00
EXHIB'T A
From: Kelly La(nch At: FaxID: To: Spencon Construction, Inc Date: 9/13/2010 02:00 PM Page: 2 of 3
CERTIFICATE OF LIABILITY INSURANCE OPID i(L DA,E(MM/DD/YYW)
SPENC -4 09/13/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sierra Oak Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lic# 0C97528 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9700 Business Park Dr. Ste 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sacramento CA 95827
Phone:916- 364 -7380 Fax:916- 364 -7381 INSURERS AFFORDING COVERAGE NAIC
INSURED
INSURI =R0. Safeco Property s Casualty Iru
INSLIRER8: Indian Harbor Insurance Coupon 36940
Spencon Construction, Inc INsu8:Rc: Nationwide Mutual Ins Co 23787
P.O. Box 1220 INSURIRD: Topa Insurance Company 18031
Danville CA 94526
INSURERE: National Union Fire Ins Co 19445
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T1-E 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
WYK LTR NSW TYPE OF DATE MMIDD DAE POLICY MMIDD YNW�
LTR RD WSURANCE POLICY NUMBER LIMBS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
B X X COMMERCIAL GENERAL LIABILITY ZSG002831201 03/28/10 03/28/11 PREMISE (Ea 0 $ 100,000
CLAIMS MADE X I OCCUR MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $2,000,000
GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2 , 000 , 000
- 1 POLICY X ° I] LOC
AUTOMOBLE LIABILITY COMBINED SINGLE LIMIT
C ANY AUTO ACP7842296231 07/17/10 07/17/11 (Ea accident) $ 1,000,000
ALL OWNED AUTOS
BODILY INJURY $
X SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
E X 'OCCUR CLAIMSMADE BR4730 09/2:0/10 03/28/11 AGGREGATE $ 2,000,000
GL $
X DEDUCTIBLE Auto $
RETENTION $ $
WORKERS COMPENSATION I TORY tIMI S I I
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE 1 E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. OISEASE - EA EMPLOYEE $
If yes. describe under
SPECIAL PROVISIONS belay E.L. DISEASE - POLICY LIMIT $
OTHER
A Equipment Floater 25CC263698 -2 01/2.6/10 01/26/11 Rent /leas 250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS
City of Cupertino is named additionally insured per attached endorsement.
Job: Reconstruction, Curbs Gutters Sidewalks Job 2010 -05
CERTIFICATE HOLDER CANC:ELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYCUP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTIC:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Cupertino REPRESENTATIVES.
City Hall AUTHORIZED REPRESENTATIVE
10300 Torre Ave
/Cuper CA 95014 _ `.46-
ACORD 25 (2009/01) ®1988 -2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
•
POLICY NUMBER: ESG002831201 CG 20 10 11 85
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL CONTRACTORS (FORM LESSEES OR
( B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Cupertino
Job: Reconstruction, Curbs Gutters Sidewalks Job 2010 -05
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of your work" for that insured by or for you.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
From: Kelly Lanch At: FaxID: To: Spencon Construction, Inc Date: 9/13/2010 02:00 PM Page: 2 of 3
•
'159frijr CERTIFICATE OF LIABILITY INSURANCE OP ID KL DATE(MMIDDIYYYY)
SPENC -4 09/13/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Sierra Oak Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lic# 0C97528 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9700 Business Park Dr. Ste 105 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sacramento CA 95827
Phone:916- 364 -7380 Fax:916- 364 -7381 INSURERS AFFORDING COVERAGE NAIC#
INSURED
INSURER k Safer* Property $ Casualty Ins
INSURER B: Indian Harbor insurance Cospan 36940
Spencon Construction, Inc INSUR Nationwide Mutual Ins Co 23787
P.O. Box 1220 INSt1RFRO: Topa Insurance Company 18031
Danville CA 94526
( INSURE:RE: National Union Fire Ins Co 19445
COVERAGES
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 WI1-t RESPECT TO W IICH 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INbN AW L POLICY EH-EC 1IVE POLICY EXPItAI ION
LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYYY) DATE (MMIDDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
8 X X COMMERCIAL GENERAL LIABILITY ESG002831201 03/28/10 03/28/11 PREM E $.100,000
CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENII_ AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000
POLICY IT n LOC
AUTOMOBLE LIABILITY
COMBINED SINGLE LIMIT 11,000,000
C ANYALITO ACP7842296231 07/17/10 07/17/11 (Ea accident)
ALL OWNED AUTOS
BODILY INJURY
X SCHEDULED AUTOS (Per person)
X HIRED AUTOS
BODILY INJURY 1
X NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS / UMBRELLA LIABILRY EACH OCCURRENCE $ 2,000,000
E X OCCUR CLAIMS MADE BR4730 09/20/10 03/28/11 AGGREGATE $2,000,000
GL $
X DEDUCTIBLE Auto $
RETENTION $ $
WORKERS COMPENSATION (TORY L MITS I I
AND EMPLOYERS' LIABILITY Y f N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $
OTHER
A Equipment Floater 25CC263698 -2 01/26/10 01/26/11 Rent /leas 250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
City of Cupertino is named additionally insured per attached endorsement.
