05-057, Don & Mike's Sweeping
AGREEMENT
THIS AGREEMENT, made and entered into this 1st day of July, 2005, by and
between the CITY OF CUPERTINO, a municipal corporation of State of California,
hereinafter referred to as "CITY", and Don & Mike's Sweeping a Contractor with
offices at 901 Dell Avenue, Campbell, CA 95008 hereinafter referred to as
"CONTRACTOR";
WITNESSETH:
WHEREAS, CITY desires to retain the CONTRACTOR for STREET
SWEEPING SERVICES, PROJECT NO. 2005-01; 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 CONTRACT DOCUMENTS. The complete contract consist of the
following contract documents:
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 and Special Provisions.
c. Plans and Specifications for STREET SWEEPING. PROJECT NO.
2005-06
d. Faithful Performance Bond.
e. Insurance Agreement, Certificate of Insurance, Endorsement of Primary
Insurance, Additional Insured Endorsement, Endorsement of Aggregate
PAGE 1 OF9
Limits of Insurance per Project, Waiver of Subrogation Endorsement
Worker's Compensation Insurance and Notice of Policy Cancellation
Endorsement.
f. This Agreement.
All of the above documents are intended to cooperate so that any work
called for in one and not mentioned in the other, or vice versa, is to be
executed the same as if mentioned in all of said documents. The
documents comprising the complete contract are sometimes hereinafter
referred to as the Contract Documents. In case of conflict between the
Plans and the Specifications on the one hand, and this Contract on the
other, the Plans and Specifications shall prevail.
2. THE WORK. CONTRACTOR agrees to furnish all of the
tools, equipment, apparatus, facilities, labor, transportation and materials
necessary to perform and complete in a good and working order, the work
of slurry sealing various streets, as called for, and in the manner
designated in, and in strict conformity with, the Plans and Specifications
prepared by the Engineer and adopted by CITY, which Plans and
Specifications are entitled, respectively, STREET SWEEPING,
PROJECT NO. 2005-06 and which Plans and Specifications are
identified by the signatures of the parties to this Contract. It is understood
and agreed that said tools, equipment, apparatus, facilities, labor,
transportation and materials shall be furnished, and that said work shall be
performed and completed as required in said Plans and Specifications
under the sole direction of CONTRACTOR, but subject to the inspection
and approval of CITY, or its representative.
CITY hereby designates as its representative for the purpose of this
Contract the Engineer, Mr. Ralph A. Qualls, Jr.
3. PROJECT COORDINATION.
(a) City. The City Engineer shall be a representative of the CITY for all
purposes under this agreement. The Assistant Director of Public Works
hereby is designated as the PROJECT MANAGER for the City Manager,
and he 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. Don Vierra 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 designee shall be subject to the prior
written acceptance and approval of the PROJECT MANAGER.
PAGE 2 OF9
4. DUTIES OF CONTRACTOR. Services to be furnished in accordance with
EXHffiIT "A" BID PROPOSAL and contract 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 a CONTRACOR 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;
(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,
drawing, specifications, or provisions of this agreement.
5. COMPENSATION. For the performance of the services described herein
by CONTRACTOR, CITY shall pay CONTRACTOR the sum of$ 9,918.00
(Nine Thousand Nine Hundred and Eighteen Dollars and No Cents) per
month, less any deductions for work not performed and or liquidated
damages, payable upon submission by CONTRACTOR of itemized billings
in triplicate; provided, however, that the total sum payable to
CONTRACTOR shall not exceed $ 119,016.00 (One Hundred Nineteen
Thousand and Sixteen Dollars and No Cents) per year. These amounts are
based on $ 14.25 (Fourteen Dollars and Twenty Five Cents) per curb mile
for 696 curb miles per month. Emergency and additional street sweeping
shall be at $ 95.00 (Ninety Five Dollars and NO Cents) per hour or at $
14.25 (Fourteen Dollars and Twenty Five Cents) per mile.
