05-056, Total Quality Maintenance
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AGREEMENT
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THIS AGREEMENT, made and entered into this~ day of June , 20 vS-, by and
between the CITY OF CUPERTINO, a municipal corporation of California, hereinafter referred
to as "CITY", and Total Quality Maintenance, a Contractor with offices at 895 Commercial
Street, Palo Alto, CA 94303, hereinafter referred to as "CONTRACTOR";
WITNESSETH:
WHEREAS, CITY desires to retain the CONTRACTOR for Contractual Janitorial
Services; and
WHEREAS, CITY desires to engage CONTRACTOR to provide these services by reason
of its qualifications and experience for performing such services, and CONTRACTOR has
offered to provide the required services on the terms and in the manner set forth herein;
NOW, THEREFORE, in consideration of their mutual covenants, the parties hereto agree
as follows:
1. DEFINITIONS.
(a) The word "City" as used in this agreement shall mean and include all the territory
lying within the municipal boundaries of the City of Cupertino, California, as presently existing,
plus all territory which may be added thereto during the term of this agreement by annexation or
otherwise.
(b) The term "City Manager" shall mean the duly appointed City Manager of the City of
Cupertino, California, or his designated representative.
2. THE AGREEMENT DOCUMENTS. The complete agreement consists of
this agreement and the following agreement documents incorporated herein by reference:
(a.) Notice to Contractors, Proposal, Time of Completion, Estimated Quantities,
Noncollusion Affidavit, Bidder Qualification Form, Subcontractors Form and Signature Form.
(b.) Standard Specifications, General Provisions, Special Provisions and Technical
Provisions.
(c.) Plans and Specifications for CONTRACTUAL JANITORIAL SERVICES,
PROJECT NO. 2005-05
(d.) Faithful Performance Bond and Fidelity Bond.
(e.) Insurance Agreement, Certificate of Insurance, Endorsement of Primary
Insurance, Additional Insured Endorsement, Endorsement of Aggregate Limits of Insurance per
Project, Waiver of Subrogation Endorsement Worker's Compensation Insurance and Notice of
Policy Cancellation Endorsement.
All of the above documents are incorporated into this agreement by reference so that any work
called for in one and not mentioned in another, is to be executed the same as if mentioned in all
of said documents. The documents comprising the complete agreement are sometimes
hereinafter referred to as the Agreement Documents. In case of conflict between the Plans and
the Specifications on the one hand, and this Agreement on the other, the Plans and Specifications
shall prevail.
3. PROJECT COORDINATION.
(a) City. The City Manager shall be representative of CITY for all purposes under this
agreement. The Public Works Superintendent hereby is designated as the PROJECT
MANAGER for the City Manager, and shall supervise the progress and execution of this
agreement.
(b) Contractor. CONTRACTOR shall assign a single PROJECT DIRECTOR to have
overall responsibility for the progress and execution of this agreement for CONTRACTOR.
Peter Vesanovic is hereby is designated as the PROJECT DIRECTOR for CONTRACTOR.
Should circumstances or conditions subsequent to the execution of this agreement require a
substitute PROJECT DIRECTOR for any reason, the PROJECT DIRECTOR designee shall be
subject to the prior written acceptance and approval of the PROJECT MANAGER.
4. DUTIES OF CONTRACTOR. Services to be furnished in accordance with
EXHffiIT "A" BID PROPOSAL and agreement specifications.
(a) Laws to be Observed. CONTRACTOR shall:
(1) Procure all permits and licenses, pay all charges and fees, and give all
notices which may be necessary and incident to the due and lawful prosecution of the services to
be performed by CONTRACTOR under this agreement;
(2) Keep itself fully informed of all existing and future federal, state, and local
laws, ordinances, regulations, orders, and decrees which may affect those engaged or employed
under this agreement, any materials used in CONTRACTOR's performance under this
agreement, or the conduct of the services under this agreement;
(3) At all times, observe and comply with, and cause all of its subcontractors
and employees, if any, to observe and comply with all of said laws, ordinances, regulations,
orders, and decrees mentioned above;
(4) Immediately report to the PROJECT MANAGER in writing any
discrepancy or inconsistency it discovers in said laws, ordinances, regulations, orders, and
decrees mentioned above in relation to any plans, drawings, specifications, or provisions of this
agreement.
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5. COMPENSATION. For the performance of the services described herein by
CONTRACTOR, CITY shall pay CONTRACTOR the sum of $ 25,242.00 (Twenty Five
Thousand, Two Hundred and Forty Two Dollars and No Cents) per month, less any deductions
for liquidated damages, plus any additional work for the month, payable upon submission by
CONTRACTOR of itemized billings in triplicate; provided, however, that the total sum payable
to CONTRACTOR shall not exceed $ 303,352.00 (Three Hundred and Three Thousand, Three
Hundred and Fifty Two Dollars and No Cents) per year unless modified by change order. The
total contract for 2 years shall not exceed $ 606,704.00 (Six Hundred and Six Thousand, Seven
Hundred and Four Dollars and No Cents) unless modified by change order.
6. LIQUIDATED DAMAGES. The CONTRACTOR shall diligently prosecute the
work to completion as scheduled in the Technical Provisions. The Contractor further
understands that he shall pay to the City of Cupertino One Hundred Fifty Dollars ($150.00) per
day, for each and every occurrence that a services item (task as specified in the Technical
Provisions) is not completed within the required times per facility. The Contractor further
understands that he shall pay to the City of Cupertino One Thousand Dollars ($1,000.00) per day,
for each and every occurrence were all the services at a facility were not completed within the
required times per facility. This does not relieve the Contractor from his responsibility of
completing the required services that were not completed as scheduled. Any service not
completed as scheduled shall be completed as soon as possible and at the Contractor's expense.
7. TERM. The term of this agreement shall be two (2) year from the start date of
the agreement. The City shall retain the option to extend the term of the agreement on a year-to-
year basis not exceeding two years from the expiration of the original term, for a possible total
of four year.
The start date of the agreement is July 1, 2005.
Any such renewal after the first two years shall be accomplished by the City providing a
written notice of renewal to the Contractor at least 30 days prior to expiration of the term. Any
such renewal shall contain the same provisions as the original agreement, 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
Consumer Price Index for all urban wage earners. There will he no CPI adjustment during the
first two-year term of the agreement.
8. TEMPORARY SUSPENSION. The City Manager shall have the authority to
suspend this agreement, wholly or in part, for such period as he deems necessary due to
unfavorable conditions or to the failure on the part of the CONTRACTOR to perform any
provision of this agreement.
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9. SUSPENSION: TERMINATION.
(a) Right to Suspend or Terminate. The CITY may suspend or terminate this
agreement for any reason by giving thirty (30) days' written notice. Upon receipt of such notice
CONTRACTOR shall immediately discontinue his performance under this agreement.
(b) Payment. Upon such suspension or termination, CONTRACTOR shall be
paid for all services actually rendered to CITY to the date of such suspension or termination;
provided, however, if this agreement is suspended or terminated for fault of CONTRACTOR,
CITY shall be obligated to compensate CONTRACTOR only for that portion of
CONTRACTOR's services which are of benefit to CITY.
10. INSPECTION. CONTRACTOR shall furnish CITY with every reasonable
opportunity for CITY to ascertain that the services of CONTRACTOR are being performed in
accordance with the requirements and intentions of this agreement. All work done and all
materials furnished, if any, shall be subject to the PROJECT MANAGER's inspection and
approval. The inspection of such work shall not relieve CONTRACTOR of any of its obligations
to fulfill its agreement as prescribed.
11. ASSIGNMENT: EMPLOYEES. Both parties shall give their personal attention
to the faithful performance of this agreement and shall not assign, transfer, convey, or otherwise
dispose of this agreement or any right, title, or interest in or to the same or any part thereof
without the prior written consent of the other party, and then only subject to such terms and
conditions as the other party may require. A consent to one assignment shall not be deemed to be
a consent to any subsequent assignment. Any assignment without such approval shall be void,
and, at the option of the other party, shall terminate this agreement and any license or privilege
granted herein. This agreement and any interest herein shall not be assignable by operation of
law without the prior written consent of the other party.
12. NOTICES. All notices hereunder shall be given in writing and mailed, postage
prepaid, by certified mail, addressed as follows:
TO CITY: Office of the City Clerk
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
TO CONTRACTOR:
Attention of the PROJECT
DIRECTOR at the address of
CONTRACTOR recited above.
13. INTEREST OF CONTRACTOR. CONTRACTOR covenants that it presently
has no interest, and shall not acquire any interest, direct or indirect, financial or otherwise, which
would conflict in any manner or degree with the performance of the services hereunder.
CONTRACTOR further covenants that, in the performance of this agreement, no subcontractor
or person having such an interest shall be employed. CONTRACTOR certifies that no one who
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has or will have any financial interest under this agreement is an officer or employee of CITY. It
is expressly agreed that, in the performance of the services hereunder, CONTRACTOR shall at
all times be deemed an independent contractor and not an agent or employee of CITY.
14. INDEMNITY. CONTRACTOR hereby agrees to indemnify, hold harmless and
assume the defense of , in any actions at law or in equity, the CITY, its officers, employees,
agents, and elective and appointive boards from:
(a) Any and all claims and demands which may be made CITY, its officers, agents, or
employees by reason of any injury to or death of any person or damage suffered or sustained by
any person or corporation caused by, or alleged to have been caused by, any act or omission,
negligent or otherwise, of CONTRACTOR or any subcontractor under this agreement or of
CONTRACTOR's or any subcontractor's employees or agents;
(b) Any and all damage to or destruction of the property of CITY, its officers, agents,
or employees occupied or used by or in the care, custody, or control of CONTRACTOR, or in
proximity to the site of CONTRACTOR's work, caused by any act or omission, negligent or
otherwise, of CONTRACTOR, or any subcontractor under this agreement or of
CONTRACTOR's or any subcontractor's employees or agents;
(c) Any and all claims and demands which may be made against CITY, its officers,
agents, or employees by reason of any injury to or death of any person or damage suffered or
sustained by any employee or agent of CONTRACTOR or any subcontractor under this
agreement, however caused, excepting however, any such claims and demands which are the
result of the sole negligence or willful misconduct of CITY, its officers, agents, or employees;
(d) Any and all claims and demands which may be made against CITY, its officers,
agents, or employees by reason of any infringement or alleged infringement of any patent rights
or claims caused or alleged to have been caused by the use of any apparatus, appliance, or
materials furnished by CONTRACTOR or any subcontractor under this agreement; and
(e) Any and all penalties imposed or damages sought on account of the violation of
any law or regulation or of any term or condition of any permit.
CONTRACTOR, at its own cost, expense, and risk, shall defend any and all suits,
actions, or other legal proceedings that may be brought or instituted by third persons against
CITY, its officers, agents, or employees, arising from their work, on any of the above claims or
demands of such third persons, or to enforce any of the above penalties, and pay and satisfy any
judgment or decree that may be rendered against CITY, its officers, agents, or employees in any
such suit, action, or other legal proceedings.
15. WORKERS' COMPENSATION. CONTRACTOR certifies that it is aware of the
provisions of the Labor Code of the State of California which require every employer to be
insured against liability for workers' compensation or to undertake self-insurance in accordance
with the provisions of that Labor Code, and it certifies that it will comply with such provisions
before commencing the performance of the work of this agreement.
5
16. INSURANCE. CONTRACTOR, at its sole cost and expense, shall obtain and
maintain in full force and effect throughout the entire term of this agreement, the insurance
coverage of at least an "A", Class VII rating as determined in accordance with the insurance
industry standard, insuring not only CONTRACTOR, but also (with the exception of workers'
compensation and employer's liability insurance), CITY, its officers, agents, and employees, and
each of them with respect to activities and services performed by CONTRACTOR for or on
behalf of CITY under the provisions of this agreement.
Certificates of such insurance, on the forms provided by CITY, shall be filed with CITY
concurrently with the execution of this agreement or, with CITY's approval, within ten (10) days
thereafter. Said certificates shall be subject to the approval of the City Attorney and shall contain
an endorsement stating that said insurance is primary coverage, and will not be canceled or
altered by the insurer except after filing with the City Clerk thirty (30) days' written notice of
such cancellation or alteration, and that the City of Cupertino is named as an additional insured.
Current certificates of such insurance shall be kept on file at all times during the term of this
agreement with the City Clerk.
17. AGREEMENT SECURITY. The CONTRACTOR shall furnish a surety bond in
an amount equal to four months of the agreement price as security for the faithful performance of
this Contract. The CONTRACTOR shall also furnish a $5,000.00 fidelity surety bond on each
and every employee performing work on the City owned property as security for the Fidelity of
the employee.
18. AGREEMENT BINDING. The terms, covenants, and conditions of this
agreement shall apply to, and shall bind the heirs, successors, executors, administrators, assigns,
and subcontractors of both parties.
19. WAIVERS. The waiver by either party of any breach or violation of any term, covenant,
or condition of this agreement or any provision, ordinance, or law shall not be deemed to be a
waiver of any other term, covenant, condition, ordinance, or law or of any subsequent breach or
violation of the same or of any other term, covenant, condition, ordinance, or law.