Job: Reconstruction, Curbs Gutters Sidewalks Job 2010 -05
CERTIFICATE HOLDER CANC:ELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITYCUP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FALURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Cupertino
City Hall REPRESENTATIVES.
10300 Torre Ave AUTHORIZED REPRESENTATIVE
(Cupertino CA 95014
ACORD 25 (2009/01) ®1988 -2009 ACORD CORPORATION. AN rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUMBER; ESG002831201 CG 2010 11 85
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS ( B)
This endorsement muddies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Cupertino
Job: Reconstruction, Curbs Gutters Sidewalks Job :2010 -05
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED (Section 1I) is amended to include as an insured the person or organization shown in the
Schedule, but only with respect to liability arising out of your work" for that insured by or for you .
CG 29 10 11 85 Copyright, Insurance Services Office, Inc., 1984
CERTIFICATE OF LIABILITY INSURANCE OP ID KL DATE(MM /DD/YYYY)
• SPENC -3 09/10/10
pRopucroi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brock Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Lic . 0728559 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9700 Business Park Dr . Ste 100 _ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Sacramento CA 95827
Phone: 916- 369 -8793 Fax: 888- 243 -0928 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Truck Insurance Exchange
INSURER B:
Spencon Construction, Inc. INSURER C:
P.O. Box 1220 INSURER D:
Danville CA 94526
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY NUMBER P LII`Y EFFECTIVE POLICY EXPIRATION
LTR INSRC TYPE OF INSURANCE DATE (MM/DD/YYYY) DATE (MMIDD /YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
UAMAGhIU HEN W.)
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
CLAIMS MADE OCCUR MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $
POLICY PRO- LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $
1 OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY _ x JTORY LIMITS ER
A ANY PROPRIETOR/PARTNER/EXECUTIVn A09294100 06/01/10 0 6 / 01 / 11 E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 1 - - - - --
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000 , 000
If yes, describe under
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1 , 000 , 000
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Job: Reconstruction of curbs, cutters and sidewalks PO No.2010 -05
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO
CITYCUP DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
City of Cupertino REPRESENTATIVES.
City Hall AUTHOR( PRESENTATIVE
10300 Torre Ave
(Cupertino CA 95014 _ Aar • / _ _
ACORD 25 (2009/01) ` air; ' - ►� •T '� reserved.
The ACORD name and logo are registered marks of ACORD
CITY OF
& Project No. 2010 -05
CUPERTINO INSURANCE AGREEMENT
A. Contractor is aware of the provisions of Section 3700 of the Labor Code, which requires
every employer to be insured against liability for worker's compensation or undertake self -
insurance in accordance with the provisions of that Code, and will comply with such provisions
before commencing the performance of the work of this Contract.
B. Contractor and all subcontractors will carry worker's compensation insurance for the
protection of its employees during the progress of the work. The insurer shall waive its rights of
subrogation against the City, the City's officers, agents and employees and shall issue an
endorsement to the policy evidencing same.