6. LIQUIDATED DAMAGES. The CONTRACTOR shall diligently
prosecute the work to completion as scheduled. The CONTRACTOR further
understands that he shall pay liquidated damages to the City of Cupertino in
the sum of One Thousand Dollars ($1,000.00) for each and every day that
services are not completed on time and/or streets are omitted. Omitted
streets must be swept by the following day.
In case of breakdown by main sweeper, immediate service within one hour by
a second sweeper is required to complete daily schedule. If down for more
PAGE 3 OF 9
than one hour, liquidated damages will be assessed at the rate of One
Hundred Dollars ($100.00) per hour for each hour above and beyond one
hour.
7. TERM. The term of this agreement shall be one (1) year from the start date
of the agreement. The City shall retain the option to extend the term of the
agreement for one (1) additional year from the expiration of the original term,
for a possible total of two years.
The start date of this agreement shall be July 1,2005.
Any such renewal after the first 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.
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.
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.
(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 CONTRA TOR, 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 the CONTRACTOR of any of its obligations to fulfill
its agreement as prescribed.
PAGE40F9
11. ASSIGNMENT: EMPLOYEES.
(a) Assignment. 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
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 convenants
that, in the performance of this agreement, no subcontractor or person having
such an interest shall be employed. CONTRACTOR certifies that no one who
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 and
independent contractor and not an agent or employee or CITY.
14. INDEMNITY. CONTRACTOR hereby agrees to indemnify and save
harmless CITY, its officers, agents, and employees of and from:
(a) 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 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;
PAGE50F9
(b) Any and all damage to or destruction ofthe 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 the 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 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
results 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 by the use of the
apparatus, appliance, or materials furnished by the 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 on any of the
above claims or demands of such third person, or to enforce any of the above .
penalties, and pay and satisfy any judgement 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 code, and it certifies that it will
comply with such provisions before commencing the performance of the work of this
agreement.
16. INSURANCE. CONTRACTOR, at its sole cost and expense, shall obtain and
maintain in full force and effect throughout the entire term of is agreement the
insurance coverage in amounts specified and having a Best's Guide Rating of "A",
Class VII or better or that is otherwise acceptable to the City. 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
PAGE 6 OF 9
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 cancelled 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 a City Clerk.
17. CONTRACT SECURITY. The CONTRACTOR shall furnish a surety bond
in an amount equal to four (4) months of the contract price as security for the
faithful performance of this Contract.
18. AGREEMENT BINDING. The terms, covenant, and conditions of this
agreement shall apply to, and shall bind the heirs, successors, executors,
administrators, assigns, and subcontractors and 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. WAGE RATES. Contractor is required to pay prevailing wage rates on this
project. Copies of the general prevailing rates of per diem wages for each
craft, classification, or type of worker needed to execute the Contract, as
determined by Director of the State of California Department of Industrial
Relations, are deemed included in the Contract Documents and on file at
City's office, and shall be made available to any interested party on request.
Pursuant to Section 1861 of the Labor Code, Contractor represents that it is
aware of the provisions of Section 3700 of the Labor Code which require
every employer to be insured against liability for workers' compensation or to
undertake self-insurance in accordance with the provisions of that Code, and
PAGE70F9
IN WITNESS WHEREOF, the patties have executed this Agreement, in duplicate, the
day and year first hereinabove written.
CONTRACTOR: Don & Mike's Sweeping
DOA/ g r4IIt:['S Sb)[[IlIA/y
n I' , IF
9nl DELL 4VE C4~PB[LL.CA
By: AlL"\... (l.~ 'l.JL4l..---/
95008
Notary acknowledgement is required. If a
corporation, corporate seal and corporate
Notary acknowledgement and Federal Tax
I.D. are required. If not a corporation a
Social Security No. is required.