The subsequent acceptance by either party of any fee or other money which may become
due hereunder shall not be deemed to be a waiver of any preceding breach or violation by the
other party of any term, covenant, or condition of this agreement or of any applicable law or
ordinance.
20. COSTS AND ATTORNEYS' FEES. The prevailing party in any action brought
to enforce the terms of this agreement or arising out of this agreement may recover its reasonable
costs and attorneys' fees expended in connection with such an action from the other party.
21. NONDISCRIMINATION. No discrimination shall be made in the employment of
persons under this agreement because of the race, color, national origin, ancestry, religion, or sex
of such person. If the value of this agreement is, or may be, Five Thousand Dollars ($5,000) or
6
more, CONTRACTOR agrees to meet all requirements of the Cupertino Municipal Code
pertaining to nondiscrimination in employment and to submit the "Compliance Report-
Nondiscrimination Provisions of City of Cupertino Agreements."
If CONTRACTOR is found in violation of the nondiscrimination provisions of the State
of California Fair Employment Practices Act or similar provisions of federal law or executive
order in the performance of this agreement, it shall thereby be found in material breach of this
agreement. Thereupon, CITY shall have the power to cancel or suspend this agreement, in whole
or in part, or to deduct from the amount payable to CONTRACTOR the sum of Twenty-five
Dollars ($25) for each person for each calendar day during which said person was discriminated
against, as damages for said breach of agreement, or both. Only a finding of the State of
California Fair Employment Practices Commission or the equivalent federal agency or officer
shall constitute evidence of a violation of agreement under this paragraph.
If CONTRACTOR is found in violation of the nondiscrimination provisions of this
agreement or the applicable affirmative action guidelines pertaining to this agreement,
CONTRACTOR shall be found in material breach of this agreement. Thereupon, CITY shall
have the power to cancel or suspend this agreement, in whole or in part, or to deduct from the
amount payable to CONTRACTOR the sum of Two Hundred Fifty Dollars ($250) for each
calendar day during which CONTRACTOR is found to have been in such noncompliance as
damages for said breach of agreement, or both.
22. AGREEMENT CONTAINS ALL UNDERSTANDINGS. This document
represents the entire and integrated agreement between CITY and CONTRACTOR and
supersedes all prior negotiations, representations, or agreements, either written or oral. This
document may be amended only by written instrument, signed by both CITY and
CONTRACTOR. All provisions of this agreement are expressly made conditions. This
agreement shall be governed by the laws of the State of California.
7
P.O. No.
IN WITNESS WHEREOF, the parties have executed this Agreement, in duplicate, the day
and year first hereinabove written.
CITY OF CUPERTINO:
BY:~ k,z U~tJ t/; 'r
By:]..j tJ~. :f..I.oS
David W. Knapp, City anager
Attest~~'dJ-
ity Clerk
Date:
,-(
City Clerk
,20Q)-
Notary acknowledgment is required. If a
corporation, corporate seal and corporate
notary acknowledgment and Federal Tax
J.D. are required. Ifnot a corporation, a
Social Security No. is required.
Social Security #
Federal Tax J.D. #
Contractor's License No. rJ A
Project Name &Number: CONTRACTURAL JANITORIAL SERVICES, Project No. 2005-05
Contractor Name & Address: Total Quality Maintenance
895 Commercial Street
Palo Alto, CA 94303
Agreement Amount: $ 303,352.00 per year, $606,704.00 for two year term
Account Numbers:
See attached sheed
File No.: 50,339
8
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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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 ~ 0/1 A_ "A ~
Title or Type of Document: ~
Document Date: h//3 jo~
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Signer(s) Other Than Named Above:
~ proved to me on the basis of satisfactory evidence
to be the personMwhose name(s1 is/~ subscribed
to the within instrument and acknowledged to me that
he/sAel#tey executed the same in his/hefftheir
authorized capacity~, and that by his/hef/tl,eir
signatur~ on the instrument the person(s), or the
entity Lipon behalf of which the personj81' acted,
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WITNESS my hand and official seal.
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Sigrfure of Notary Public
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o Attorney in Fact
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Signer's Name:
o Individual
o Corporate Officer - Title(s):
o Partner - 0 Limited 0 General
o Attorney in Fact
o Trustee
o Guardian or Conservator
o Other:
RIGHT THUMBPRINT
OF SIGNER
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Signer Is Representing:
@2004 National Notary Association' 9350 De Soto Ave., P.O. Box 2402 . Chatsworth, CA 91313.2402
Item No. 5907
Reorder: Call Toli-Free 1-800-876-6827
Account Numbers:
1 Bus Stops - 110-8407-7014 $ 1,515.00 per month
2 City Hall Building - 110-8501-7014 $ 2,008.00 per month
3 Community Hall Building - 110-8512-7014 $ 1,151.00 per month
4 Creekside Park Building - 110-8511-7014 $ 325.00 per month
5 Library Building - 110-8502-7014 $ 4,755.00 pre month
6 McClellan Ranch Building & Museum - 110-8506-7014 $ 260.00 per month
7 Monta Vista Recreation & Pre School Buildings -110-8507-7014 $1,134.00 per month
8 Park Restrooms - 110-8303-7014 - $ 805.20; 110-8302-7014- $ 4,026.00 per month
$402.60; 110-8315-7014 - $402.60; 110-8314-7014 - $2,415.60
9 Portal Park Building - 110-8509-7014 $ 335.00 per month
10 Quinlan Community Center Building -110-8504-7014 $ 3,470.00 per month
11 Senior Center Building - 110-8505-7014 $ 2,165.00 per month
12 Service Center Building - 110-8503-7014 $ 1,020.00 per month
13 Sports Center Building- 570-8510-7014 $ 2,743.00 per month
14 Wilson Park Building - 110-8508-7014 $ 335.00 per month
15 Call Back For Unscheduled or Emergency Cleaning $ 18.50 per hour
16 Unscheduled Carpet Cleaning $ 0.08 per S.F.
9
EXHIBIT A
BID PROPOSAL
CONTRACTRUAL JANITORIAL SERVICES
PROJECT 2005-05
TO: THE DIRECTOR OF PUBLIC WORKS, CITY OF CUPERTINO, STATE OF CALIFORNIA
Dear Sir:
In compliance with the plans and specifications furnished for the work of the CONTRACTRUAL
JANITORIAL SERVICES PROJECT in the City of Cupertino, PROJECT NO. 2005-05, the
undersigned, hereby declare that I have read the proposal requirement, visited the sites, and
examined the specifications. I, the undersigned, hereby propose to do all work required to
complete the work in accordance with the specifications for the prices set forth in the following
schedule. I further understand that said prices include all costs including, but not limited to,
local, state and federal taxes, and transportation costs.
I, the undersigned, also understand that the quantities shown below are estimates only, being
given as a basis for comparison of bids. The City of Cupertino does not state that the actual
amount of work will correspond but reserves the right to increase or decrease the amount of any
class or portion of the work or to omit items or portions of work deemed unnecessary by the
Engineer.
The City of Cupertino reserves the right to unilaterally determine and award the contract to any
qualified bidder based on the most advantageous proposal, to reject any or all bids, or to waive
any irregularities in the procedures.
The work to be done consists of furnishing all labor, methods of process, tools, machinery and
material required to complete the CONTRACTURAL JANITORIAL SERVICES, PROJECT
NO. 2005-05 as described in the Special Provisions and Technical Provisions.
I, the undersigned, shall diligently prosecute the work to completion as scheduled per facility and
as specified in the Technical Provisions. I further understand that I shall pay to the City of
Cupertino liquidated damages as spelled out in the Special Provisions.
In the event of discrepancies between the written unit price and the numerical unit price, the
written price shall govern.
Bid Proposal Page I of9
EXHIBIT A
Bid Est.Qty. Item
Item Unit
12 Months Bus Stops
Per Mo.
2 12 Months City Hall Building
Per Mo.
3 12 Months Community Hall Building
Per Mo,
4 12 Months Creekside Park Building
Per Mo.
S 12 Months Library Building
Per Mo.
6 12 Months McClellan Ranch Building &
Museum
Unit
Price
Total
$ (, ~/S-, 00
/Mo.
$11: /1'0, 00
1
$
ZJ)fJl5' 19 0 /Mo. $ 'Zit at:; ~ 0 0
.
$ 1(/5'/ r t)iJ
/Mo. $ /~ ('12,0 D
$
3Z~~oo /Mo. $ ~900.0D
$ '-I; HJ-' 0 D /Mo. $ 5'~DtJD_ 00
$
2&O.oD /Mo. $ 3{/20100
Per Mo.
7
12 Months
Monta Vista Recreation & Pre School
Buildings
$ 1;/30/,00
/Mo. $ / ~ !va 'if, 00
Per Mo.
8 12 Months Park Restrooms $ t 02 G,.. 00 /Mo. $ '-I~ 3/2,.., 00
.
Per Mo.
9 12 Months Portal Park Building $ 3"3.C DO /Mo, $ 'f/OZ,O,c/O
Per Mo.
10 12 Months Quinlan Community Center Building $ 3/ '--I"'HJ. DO/Mo. $%(0'/0.00
.
Per Mo.
Bid Proposal Page 2 of9
EXHIBIT A
II 12 Months Senior Center Building $ 2/~J.oo /Mo. $ ?5',9Jt2tJD
(
Per Mo.
12 12 Months Service Center Building $ /;020,00 /Mo. $ /~Zr()rOO
,
,
Per Mo.
13 12 Months Sports Center Building $ ~ 1'1"3,00 /Mo. $ ?:z;0h, DO
I
Per Mo.
14 12 Months Wilson Park Building $ g~..r; 0 0 /Mo. $ I./;OZO f) () CJ'f'
Per Mo. tfLfLf,OD
15 24 Hours Call Back For Unscheduled or $ I fS" 0 /Hr. $ f~,oo
Emergency Cleaning
Per Hr. If, 00
16 50 S.F. Unscheduled Carpet Cleaning ,Of( IS.F. $ .- CA1t
$
Per S.F.
TOTAL BID
$ 302.9of,OD
I
C/r1~ 303352,Ol
./
~evl sed TO~(
Bid Proposal Page 3 of9
EXHIBIT A
I, the undersigned, agree that if this proposal is accepted, I will enter into a contract with the City
of Cupertino to provide all necessary machinery, tools, apparatus, and other means of
construction and to do all the work specified in the contract in the manner and time specified.
I, the undersigned, declare that this bid is made without connection with any person, firm, or
corporation making a bid for the same work, and is in all respects fair, and without collusion or
fraud.
I, the undersigned, recognize that the Director of Public Works of the City of Cupertino will
reserve the right to establish the priority of one job over another and each starting date where
conflict of construction schedules occur.
Attached hereto is the required certified check or bid bond in the amount of $ -:3'0 ,7.fo, as
(
required by law and the Notice to Bidders. (10% of bid amount)
Bid Proposal Page 4 of 9
EXHIBIT A
NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY
BIDDER AND SUBMITTED WITH BID
I, the undersigned, being first duly sworn, depose and say that I am
f{>>iUMorJS /JqrJa~ of -Io/ttP ~Iz M/NI.-Jl/4f,k-e-
(Business Title) (Business Na e)
the party making the foregoing bid, that the bid is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, asspciation, organization, or corporation, The bid is
genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited
any other bidder to put in a false or sham bid, and has not directly or indirectly colluded,
conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that
anyone shall refrain from bidding. The bidder has not in any manner, directly or indirectly,
sought by agreement, communication, or conference with anyone to fix the bid price of the
bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of
that of any other bidder, or to secure any advantage against the public body awarding the contract
of anyone interested in the proposed contract. All statements contained in the bid are true and,
further, the bidder has not, directly or indirectly, submitted the bid price or any breakdown
thereof, or contents thereof, or divulged information or data relative thereto, or paid, and will not
pay, any fee to any corporation, partnership, company, association, organization, bid depository,
or to any member or agent thereof to effectuate a collusive or sham bid.
Bid Proposal Page 5 of 9
EXHIBIT A
BIDDER QUALIFICATION FORM
In further compliance with the specifications furnished, I, the undersigned, submit the following
statements as to my experience and qualifications to perform this work as a part of this proposal.
We have been in business under the present name for
q
years.
Our experience in work comparable with that required by the proposal contract is ~
years operating under the following different name(s).
~Jjk~~^-\~k0~~J'(/_ 31 'lJedf/j. ~J!jrJ.p~;,/~!;) ~~
flt~- ~ ~ .~~:d~ :;:::kN4N~ .
__ ~ __-- ---L_ l_~I~6l .vt- Ac/'1J2 .~
My California Contractor's License Number is AJ f}
The classification of my Contractor's License is AlA-
The expiration date for my Contractor's License is j\J k
*******~**********************************************************************
*
(This Section for City use only)
*
The above information has been verified by
on
*
Contractors State License Board (800) 321-2752 or (408) 277-1244.