C. Contractor shall carry at all times, on all operations hereunder, commercial general liability
insurance, automobile liability insurance and builder's all risk insurance. All insurance coverage
shall be in amounts required by the City and shall be evidenced by the issuance of a certificate in a
form prescribed by the City and shall be underwritten by insurance companies satisfactory to the
City for all operations, sub - contract work, contractual obligations, product or completed operations,
all owned vehicles and non -owned vehicles. Said insurance coverage obtained by the Contractor,
excepting worker's compensation coverage, shall name the City, its engineer, and each of its
directors, officers, agents and employees, as determined by the City, as additional insureds on said
policies. Insurers must be licensed to do business in the State of California. The Insurers must also
have an "A" policyholder's rating and a financial rating of at least Class VII in accordance with the
current Best's Guide Rating or that is otherwise acceptable to the City.
D. Before Contractor performs any work at, or prepares or delivers materials to, the site of
construction, Contractor shall furnish certificates of insurance evidencing the foregoing insurance
coverages and such certificates shall provide the name and policy number of each carrier and policy
and that the insurance is in force and will not be canceled or modified without thirty (30) days
written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in
force until the work under this Contract is fully completed. The requirement for carrying the
foregoing insurance shall not derogate from the provisions for indemnification of the City by
Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor
diminishing the obligations of Contractor with respect to the foregoing, Contractor shall maintain in
full force and effect during the life of this Contract, the following insurance in amounts not less than
the amounts specified and having a Best's Guide Rating of A, Class VII or better or that is
otherwise acceptable to the City.
City of Cupertino
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00530 - 2
Project No. 201'0 -05
LIMITS
Worker's Compensation In accordance with the Worker's Compensation
& Employers' Liability Act of the State of California — Worker's comp
"statutory" per CA Law; Employers' Liability
$1,000,000 per occurrence.
General Liability - commercial general liability; Combined single limit of $2.0 million per
including provisions for contractual liability, occurrence; $4.0 million in the aggregate
personal injury, independent contractors and
products — completed operations hazard.
Automobile Liability - comprehensive covering Combined single limit of $1.0 million per
owned, non -owned and hired automobiles. occurrence.
By:
(Contractor's Name)
Dated: 20
City of Cupertino
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00530 - 3
Sep 091010:19a SPENCON 19259842583 p.4
Project No. 2010 -05
LIMITS
f
Worker's Compensation In accordance with the Worker's Compensation
& Employers' Liability Act of the State of California — Worker's comp
"statutory!' per CA Law; Employers' Liability
S1,000,000 per occurrence.
General Liability - commercial general liability; Combined single limit of $2.0 million per
including provisions for contractual liability, occurrence; $4.0 million in the aggregate
personal injury, .independent contractors and
products — completed operations hazard.
Automobile Liability - comprehensive covering Combined single limit of $1.0 million per
owned, non -owned and hired automobiles. oc QUIT= ce.
1
1 1
1-'ff.Chia.)/J . By: Of / j
A :' / 1
(Contractor's Name)
Dated: ( 4 ) '2 7 20 ( 0
City of Cuperiuo
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00550 - 3
Sop 0810 10:19a SPENCON 19259842583 p.5
L11 7 1.11.
. `' � = :f
V Project No. 2010 -05
CUPERTINO
CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO
This certifies to the City of Cupertino that the following described policies have been issued to the
insured named below and are in force at this time. _un I
Insured: S (/ i
ddress: ' • k 1 a
I escriptiozx of operations/locations /products insured (show contract name and /or number, if any):
at 01vad 41 1 I 1L. •. -H - _ I. A • •- l., 6 .
W I -
~ __
WORKER'S COMPENSATION * Statutory Min. --
* Employer's
i rU E,I. VALLQ__ Liability ,
(name of insurer) $ / � ' 6 . 7D $_ // / i 0V $ , , 6h . ,
Insurance Company's State License No.