CITY OF
Mayor
~JJ-
City Clerk
--
Soc. Security # Federal Tax LD
By:
Attest:
Contractor's License No. n/ a
Date:
1--13
City Clerk
, 2005
Project Name & Number: STREET SWEEPING, PROJECT NO. 2005-06
Contractor's Name and Address:
Don & Mike's Sweeping
901 Dell Avenue
Campbell, CA 95008
Phone: 408-866-2072
Contract Amount: $ 9,918.00 per month; $ 119,016.00 per year
Account Numbers: 230-8004-7014 = $ 60,000.00 and 520-8003-7106 = $ 59,016.00
File Number: 50,206.04
PAGE90F9
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NOTARY CERTIFICATE
CALlFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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Prod. No. 5907
Reorder: Call Toll-Free 1-800-876-6827
EXHIBIT A
BID PROPOSAL
STREET SWEEPING, PROJECT 2005-06
TO: THE DIRECTOR OF PUBLIC WORKS, CITY OF CUPERTINO, STATE OF CALlFORNIA
Dear Sir:
In compliance with the plans and specifications furnished for the work of the STREET
SWEEPING, PROJECT 2005-06for the City of Cupertino, 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
plans and 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.
Bidders shall complete the entire Statement of Qualification and submit it with the bid
proposal documents. Failure to complete the Questionnaire or inclusion of anv false
statement(s) shall be J!rounds for immediate disqualification.
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 STREET SWEEPING, PROJECT 2005-06as described in the
Special Provisions.
I, the undersigned, shall diligently prosecute the work to completion as scheduled. I further
understand that I shall pay to the City of Cupertino the sum of Five Hundred Dollars ($500.00)
per day, for each and every day services are not completed on time and/or streets are omitted.
In the event of discrepancies between the written unit price and the numerical unit price, the
written price shall govern.
Bid Proposal Page 1 of 8
EXHIBIT A
I, the undersigned, agree that ifthis 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 $ 11, 901 . 60 , as
required by law and the Notice to Bidders. (10% of bid amount)
Bid Proposal Page 3 of 8
EXHIBIT A
NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY.
BIDDER AND SUBMITIED WITH BID
4 the undersigned, being first duly sworn, depose and say than am
.r
PRE-SIDE-N7
(Business Title)
of DON & ~IKE-'S SWeE-PINg
(Business Name)
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, association, 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
:r~.""
bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or "0'[
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 infonnation 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 4 of 8
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 21
years.
Our experience in work comparable with that required by the proposal contract is
years operating under the following different name(s).
My California Contractor's License Number is NONE.
The classification of my Contractor's License is
The expiration date for my Contractor's License is
******************************************************************************
*
(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 5 of 8
EXHIBIT A
BIDDER mSTORY OF WORK
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.
Year Location
app/1..ox:.
10Y/1..-6 Newa/1..k rn
Tvpe of Work
For Whom
Performed
CI7l}
o '1 N F '" ./) .R J(
Contact
phone No.
PAf1
D[f1[J ((]
Amount
App/1.. 0 x:.
$3~000.00
A/Qggf ^J"{l{l,Qi.~~
Ph#510-794--2372
-6weepina hPnvJCP ~nnn Oq c~gg
App/1.. 0 x:.
lR{/n,l, rJlplJnfinn,rn A/nnn! 61"'J~,Qiqg
City ot
C!:lJ'[R7INO
Bo~ Rizzo App/1..ox:.
Rr.n ,jIlin $84-56.00 mo.
'P/'#':?77_n5"'-
c.i.ty ot John
f..AJ1PBfLf. Tnqllin/n
App/1..ox:.
~S)7).OO TTb.
l.{/fl Camp~ell Ca -6t/1..eet -6weeping
Ph1l866-2127
Bid Proposal Page 6 of 8
EYJIIBIT MI/ft
SUBCONTRACTOR'S FORM
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.
1. Name
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.
Contractor's License No.