******************************************************************************
Where federal funds are involved, no bid submitted shall be invalidated by the failure of the
bidder to be licensed in accordance with the laws of the State of California, however, at the time
the contract is awarded the contractor shall be properly licensed.
Bid Proposal Page 60f9
BIDDER HISTORY OF WORK
EXHIBIT A
The following is an example of work similar in character to that required in the proposed contract
which our organization or personnel in our organization has completed within the past three (3)
years.
For Whom Contact
Performed Phone No. Amount
Year Location Type of Work
{ 1ft -(1t/lltUtJ ) 5AF t.AAS
./
(;;) QfJ~ r2Pa dLf2-
diltJr!vw &(2111 {l.R<J
leS-o 84'14"6/0/ /I L(0~/OOo/Y-f14(L
(/99 - &;f2IILNI. ) (lo/tpLttJ- -r f[hifr1~s
't2aui (' ()-j, ~ ,-/0 r =rfp <{ LI 'f 0 S-
fin' - t1U/LA.PI1.+J JfalJ!otlttC Aif.kj~ od/J;Jv(2J fed/! ~
~p ~r2A+c we -=rZ~2jn .f!&iL0W)VfJML
JtJ tJrkrtA-) SealJ/Cv
-it. L(uO; ooc('(-p/t1'L
Bid Proposal Page 7 of 9
SUBCONTRACTOR'S FORM
EXHIBIT A
The subcontractor(s), as defined in the General Provisions and in Section 7026 of the California
Business and Professions Code, that I propose to hire to perform any of the work for this project
in an amount in excess of one-half of one percent (0.5%) of the total bid are listed below. Only
those listed below shall perform work on this project and each of them has been provided with a
full and complete set of plans and specifications for this project by the bidder.
NIl}
1. Name
Contractor's License No.
Address & phone no.
Work to be Performed
2. Name
Address & phone no.
Work to be performed
3. Name
Address & phone no.
Work to be performed
4. Name
Address & phone no.
Work to be performed
5. Name
Address & phone no.
Work to be performed
6. Name
Address & phone no.
Work to be performed
Contractor's License No.
Contractor's License No.
Contractor's License No.
Contractor's License No.
Contractor's License No.
BIDDER'S SIGNATURE FORM
Bid Proposal Page 8 of 9
EXHIBIT A
IF YOU ARE AN INDIVIDUAL, SO STATE. IF YOU ARE A COMPANY OR A CO-
PARTNERSHIP, STATE THE COMPANY NAME AND LIST THE NAMES OF ALL
INDIVIDUAL CO-PARTNERS COMPOSING THE COMPANY. IF YOU ARE A
CORPORATION, STATE THE LEGAL NAME OF THE CORPORATION AND THE NAMES
OF THE PRESIDENT, SECRETARY-TREASURER, AND MANAGER. THE CORPORATE
SEAL MUST BE AFFIXED TO THIS FORM. ENTER THE NAME OF YOUR BUSINESS
ON THE LINE OPPOSITE THE APPROPRIATE BUSINESS TYPE.
TYPE OF Cltn . ~ NAME OF /. Q tit
BUSINESS htt'J&d Ol1f1/r~ BUSINESS:Jelt.~ )1lJ;~ . 4nJWt-e
CORPORATION: fofJi Qniufy ;)tl/~f'4t/A-;lJt!e,. .
nklL flM/'JOll/ C?t1J/J ,dllv1-
pe Jt~I1(tJo-I{C- S;ee(/Q~ ~~R.
&tU~ .7l)f?)-(~ MaNQCj-ee
GO P,'\RTNERSIIIP:
ll> ill IV ID U i '\:L:
~OINT VENTURE:
OTHER:
Name and Signature of Bidder:
(Describe)
3a,e.t t t.t- rue.Jet
~#'(~~~
5/2/0~-
Address (mailing & location): -rd-aJ tjJJa/Ik" )/I1/rVk~A-:J{'e.
1 I
9r (Po/1l/l1ei2(J/cd ~+.
~jo GilD} (Vt~ Q1j3o"S
(~O) gLib - LfTtJO
fbfl~ f II b - LITtY!
-tqff) ;)-tflJ1~ b2
t
Date:
Telephone Number:
Fax Number:
E-Mail Address:
Acknowledgment of all addenda received is required by circling each addendum number.
(!) 0 3 4 5 6 7 8 9 10
Acknowledgment of attendance for at Pre-Bid Conference
(0 YES
NO
Bid Proposal Page 9 of9
1 Y
CUPEI\1INO
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.
Worker's Compensation
& Employers' Liability
LIMITS
In accordance with the Worker's Compensation
Act of the State of California - Worker's comp -
"statutory" per CA Law; Employers' Liability-
$1,000,000 per occurrence.
Insurance Agreement Page 1 of 2
~ i
PUBUC WORKS
, ; "",1 )~r;
'~ ~ r\;
ITY
CUPEI\TINO 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.
'ro-l~ I t)f,.,lC'/1 ~ rnt1,n!-r'1. 9 CC
BQ S {.:o/l1T'"1>>yc.ud S";r~",r-
'P41o Ailz, J CA 9'-1303
Description of operations/locations/products insured (show contract name and/or number, if any):
Insured:
Address:
WORKER'S COMPENSATION
e"t'~fl- AJtdltJJ?CoL/
(name of insurer)
· Statutory Min.
· Employer's
Liability
$111 $ 1 "'"
Insurance Company's State License No. N ( L I .1(. 1. 'll .3 1 2.
$
,1hl
Check Policy Type:
COMPREHENSIVE GENERAL
LIABILITY
[ ] Premises/Operations
[ ]
Each Occurrence
$
General Aggregate
(if applicable)
$
Owners & Contractors
Protective
[ ] Contractual for Specific
Contract
$
[ ] Products Liability
[ ] xeD Hazards
[ ] Broad Form P.D.
[ ] Severability of Interest
Clause
[ ] Personal fujury with Medical Expense'
Employee Exclusion Removed (anyone person)
or Self- fusured
COMMERCIAL GENERAL LIABILITY Retention
Aggregate
$
Personal Injury
Fire Damage (anyone fire) $
$
$
(name of insurer)
Policy No.
Expiration Date
Certificate of Insurance Agreement Page 1 of 2
AUTOMOTIVENEHICLE LIABILITY
Commercial Form
Liability Coverage
BODILY INJURY
Each Person
PROPERTY DAMAGE
Each Accident
$
$
Each Accident
M o..rc 'h \1 s 11
. (name of insurer)
$ or
Combined Single Limit $ ~ 0 C) 0; Q 00
Policy No. Di8 7A ~~~J.. 3~fjbj5 Expiration Date ~~()05_
'Y;:;1:initial)
A copy of all Endorsements to the policy(ies) which in any way
limit the above-listed types of coverage are attached to this
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
all the terms, exclusions and conditions of such policies.
IT IS HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by
the Agreement between the City and the insured.
By: ~OlZJY\1\ !'k-Ya> ~* Dated: -JUNe. 2~ 2005
Attach Certificate of Insurance and Additional Insured Endorsement on company forms.
Certificate of Insurance Agreement Page 2 of 2
POLICY NUMBER
CP0108326
COMMERCIAL GENERAL LIABILITY
CG20101001
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
Name of Person or Organization:
!he City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all
public agencies.
INSURANCE AFFORDED BY THIS POLICY FOR THE BENEFIT OF THE ABOVE NAMED
ADDITIONAL INSURED SHALL BE PRIMARY INSURANCE BUT ONLY AS RESPECTS TO
LIABILITY ARISING OUT OF THE NAMED INSURED'S OPERATIONS PERFORMED FOR
THE ADDITIONAL INSURED.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
A. Section II - Who Is An Insured 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 ongoing operations
performed for that insured.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is
added:
2. Exclusions
This insurance does not apply to "bodily injury" or "property damage" occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such
work, on the project (other than service, maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the site of the covered operations has been
completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to
its intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as a part of the same
project.
CG 20 10 1001
@ ISO Properties, Inc., 2000
CP0108326
COMMERCIAL GENERAL
LIABILITY
CG 20 371001
POLICY NUMBER:
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 Person or Organization:
The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies.
Location And Description of Completed Operations:
Contractual Janitorial Services, Project NO. 2005-05
Additional Premium: $0
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
Section II - Who Is An Insured 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" at the location designated and described in the
schedule of this endorsement performed for that insured and included in the "products-completed operations
hazard" .
CG 20 3710 01
@ ISO Properties, Inc., 2000
~CORD.~ CERTIFICA TE OF LIABILITY INSURANCE CSR KH I DATE (MMIDDIYYYY)
TOTAL 1 06/14/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Andreini & Company-San Mateo ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License 0208825 HOLDER. THIS CERTIFICA TE DOES NOT AMEND, EXTEND OR
220 West 20th Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Mateo CA 94403
Phone: 650-573-1111 Fax: 650-378-4361 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Star Insurance Company
--
INSURER B
Total Quality Maintenance Inc. INSURER C:
__u
895 Commercial Street INSURER 0
Palo Alto CA 94303
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 CONUITlONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER PD~~~ir.fMrD1r~E I POLlCY1IEXPIRA T~~N LIMITS
DATE MMIDDIYY
GENERAL LIABILITY EACH OCCURRENCE S 1000000
- UAMAGFT{J"RENTEU-- --
A X X COMMERCIAL GENERAL LIABILITY CP0108326 07/24/04 07/24/05 ....F'REMISES (Ea occurence) S 300000
I CLAIMS MADE ~ OCCUR MED EXP (Anyone person) S 5000
---~-
PERSONAL & ADV INJURY S 1000000
-
GENERAL AGGREGATE S 2000000
-
GEN'L AGGRE5flE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S 1000000
I: PRO- n Emp Ben. 1000000
POLICY X JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
'---- S
ANY AUTO (Ea accidenl)
'--
ALL OWNED AUTOS BODIL Y INJURY
- S
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODIL Y INJURY
- S
NON-OWNED AUTOS (Per aCCident)
- ---'-~---'~-- ~~~-----_.,._-----
PROPERTY DAMAGE S
(Per accldenl)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S
R ANY AUTO ~_.-
OTHER THAN EA ACC S
AUTO ONLY AGG S
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S
tJ OCCUR o CLAIMS MADE AGGREGATE S
S
~ DEDUCTIBLE S
RETENTION S $
WORKERS COMPENSATION AND I Tb'~yS ~I~WS I IUE~-
EMPLOYERS' LIABILITY EL EACH ACCIDENT
ANY PROPRIETOR/PARTNER/EXECUTIVE $
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $
g~E(:I~~s~~~v':~~~~S below EL DISEASE - POLICY LIMIT $
OTHER
A Crime CP0108326 07/24/04 07/24/05 Crime Cov 10000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Contractual Janitorial Services, Project NO. 2005-05 The City of
Cupertino ("City") and its directors, officers, engineers, agents, and
employees and all public agencies from who permits will be obtained and
their directors, officers, engineers, agents and employees are herby
declared to be Additional Insureds per the attached endorsements.
CERTIFICATE HOLDER
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICA TE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Cupertino IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
Office of the City Clerk
10300 Torre Avenue REPRESENTATIVES.
Cupertino CA 95014 AUTH~~
ACORD 25 (2001/08)
@ ACORD CORPORA TlON 1988
r-.
I
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
ACORD. CERTIFICATE OF LIABILITY INSURANCE OP 10 S~ DATE (MM/DDIYYYY)
TOTAL-4 06/15/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CAL Insurance & Associates Inc ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License #0241094 HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
2311 Taraval street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Francisco CA 94116-2253
Phone: 415-661-6500 Fax:415-661-2254 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A Ever., t ..t10na1 Insurance CO.
INSURER B
Total ~uality Maintenance INSURER C
Peter esanovic
895 Commercial street INSURER 0
Palo Alto CA 94303 -_.._-~
INSURFR F I
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TilE POliCY PERIOD INDICATED N"IWIIIISIANDING
ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATF MAY RF ISS,,f[) OR
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Al.L THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYYI DATE (MMlb~DNYiN LIMITS
GENERAL LIABILITY oACH OCCURRENCE $
- ='.nc_""
- COMMERCIAL GENERAL LIABILITY c'REMISES lEa occurence) $
=:J CLAIMS MADE D OCCUR MEJ EXP (Anyone person) $
-
~ERSONAL & ADV INJURY $
-
0ENERALAGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER "h~0DUC IS - COMPIOP AGG $
I n PRO- nLOC .____~_ ~m
POLICY JECT
~OMOBILE LIABILITY IMt51NElI SINI;.LE lIMIl $
ANY AUTO ;: l-_d dccldent)
-
ALL OWNED AUTOS UI,)[iI:'" 'r INJURY
- $
SCHEDULED AUTOS ;: !-Jar person}
-
HIRED AUTOS ~UUIL Y INJURY
- LF't:lr aCCident) $
NON-OWNED AUTOS
-
- I :'ROPERTY DAMAGE $
\p~~r <1cr.1(1I1nt)
GARAGE LIABILITY i\UTO ONL Y - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE AGGREGATE $
-
$
==1 ~EDUCTIBLE $
RETENTION $ ! $
WORKERS COMPENSATION AND X IT;Cy~i~~ I IUE~-
A EMPLOYERS' LIABILITY 3900033801-041 07/01/04 07/01/05 E _ EACH ACCIDENT $ 1000000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE $ 1000000
If yes. descnbe under "L DISEASE - POLICY LIMIT $ 1000000
SPECIAL PROVISIONS below
OTHER I
! I
I
I I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
*NOTE: 10-DAY NOTICE OF CANCELLATION MAY BE ISSUED FOR NON-PAYMENT OF
PREMIUM.