Check Policy Type: Each Occurrence $
COMPREHENSIVE GENERAL
1:
Premises /Operatiazas General Aggregate $
(if appli.ca.blc)
p► j Owners & Contractors
Protective Aggregate $
Contractual for Specific
Contract Personal Injury
$
• Products Liability
I�.4 XCU Hazards
./ Broad Form P.D. Fire Damage (any one Fire) $ OCA / 6-6D
f YSeverability of Interest
Clause •
Pcrsornal Injury with Medical Expense $— .., /
Employee Exclusion Removed (any one person)
or Self- In;rured . /
COMMERCIAL GENERAL L LIABILITY Retention $ /r/ h
• l l_A ■[I r bc - ' . __I 1.1 2,Co -
(name of insurer)
Policy No, C AL Alto,,j)_ , • / Expiration Date 2E3 11
City of Cupertino
Reeoastruction of Curbs, Outters and Sidewalks Insurance Forms
00530 - 4
Sep 091010.19a SPENCON 19259842583 p. 6
Project No. 2010 -05
AUTOMOTIVE/VEHICLE LIABILITY BODILY INJURY PROPERTY DAMAGE
Commercial Form Each Person, Each Accident
Liability Coverage
$ $
Each Accident
?l CIL . 1(1 , (dItt4
(name of insurer)
$ _ or
Combined Single Limit $ / j 22JT). zia, c 2 7 2 D
Pol No. 1 v i . Expiration Date _717
. ... -• . „ „ _ , .�
BUILDER'S RISK "ALL RISK"
I This is to certify that the following policy has been issued by the below - stated company in
conformance with the requirements of the project documents and is in force at this time.
N/A
(Name of insurer)
Policy No. Expiration Date
Limits of Liability: Deductible: _
lW A copy of all Endorsements to the policy(ies) which in any way
ag• . ' • 'dal) limit the above - listed types of coverage are attached to this
1 Certificate of Insurance,
This Certificate of Insurance is not an insurance policy and does not amend, extend or alter the
coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or
condition of any contract or any other document with respect to which, this Certificate of Insurance
, may be issued or may pertain, the insurance afforded by the policies described herein is subject to •
I all the terms, exclusions and conditions of such policies. 1
IT IS HE' BY CER 1 1 that the above policy(ics) provide liability insurance as required by
the Ay _ it betty - . . ity : i the insured.
BY . /.._
JP
/.‘.��Z Dated: ! /( ) 20 '
Att • h Certificate of Insurance and Additional Insured Endorsement on company forms.
City of Cupertino
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00530 - 5
Sep 091010:19a SPENCON 19259842583 p.7
CITY OF
,&/,,,/," . Project No. 2010 -05
j
%' ADDITIONAL LNSURED ENDORSEMENT
I y,,.r\ and
CUPERTINO ENDORSEMENT OF PRLMARY INSURANCE
and
NOTICE OF POLICY
CANCELLATION E■DORSF,ME.NT
Project Title and Number: 'Pro k 1 • 20) 0— O L D
In consideration of the policy premium and notwithstanding any inconsistent statement in the policy
to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as
follows_
The City of Cupertino ( "City ") and its directors, officers, engineers, agents and employees,
and all public agencies from whom permits will be obtained and their directors, officers, engineers,'
agents and employees, and the State of California, and its officers, agents and employees, are
hereby declared to be additional insureds under the terms of this policy, but only with respect to the i
operations of the Contractor at or upon any of the premises of the City in connection with the
Contract with the City, or acts or omissions of the additional insureds in connection with, but
limited to its general supervision or inspection of said operations.
I The insurance afforded by this policy is primary insurance, and no additional insurance held
or owned by the designated additional ins`ured(s) shall be called upon to cover a loss under said
additional policy.
I
Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided,
canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior
written notice by certified mail, return receipt requested, has been given to the City of Cupertino
( "City"). Such notice shall be addressed to the City as indicated below.
POLICY INFORMATION
1. Insurance Company: d- F \0 1 -A j 1...1_..l1
2. Insurance Policy Number: ( 3 0 00 ZB r3 1 20
3. Effective Date of this Endorsernen,t: —9 / 20
• 4. Insured.: _ l� o n, , Ti �) Y / 1.., �
d.: V l . i
All notices herein provided to be given by the Insurance Company to the City in connection
j with this policy and these Endorsements, shall be mailed to or delivered to the City a 10300 Torre
Avenue C, .crtino, Califrria_95014.
I
I
I, ` i / S
(print/type name)
City of Cupertino
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00530 -
Sep 09 1'010:19a SPENCON 19259842583 P
—} Projcct No. 2010 -05
warrant that I have authority to bind the below stud , Insuran a ompany and by my signature '
hereon do so bind this Company. /
Signature of Authorized Representative: 4/ C_.-'' ?.