Bid Proposal Page 7 of 8
EXHIBIT A
BIDDER'S SIGNATURE FORM
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
BUSINESS ~t~€€t ~w€€pinq
NAME OF
BUSINESS DON & rUKE-' S SUJE-E-PINq
CORPORATION: DON & fYlIKE-' S SUJE-E-PIN(j
P~€~id€nt Don Vi€~~a, S€c~€ta~y 7~€a~u~€~ Jim Vi€~~a,fYIanag€~ Don Vi0~~a
CO-PARTNERSHIP:
INDIVIDUAL:
JOINT VENTURE:
OTHER:
(Describe)
jJ tfYV 1/ ~VLA/
DON VTfRRA
(Print or type name)
Name and Signature of Bidder:
Date:
5-24-05
Address (mailing & location): 901 j)f r r 4I1D/UE.
CAfYlPBfLf. rA 9Snn8
Telephone Number:
(1. 0 8) R (If) - ) n 7 )
E-Mail Address:
N/A
Acknowledgment of all addenda received is required by circling each addendum number.
~ 2 3 4 5 6 7 8 9 10
Bid Proposal Page 8 of 8
INSURANCE FORMS INSTRUCTIONS
FOR ITEMS 3, 4 AND 5, THE FORMS PROVIDED BY THE CITY OF CUPERTINO
MUST BE USED. FORMS OTHER THAN THESE WILL NOT BE ACCEPTED.
ALL DOCUMENTS MUST BE ORIGINALS - SUBMIT IN TRIPLICATE
1. Insurance Agreement - Must be signed by Contractor.
2. Certificate of Insurance to the City of Cupertino - must be completed by the insurance
agent or must provide a certificate on the company's form. They must contain the same
information.
3. Endorsement of Additional Insured and Primary Insurance and Notice of Cancellation - must be
signed by the insurance agent for general liability and automobile liability only.
4. Comprehensive general liability/commercial general liability endorsement of aggregate limits of
insurance per project - must be signed by the insurance agent for general liability only.
5. Waiver of subrogation endorsement worker's compensation insurance - must be signed by the
insurance agent for worker's compensation only.
Insurance Instructions
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
Jun 27 05 10:5Sa
State Farm - Joan Peros, Agent Lie. #0577260
Auto - Life - Health - Home - Business
8060 Santa Teresa Blvd., Suite 210 Gilroy, CA 95020
Ph: 408-847-6650 Fax: 408-847-6621
. . . ','n~ jOlUL~!O.~,13_8Bl,@s!a~fap:n.com
"facsimile transmittal
"'1 . .... ~ ~ '.: ,.,.. .
To:
Fax:
408-866-4631
Mary
DOD & Mike's Sweeping
From: Mitchell Vaughn - Joan Peros Office Date: 6/27/2005
Re: City Of Cupertino Certs OfInsurance Pages: 5
cc:
o Urgent
o For Review
o Please Conment
o Please Reply
o Please Recycle
.
.
.
.
.
.
Notes:
Dear Mary,
Please find attached the Certificates of Insurance along with the Waiver of
Subrogation for workers comp for the City of Cupertino. I don't have a copy of
Additional Insured endorsement and have requested that from the regional office
and that will take a couple of days to get. I talked with .Toan and this is the form
that we must use due to limitations set by the states department of insurance.
Give me a call if you have any questions.
Sincerely,
Mitchell Vaughn for Joan Peros
~JJ
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p. 1
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Jun 27 05 10:5Sa
10.2
CERTIFICATE OF INSURANCE
o STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
IZI STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
o STATE FARM FIRE AND CASUAlTY COMPANY, Scarborough, Ontario
o STATE FARM FLORIDA INSURANCE COMPANY. Winter Haven, Florida
o STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder DON & MI KE I S SWEEPING INC
This certifies that
I .,.AII....
..