WORKERS COMP WAIVER OF SUBROGATION TO FOLLOW FOR THE CITY OF CUPERTINO, ITS
DIRECTORS, OFFICERS, AGENTS, CONSULTANTS AND EMPLOYEES.
CERTIFICATE HOLDER
CANCELLATION
CUPERTI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
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
CITY OF CUPERTINO IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
10300 TORRE AVENUE
CUPERTINO CA 95014-3202 REPRESENTATIVES.
A~ATlVi I .-
f~" yv-
ACORD 25 (2001/08)
@)ACORDCORPORATION 1988
10
CITY OF
CUPEIQ'INO
WAIVER OF SUBROGATION ENDORSEMENT
WORKER'S COMPENSATION INSURANCE
Project Title and Number: {! 0 () t (' a. c. +""4.\ ~A t1i k",({j Serv ,'c.e<: rr~ 'f' (f ~oos-oS"
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:
It is agreed that with respect to such insurance as is afforded by the policy, the Insurance
Company waives any right of subrogation against the City of Cupertino, and each of its directors,
officers, agents, consultants 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 INFORMATION
1. Insurance Company:
E tlfy-eJ'"f ;t/tt/-/,,),?cc../ Il1rl/r~, V1U.
2. Insurance Policy Number: J10003J'!O /
3. Effective Date of this Endorsement: t, / /1
2005
4. Insured:
to/a/ t)t/c~hi., t14/1ni~r1UY1l.c.
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.
<. Il ....
I, ~ I l \.l A (. I.. (0 F r ,y A l. L C J IV''' ()l (. L Ii 'f I "f .r N j , '..~ tpnnt/type name)
warrant that I have authority to bind the below listed Insurance Company and by my signature
hereon do so bind this Company.
Signature of Authorized Representativ,e: /~//~
(Original signature required on ~4 Endo,rsp~eh~~shed to the District)
,/>M/' ;V' .'
Names of ~t II *J7t.. {; f F E. Y.
Agent/Agency: L A L I. /'or { V II J\ 1\1 L v&. A J J r L TItle: C ,., "" "" I:: /' ( I " L
Acct.;",. ["(.C~i'I'o/(.
Address: 1. J I I T 1'\ It A V A L 5 T ~ E. f T Telephone: 'Ii)' ~ I,Sdo
SAN
f itA i'lL 1$ ('0, ( A q"t II (,
,
Facsimile: tllf' t..bl ~2,~'f
Subrogation Endorsement Page 1 of I
C'OMM'ERCIAL AUTOMOBILE ENROLLEE SUPPLEMENTAL OECLARA TIONS
-
-
Policy No./lnsurer: D187A00001-130860 - CaliforniaD
ITEM ONE:
Discover Property & Casually Ins Co
NAME/ADDRESS OF NAMED INSURED (LESSEE): (see Schedule of Covered Aulos) NAME/ADDRESS OF LESSOR:
TOTAL QUALITY MAINTENANCE Enterprise Rent-A-Car Company of San Francisco
895 COMMERCIAL STREET 3591 Pearl Ave
PALO ALTO CA 94303 San Jose, CA 95136
Coverage is in effect from 8/9/2004 to 8/9/2005 at 12:01 A.M., Group No: 23/L2
Standard time at the Insured's address stated above. Phone: (800) 325-8838
ITEM TWO. SCHEDULE OF COVERAGES AND COVERED AUTOS:
This Coverage Part provides only those coverages where a limit is shown or an applicable box is checked below. Each of these
coverages will apply only to leased "autos" shown as covered "autos." "Autos" are shown as covered "autos for a particular coverage
by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name
of the coverage.
COVERED LIMIT
COVERAGES AUTOS THE MOST WE WILL PAY FOR ANY ONE
ACCIDENT OR LOSS
Liability 10 $ 1,000,000 Combined Single Limit
Personal Injury Protection (P .I.P.) Separately Stated In Each P.I.P. Endorsement
(or eauivalent No-Fault coveraae) 11
Added Personal InJury Protection Separately Stated In Each P.I.P. Endorsement
(or Eauivalent Added No-Fault coveraae)
Property Protection Insurance Separately Stated In Each P.I.P, Endorsement
(Michiaan Only) 11
"Auto" Medical Payments 12 $ 5,000 per person (refer to Schedule of Covered Autos You Lease for
coveraae Der vehicle)
Uninsured Motorists 13 $ (refer to Schedule of Covered Autos You Lease for limits per unit)
Underinsured Motorists
(when not included in Uninsured 13 $ (refer to Schedule of Covered Autos You Lease for limits per unit)
Motorists coveraae)
(risk retained Actual Cash Value or Cost of Repair, Whichever is Less Minus $ (see Schedule
Physical Damage of Covered Autos You Lease) Deductible For Each Covered "Auto", But No
Comprehensive Coverage by Enterprise Deductible Applies to "Loss. Caused By Fire Or Lightning.
Fleet Services) See ITEM THREE for hired or borrowed "autos."
Physical Damage (risk retained Actual Cash Value or Cost of Repair, Whichever is Less Minus $ (see Schedule
Collision Coverage by Enterprise of Covered Autos You Lease) Deductible For Each Covered "Auto."
Fleet Services) See ITEM THREE for hired or borrowed "autos."
,-
FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART:
See "Listing of Forms and Endorsements Attached at Inception"
ITEM THREE. SCHEDULE OF COVERED AUTOS YOU LEASE: (see attached)
ITEM FOUR. SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGES AND PREMIUMS:
D Hired Auto Liability (if box Is checked, coverage is applicable as described under Coverage Symbol 14 on form CA 9954).
D Hired Auto Physical Damage (if box is checked, coverage is applicable up to $25,000 limit per vehicle subject to
. ($ Deductible Comprehensive and $ Deductible Collision.)
Producer Name & Code: Marsh USA Inc.
',';
10f2
COMMERCIAL AUTOMOBILE ENROLLEE SUPPLEMENTAL DECLARATIONS
ITEM FIVE. SCHEDULE OF NON.OWNERSHIP LIABILITY:
o (If box is checked, coverage is applicable as described under Coverage Symbol 15 on form CA 99 54.)
ITEM SIX. SCHEDULE OF OPTIONAL COVERAGE:
o DRIVE OTHER CAR - Specified Individuals/Per list on file with USF&G. (see attached Form CA9910).
DEATH LEASE CANCELLATION (refer to Schedule of Covered Autos You Lease) - coverage retained by Enterprise Fleet Services.
LOANER CAR (refer to Schedule of Covered Autos You Lease) - 30 day limit- coverage retained by Enterprise Fleet Services.
Listina of Forms and Endorsements Attached at Inception: _ UC 10090100, CAOO011001, CA99540797, CA99030797, IL0021 0702, CA99171001,
CA20541 001 , CA23561102, CA21540202, CA21550400, CA00381202, CA01430297, IL02700702
20f2
SCHEDULE OF COVERED AUTOS YOU LEASE
Named Insured (Lessee) and address: (see Endorsement No.1) Customer #:
TOTAL QUALITY MAINTENANCE I 130860
TOTAL QUALITY MAINTENANCE I 130860
TOTAL QUALITY MAINTENANCE I
Policy No. Insurer:
D187A00001-130860 - California Discover Property & Casualty Ins Co
895 COMMERCIAL STREET
PALO ALTO ,CA 94303
*Coverage retained by Enterprise Fleet Services
Policv Period: 81912004 to 81912005
Vehicle Chan~ es Schedule of Vehicles
Add DeletE Change Effective Unit' Year Make Model Series Serial No. State UMlUIIM .Comp .CoIl1slon Medical .Death .Loane Personal
Coverage Oed. Oed. Payments Lease Car InJury
Cancel. Protection
XG9173 1991 FORD AERO CARG 1FTCA14U8MZB53532 CA 1.000,000 NlC N/C Yes No No No
XG9176 1993 FORD AERO VAN 1FTDA14U3PZB39241 CA 1,000,000 500 500 Yes No Yes No
XG9174 1996 FORD AERO VAN 1FTDA14U3TZC02526 CA 1,000 000 NlC N/C Yes No No No
XM9435 2003 FORD E25C LWB 1 FTNS24L73HB80597 CA 1,000,000 500 500 Yes No Yes No
LM9488 2004 FORD RANG XL2W 1FTYR10U44PB59893 CA 1 000 000 500 500 Yes No Yes No
X 4/20/2005 WAC813 2005 FORD RANG XL2W 1FTYR10U85PA54436 CA 1,000 000 500 500 Yes No Yes No
XG9718 2001 FORD RANE XLT4 1FTZR15E81PA68806 CA 1000,000 500 500 Yes No Yes No
XG9175 1992 0000 VAN B250 2B7HB21YONK149981 CA 1,000,000 NlC NlC Yes No No No
X 4/1812005 XG9752 2001 TOYO SEQU 4LT4 5TDBT 48AX1 5033817 CA 1000,000 500 500 Yes No Yes No
NlC = Not Covered
Date issued 61612005
Page 1
Producer: Marsh USA Inc.
Bond No. 41027477
FMTHFULPERFORMANCEBOND
KNOW ALL MEN BY TIIESE PRESENT:
THAT WE, TOTAL QUALITY MAINTENANCE, INC as
Principal, (contractor' s name)
and PLATTE RIVER INSURANCE COMPANY as
Surety, (bonding company's name)
are held and firmly bOlUld unto the City of Cupertino, State of California, in the sum of
ONF. RmrnRF.ll ONE THOUSAND ONE HUNDRED SEVENTEEN AND 34/100 lawful
money of the United States, for the payment of which will and truly to be made, we bind oursc1vcs,)
our heirs, executors, successors and assigns, jointly and severally, fimlly by these presents,
THE CONDITION of the foregoing obligation is such that,
WHEREAS, the Principal has entered into a contract with the City dated
JULY 1 20~ with the obligee to do and perform the following work to-wit:
CONTRACTURAL JANITORIAL SERVICES, ~ROJECT NO. 20_Q.5:-05
NOW, THEREFORE, if the said principal shall well and truly perform the work contracted
to be performed lUlder said contract, then this obligation shall be void; otherwise to remain in full
force and effect.
IN WITNESS WHEREOF, this instnunent has been duly executed by Principal and Surety
this 17th day of JUNE , 2005 .
(To be signed by Principal and Surety, Notary acknowledgment required)
CONTRACTOR TOTAL OUALITY MAINTENANCE. INC
895 COMMERCIAL STREET .-.
PALO ALTO, CA 94303
Principal PETER VESANO
v'
PI.ATI'F. RIVER INSURANCE COMPANY
Surety
Street Address: 350 SANSOKE ST. STE 1000
City, State, Zip SAN FRANCISCO, CA 94104.
. By: ..O/A. LY~
CLARlC~
The above bond is accepted and approved this 17 th day of JUNE
,2005.
Faithful Performance Bond Page 1 of 1
PLATTE RIVER INSURANCE COMPANY
POWER OF ATTORNEY
4 1 0 2 7 4 -/ 7
KNOW ALL MEN BY THESE PRESENTS, That the PLATTE RIVER INSURANCE COMPANY, a corporation of the State of Nebraska, having its
principal offices in the City of Madison, Wisconsin, does make, constitute and appoint
______________________________________________________---------- CLARICE LEUNG OF SAN FRANCISCO, CA -----------------------------------------------------------------
its true and lawful Attomey(s)-in-fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed, any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in
amount the sum of
__________________________________ ALL WRITIEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED $1,000,000.00 mnnnmmmmm______m__
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board
of Directors of PLATTE RIVER INSURANCE COMPANY at a meeting duly called and held on the 8th day of January, 2002.
"RESOLVED, that the President, and Executive Vice-President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are
granted the power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings and
other writings obligatory in the nature thereof, one or more vice-presidc:lls, assistant secretaries and allorney(s)-lIl-fact, each appointee to have the
powers and duties usual to such offices to the business of the Corporation; the signature of such officers and seal of the Corporation may be affixed to
such power of attorney or to any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signatures
or facsimile seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking or other writing obligatory in
the nature thereof to which it is attached, Any such appointment may be revoked, for cause, or without cause, by any of said officers, at any time."
IN WITNESS WHEREOF, the PLATTE RIVER INSURANCE COMPANY has caused these presents to be signed by its officer undersigned and its
corporate seal to be hereto affixed duly attested by its Executive Vice President, this 7th day of July, 2004.