(Original signature required on all Endo .• eats furnished to the District)
1 Names of (
Agent/Agency: _,.J Q te-r ra_ a& 1 — -fa ri rers
Address dlileAS Y K dr Telephone:9 /66) — 75
d//I wit& ,L:t</ ?i > Faesjmile: /_L p7
•
•
City of Cupertino
Reconstruction of Curbs, Cutters and Sidcwalks Insurance Forms
00530 -7
Sep 09 1010.20a SPENCON 10259842583 p.9
CITY of Project No. 2010 -05
��f COMPREHENSIVE GENT RAL LIABILITY
COMMERCIAL GENERAL LIA.B LITY
•'':
ENDORSEMENT OF AGGREGATE LIMITS OF
CUPERTINO INSURANCE PER PROJECT
Project Title and Number: ?I'l' ll 2-C) ID — 0`�
�
In consideration of the policy premium and notwithstanding any inconsistent statement in the policy
to which this Endorsement is attached or any other Endorsement attached thereto, it is as follows:
This Endorsement modifies the insurance provided under the General Liability Coverage part of the
below- referenced policy of insurance. j
The general aggregate limit under LIMM1T5 OF INSURANCE applies separately to the project '
described as Pttr-Q-2:*----. POLICY INFORMATION
1. Insurance Company: t QA J 0 S . e0 .
, 2. Insurance Policy Nurnber: ( � 22 i 2 1
3. Effective Date of this Endorsement: " 20 /�
1
4. Insured: Q jZ te4 . C
1
5. Additional Insured: City of Cupertino, its directors. officers, agents and employees.
Ali notices herein provided to be given by the Insurance Company to the City in connection with
this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue;
Cupertino, Calimi 95014.
1
1, b V P J •, 41, (print/type name)
' warrant that I h • - authority to bind e below Iisted,hs . ce Co ..any and by my signature hereon do
so bind this Company.
Signature of Authorized Representative: —
(Original signature required on all Endors ents fitrnis ed to the District)
Names of �/
Agent/Agency: QY A , ' 1. . -t\ Title: L
Address. " / 1111 1, –, , . r Oct Telcphorle:Q /6 3(p cf — �'r c7
•
City of Cupertino
Reconstruction of Curbs, Gutters and Sidewalks Insurance Forms
00530 - 8
Sep 091010:20a SPENCON 19259842583 p.10
.., 1 yr
V , 1 I/ //, � �
Project No. 20 (0-05
WAIVER OF SUBROGATION ENDORSE
W,`'vt WORKER'S COMPENSATION INSURA_YC�E
CUPERTINO
Project Title and Number: V rO \ . 20 tO - cfr
' In consideration of the poiicy premium and notwithstanding any inconsistent statement in the policy
to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows:,
ft is agreed that with respect to such insurance as is corded by the policy, the Insurance Company
waives any right of subrogation against the City of Cupertino, and each of its directors, officers, agents,
consutta.nts and employees by reason of any payment made on account of injury, including death �
resulting therefrom, sustained by any employee of the insured, arising out of the performance of the
'above-referenced. Contract
POLICY INFORMaTZON
1 1. Insurance Company: rt. r one 4'5 11 c t j rC�, �X�- .Y n - _
1 2. Insurance Policy Number: � 4 / ()
i. Effective Date of —
thxs Endorsement: `]' —Z (�- _20 _
1 4. Insured: 1 A. le 4 /II 5 l 'lr∎ . ' )&. 1 a
All notices herein provided to be given by the Insurance Company to the City in connection with
this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue;
Cupertino, California 95014.
I, h
warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do
so bind this Company.
I S iRnatuTC 4f Autho ized RiTrnsenttetive:
(Original signature required on all Endorse ents flails ed to c District
Names o f ___,
1
. Agent/Agency: .. _1 I,LV .oLL Title: T
I Address: ) 0 D
,i1 1_ , �� A L►1 J t (i Facsimile: q / 06 87 g
City of Cupertino
Rcconstruction of Cubs, Gutters and Sidewalks t.usuraucc Forms
00530 - 9