.....u.C\
901 DELL AVE
CAMPELL, CA 95008
CITY OF CUPERTINO
STREET SWEEPING
Address of policyholder
Location of operations
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims,
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
97-wK-6782-3 Comprehensive 9/10/04 9/10/05 BODILY INJURY AND
Business Liability : PROPERTY DAMAGE
- - -- - -. - -.. -.... - - - - - - - -.. - -.. -..- .~- PrOducts ~ 'Completed -Op~~aiioris- -.. -- -.. - - - - - - -- -. - - - -- - --
This insurance includes:
I8J Contractual Liability Each Occurrence $ 1,000,000
I8J Personal Injury
I8J Advertising Injury General Aggregate $2,000,000
I8J MEDICAL EXPENSES: $5,000
0 Products - Completed $2,000,000
0 Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date : Expiration Date (Combined Single Lirnit)
97-EK-8071-G I8J Umbrella 9/10/04 , 9/10/05 Each Occurrence $1,000,000
o Other Aggregate $1,000,000
POLICY PERIOD Part I - Workers Compensation - Statutory
Effective Date : Expiration Date
97-WQ-4547-7 Workers' Compensation 12/13/04 12/13/05 Part II - Employers Liability
and Employers Liability Each Accident $1,000,000
Disease - Each Employee $ 1, 000 , 000
Disease - Policy Limit $1,000,000
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
D38 2411-D04-0SK Auto 4/4/05 : 4/4/06 SOO/lMM/500
062 3520-D16-0SE Auto 4/16/05 , 4/16/06 SOO/lMM/500
V23 971-D30-05I Auto 3/30/05 2/30/06 SOO/lMM/500
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certificate Holder
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO, CA 95014
If any of the described policies are canceled before
their expiration date. State Farm will try to mail a
written notice to the certificate holder 30 days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
Fann or its agents or representatives.
50\\11\ p~.'C& f::~ 7
Signature of Authorized Repres latlve
AGENT
Title
JOAN PEROS
Agent Name
Telephone Number 408 - 84 7 - 6650
6/27/05
Date
558-9$4 as Rev.11-08-2004 Printed in U.S.A
Agent's Code Stamp
~~n~~e J PEROS 05-2326
S SlUeON "ALLEY f154
CERTIFICATE OF INSURANCE
o STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
I:8J STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
o STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
o STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
o STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below;
Policyholder DON & MIKE'S SWEEPING INC.
Jun 27 05 10:57a
.,..,. ....
A
This certifies that
1....".Cl
Address of policyholder
Location of operations
Description of operations
10.3
901 DELL AVE.
CAMPBELL, CA 95008
CITY OF CUPERTINO
STREET SWEEPING
The policies listed below have been issued to the pollcyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The Ii mils of liability shown may have been reduced by any paid claims.
POLICY NUMBER
This insurance includes:
POLICY NUMBER
V23 9717-A16-05I
V24 6025-A09-05J
315 5741-B04-05W
TYPE OF INSURANCE
POLICY PERIOD
Effective Date : Expiration Date
LIMITS OF LIABILITY
(at beginning of policy period)
BODILY INJURY AND
PROPERTY DAMAGE
Each Occurrence $
General Aggregate $
Products - Completed $
Operations Aaoregate
BODILY INJURY AND PROPERTY DAMAGE
(Combined Single limit)
Each Occurrence $
Aggregate $
Part J - Workers Compensation - Statutory
Part II - Employers Liability
Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
LIMITS OF LIABILITY
(at beginning of policy period)
500/1MM/500
500/1MM/500
500/1MM/SOO
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN,
Comprehensive
Business Liability
-[JProdu-~ts-:-CorT;p(eted .Operations. - - - - - -- -------- - - --- ~ - - - --
o Contractual Liability
o Personal Injury
o Advertising Injury
o Medical Expenses: $5,000
o
o
EXCESS LIABILITY
o Umbrella
o Other
POUCY PERIOD
Effective Date : Expiration Date
POLICY PERIOD
Effective Date : Expiration Date
Workers' Compensation
and Employers Liability
TYPE OF INSURANCE
POLICY PERIOD
Effective Date : Expiration Date
1/16/05 : 1/16/06
1/9/05 1/9/06
2/4/05 2/4/06
Auto
Auto
Auto
Name and Address of Certificate Holder
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO, CA 95014
558-994a.5 Rev.11-08-2OO4 Printed in U.S.A.