Attest:
PLATTE RIVER INSURANCE COMPANY
:J:::~,,:~
Executive Vice President
b~ :r /~
David F. Pauly
President and CEO
STATE OF WISCONSIN } s s '
COUNTY OF DANE . ..
On the 8th day of January, 2002 before me personally came David F. Pauly, to me known, who being by me duly sworn, did depose and say: 'that he
resides in the County of Dane, State of Wisconsin; that he is President and CEO of PLATTE RIVER INSURANCE COMPANY, the corporation
described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such
corporate seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.
<<~d ~
STATE OF WISCONSIN } S S .
COUNTY OF DANE . ..
CERTIFICATE
Kathleen A. Paulson
Notary Public, Dane Co., WI
My Commission Expires 10-15-2006
I, the undersigned, duly elected to the office stated below, now the incumbent in PLATTE RIVER INSURANCE COMPANY, a Nebraska Corporation,
authorized to make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has not been
revoked; and furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Madiscn, State of Wisconsin this
17th
day of
JUNE
,2
00')
~"~
Assistant Secretary
THIS DOCUMENT IS NOT VALID UNLESS PRINTED ON GREEN SHADED BACKGROUND WITH A RED SERIAL NUMBER IN THE UPPER
RIGHT HAND CORNER. IF YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY OF THIS DOCUMENT CALL 800-475-4450.
PR-OOl (7-04)
CAUFOfUlIA ALL-PUI1POSE ACKNOWLEDGMErH'
-~~2~:!Z;?;:;~~?:2~~~
k:;J_lMr
State or
CALIFORNIA
County of SAN FRANCXSCO
On
TIINE 17 t.- 2005
IMI,
before me, _Ma.9'l_~_~~_1J!g_'!.l?~n
H/''',H 1tIlI (o( ()(r~-, 1\
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personally appealed ~~!~rice _~eu~g
51 personally known to me- on
IWA<I'.II~ ~1\".t~,I~'1
.... ---................. ""-~,-.... .................----~../'\.. -. -"'- (
,18MARYLEE M. THOM'H-l ~
COIvW.. # 1377SJ.7
g _ - NOTARY PUBUC-CAUFORNlAg
~ SAN FRANCISCO COUNTY ....
<If:. IF COMM. EXP. OCT. 10.2006...
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subscribed to Ihe wilhiniAslrument and ac-
knowledged 10 me II lal he/she/lhey executed
the same in his/Iter/their Cluthorizect",
capacity(ies), and thaI by hi:oItlt'!lthoil
sigllalure(~;) 011 the inslrument tlw person(s),
or (he entily UpOll behalf (If which tile
person(s) 3elerl. PX(~cul~d Ihe in~;lrulllen1.
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Iraoou\enl reallachrnen< oIlhls lonn.
CAPACITY CLAIMED BY SIGN Ell
o INDMDVAl
o CORPORATE OFFICfR
OESCIUPTlON OF ATTACHED DOCUMENT
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o PARTNER(S)
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o ATTORNEY-IN-FACT
o TAUSTEE(Sf"
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o GENERAL
N\ IMlll 1\ III I' 6GES
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SIGNER IS I1EPRESElffiliG:
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86/28/2805 13:23
877-257-2166
HARTFORD sue
-1' .
PAGE
r..J~1 ...:.,..J
CrimeSHIELD Policy
for Mercantile Entities
~
x
Co C<:lde
CD Hartford Fire Insurance Company
Hartford. CT 06115
(}] Hartford Casualty Insurance Company
Hartford. CT 06115
o
C<:l C<:lde
[[] Hartford Insurance Company of Illinois
Naperville. II 60566
@] Hartford Insurance Company of the Midwest
Indianapolis. IN 46204
QJ Hartford Insurance Company of the Southeast
Maitland. Fl32751
The Company is Shown above by Co. Code u=J
POLICY NUMBER
57BDDDN0620
In retum for the payment of the premium, and subject to all the terms of this Policy, we agree with you to provide
the insurance stated in this Policy.
DECLARATIONS
ITEM
1. Named Insured: TOTAL QUALITY 11AINTENANCE, INC., "AS RESPECTS THE AGREEMENT FOR
CONTRACTUAL JANITOR!AL SERVICES, PROJECT NO. 2005-05"
2. Mailing Address: 895 COMMERCIAL STREET
PALO ALTO, CA 94303
from July 1, 2005 until cancelled
(12:01 A.M. Standard Time at Your Mailing Address)
~. Policy PerIod:
4. Coverages, Limits of Insurance and OQductiblQs:
Insuring Agreements, Limit of Insurance and Deductible Amounts shown below are subject to all of the terms
of this policy that apply.
5. Form Numbers of Endorsements Forming Part of This Policy When Issued:
CLAIM-03, F-4220-0, F-42S3-1, F-4262-0. F-4265-0, F-4336-0, F-4347-0,
F-SOll-O. END. 4S
6. Cancellation of Prior Insurance: By acceptance of this Policy you give us notice cancelling prior policies or
bonds numbered: the cancel1<ltlons to be effective at the
time this policy becomes effective.
This Policy has been signed by the Company's President and Secretary. but it shall not be binding unless It is
countersigned by its authorized representative.
~l)l kUc...
I\,.icl'l.lcl S. Wilder. S/,!cr~'dry
Insuring Agreements Forming Part of This Policy
1. Employee Theft
2. Depositors Forgery or Alteration
3. Theft. Disappearance and Destruction - Money. Sec/JritJ(JS 9f'ld Other Propp-fly
4. Robbery and Safe Burglary - Money and SCCl)rfties
5. Computer and Funds Transfer Fraud
Limit of
Insurance
$50,000
~O
$ 0
So
$0
Countersigned J:yy
Form F-4201-O
@ 1998. The Hartford
Deductible
Amount
$ 500
$ 0
$ 0
$ 0
$ 0
-f---1:;- ~
c...- ___-- -.,.;'.
Rlmano /I ~cr. Pruidcnl & COO
, Authorizod Re;JroSElntallve
Page 1 of 12
OS/20/2005 13:23
877-257-2155
HARTFORD sue
PAGE 03/23
Throughout this Polley the words "you~ and "your" refer to the named Insured in the Declarations. The words
"we". "us~. and .our" refer to the Company providing this insurance. Other words and phrases that appear in
quotation marks have a special meaning. Refer to Section V., Exclusions; Section VI., General Conditions;
and Section VII., Definitions. to determine where this Policy restricts coverage,
I. CONSIDERATION CLAUSE
In exchange for the payment of premium and subject to the Declarations, Insuring Agreements. Exclusions.
General Conditions, Definitions and terms of this Policy. we will pay for loss which you sustclin resultihg
directly from acts committed or events occurring at any time and discovered by you during the Policy Period
shown in the Declarations or during the period of time provided in General Condition l., EXTENDED
PERIOD TO DISCOVER LOSS.
11. INSURING AGREEMENTS
Coverage is provided under the following Insuring Agreements if either an amount is staLed in the Insuring
Agreement or for which there is a limit of Liability shawn in the Declarations
A. INSURING AGREEMENT 1. - EMPLOYEE THEFT
We will pay for loss of or damage to "money~. "securitie9~ and "other property" which results directly
from "theft" by an "employee". whether or not identifiable, while acting alone or in collusion with other
persons.
B. INSURING AGREEMENT 2. - DEPOSITORS FORGERY OR ALTERATION
1. We will pay for loss resulting directly from "forgery" or alteration of checks, drafts. promissory
notes, or similar written promises. orders or directions to pay a sum certain in "money" that are
a. made or drawn upon you: or
b. made or drawn upon one acting as your agent and drawn on your account
or that are purported to have been so made or drawn.
2. We will treat mechanically reproduced signatures the same as handwritten signatures.
3. If you are sued for refusing to pay any instrument in B.1. above, on the basis that It has been
forged or altered and you have our written consent to defend against that suit. we will pay for
any reasonable legal expenses that you incur and pay in suct! defense. Tt!e amount that we will
pay is in addition to the limit of Liability applicable to this Insuring Agreement. If a Deductible
Amount applies to this Insuring Agreement. we will also apply it to the amount of legal expenses
incurred in this Insuring Agreement.
4. You must indude with your proof of loss any instrument involved in that loss, or, if that is not
possible, an affidavit setting forth the amount and cause of loss and describing both sides of
said instrument..
5. This Insuring Agreement covers loss you sustain anywhere in the world: the Territory General
Condition does not apply.
C. INSURING AGREEMENT 3. ~ THEFT, DISAPPEARANCE AND DESTRUCTION -
MONEY, SECURITIES AND OTHER PROPERTY
1. INSIDE THE PREMISES
3. We will pay for loss of "money" and "securities" inside the "premises" or "banking
premises" resulting directly from "theft", disappearance or destruction.
b. W~ will pay for loss of or damage to "other property~
(1) inside the "premises" resulting directly from an actual or attempted "robbery" of a
"custodian"; or
(2) inside the "premises' in a safe or vault resulting directly from an actual or attempted
.safe burglary".
c. We will pay for loss from damage to the -premlses~ or its exterior resulting from an actual
or attempted
(1) "theW of "money. or "securities"; or
(2) "robbery" or "safe burglary" of .other property"
Form F..4~01-0 P3ge 2 of 12
@ 1998. The Hartford
06/2e/2005 13:23
877-257-2166
HARTFORD BUC
PAGE 04/23
if you are the owner of the "premises" or are liable for damage to it.
d. We will pay for loss of or damage to a locked safe, vault, cash register. or cash box or
cash drawer located inside the "premises" resulting directly from an actual or attempted
"theft" or unlawful entry into those containers.
2. OUTSIDE THE PREMISES
We will pay for
a. loss of "money. and "securities" outside the "premises" in the care and custody of a
"messenger" or an armored motor vehicle company resulting directly from "theft'.
disappearance or destruction; or
b. loss of or damage to "other property" outside the "premises" in the care and custody of a
"messenger" or an armored motor vehicle company resulting directly from an actual or
attempted "robbery".
D. INSURING AGREEMENT 4. - ROBBERY AND SAFE BURGLARY - MONEY AND SECURITIES
1. INSIDE THE PREMISES
We will pay for loss of or damage to "money" and "securities"
a. resulting directly from an actual or attempted "robbery" of a "custodian" inside the
.premises"; or
b. resulting directly from an actual or an attempted "safe burglary" occurring inside the
'premises' or inside a "banking premises".
2. OUTSIDE THE PREMISES
We will pay for loss of or damage to "money. and "securities" outside the "premises" in the care
and custody of a "messenger" or an armored motor vehicle company resulting directly from an
actual or attempted "robbery",
E. INSURING AGREEMENT 5. - COMPUTER AND FUNDS TRANSFER FRAUD
We will pay for loss of and loss from damage to "money", "securities" and "other property" following
and directly related to the use of any computer to fraudulently cause a transfer of that property from
inside the "premises~ or "banking premises.
1. to a person (other than a "messenger") outside those "premises"; or
2. to a place outside those "premises".
And, we will pay for loss of "money. or "securities" through "funds transfer fraud" resulting directly from
"fraudulent transfer instructions" communicated to a "financial institution" and instructing such
institution to pay, deliver. or transfer "money" or "securities" from your "transfer account".
F. INSURING AGREEMENT 6. - MONEY ORDERS AND COUNTERFEIT CURRENCY
1. We will pay for loss resulting directly from your having in good faith, in exchange for
merchandise. "money" or services accepted
a. money orders issued by any post office, express company or bank in the United States of
America or Canada that are not paid upon presentation; and
b. "counterfeit" United States of America or Canadian Paper currency
that is acquired during the regular course of business. The Limit of Insurance under this insuring
agreement is $50,000. and there is no deductible applying to loss covered under this agreement.
2. You must notify the pOlice if you have reason to believe that you have accepted a .counterfeit"
money order or "counterfeit" paper currency.
Form F-4201-0 Page 3 of 12
~ 199B, The Hartford
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PAC;E 85/23
111. LIMIT OF INSURANCE
The most that we will pay for loss in anyone "occurrence" is the applicable Limit of Insurance shown in the
Declarations.
IV. DEDUCTIBLE
We will not pay for loss in anyone .occurrence" unless the amount of the loss exceeds the Deductible
Amount shown in tt1e Declarations, We will then pay the amount of loss In excess of the Deductible Amount,
up to the Limit of Insurance. In the event that more than one Deductible Amount could apply to the same
loss, only the highest Deductible Amount will be applied.
You must give us notice as soon as possible of any loss of the type Insured under the Policy if, in your best
estimation, such loss will, or will appear to exceed 25% of the current Deductible Amount for the Insuring
Agreement under which the loss has occurred.
v. EXCLUSIONS (Applying To All Insuring Agreements Unless Otherwise Spflcified)
This Policy Does Not Apply To And We Will Not Psy For:
A. Accounting or Arithmetical Errors or Omissions
Loss resulting from accounting or arithmetical errors or omissions.
B. Acts Committed By You
Loss resulting from "theft" or any other dishonest or criminal acts committed by you whether acting
alone or in collusion with others.
C. Acts of Employees, Managafs, Directors, TrusteQs or Representatives
Loss resulting from "theft" or any other dishonest or criminal act committed by any of your
"employees", managers, directors, trustees or representatives whether acting alone or in collusion wilh
other persons or while performing services for you or otherwise except when covered under Insuring
Agreement 1.
D. Employee Cancelled Under Prior Insur3nce
Loss cause by any "employee" of yours or predecessor in interest of yours. for whom similar prior
insurance has been cancelled and not rein~ted since the last cancellation.
E. Exchanges or Purchases
Loss resulting from the giving or surrendering of property in any exchange or purchase.
F. Fire
Loss from damage to the premises resulting from fire, however caused, eXc9pt for loss of or damage
to "moneyft or .securities. and loss from damage 10 a safe or vault under Insuring Agreemenl 3. and 4.
G. Governmental Action
Loss resulting from seizure or destruction of property by order of governmental authority.
H. Indirect Loss
Loss that is an indirect result of any act or "occurrence" covered by this Policy including but not limited
to loss resulting from
1. your inability to realize income that you would have realized had there been no loss of or
damage to "money\ "securities" or "other property".
2. payment or damages of any type for which you are legally liable. But we will pay compensatory
damages arising directly from a loss covered under this policy.
3. payment of costs, fees or other expenses you incur In establist'iing either tt'ie existence of or the
amount of loss under this policy.
I. Inventory Shortages
Loss, or that part of any los9, the proof of which is as to its existence or ambunt Is dependent upon
1. an inventory computation; or
2. a profit and loss computation.
However, where you establish wholly apart from such inventory computations that you have sustained
a loss covered under this Policy, then you may offer your inventory records and actual physical count
of inventory in support of the amount of loss claimed.
Page 4 of 12
Form F-4201-0
@ 1998, The Hartford
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PAGE 06/23
J. Legal Expenses
Expenses related to any legal action except when covered under Insuring Agreement 2.
K. Money Operated Devices
Loss of property containe<l in any money operated device unless the amount of any "money" deposited
in it is recorded by a continuous recording instrument in the device.
L. Motor Vehicles or Equipment And Accessories
Loss of or damage to motor vehicles, trailers, or semi-trailers or equipment or accessones attached to
them.
M. Nuclear
Loss resulting from nuclear reaction. nuclear radiation, or radioactive contamination. or any related act
or incident.
N. Risks Inherent In Insurance Operations
Loss resulting directly or indirectly from contractual or extra contractual liability sustained by you in
connection with the issuance of contracts or purported contracts of insurance, indemnity or suretyship.
o Trading Losses
Loss resulting directly or indirectly from trading. whether in your name or in a genuine or fictitious
account.
P. Transfer or Surrender of Property
Loss of or damage to property of any kind after it has been transferred or surrendered to a person or
place outside the .premlses" or "banking premi~es"
1. on the basis of unauthorized instructions: or
2. as a result of a threat to do bodily harm to any person; or
3. as 3 result of a threat to do damage to any property.
But this Exclusion does not apply under Insuring Agreement 3. or 4, to loss of "money", "securities.
and .other property" while outside the .premises. or "bankIng premises' in the care and custody of a
"messenger" if you:
1. had no knowledge of any threat at the time that the conveyance began: or
2. had knowledge of a threat at the time the conveyance began, but the loss was not related to the
threat.
a. Vandalism
Loss from damages to the "premises" or to the exterior of any safe. vault. cash box, cash drawer or,
cash register by vandalism or mischief.
R. Voluntary Parting of Title To or Possession of Property
Loss resulting from your, or anyone acting on your express or implied authority, being induced by any
dishonest act to voluntarily part with title to or possession of any property.
S. War and Similar Actions
Loss resulting from war, whether or not declared, warlike action, insurrection, rebellion. or revolution,
or any related act or incident.
T. Warehouse Receipts L05ses
Loss resulting from fraudulent or dishonest signing, issuing. cancelling or failing to cancel, 3
warehouse receipt or any papers connected with It.
VI. GENERAL CONDITIONS
A. ARMORED MOTOR VEHICLE COMPANtES
Under Insuring Agreements 3. and 4. we will pay only for the amount of loss you cannot recover
1. under your contract with the armored motor vehicle company; and
2. from any insurance or Indemnity carried, by or for the benefit of customers of the armored motor
vehicle company or from the armored motor vehicle company.
B. CALCULATION OF PREMIUM
The premium charged for this Policy was computed based on rates in effect at the time the Policy
was issued. On each renewal. continuation, or anniversary of the effective date of this Policy, we will
compute the premium in accordance with our rates and rules then in effect.
Form F-4201-0
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C. CANCELLATION OR NONRENEWAL OF POLICY
1. CANCELLATION
a. The first named Insured shown in the Declarations may cancel this Policy by mailing or
delivering to us advance written notice of cancellation.
b. We may cancel this policy by mailing or delivering to the first named Insured written notice
of cancellation at least:
(1) 10 days before the effective date of cancellation if we cancel for non-payment of
premium; or
(2) 90 days before the effective date of cancellation if we cancel for any other reason.
c. We will mail or deliver our notice to the first named Insured's last mailing address known
to us.
d. Notice of cancellation will state the effective date of cancellation The Policy Period will
end on that date.
e. If this policy is cancelled, we will send the first named Insured any premium refund due. If
we cancel, the refund will be pro rata. If the first named Insured cancels. the refund may
be less than pro rata. The C3ncellation will be effective even if we have not made or
offered a refund.
f. If notice is mailed. proof of mailing will be sufficient proof of notice.
2. NONRENEWAL
a. We may elect not to renew this Policy at eact, annual anniversary date.
b. If we decide not to renew this policy, we will mail or deliver written notice to the first
named Insured shown in the Declarations. at the address shown in this Policy. at least 90
days before the annual anniversary dale.
c. If notice is mailed, proof of mailing will be suffiCient proof of notice.
D. CANCELLATION AS TO ANY EMPLOYEE
Insuring Agreement 1. is cancelled as to any "employee"
1. immediately upon discovery by you or any of your partners, members, managers, officers.
directors or trustees not in collusion with the .employee" of "theft" or any other dist10nest act
committed by th@ "employee" whether before or after becoming employed by you; or
2. on the date specified in a notice mailed to you. The date will be at least 30 days after the date
of the mailing. And. the mailing of notice to you at the last mailing address known to us will be
sufficient proof of notice. Delivery of notice is the same as mailing.
E. CHANGES
This Policy contains all of the agreements between you and us concerning the insurance afforded.
The first named Insured shown in the Declarations is authorized to make changes in the terms of this
Policy with our consent. This Policy's terms can be amended or waived only by endorsement issued
by us and made a part of this Policy.
F. CONCEALMENT, MISREPRESENTATION OR FRAUD
Tt1is Policy is void in any case of fraud by you as it relates to this Policy at any time. It is also void if
you or any other Insured, at any time, Intentionally conceal or misrepresent a material fact concerning
1. this Policy;
2. the property covered under this Policy;
3. your interest in the property covered under this Policy; or
4. a claim under tt1is Policy.
G. CONSOLIDATION OR MERGER
If through consol1dation or merger with, or purchase or acquisition of assets or liabilities of, some other
entity. any additional persons become "employees" or you acquire the use and control of any
additional "premises.
1. you must give us written notice and obtain our written consent to extend this insurance to such
additional "employees" or "premises". We may condition our consent upon payment of an
Form F-4201-0
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addition31 premium; but there shalt only be a premium charge if such merger or acquisition
results in a 15%, or greater, increase in the number of "employees", assets or revenues acquired
through the merger or acquisition,
2. For the first 60 days after the effective date of such consolidation. merger, acquisition of assets
or liabilities. any insurance afforded for "employees" or "premises" also applies to these
additional "employees. or "premises" for acts committed withm this 60 cay period.
H. DISCOVERY
1. We will pay for loss which you sustain through acts or events committed or occumng at any time
and which are discovered by you during the Policy Period or during the period orovided in
General Condition L., EXTENDED PERIOD TO DISCOVER LOSS.
2. . Discovery of loss occurs wtlen you first become aware of facts which would cause a reasonable
person to assume that a loss covered by this Policy has been, or may be incurred even though
the exact amount or the details of the loss may not then be krown
3. Discovery also occurs when you receive notice of an actual or potential daim against you
alleging facts, which if true, would constitute a covered loss under this policy,
I. DUTIES IN THE EVENT OF LOSS
After you discover a loss or a situation which may result 111 a loss of or damage to "money", "securities.
or .other property., you must
1 notify us as soon as possible but no later than 60 days after discovery of loss.
2 submit to examination under oath at our request and give us a signed statement of your
answers.
3. gIve us a detailed, sworn proof of loss within 120 days.
4. cooperate with us in the investigation and settlement of any claim,
5. notify the police if you have reason to believe that your loss involves a violation of law.
J. EMPLOYEE BENEFIT PLANS
1. If anyone or more "employee benefit Plans" are insured Jointly with any other entity under this
Policy, you or the plan administrator must select a Limit of Insurance for Insuring Agreement 1.
that is sufficient to provide a limit of Insurance for each Plan which is at least equal to that
required if each Plan were separately insured
2. If the first named Insured is an entity other than a Plan, any payments we make to the Insured
for loss sustained by any Plan will be held by that Insured for the use and benefit of the Plants)
sustaining the loss.
3, If two or more Plans are insured under this Policy, any payment which we make for loss
sustained by two or more Plans, or of commingled "funds. or .other property" of two or more
Plans, which arises out of one .occurrence", is to be shared by each Plan sustaining loss in the
proportion that the limit of Insurance required for each Plan bears to the total of those limits.
4. This Policy insures those Plans which are named as additional Insureds in the Declarations or on
any attached Schedule for loss through fraud or dishonesty as defll1ed in Section 2580.412-9 of
the Employee Retirement Income Security Act (ERISA) as amended. For any Plans not
specifically named as Insureds, this Policy is deemed to be in compliance with, and satisfy the
bonding requirements of Section 2580.312-11 of the act. This insurance provides a Limit of
Insurance which is equal to 10% of the amount of the funds handled or $500,000., whichever is
less, for each Plan bonded and the minimum Limit of Insurance for any Plan shall be $1,000.
The limit of Insurance available for any Plan loss will be determined by the amount of funds
handled on the date when any covered loss occurs subject to the foregoing limitations.
5. The Deductible provision which applies to the Employee Theft Insuring Agreement shall not
apply to loss which is sustained by any Plan subject to ERISA and wt1ich Plan is covered under
this insurance.
K. EXAMINATION OF YOUR BOOKS AND RECORDS
1. We may examine and audit your books and records as they relate to this Policy at any time
during the Policy Period and up to three years afterward.
2. We may also examine and audit the books and records of any organization which you newly
acquire and that is deemed to be a named Insured under this Policy.
Form F-4201-0
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L. EXTENDED PERIOD TO DISCOVER LOSS
We will pay for loss which you sustained prior to the effective date of termination or cancellation of this
insurance, which is discovered by you
1. no later than 60 days from the date of the termination. cancellation or non-rene'Nal: and
2. as respects any flemployee benefit Plan(s)". no later than 1 year from the date of that
termination, cancellation or non-renewal.
Howe.....er, this extended period to discover loss terminates immediately upon the effective date of any
other insurance obtained by you to replace, in whole or in part. the insurance afforded by this Policy.
whether or not such other insurance provides coverage for loss sustained prior to its effective date.
M. FACSIMILE SIGNATURES
We willlreat mechanically reproduced facsimile signatures the same as handwritten signatures.
N. INSPECTION AND SURVEYS
1. We have the right but are not obligated to
a. make Inspections and surveys at any time;
b. give you reports on the conditions we find: and
c. recommend changes.
2. Any inspections. surveys, reports or recommendations relate only to insurability and the
premiums to be charged. We do not make safely inspections. We do not undertake to perform
the duty of any person or organization to provide for the health or the :;afety of workers or the
public. And, we do not warrant that conditions
a. are safe or healthful; or
b. comply with laws, regulations, codes or standards.
3. This condition applies not only to us, but also to any rating, advisory. rate service or similar
organization which makes insurance inspections. surveys, reports or recommendations.
O. JOINT INSURED
1. If more than one Insured is named in the Declarations, the first named Insured WIll act for itself
and for every other Insured for all purposes of thiS Policy. If the first named Insured ceases to
be covered. then the next named Insured will become the first named In3ured.
2. If any Insured, partner, member or officer of an Insured has knowledge of any information
relevant to this POlicy. that knowledge is considered to be knowledge of every Insured.
3. An "employee" of any Insured is considered to be an "employee" of every Insured.
4. If this Polley or any of its Insuring Agreements is cancelled. terminated or non-renewed as to any
Insured. loss sustained by that Insured is covered only if discovered by you during the period of
time provided in General Condition L., EXTENDED PERIOD TO DISCOVER LOSS. And, this
extended period to discover loss also terminates in accordance with paragraph 2 of that
condition.