If any of the described policies are canceled before
their expiration date, State Farm will try to mail a
written notice to the certificate holder 30 days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
Farm or its age ts or representatives.
~.
~
Signature of Au
AGENT
Tille
JOAN PEROS
Agent Name
Telephone Number 408-847-6650
6/27/05
Date
Agenfs Code Stamp
Agent Code
AFO Code
J PEROS 05..2326
S SILICON VALLEY F154
Jun 27 05 10:57a
10.4
CERTIFICATE OF INSURANCE
o STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
!8J STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
o STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
o STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
o STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Policyholder DON & MIKE'S SWEEt'ING INC.
PA'I ....
A
This certifies that
1.II.a...\
901 DELL AVE.
CAMPBELL, CA 95008
CITY OF CUPERTINO
STREET SWEEPING
Address of policyholder
Location of operations
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms, exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
Comprehensive BODILY INJURY AND
Business Liability , PROPERTY DAMAGE
--... -- -- - - - ---------.- - ~- --- t]"prod~jctS-:-CO-mpleted "Operations""""" --- - - - u - ---" - n - - - ---
This insurance includes:
o Contractual Liability Each OcculTence $
o Personal Injury
o Advertising Injury General Aggregate $
o Medical Expenses: $5,000
0 Products - Completed $
0 Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date ; Expiration Date (Combined Single Limit)
o Umbrella Each Occurrence $
o Other Aggregate $
POLICY PERIOD Part I - Workers Compensation - Statutory
Effective Date : Expiration Date
Workers' Compensation Part II - Employers liability
and Employers Liability Each Accident $
Disease - Each Employee $
Disease - Policy Limit $
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date : Expiration Date (at beginning of policy period)
355 9027-D26-05P Auto 4(26(05 : 4/26/06 500/1MM/SOO
082 6935-E16-05 Auto 5/16/05 5/16/06 500/1MM/500
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Name and Address of Certificate Holder
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO, CA 95014
If any of the described policies are canceled before
their expiration date, State Farm will try to mail a
written notice to the certificate holder 30 days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
Farm or its agents or representatives.
-SO~^ .p-e/{J~ ~ J
Signature of Authorized Representat
AGENT 6/27/05
Th ~~
JOAN PEROS
Agent Name
Telephone Number 408-847-6650
Agenfs Code Sta~~ET.lOS 05 23~6
Agent Code ~r" f\ - ..
AFOCode S SILICON VALLEY F154
558-994 a.S Rev. 11-08-2004 Printed in U.S.A.
Jun 27 05 10:57a
p.5
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC040306
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule.
The additional premium for this endorsement shall be
otherwise due on such remuneration.
5 % of the California workers' compensation premium
Schedule
Person or OrQanization
CITY OF CUPERTINO
1030 TORRE AVE
CUPERTINO CA 95014
Job DescriDtion
STREET SWEEPING
SMURFIT-STONE CONTAINER CORP
ITS SUBSIDIARIES & AFFILIATES
1901 JUNCTION AVE
SAN JOSE CA 95131
STREET SWBEPING
CITY OF CAMPBELL DEVELOPMENT
AGENCY, ITS OFFICERS, EMPLOYEE
& VOLUNTEERS
ATTN: DEPT OF PUBLIC WORKS
70 N FIRST ST
CAMPBELL CA 95008
STREET SWEEPING
This endorsement changes the policy to which it is attathed and is effective on the date issued unless otherwise stated,
(The Infonnatlo. below is required only when this endorselllent is issued subsequent to prep.ation of the policy.1
Endorsement Effective Poley No. 97 -WQ-4 54 7 -7 Endorsement No.
Insured DON &. MIKE'S SWEEPING INC Insurance Company STATE FARM FIRE AND CASUALTY COMPANY
~B
CounlersignedBy _./rJ ,,, e/c.s..
~,,)
WC 040306
(Ed. 4~84)
Printed in U.S.A.