5. We will not pay a greater amount for loss sustained by more than one Insured than we would
pay if all of the loss had been sustained by one Insured.
P. LEGAL ACTION AGAINST US
You may not bring any legal action against uS involving loss
1. unless you have complied with all the terms of this Policy; and
2. until 90 days after you have filed proof of loss with us: and
3. unless such action is brought within 2 years from the date that you discover such 10s9.
Q. LIBERALIZATION
If we adopt any revision that would broaden the coverage within the Policy without additional premium
within 45 days prior to or during the Policy Period, the broadened coverage will immediately apply to
this Policy.
R. LOSS COVEREO UNDER MORE THAN ONE INSURING AGREEMENT OF THIS POLICY
If two or more Insuring Agreements of this Polley apply to the same loss, we will p:JY the lesser of
1. the actual amount of loss; or
2. the sum of the LImits of Insurance applicable to those Insuring Agreements.
Page 8 of 12
Form F-4201-O
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S. NON ACCUMULATION OF LIMIT OF INSURANCE
Regardless of the number of years ttlis Policy remains in force or the number of premiums paid. no
Limit of Insurance cumulates from year to year or Polley Period to Policy Period,
T. OTHER INSURANCE
1. ThIs policy does not apply to loss recoverable or recovered under other insurance or Indemnity.
If the limit of the other insurance or indeml'1ily is insufficient to cover the entire amount of the
loss, this Policy will apply to that part of tt1e loss. other than that falling within any Deductible
Amount, not recoverable or recovered under the other insumnce or indemnity.
2. However, this Policy will not apply to tt1e amount of loss that is more than the applicable Limit of
Insurance shOWTI in the Declarations.
U. OWNERSHIP OF PROPERTY; INTERESTS COVERED
1. The property covered under this Policy is limited to property
a. that you own. lease or client property which you hold on your .premises" or which is in the
custody of one acting as your "messenger'" and while such property Is in transit; or
b. for which yOU are legally liable excepting loss of dlent property occurring on such client's
premises.
2. However, this Policy is for your benefit alone and no other person or organization has any rights
or benefits. However, any claim for a loss of client property occurring on your "premises' or
while In transit in the custody of a "messenger" may only be made by you in your proof of loss.
V. PREMIUMS
The first named Insured is responsible for the payment of all premiums and will be the payee for all
return premiums we pay.
W. RECORDS
You must keep records of all property covered under this policy so we can verify the amount of any
loss.
X. RECOVERIES
1. Any recoveries, less the cost of obtaining them. made after the settlement of loss covered by
this Policy will be distributed
a. to you, until you are reimbursed for any loss that you sustain that exceeds the limit of
Insurance and the Deductible Amount, if any;
b. then to us, until we are reimbursed for the settlement made; and
c. then to you. ul'1til you are reimbursed for that part of the loss equal to the Deductible
Amount. if any.
2. Recoveries do not include any recovery
a. from insurance, suretyship, reinsurance, security or indemnity taken for our benefit: or
b. of original "securities. after dupliC3tes of them have been issued.
Y. SPECIAL LIMIT OF INSURANCE FOR SPECIFIED PROPERTY (Insuring Agreement 3.)
We will pay no more than $5,000. for anyone 'occurrence" of loss of or damage to
1. precious metals, precious or semi-precious stones, pearls. furs or completely or partially
completed articles made of or containing such materials that constitute the prinCipal value of
such articles; or
2. manuscripts, drawings or records of any kind or the cost of reconstructing them or reproducing
any information contained in them.
Z. TERRITORY
This Policy covers acts committed or events occurring within the United States of America. U.S. Virgin
Islands, Puerto Rleo or Canada. However, we will pay for 1055 under Insuring Agreement 1. which is
caused by an "employee" while temporarily outside of the territories named in this General Condition
for a period of not more than 90 consecutive days.
Page 9 of 12
Form F-4201-0
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AA. TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY
1. Your rights and duties under this policy may not be transferred without our written consent
except in the case of death of an individual named Insured.
2. If you die. your rights and dutIes will be transferred to your legal representative but only while
acting within the scope of duties as your legal representative. Until your legal representative is
appointed. anyone having proper temporary custody of your property will have your rights and
duties but only with respect to that property.
BB. TRANSFER OF YOUR RIGHTS OF RECOVERY AGAINST OTHERS TO US
You must transfer to us all your rights of recovery against any person or organization for any loss you
sustained and for which we have paid or settled. You must also do everything necessary to secure
those rights and do nothing after loss to impair them.
ceo VALUATION
1. Subject to the applicable Limit of Insurance. we will pay for
a. loss of Kmoney" but only up to and including its face value. We may. at our option, pay for
a loss of -money" issued by other than the United States of America in either the face
value in the "money" issued in that country, or. in the United States of America dollar
equivalent determined by the rate of exchange on the day that the loss occurred.
b. loss of "securities' but only up to and induding their value at the close of business on the
day that the loss was discovered. But. we may, at our option, 1) pay the value of such
.securities~. 2) replace them in kind in which event you must assign to us all your rights.
title and interest in and to those "securities" or 3) pay the cost of any Lost Securities Bond
required in connection with issuing duplicates of the "securities". However. we will be
liable only for the payment of so much of the cost of the bond as would be charged for a
bond having a penalty not exceeding
(1) the value ofthe "securities. at the close of the business on the day the loss was
discovered; or
(2) the Limit of Insurance.
C. loss of or damage to "other property" or loss from damage to the "premises" or its exterior
for the replacement cost of the property without deduction for depreciation. However. we
will not pay for more than the lesser of
(1) the Limit of Insurance applicable to the lost or damaged property: or
(2) the cost to replace the lost or damaged property with property of comparable
material and quality and used for the same purpose: or
(3) the amount that you actually spend that Is necessary to repair or replace the lost or
damaged property.
2. We will not pay on a replacement cost basis for any loss or damage
a. until the lost or damaged property is actually repaired or replaced: and
b, unless the repair or replacement is made as soon as reasonably possible after the loss or
damage.
If the lost or damaged property is not repaired or replaced. we will pay based on actual cash
value.
3. We may. at our option. pay for loss of or damage to property other than "money" in the "money"
of the country in which the loss occurred: or in the United States of America dollar equivalent of
the "money" of the country where the IOS9 occurred determined by the rate of exchange on the
day the toss was discovered. Any property that we pay for or replace becomes our property.
4. Loss of or loss from damage to any books or records of account or other records, tapes, disks, or
electronic media used by you in the business but only if
a. such books, records, tapes or disks are actually reproduced and then only for not more
than the blank books, pages, tapes and disks or other materials plus the cost of labor for
the actual transcription or copying of data which you shall furnish to reproduce such books,
records, tapes or disks.
VII DEFINITIONS
A. ~B8nk/ng premises" means the interior portion of that part of any building occupied by a banking
institution or similar safe depository.
B. "Counterfeit" means an imitation of an actual valid original which is intended to deceive and to be
taken as an original.
Pag9 10 of 12
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C. ~Custodian" means you, or any of your partners, or members or any "employee" wtlile having the care
and custody of property inside the "premises", excluding any person while acting as a .watchperson" or
janitor.
D. HEmployee" meanS
1. any natural person
a. while in your service or for 60 days after termination of service; and
b. who you compensate directly by salary, wages, commissions; and
c. who yOU have the right to direct and control while performing services for you: including
d, who is performing services for you as the chairman, or a member of any committee and
whether compensated or not; or
e. who is a director or trustee while acting as a member of any of your elected or appointed
committees to perform on your behalf, specific. as distinguished from general directorial
acts; or
f. who is a non-compensated officer; or
g. wllo is a volunteer wtlo is not compensated, other than one who is a fund solicitor, while
performing services for you that are usual to the duties of an "employee"; or
h. who is a former employee, director, partner. member, representative or trustee retained as
a consultant while performing services for you; or
I. who is 3 student intem or guest student pursuing studies or duties in any of your offices or
"premises"; and
j. who is your partner or member (of limited liability corporations), but we will not pay for loss
caused by any partner or member, unless the amount of the loss exceeds the sum of
(1) any amounts you owe tMt partner or member; and
(2) the value of that partner's partnership interest, or that member's ownership interest
determined by the closing of your organization's books on the date of discovery of
the loss by your organization by anyone not in collusion with the person causing the
loss, and
(3) any applicable Deductible Amount; then
we will pay the amount of loss excess of that sum, up to the Limit of Insurance applicable
to Insuring Agreement 1.
2. a natural person who is a trustee, officer, "employee", administrator or manager. except an
administrator or a manager who is an independent contractor, of any "employee benefit Plan(s)"
insured under this Policy; and your director or trustee while that person is handling "funds" or
"other property" of "employee benefit Plan(s)" insured under this Policy,
3. a natural person who is fumished temporarily to you to substitute for a permanent "employee" to
meet seasonal or short term work load conditions and while that temporary person is subject to
your direction and control and performing services for you. However, such persons are
excluded while having care and custody of property outside the "premises"; and
a. "employee" does NOT mean
(1) any agent, broker, person leased to you by a labor leasing firm, factor, commission
merchant, consignee, independent contractor or representative of the same general
character; or
(2) any manager, director, partner, member or trustee except while performing acts
coming within the scope of the usual duties of an "employee".
E. "Employee benefit Plan(sr means any welfare or pension Plan listed in the Declarations, on an
attached schedule or for which automatic coverage is afforded that is subject to the Employee
Retirement Income Security Act (ERISA) of 1974, as amended,
F. HFinanc/el instftution" means a banI<, savings bank, savings and loan association or similar thrift
institution, a stockbroker. mutual fund. liquid assets fund, or similar investment Institution in Which you
maintain a "transfer account". I
G. ~Forgery" means the signing of the name of another person or organizabon with intent to deceive; it
does not mean a signature which consists in whole or in part of one's own name signed with or without
authority, in any capacity, for any reason.
one
Page 11 of 12
Fonn F-4201..o
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PAGE
13/23
H. MFraudul6nt transfer Instructions.M means
1. fraudulent electronic, telegraphic. facsimile, cable. teletype or telephone instructions to a
"financial institution" to debit a "transfer account" and to pay. transfer or deliver "money" or
"securities" from such account and which instructions purport to have been authorized by you but
which have been fraudulently transmitted by another; or
2. fraudulent written instructions to a .financial institution" to debit a "transfer account" and to pay,
transfer or deliver "money" or .securities" from such account through an electronic funds transfer
system at specified times or under specified conditions and which instructions purport to have
been duly authorized by you but which have been fraudulently issued. forged or altered by
another.
I. "'Funds transfer fraud" means .theft" of "money" or "securities' from any of your "transfer accounts" at a
"financial institutIon" and occurring through "fraudulent transfer instructions" communicated to such
"finandal institution".
J. "Messenger" means you, any of your partners or members or any "employee" while having care and
custody of property outside the "premises-.
K. "Money" means currency. coins and bank notes in current use and having a face value: and travelers
checks. register checks and money orders held for sale to the general public.
L. "Occurrence" means
1. as respects the Employee Theft Insuring Agreement. all loss caused by, or Involving, one or
more "employees". whether the result of a single act or a series of acts.
2. as respects the Forgery or Alteration Insuring Agreement. all loss caused by any person or in
which that person is involved, whether the loss involves one or more instruments.
3. as respects all other Insuring Agreements, an act or series of related acts involving one or more
persons: or an act or event or a series of related acts or events not involving any person.
M. "Other Property"means any tangible property other than "money" or "securities" that has intrinsic value
but does not include any property excluded under this Policy. "Other property" does not include trade
secrets, proprietary information, confidential information or any copyrights, patents. trademarks.
proprietary manufacturing or processing procedures. or secret or confidential information. including but
not limited to credit card numbers. bank account numbers or any Similar information.
N, "Premises" means the interior at that portion of any building which you occupy in conducting your
business.
O. "Robbery" means the unlawful tak.lng of property from the care and custody of a person by one who
has caused or threatened to cause tt1at person bodily harm, or. committed an obviously unlawful act
witnessed by that person.
P. "Safe burglary" means the unlawful taking of property from within a locked safe or vault by a person
unlawfully entering the safe or vault as evidenced by marks of forcible entry upon its exterior. or. the
taking of a safe or vault from inside the "premises".
a. MSecurities" means negotiable or non-negotiable instruments or contracts representing either "money"
or property and includes tokens, tiCkets, revenue and other stamps (whether represented by actual
stampS or unused value in a meter) in current use; and, evidences of debt issued in connection with
credit or charge cards. which cards are not issued by you: but does not include "money".
R. "Theft" means the unlawful taking of "money", "securities" or "other property" to the deprivation of the
Insured.
S. 'Transfer account~ means an account maintained by you at a "financial institution" from which you or
your authorized representative may cause the payment, transfer or delivery of "money" or .securities"
by any means described in the ~fraudulent transfer instructions" definition.
T. "Watchperso"" means any person who you retain specifically to have the care and custody of property
inside the "premises" and who has no other duties.
Form F-4201.0
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x
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RETROACTIVE DATE ENDORSEMENT
LOS5SU5T~NEDCOVERAGE
This endorsement applies to all of the Insuring Agreements forming a part of this Policy.
A. SCHEDULE
RETROACTIVE DATE
07/01/?005
B. PROVISIONS
1. This Policy is amended by deleting the CONSIDERATION CLAUSE in its entirety and by replacing it with
the following:
In exchange for the payment of premium and subject to the Declarations. Insuring Agreements,
Definitions. Exclusions, General Conditions and terms of the Policy. we will P8Y for loss which you sustain
resulting directly from acts committed or events occurring after the RETROACTIVE DATE shown in the
SCHEDULE and discovered by you during the Policy Period shown in the Declarations or during the
period of time provided in the EXTENDED PERIOD TO DISCOVER lOSS General Condition.
2. Paragraph 1. of the DISCOVERY General Condition is deleted and replaced by the following:
1. We will pay for loss which you sustain directly from acts committed or events occurring sfter the
RETROACTIVE DATE shown in the SCHEDULE and which are discovered by you during the Policy
Period or during the period provided in the EXTENDED PERIOD TO DISCOVER LOSS General
Condition.
Fonn F-4220-0
Page 1 of 1
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877-257-2166
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PA(3E 15/23
x
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
THEFT OF CLIENTS' PROPERTY OFF PREMISE -
SCHEDULE
This endorsements adds an additional Insuring Agreement to the Policy as follows:
A. SCHEDULE
INSURING AGREEMENT 1.C
THEFT OF CLIENTS' PROPERTY - OFF PREMISE
NAME OF CLIENT
LIMIT OF DEDUCTIBLE
INSURANCE AMOUNT
$50,000 $ SOO
$ $
$ $
S $
$ $
CITY OF CUPERTIO, CA
B. PROVISIONS
1. We will pay for 1059 of or damage to "money". .securities. and "other property" that Is owned or leased by a
client named in the SCHEDULE and with which you are under written contract to perform services on that
client's premises and which loss results directly from "theft" by an identified "employee". whether acting
alone or in collusion with others.
2. The most we will pay for loss in an "occurrence" is the Limit of Insurance shown in the SCHEDULE subject
to the Deductible Amount. That Limit of Insurance is a part of, not in addition to, the Limit of Insurance,
shown in the Declarations,
3. Paragraph lob. of the OWNERSHIP OF PROPERTY; INTERESTS COVERED General Condition is
replaced by the following:
b. for which you are legally liable.
4. The insurance provided by this Insuring Agreement is for your benefit alone. Any claim for loss sustained
by your client and caused by "theft" by an "employee" shall be made by you. No other person or
organization has any rights under this Polley.
Form F-4253-1
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PAGE 15/23
J
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
A MESSAGE TO OUR CALIFORNIA POLICYHOLDERS
Companies writing property and casualty insurance business in California are required to participate in the
California Insurance Guarantee Association. If a company becomes insolvent the California Insurance Guarantee
Association settles unpaid claims and assesses each Insurance company for Its fair share
California law requires all companies to surcharge Policies to recover these assessments.
surcharged, "CA Surcharge" with an arrount will be displayed on your premium notice.
If your Policy is
Form F-4262-0
Page 1 of 1
@ 1998. The Hartford
.06/20/2005 13:23
877-257-2166
HAF~TFORD BUC
PA(3E 17/23
J
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL
This endorsement does not apply to coverage provided by employee theft (INSURING AGREEMENT 1.) and
forgery or alteration (INSURING AGREEMENT 2.).
A. The following provisions are added to the CANCELLATION General Condition as follows:
g. All Policies In Effect For More Than 60 Days
(1) If this Policy has been in effect for rrore than 60 days. or Is a renewal of a Policy we issued, we may
cancel this Policy only upon the occurrence. after the effective date of the Policy. of one or rrore of
the following:
(a) Nonpayment of premum, including payment due on a prior Policy we Issued and due durin9 the
current Policy term covering the same risks.
(b) Discovery of fraud or rmterial misrepresentation by:
(i) Any insured or his or her representative in obtaining this insurance: or
(ii) You or your representative in pursuing a claim under this Policy.
(c) A judgment by a court or an administrative tribunal that you have violated a California or
Federal law, having as one of its necessary elements an act which materially increases any of
the risks insured against.
(d) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or
regulations establishing safety standards, by you or your representative, which materially
increase any of the risks insured against.
(e) Failure by you or your representative to il'11Jlement reasonable loss control requirerrents,
agreed to by you as a condition of Policy issuance, or which were conditions precedent to our
use of a particular rate or rating plan. if that failure materially increases any of the risks insured
against.
(f) A determination by the Commissioner of Insurance that the:
(i) Loss of, or changes in. our reinsurance covering all or part of the risk would threaten our
financial integrity or solvency: or
(ii) Continuation of the Policy coverage would:
(aa) Place us in violation of California law or the laws of the state where we are
dorriciled: or
(bb) Threaten our solvency.
(g) A change by you or your representcltive in the activities or property of the corrmercial or
industrial enterprise, which results in a materially added. unless the added. increased or
changed risk is included in the Policy.
(2) We will mail or deliver advance written notice of cancellation. stating the reason for cancellation, to
the first narrec:llnsured, and to the producer of record, at least:
(a) 10 days before the effective date of cancellation if we cancel for a reason listed in paragraph (g)
(1) (a) or (b).
(b) 30 days before the effective date of cancellation if we cancel for any other reason listed in
paragraph 6.a.(9) (1).
B. Paragraph b. of the NONRENEWAL General Condition is replaced by the following:
b. If we elect not to renew this Policy:
(1) We will mail or deliver written notice stating the reason for nonrenewal to the first narred Insured
shown in the Declarations and to the producer of racord, at least 60 days. but not rrore than 120
days, before the expiration or anniversary date.
(2) We will rmil or deliver our notice to the first narred Insured. and to the producer of record. at the
mailing address shown In the Policy.
Fonn F-426S.0
Page 1 of 2
@ 1998. The Hartford
Includes copyrighted rraterial of Insurance Services Office, Inc. with its permission
@copyright, Insurance Services Office. Inc.. 1996
B6/2B~2BB~ 13:23
877-257-2166
HARTFOPD BUC
PA(;E 18/23
C. The following is added to the NONRENEWAL General Condition:
d. We are not required to send notice of nonrenewal in the fol/owing situations:
(1) If the transfer or renewal of a POliCY, without any changes In terms, conditions, or rates. is between
us and a rrerrber of our insurance group.
(2) If the Policy has extended for 90 days or less, provided that notice has been given in accordance
with ParagTCIph B.(b) above.
(3) If you have obtained replacement coveTCIge, or if the first named Insured has agree, in writing. within
60 days of the termnation of the Policy. to obtain that coverage.
(4) If the Policy is for a period of no rrore than 60 days and you are notified at the tirre of issuance that
it will not be renewed.
(5) If the first narred Insured requests a change in the terms or conditions or risks covered by the Policy
within 60 days of the end of the Policy Period.
(6) If we have made a written offer to the first named Insured, in accordance with the timefrarres shown
in paragraph 8.(b) above. to renew the Policy under changed terms or conditions or at an increased
premum rate, when the increase exceeds 25%.
Form F~265-0
Page 2 of2
@ 1998. The Hartford
Includes copyrighted material of Insurance Services Office. Inc. with its permission
@copyright, Insurance Services Office, Inc., 1996
8~/~8/2885 13:23
877-257-2155
HARTFORD BUC
PAGE 28/23
x
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CALIFORNIA CHANGES - ACTUAL CASH VALUE
The VALUATION GENERAL CONDITION is amended by adding the followmg:
5. Actual cash value is calculated as the amount it would cost to repair or replace "Other Property". at the time 01
loss or damage, with material of like kind and quality, subject to 3 deduction for deterioration. depreciation and
obsolescence, Actual cash value applies to valuation of "Other Property" regardless of whether that property
has sustained partial or total loss or damage.
The actual cash value of the lost or damaged property may be significantly less than its replacement cost.
Form F-4347-O
Page 1 of 1
@ 1999, The Hartford
Includes copyrighted material of Insurance Services Office. Inc. with its permission
i?Jcopyright. Insurance Services Office, Ino.. 1999
06/20/2005 13:23
,
877-257-2166
HARTFORD BUC
PA(;E21/ 23
x
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMEND GENERAL CONDITION J. 4. -
EMPLOYEE BENEFIT PLANS
This endorsement applies to the CrimeSHIELD Policy for Mercantile Entities.
PROVISIONS
SECTION VI. GENERAL CONDITIONS, J. 4. EMPL.OYEE BENEFIT PLANS, is hereby deleted in its entirety
and replaced with the following:
4. This Policy insures any Employee Welfare or Pension Benefit Plan which is sponsored by one or more of
the Named Insureds for loss through fraud or dishonesty as defined in Section 2580.412-9 of the Employee
Retirement Income Security Act (ERISA) as amended. For those plans which are specifically named as
additional Insureds in the Declarations or on any attached Schedule, the maximum limit of Insurance is the
amount shown on the Declarations under Item 4., Coverages. LImits of Insurance and DeducUbles,
Insuring Agreements FormIng Part of This Policy, 1. Employee Theft. For "ny Plan not specifically
named as an Insured. this Policy is deemed to be In compliance with, and sallsfy the bonding requirements
of Section 2560.412-11 of ERISA. For such unnamed Plans, this insurance provides a Limit of Insurance
for each Plan which is the lessor of:
(a) $500,000; or
(b) 10% of the amount of the funds handled; or
(c) The Limit of Insurance shown on the Declarations under It~m 4., Coverages, limits of
Insurance and Deductlbles, Insuring Agreements Forming Part of This Policy,
1. Employee Theft.
The minimum Limit of Insurance for any Plan shall be $1 ,000. In no event shall coverage for any Plan,
whether specifically named as an additional Insured or not, be more than the Limit of Insurance shown on
the Declarations under Item 4., Coverages, Limits of Insurance and Deductibles, Insuring Agreements
Forming Part of This Policy, 1. Employee Theft.
The Limit of Insurance available for any Plan loss will be determined to equal the amount required under
ERISA at the time you discover a loss, subject to the foregoing IImitations-
Page 1 of 1
Form F..s011-0
02001 The Hartford
. 85/20/20~5 13: 23
877-257-2155
HARTFORD BUC
PA6E d/23
d'~"~
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"1'1' 1..I]E '.', . .
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Claims Inquiries Notice
Hartford Fire Insurance Company
Hartford Casualty Insurance Company
Hartford Accident and Indemnity Company
Hartford Unden.vriters Insurance Company
Twin City Insurance Company
Hartford Insurance Company orminois
Hartford Insurance Company of the Midwest
Hartford Insurance Company of the Southwest
Please address inquiries regarding Claims for all surety and fidelity products issued by The
Hartford's underwriting companies to the following:
Phone Number:
Fax- Claims
E-mail
888-266-3488
860-757 -5835 or 860 -547-8265
bond.c] aims(QJthehartford.com
Mailing Address
The Hartford
BOND, T-4
690 Asylum Avenue
Hartford, CT 0611 5
Claims Inquiries Notice 200:l
ACORD~ CERTIFICATE OF LIABILITY INSURANCE CSR MY I DATE (MM/DDNYYY)
TOTAL-1 08/15/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Andreini & Company-San Mateo ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
License 0208825 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
220 West 20th Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Mateo CA 94403
Phone: 650-573-1111 Fax: 650-378-4361 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Star Insurance Company
INSURER B:
Total Quality Maintenance Inc. INSURER C:
895 Commercial Street INSURER 0:
Palo Alto CA 94303
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.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER ~~1f~TJ'~fJ~,w;E PQ~~Y(IEXPIRA "':!,.~N LIMITS
DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X Iil COMMERCIAL GENERAL LIABILITY CP0108326 07/24/05 07/24/06 ~~~~~s (Ea occurence) $ 300000
I I CLAIMS M,AOE ~ OCCUR MED EXP (Anyone person) $ 5000
=1 PERSONAL & ADV INJURY $ 1000000
GENERAL AGGREGATE $2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $ 1000000
I nPRO- n Emp Ben. 1000000
POLICY JECT LOC
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 $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TB'~v" ~I~'I~S I IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE ' E.L. EACH ACCIDENT $
OFFICERlMEMBER EXCLUDED? EL. DISEASE - EA EMPLOYEE $
If yes, describe under EL. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Contractual Janitorial Services, Project NO. 2005-05 The City of
Cupertino ("City") and its directors, officers, engineers, agents, and
employees and all public agencies from who permits will be obtained and
their directors, officers, engineers, agents and employees are herby
declared to be Additional Insureds per the attached endorsements.
CERTIFICATE HOLDER
CANCELLA TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO~
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Cupertino IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
Office of the City Clerk
10300 Torre Avenue REPRESENTATIVES.
Cupertino CA 95014 AUTH~
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
05 -05" 0
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)